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Objective:To explore the difference of clinical characteristics between senile Parkinson's disease(PD)with depression and unipolar depression.Methods:From March 2019 to March 2020, 53 patients with Parkinson's disease depression and 57 patients with unipolar depression who were admitted to the neurology department of Beijing Hospital were continuously collected.The gender, age and education level of the patients were recorded.The course of disease and other general data of the patients with Parkinson's disease were also recorded.Depression and anxiety of the patients were evaluated by Beck Depression Inventory(BDI)and Generalized Anxiety Disorder Scale(GAD-7). Quality of life of patients with Parkinson's disease was evaluated by 8-item Parkinson's disease questionnaire(PDQ-8). Differences in the assessment results and quality of life scores between the two groups were analyzed.Results:The incidence of depression comorbid with anxiety in elderly PD patients was 52.8%(28/53), lower than that in elderly unipolar depression patients comorbid with anxiety [84.2%(48/57)]( χ2=12.664, P<0.001). The scores of activity inhibition [(1.8±0.8)points]and hyposexuality [(0.4±1.0)points]in elderly PD patients with comorbid depression were higher than that in patients with unipolar depression [(1.1±0.8)points, (0.0±0.0)points]( t=4.399, 2.942, P<0.001, =0.005). Moreover, the incidence of activity inhibition(98.1%)and hyposexuality(15.1%)in PD patients with comorbid depression was higher than that in patients with unipolar depression(78.9%, 0.0%)( χ2=9.680, 9.279, both P=0.002). The scores of self-blame [(1.0±0.8)points]and pain [(1.0±0.8)points]in elderly patients with unipolar depression were higher than those in PD patients with comorbid depression [(0.5±0.7)points, (0.9±0.7)points]( t=-3.902, -2.486, P<0.001, =0.014). Moreover, the incidence of self-blame(66.7%), irritability(78.9%)and image distortion(56.1%)in elderly patients with unipolar depression was higher than that in PD patients(35.8%, 56.6%, 35.8%)( χ2=10.447, 6.320, 4.547, P=0.001, 0.012, 0.033). The scores of PDQ-8 in PD patients with comorbid depression and anxiety [14.8(10.8, 19.0)points]( Z=-3.544, P<0.001)were higher than those in PD patients with depression only [7.0(4.8, 11.0)points]. Conclusions:The focus of depression in elderly PD patients is different from that in elderly unipolar depression patients.Elderly patients with unipolar depression are more likely to be comorbid with anxiety.Depression reduces the quality of life in PD patients, and the comorbidity of anxiety further reduces the overall quality of life in PD patients with depression.
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Objective:To investigate the accurrence and related factors of depression in patients with parkinson's disease (PD).Methods:One hundred PD patients with Parkinson′s disease (PD) were enrolled in Department of Neurology in Beijing Hospital from March to June 2019. The depressive mood, sleep status and health-related quality of life of PD patients were evaluated by Beck Depression Scale (BDI), Parkinson′s Disease Sleep Scale 2 (PDSS-2), and 8 items of Parkinson′s Disease Questionnaire (PDQ-8). Spearman correlation analysis and multivariate regression analysis were used to analyze the related factors of PD depression. Nonparametric test was used to analyze the differences between different sleep disorder domains in PD patients with depression.Results:The total score of BDI in 100 PD patients ranged from 0 to 44, with an average of 9.9±8.6 points; the total score of PDSS-2 ranged from 0 to 43, with an average of 12.0±9.2; the total scores of PDQ-8 ranged from 0 to 24, with an average of 6.4±6.0 points. The detection rate of depression in 100 PD patients was 42.0% (42/100), and the total BDI score of 22 patients with mild depression ranged from 10 to 15 with an average of 13.0±1.9; the total BDI score of 14 patients with moderate depression ranged from 16 to 25, with an average of 19.1±3.0; the total BDI score of 6 patients with major depression ranged from 28 to 44 points, with an average of 33.3±6.4. The depression in PD patients was positively correlated with PDQ-8 score ( t=8.908, P<0.01) and PDSS-2 score ( t=2.286, P=0.02); and 85.7% (36/42) of PD patients with depression had sleep disturbance. The score of sleep disturbance domain of PD patients with depression (9.8±3.9) was higher than that of nocturnal motor symptom domain (4.8±4.5) and nocturnal PD non-motor symptom domain (4.1±3.3) ( P<0.01). The scores of emotional health, relationship with loved ones, attention, communication ability dimensions of PDQ-8 were positively correlated with PD depression ( P<0.05). Conclusion:Depression is a common non-motor symptom of PD patients; and PD patients with depression suffer from reduced quality of life and are more prone to sleep disorders.
