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Objective:To explore the significance of four-dimensional CT angiography(4D CTA) and CT perfusion (CTP) imaging in evaluating collateral circulation grades in patients with moyamoya disease and moyamoya syndrome and their relationship with cerebral hemodynamics.Methods:The clinical and imaging data of 32 patients with moyamoya disease and moyamoya syndrome in Beijing Hospital from January 2017 to January 2022 were retrospectively analyzed. All patients underwent 4D CTA-CTP imaging. Collateral circulation was scored on CTA images by using Alberta stroke program early CT score system, and on digital subtraction angiography (DSA) images by using American society of interventional and therapeutic neuroradiology/Society of interventional radiology score system, respectively. The patients were divided into Ⅰ-Ⅲ circulation compensation grades based on collateral circulation score. Regions of interest were delineated at basal ganglia on perfusion maps and the perfusion parameters were obtained including cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), mean transit time (TTP) and delay time (DLY). The Kruskal-Wallis test was used to compare the perfusion parameters in different collateral circulation grades, and pairwise comparison was performed with Bonferroni correction. Kappa and Spearman tests were used to analyze the consistency and correlation of 4D CTA and DSA in the classification of collateral circulation.Results:4D CTA and DSA had a moderate consistency (Kappa=0.693, P<0.001) and a strong correlation ( r=0.805, P<0.001) in evaluating collateral grades. There were statistically significant differences in CBF, MTT and TTP among collateral compensation grade Ⅰ, grade Ⅱ and grade Ⅲ ( H values were 7.91, 11.69, 8.93; P values were 0.019, 0.003 and 0.012, respectively). Further pairwise comparison showed that the CBF of collateral compensation grade Ⅰ was lower than that of grade Ⅲ ( P=0.015), MTT of grade Ⅱ was higher than that of grade Ⅲ ( P=0.005), and TTP of grade Ⅰ was higher than that of grade Ⅲ ( P=0.015). There was no statistical significance of other indicators in pairwise comparison. There were no significant differences in CBV and DLY among collateral compensation grade Ⅰ, grade Ⅱ and grade Ⅲ ( P>0.05). Conclusions:4D CTA-CTP is equivalent to DSA in evaluating collateral circulation in patients with moyamoya disease and moyamoya syndrome. It can also evaluate the cerebral hemodynamics comprehensively, which has high clinical significance for disease monitoring.
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Objective:To investigate the characteristics and clinical related factors of Parkinson′s disease (PD) patients with subjective cognitive decline (SCD).Methods:Ninety-nine PD patients with normal cognitive function enrolled in Beijing Hospital from January to December 2018 were collected for the study. Patients with PD were divided into groups with ( n=57) and without ( n=42) SCD using the first question in Part 1 of the Unified Parkinson′s Disease Rating Scale (UPDRS). All patients were assessed by Montreal Cognitive Assessment (MoCA), modified Hoehn-Yahr grading, UPDRS, Hamilton Rating Scale for Depression (HAMD), Hamilton Rating Scale for Anxiety (HAMA), Parkinson′s Disease Sleep Scale, Ability of Daily Living Scale and 39-item Parkinson′s Disease Questionnaire (PDQ-39). Levodopa equivalent dose conversion was performed for patients taking anti-PD drugs. Patients′ self-reported years of formal education were collected. Results:The proportion of PD with SCD in this group was 57.58% (57/99). There were statistically significant differences in MoCA [28.00 (27.00, 29.00) vs 28.00 (27.00, 29.00) ,Z=-2.28, P=0.023], HAMD [6.00 (5.00, 8.50) vs 5.00 (2.00, 8.00), Z=-2.23, P=0.026], HAMA [7.00 (6.00, 11.00) vs 6.00 (3.00, 8.25) , Z=-2.70, P=0.007], PDQ-39-emotional health [2.00 (0, 5.00) vs 1.00 (0, 3.00), Z=-2.03, P=0.042] and PDQ-39-cognitive scores [4.00 (2.00, 5.00) vs 2.00 (0, 4.00), Z=-3.42, P=0.001] between PD with and without SCD groups. SCD was correlated with MoCA ( r=-0.23, P=0.022), HAMD ( r=0.23, P=0.025) and HAMA ( r=0.27, P=0.006) scores to varying degrees. When controlling for HAMD and HAMA scores, the correlation between SCD and MoCA scores ( r′=-0.18, P=0.084) was no longer existed. Conclusions:SCD is common in PD patients with normal cognitive function and is associated with poorer cognitive performance and more severe symptoms of depression and anxiety. In this group of patients, the relationship between SCD and affective symptoms may be greater than that of objective overall cognitive function, which is worthy of further studies.