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Objective To analyze the clinical characteristics and related factors associated with impulse compulsive behaviors (ICBs) in Parkinson's disease (PD).Methods Two hundred and thirty-one PD outpatients were recruited from Beijing Hospital and Chinese Medicine Hospital of Pinggu District of Beijing from November 2012 to November 2015.Questionnaire for Impulse Compulsive Disorders in Parkinson's Disease (QUIP) was used to assess all subjects if they have ICBs or not.The general materials, medication utilized were recorded , and the related scales were used to evaluate PD patients.Intergroup analysis was made according to with or without ICBs.The Logistic regression analysis was adopted to analyze the relevance between incidence of ICBs and on-set age of PD, drinking tea or not, the 39-item Parkinson's Disease Questionnaire score, dosage of amantadine and dopamine agonist levodopa equivalent daily doses (DA-LEDD).Results Twenty-four cases of 231 outpatients were QUIP screening positive , and only 13 cases ( 5.63%) were diagnosed with ICBs as follows : hypersexuality in four ( 1.73%), compulsive shopping in two (0.87%), pathological gambling in one (0.43%), punding in eight(3.46%), dopamine dysregulation syndrome in two (0.87%) and with two or more ICBs in three (1.30%).Compared with non-ICBs group, ICBs group took more dopamine agonists (137.5(37.5, 175.0) mg/d vs 50.0(0, 125.0) mg/d, Z＝-2.175,P＝0.030), and had higher percentage of drinking tea (2/13 vs 3/218(1.4%),χ2＝11.369,P＝0.027).Logistic regression showed that higher dosage of dopamine agonist ( DA-LEDD≥100 mg/d,OR＝4.404, 95%CI 1.191-16.284,P＝0.026) was a risk factor for ICBs.Conclusions ICBs are not rare in Parkinson's disease, and punding is more common among the clinical phenotypes of ICBs. More dopamine agonists in PD (more than 100 mg/d) may be associated with about 4-fold increased odds of having ICBs.
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Objective To investigate the prevalence of depression in Parkinson's disease ( PD) patients, analyze the clinical features of depression in PD patients , and evaluate its impact on quality of life. Methods One hundred and ninety-five PD patients and 63 normol controls were recruited in this study.The detailed clinical information was documented.Unified Parkinson's Disease Rating Scale and Hoehn-Yahr stage were used to evaluate the severity of motor function impairment in PD patients.Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale were employed to assess the severity of depression and anxiety in PD patients.The 39-item Parkinson's Disease Questionnaire was applied to assess the quality of life.The cross-sectional data were calculated with SPSS 21.0 statistic software, and P ＜0.05 was considered statistically significant.Results The average score of HAMD was 8.74 ±5.51 in 195 PD patients.Depressive symptoms were found in 54.4%of the PD patients ( mild depression 48.7% and moderate depression 5.6%).Depression significantly impaired the quality of life in PD.Compared with PD without depression, PD with depression earned more scores in anxiety factor (4 (2, 5) vs 1(0, 2), Z＝ -8.69, P＝0.00), blocker factor (2 (1, 3) vs 0(0, 1), Z＝-7.95, P＝0.00), cognitive factor (1 (0, 2) vs 0(0, 0), Z＝-7.01, P＝0.00), sleep factor (2(1, 3) vs 0(0, 1), Z＝-6.42, P＝0.00) and despair factor (2 (1, 3) vs 1 (0, 1), Z＝-7.16, P＝0.00).There was no significant difference in day and night change (0(0, 0) vs 0(0, 0), Z＝-0.19, P＝0.85) and body weight (0(0, 0) vs 0(0, 0), Z＝-1.28, P＝0.20) between these two groups.The PD with depression obtained higher scores in total quality of life (30(22, 44) vs 14 (5, 24), Z＝-7.03, P＝0.00), motor function (6 (2, 13) vs 1 (0, 5), Z＝-3.67, P＝0.00), daily life ability (4 (1, 8) vs 1 (0, 4), Z＝-2.81, P＝0.01) , emotional health (5 (2, 11) vs 0 (0, 2), Z＝-5.82, P＝0.00), humiliation (2 (0, 5) vs 0 (0, 1), Z＝-3.10, P＝0.00), social support (0 (0, 1) vs 0 (0, 0), Z＝-2.86, P＝0.00), recognition function (4 (2, 6) vs 2 (0, 4), Z＝-2.87, P＝0.00), sociability(1(0, 3) vs 0(0, 1), Z＝-3.25, P＝0.00), and body pain (3 (1, 6) vs 1 (0, 2), Z＝-3.91, P＝0.00) than patients without depression.Conclusions Incidence of depression ( mainly mild ) in PD patients is high. Depressive symptoms significantly affect the quality of life of PD patients.
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Objective To investigate the expression level of adenosine 2A receptors in peripheral blood lymphocytes and the correlation with disease progression of Parkinson's disease (PD).Methods In this retrospcctive study,out patients with PD(42 cases)and healthy controls(32 cases) were recruited at Beijing Hospital.The expression level of A2A receptors in peripheral blood lymphocytes was detected by flow cytometry.The concentration of free A2A receptors in plasma was detected by enzyme linked immunosorbent assay (ELISA).The expression of A2A receptors and plasma free A2A receptors in peripheral blood lymphocytes of the PD group and the control group was compared.Multivariate regression analysis and single factor correlation analysis were performed on sex,age,course of disease,duration of medication,drug type and dose,motor complications,and PD unified Parkinson's disease rating scale (UPDRS)score.Results A2A receptor expression in lymphocytes was significantly higher in the PD group than in the control group (8.96 ± 4.73)％ vs.(5.39±2.42)％ (t=4.210,P＜0.05).There was no significant difference in A2A receptor concentrations in plasma between the two groups (1.82 ± 1.91) μg/L vs.(1.15 ± 0.71) μg/L(t=1.078,P＞0.05).In the PD group,A2A receptor expression in lymphocytes in patients with motor complications was statistically lower than in patients without them (P＜ 0.05).Lymphocyte A2A receptor levels in the 5-9 years duration subgroup were significantly lower than those in the ＜5 years duration subgroup (Z=2.780,P＜0.01) and the≥10 years duration subgroup (Z=-2.149,P＜0.05).Conclusions The expression of A2A receptors in peripheral blood lymphocytes is correlated with PD.The expression of A2 A receptors in peripheral blood lymphocytes of patients with PD fluctuates with the occurrence of motor complications and the progression of disease.Further research is needed to establish A2A receptors as a biomarker for monitoring disease progression.
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One hundred patients with Parkinson's disease (PD) aged 60 and above treated with levodopa were enrolled in this cross section study.The general conditions,medication,unified Parkinson's disease rating scale (UPDRS) scores and the incidence of levodopa-induced dyskinesia (LID) were documented.The incidence rate of LID in this group of PD patients was 37.0％ (37/100).The incidence was significantly higher in patients with levodopa treatment ≥ 4 years than that in patients with levodopa treatment ＜ 4 years (55％ vs.26％,x2 =8.770,P =0.003).The incidence rate ofpeak dosage dyskinesia in tremor-dominant PD patients was lower than that in rigidity-dominant PD patients(x2 =4.399,P =0.036).The incidence rate of LID was correlated with the duration of levodopa therapy.Amantadine may reduce the incidence of off dystonia.