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Objective:To investigate the grey matter alterations of Parkinson′s disease (PD) patients with and without sleep disorders, and to explore the relationship between different sleep-related problems and clinical variables as well as grey matter volume (GMV) in PD.Methods:Forty-six PD patients and 38 healthy controls (HCs) were recruited from January 2018 to December 2021 in the Department of Neurology, Beijing Hospital. PD patients were divided into PD with sleep disorders (PD-S, n=26) and PD without sleep disorders (PD-nS, n=20) subgroups (cutoff points of 82 for Parkinson′s Disease Sleep Scale or less than 5 for each item was considered as an indicator of substantial sleep disorder). The Mini-Mental State Examination (MMSE), the third part of the Unified Parkinson′s Disease Rating Scale (UPDRS-Ⅲ), Hamilton Rating Scale for Anxiety (HAMA), Hamilton Rating Scale for Depression (HAMD), Non-Motor Symptoms Questionnaire (NMSQ), and Parkinson′s Disease Questionnaire-39 (PDQ-39) were used to evaluate cognitive function, motor symptoms, anxious and depressive symptoms, non-motor symptoms, and the quality of life of the patients. Optimized voxel-based morphometry was applied to the magnetic resonance imaging brain images in all participants,and multiple linear regression analysis was used to test the correlation between GMV and sleep quality in patients with PD. Results:Compared with the HCs, PD-nS patients showed decreased GMV in bilateral limbic lobe, parahippocampal gyrus, amygdala, cingulate gyrus, hippocampus, right cerebellum, bilateral frontotemporal lobe, bilateral occipital lobe and the left parietal lobe. PD-S group exhibited reduced GMV in bilateral limbic lobe, parahippocampal gyrus, amygdala, right cerebellum, bilateral frontotemporal lobe and bilateral parietal-occipital lobe, compared to the HCs. Compared with PD-nS, PD-S patients revealed higher depressive (HAMD score: 12.19±5.59 vs 6.95±3.19, t=-4.01, P<0.001), anxious (HAMA score: 12.04±5.32 vs 7.25±4.68, t=-3.18, P=0.003), and non-motor symptoms scores (NMSQ score: 12.92±5.18 vs 9.90±4.10, t=-2.14, P=0.038), poorer quality of life (PDQ-39 score: 35.31±22.01 vs 22.40±9.00, t=-2.71, P=0.010), and reduced GMV in the left insula, frontal, and parietal lobe ( P<0.001, uncorrected, cluster>100). There was a marked relationship between sleep quality and the reduced GMV of the right medial temporal gyrus (β=0.006, 95% CI 0.002-0.010, P=0.003), left middle frontal gyrus (β=0.006, 95% CI 0.002-0.010, P=0.002), the right cerebellum (β=0.014, 95% CI 0.005-0.023, P=0.003), and the right medial occipital gyrus (β=0.017, 95% CI 0.011-0.024, P<0.001). Significant grey matter changes were associated with nocturnal restlessness, mainly within the left limbic lobe, bilateral occipital lobe, the right cerebellum, and parietal lobe (β=0.008, 95% CI 0.006-0.010, P<0.001). Furthermore, nocturia in PD was related to certain grey matter atrophy, including bilateral limbic lobe, the right inferior parietal gyrus, and bilateral frontal lobe (β=0.010, 95% CI 0.008-0.013, P<0.001). The symptom of daytime dozing was correlated with GMV reduction in the right occipital lobe, the left temporal lobe (β=0.014, 95% CI 0.010-0.019, P<0.001). There were also several compensatory brain regions, including bilateral frontal lobe, the left limbic lobe and cingulate ( P<0.001, uncorrected, cluster>60). Conclusions:Sleep disturbance is common in PD, which is related to the anxious and depressive symptoms, non-motor symptoms, and the quality of life. PD patients with different sleep disorders show grey matter alterations in severeal brain regions, which are associated with sleep quality, nocturnal restlessness, psychosis, and daytime dozing.