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Objective To investigate the prevalence of Helicobacter pylori (HP) infection in patients with Parkinson's disease (PD), and analyze the relationship of HP infection with the symptoms, disease progression and motor complications of PD.Methods 72 PD outpatients were randomly selected, and 100 gender and age-matched subjects who took health physical examination were considered as healthy controls.Basic data were collected and estimated by Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr stage, the 39-item Parkinson' s Disease Questionnaire (PDQ-39), Activity of Daily Living Scale (ADL), Minimum Mental State Examination (MMSE), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA).All subjects underwent 13C-urea breath test to determine Helicobacter pylori infection status.Results There was no significant difference in H P infection rate between PD and control groups [37.5 ％ (27 cases)vs.32.0％ (32 cases), P=0.45].According to the initial symptoms, PD patients were divided into two groups: bradykinesia/ rigidity group and tremor group.The HP infection rate was higher in bradykinesia/rigidity group than in tremor group [52.2％ (12 cases) vs.30.6％ (15 cases)], but had no significant difference (P=0.08).The mean HY stage was higher in the HP-infected patient group than in the non-infected group [(2.6±0.7) vs.(2.2±0.9), P=0.03].The HP infection rate was higher in patients with HY stage ≥2 than with HY stage ＜2 [46.4％ (26 cases) vs.6.3％ (1 case),P=0.003].There were no correlations of HP infection with gender, age, age of onset, UPDRS, UPDRS-Ⅲ, PDQ-39, the course of the disease, wearing-off phenomenon, and dyskinesias.Conclusions The PD patients with HP infection are mainly at middle-and late-stage.HP infection may be related with the progress of the disease.It needs further study and validation by expanding the sample to investigate whether HP infection affects the motor complications.
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To explore the safety of ropinirole in the treatment of Parkinson′s disease( PD).A total of 221 PD patients participated in a multi-center,12-week randomized,bromocriptine-controlled,double-blind, double-dummy and parallel-group trial.The safety was assessed on the basis of adverse reactions , blood pressure,pulse,laboratory parameters and electrocardiography recordings.The incidence of adverse reaction was 34.9%in ropinirole group and 34.8% in bromocriptine group.And the frequency of adverse reactions had no inter-group statistical significance (χ2 =0.000,P=0.995).Ropinirole has an excellent profile of safety in the treatment of Chinese PD patients.
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Objective To evaluate the effect of Parkinson's disease treatment guideline on the initial medicine therapy and to explore the impact of hospital grade level and type of insurance on the initial prescription for Parkinson's disease.Methods We identified 136 PD patients as part of a population-based study in Beijing and made a comparison between the patients with initial prescriptions of dopamine receptor agonists (DA) and levodopa (LD).Results Among 136 patients,excluding patients without initial medication of levodopa or dopamine receptor agonist,there were 61 cases with initial drug administration aged ≥ 65 years.Among the 61 cases,1 cases and 19 cases administrated dopamine receptor agonist and levodopa respectively before 2006,1 case and 11 cases respectively from 2007 to 2009,and 5 cases and 24 cases respectively after 2010.There was no significant difference in the percentage between patients with initial administration of levodopa and dopamine receptor agonist in the three periods (x2 =1.891,P =0.388).In 41 patients with initial drug administration of dopamine receptor agonist or levodopa aged＜65 years,1 cases and 23 cases administrated dopamine receptor agonist or levodopa respectively before 2006,0 case and 10 cases respectively from 2007 to 2009,and 3 cases and 4 cases respectively after 2010.There was significant differences in the percentage between patients with initial administration of levodopa and dopamine receptor agonist in the three periods (x2 =10.644,P=0.005).The percentage of patients with initial administration of dopamine receptor agonist aged＜65 years was increased after 2010 as compared before 2006 (x2 =7.219,P=0.028).There were no significant differences in the percentage of patients with initial administration of dopamine receptor agonist between grade 3 and non-grade 3 hospitals (13.6％ vs.6.3％,x2=0.675,P=0.686)and between patients with and without insurance (13.1％ vs.10.0％,x2=0.141,P=1.000).Conclusions The percentage of patients with initial administration of levodopa and dopamine receptor agonist has no significant difference between patients with initial drug administration aged ≥ 65 years before and after the introduction of Parkinson's disease treatment guideline,while the percentage is increased in patients with initial drug administration aged＜65 years.No impact of hospital grade level and type of insurance on initial administration for Parkinson's disease is found.
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Objective To evaluate the clinical efficacy and safety of akatinol memantine in the treatment of Alzheimer's disease (AD).Methods Two hundred and forty-one patients with AD were randomly assigned to receive 10 mg of donepezil daily or 20 mg of memantine daily for 24 weeks.The primary efficacy variables were the Clinician' s Interview-Based Impression of Change Plus (CIBIC-Plus),the Alzheimer Disease Assessment Scale-cognition (ADAS-cog) and the Activities of Daily Living (ADL).The secondary efficacy variables were the Neuropsychiatric Inventory (NPI) and the Mini-Mental Status Examination (MMSE).Results Two hundred and seven patients completed the study and were evaluated at week 24.Both memantine and donepezil had significant efficacies at the end point, according to the ADAS-cog, the ADL, the NPI and the MMSE.Patients receiving memantine had a similar outcome as those receiving donepezil, according to the results of all the variables changes (CIBIC-Plus: memantine 3.4±0.8vs donepezil 3.5±0.8; ADAS-cog: memantine-4.7±5.8 vs donepezil-4.6±6.5; ADL: memantine -2.4±6.7 vs donepezil-2.2±5.3 ; NP1: memantine-5.8±9.0 vs donepezil-3.1±8.5 ; MMSE:memantine 1.7±3.1 vs donepezil 1.8±2.8, all P >0.05).The adverse events were as following: donepezil group 41.88% and memanintine group 30.58%.Conclusion The memantine as a new drug for AD, has the similar efficacy as donepezil, and it is safe.
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@#ObjectiveTo investigate the incidence and correlative risk factors of aspiration in Alzheimer disease (AD) patients with aspiration pneumonia. MethodsData of 88 cases with AD were retrospectively investigated. Several possible correlative risk factors were analyzed with multiple Logistic regression. Results38 cases with AD complicated aspiration pneumonia during the observation period [average (3.51±0.25) years].The total average annual incidence of aspiration pneumonia in AD was 12.3%. The annual incidence of aspiration pneumonia in mild AD, moderate AD and severe AD were 11.1%,12.3%,17.6% respectively.The correlative risk factors of aspiration in AD patients with aspiration pneumonia were severity of AD,application of neurosedatives, silent bilateral basal ganglia lacunar infarction (SBI), decrease of activity of daily living (ADL) and leukoaraiosis (LA). ConclusionAspiration pneumonia is a common complication occurring not only in severe AD but also in mild and moderate AD.