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Epilepsy is a common disease in the elderly, but drug therapy for epilepsy faces difficulties due to comorbidities, drug combinations and altered pharmacokinetics in the elderly.This article reviews the selection, adverse reactions, metabolism and drug interactions of epilepsy drugs in the elderly.
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Objective:To investigate the characteristics of white matter lesions(WML)found by magnetic resonance imaging(MRI)and the relationship with clinical features in patients with Parkinson's disease(PD).Methods:This was a retrospective study by using a method of MRI T2WI-FLAIR.The WML in 87 PD patients were evaluated by using the Fazekas scale and Scheltens scale.Patients were divided into the early PD group[n=47, Hoehn-Yahr(H-Y)stage 1.0-2.0] vs.the middle-advanced PD group(n=40, H-Y stage 2.5-4.0), the non-depressed PD group(n=71) vs. the depressed PD group(n=16), the non-anxions PD group(n=62) vs.the anxions PD group(n=25). An ordinal regression model was used to investigate the correlations of WML with gender, age, Mini-Mental State Examination(MMSE)score, Unified Parkinson's disease Rating Scale-Ⅲ score(UPDRS-Ⅲ), Hamilton Rating Scale for Depression score(HAMD)and Hamilton Rating Scale for Anxiety score(HAMA). Results:Compared with the early PD group, the middle-advanced PD group showed that the WML were increased in lobe of brain(5.30±4.85 vs. 3.43±3.13, P<0.05), especially in the occipital lobe(0.48±0.99 vs. 0.11±0.31, P<0.05). There was no significant difference in the WML between the non-depressed/anxions and the depressed/anxions PD group.After being evaluated by the Scheltens scale, WML in periventricular hyperintensities(PVH)regions( OR=1.13, P<0.01), in brain lobe( OR=1.10, P<0.01)and in basal ganglia regions( OR=1.15, P<0.01)were correlated with age.WML in the brain besides the PV region were correlated with MMSE score( OR=0.68, P<0.01), especially in posterior horns( OR=0.60, P<0.01)and lateral ventricles( OR=0.68, P<0.05). WML in temporal lobe was correlated with MMSE score( OR=0.68, P<0.05). WML in brain lobe was correlated with H-Y stages( OR=2.10, P<0.05), especially in the occipital lobe( OR=3.33, P<0.05). WML in parietal lobe was associated with HAMD score( OR=1.13, P<0.05). WML in basal ganglia regions was related to diabetes( OR=6.34, P<0.05), especially in the putamen( OR=6.86, P<0.01). After being evaluated by the Fazekas scale, WML in PVH region( OR=1.16, P<0.01)and deep white matter hyperintensities( OR=1.13, P<0.01)were correlated with age.WML in PVH region were associated with MMSE score( OR=0.65, P<0.01). WML scores in PD patients had no correlation with gender, hypertension, coronary heart disease, hyperlipemia, UPDRS-Ⅲ score and HAMA score. Conclusions:The WML is present in PD patients, and it is correlated with age, diabetes, severity of disease, depression and cognitive function.