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Objective To study the neuropsychological features of patients with Alzheimer disease (AD) and mild cognitive impairment (MCI). Methods Fifty-two AD, 26 MCI and 24 healthy aging cases were investigated by the clinical evaluation and a series of neuropsychological tests which include mini-mental state examination (MMSE), clinical dementia rating scale (CDR), activity of daily living scale (ADL) and clinical memory scale (CMS). Results The scores of the neuropsychological tests in AD,MCI and normal control groups were as follows: MMSE scores were 18. 9?5. 1, 26. 9?2. 1, 29. 0?1.1 respectively; ADL scores were 48. 3?17. 7, 26. 7?9. 3, 22. 1?4.1 respectively; Memory Quotient(MQ)scores were 52. 5?26. 7, 81. 3?10. 8, 101. 8?11. 6; CMS scores were 52. 5?26. 7, 81. 3?10. 8, 101. 8?11. 6 respectively. All neuropsychological tests except ADL in MCI group were significantly lower than those in the normal controKall P
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Objective To evaluate the roles of plasma p-tau(~ 181P)protein for clinical diagnosis of Alzheimer′s Disease (AD). Methods Subjects including 23 mild AD(19≤MMSE≤26) and 35 moderate and severe AD(MMSE0.05). Level of p-tau(~ 181P) protein was significantly higher in the moderate and severe AD group(18.3?20.3)ng/L than that in HC( P
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<p><b>OBJECTIVE</b>To improve the therapeutic and preventive measure for elderly patients (75 years and over) with idiopathic Parkinson's disease (OEIPD).</p><p><b>METHODS</b>Fifteen OEIPD patients were observed prospectively over a long period of time. Their diagnosis was confirmed by autopsy. Based on clinical and pathological data, the causes of death were analyzed.</p><p><b>RESULTS</b>The mean clinical course in OEIPD patients was 6.2 +/- 3.6 years. The majority of the 15 patients were the akinetic type and the akinetic type with tremor (80.0%). In the late stages of disease (4.8 +/- 3.5 year), choking occurred in 12 OEIPD patients who received nasal feeding for an average of 4 months after the occurrence of choking. The most common complication in 12 patients was repeated pulmonary infections with an average rate of 2.9 +/- 1.9. The causes of death were bronchial pneumonia and shock induced by pulmonary infection (11 cases, accounted for 73.3%), acute myocardial infarction (2 cases), one case with cardiac rupture and one case with rupture of aortic aneurysm.</p><p><b>CONCLUSIONS</b>The clinical course was shorter in OEIPD patients. Levodopa therapy should be started early in OEIPD patients. Bronchial pneumonia and infectious shock constitute the major cause of death and choking was one of the main causes of aspiration pneumonia. Nasal feeding should be started as early as possible after the appearance of choking. Silent aspiration can be reduced by teaching the patient to protect the airway by 'supraglottic swallowing'.</p>
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Aged , Aged, 80 and over , Female , Humans , Male , Airway Obstruction , Brain , Pathology , Cause of Death , Enteral Nutrition , Lung , Pathology , Parkinson Disease , Mortality , PathologyABSTRACT
Objective To study the mirror writing in elderly patients with senile dementia and vascular dementia. Methods Thirty-three senile dementia patients and 30 vascular dementia patients were studied. Age- and education-matched 63 healthy elder people were included in control groups. Ten items for determination of handedness, Mini Mental Status Examination(MMSE), Global Deterioration Scale (GDS) and the written language of Chinese Aphasia Examination Scale(draft) were adopted to examine all patients. Hachinski Ischemic Scale was used for differentiation between senile dementia and vascular dementia. Results Seventeen (51.51%) of senile dementia patients and 23 (76.60%) of vascular dementia patients were mirror writiers. In the corresponding control groups, these numbers were found to be 2(6.06%) and 7 (23.30%) respectively. The occurrence rate of mirror writing in senile dementia group and vascular dementia group was markedly higher than in the normal controls(P
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Objective To assess the diagnostic value of the single-photon-emission computed tomography (SPECT) and the magnetic resonance imaging (MRI) for Alzheimer's disease (AD) and vascular dementia (VD), and to explore the correlation between cerebral atrophy and cerebral regional blood flow and the degree of cognitive impairment in AD patients. Methods The temporal and frontal lobes and hippocampus were quantitatively detected by MRI and the cerebral regional blood flow in these regions was analysed semi-quantitatively by SPECT for 36 patients with AD, 32 with VD and 30 sex-matched non-demented elderly controls (NC). Results The hippocampal atrophy of AD and VD groups detected on MRI was significantly different from that of the NC group. Left hippocampal height was (9.27?3.43)mm in AD, (11.62?5.72)mm in VD and (12.13?2.97)mm in NC(P0.05, compared to that of NC), showing that hippocampal atrophy could not be detected by MRI. However, RAR of the left hippocampus by SPECT detection was 0.61?0.07 (P