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Objective To analyze the impact of depressive symptoms on quality of life in patients with Parkinson's disease(PD)based on middle-and long-term follow-up study,and to explore predictors for the reduced quality of life in PD patients.Methods Clinical data of 80 PD patients were searched from the electronic database in our research center.Patients who had complete general information and the following data of unified Parkinson's disease rating scale(UPDRS),Hoehn and Yahr scale(HY),mini-mental state examination(MMSE),Hamilton depression rating scale(HAMD),Hamilton rating scale for anxiety(HAMA),the 39-item Parkinson's disease questionnaire(PDQ-39),etc.after one-year follow-up were included in this study.The differences in quality of life were analyzed and compared among the non-depression group (n =38),depression remission group (n =22) and depression group(n=20).A follow-up visit was conducted after four years.The disease progression and decline in quality of life were compared between the depression and non-depression groups according to the baseline value of the Hamilton Depression Rating Scale.According to the change in PDQ-39 value,cluster analysis was used to reclassify patients into fast-decline group and slow-decline group.Logistic regression analysis was used to determine independent risk factors for the decline of quality of life.Results At the end of 1 year follow-up,the quality of life was decreased in the depression group as compared with the baseline(P =0.017),and the score of PDQ-39 was higher in the depression group than in the non-depression group and depression remission group.At the end of 4-year follow-up,UPDRS total score,UPDRSⅢ score,HY stage and PDQ-39 score were increased as compared with the baseline,the quality of life decreased more significantly,and the disease progressed faster in the depression group than the other two groups(P ＜0.05).The differences in the disease course,total score of UPDRS,HY stage and HAMD score were statistically significant between the fast-decline group and slow-decline group(P =0.001,0.039,0.003 and ＜0.001,respectively).Logistic regression analysis showed that disease course (OR =1.254,P =0.020),and baseline HAMD score (OR =1.450,P =0.003) were the independent risk factors for the decline of quality of life.Conclusions The quality of life of PD patients is worse in the depression group than in the depression remission group and non-depression group.In PD patients with depressive symptoms,the illness progression is faster,and the quality of life is decreased more significantly.The disease course and depression can predict the decline of quality of life in PD patients.
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Objective@#To survey the prevalence and distribution of sleep disorders in patients with Parkinson disease (PD) and to analyze the influencing factors.@*Methods@#The prevalence and distribution of sleep disorders were surveyed with Parkinson Disease Sleep Scale (PDSS) among 206 PD patients. The association of sleep disorders with age, course of disease, cognitive function, motor function, depression, and the equivalent dose of levodopa (LED) was analyzed.@*Results@#The overall PDSS score in 206 patients was (116.9±21.4). The three most frequent items of sleep disorders were the overall sleep quality(181/206, 87.9%), difficulty in maintaining sleep(160/206, 77.7%)and nocturnal enuresis(151/206, 73.3%); the three least frequent items were early awaking(87/206, 42.2%), urinary incontinence(56/206, 27.2%)and hallucination(44/206, 21.4%). The three items with the lowest average scores were nocturnal enuresis(6.9±3.1), difficulty in maintaining of sleep(7.1±2.7)and overall sleep quality(7.1±2.0); three items with the highest average scores were audiovisual illusion(9.3±1.8), incontinence caused by motion disability(9.0±2.1) and early awaking with upper and lower limb pain(8.7±2.1). PD patients were divided into group 1 [Hoehn-Yahr(H&Y) stage 1.0-1.5], group 2 (H&Y stage 2.0-2.5) and group 3 (H&Y stage 3.0-4.0). One-way analysis of variance or non-parametric test showed that there were significant differences in the course of disease(F=21.91, P=0.00), total score and the subscale scores of Unified Parkinson Disease Rating Scale(UPDRS, UPDRS Ⅰ-Ⅳ) (F=90.67, χ2=12.86, F=31.20, F=60.17, χ2=24.01, all P<0.01), the Hamilton Rating Scale for Depression(HAMD) scores (χ2=11.06, P=0.00), LED (F=14.93, P=0.00) and Minimum Mental State Examination(MMSE) scores (χ2=9.81, P=0.01) among three groups. There was no significant difference in age and PDSS scores among three groups. The results showed that there were significant differences in terms of restless state and nocturnal dysphoria (F=5.12, P=0.01; F=3.27, P=0.04) between group 1 and group 3. The linear regression analysis showed that the HAMD and the LED scores had the greatest influence on PDSS score (R2=0.142, 0.196).@*Conclusion@#PD patients have a variety of sleep symptoms. The treatment of large doses of dopamine and depression contribute to the occurrence of PD 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.