摘要
目的 探讨双侧丘脑底核脑深部电刺激(STN-DBS)对帕金森病(PD)患者情绪和认知功能的影响.方法 回顾性分析2014年4月至2016年12月于南京医科大学附属脑科医院功能神经外科行双侧STN-DBS治疗的80例PD患者术后5年的临床资料.术前及术后6个月,1、2、3、4、5年时分别采用药物关期状态下的统一 PD评定量表第三部分(UPDRS-Ⅲ)、39项PD生活质量问卷(PDQ-39)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、简易精神状态量表(MMSE)及蒙特利尔认知评估量表(MoCA)进行评估,并计算左旋多巴每日等效剂量(LEDD).比较患者手术前、后各项评分和LEDD的变化,并且分析运动症状(UPDRS-Ⅲ评分)、生活质量(PDQ-39评分)的改善情况与MMSE、MoCA、HAMA、HAMD评分改善率之间的相关性.结果 与术前相比,患者术后6个月,1、2、3、4、5年时的UPDRS-Ⅲ评分(药物关期状态)、LEDD、PDQ-39评分、HAMA评分、HAMD评分均明显降低,MoCA评分均较术前升高,差异均有统计学意义(均P＜0.05).术后6个月,1、2、3、4年的MMSE评分较术前升高,差异均有统计学意义(均P＜0.05),而术后5年的MMSE评分与术前的差异无统计学意义(P＞0.05).Spearman等级相关分析结果显示,患者在术后1、3、5年的MMSE评分改善率与对应时间点的PDQ-39评分改善率呈正相关关系(术后1年:rs=0.26,P=0.026;术后3年:rs=0.23,P=0.043;术后5年:rs=0.35,P=0.002);术后5年的MoCA评分改善率与对应时间点的PDQ-39评分改善率呈正相关关系(rs=0.28,P=0.014).患者术后1、3、5年的MMSE、MoCA、HAMA、HAMD评分改善率与对应时间点的UPDRS-Ⅲ评分改善率均无明显相关性(均P＞0.05).结论 双侧STN-DBS对PD患者焦虑、抑郁情绪及总体认知功能的改善长期有效,且PD患者总体认知功能的改善与生活质量的改善有关.
Abstract
Objective To explore the effect of deep brain stimulation of bilateral subthalamic nucleus(STN-DBS)on the mood and cognition in patients with Parkinson's disease(PD).Methods The clinical data of 80 PD patients who underwent bilateral STN-DBS treatment at the Functional Neurosurgery of Affiliated Brain Hospital of Nanjing Medical University from April 2014 to December 2016 were retrospectively analyzed 5 years after surgery.Before surgery,6 months after surgery,and 1,2,3,4,and 5 years later,the patients were assessed based on the Unified Parkinson's Disease Rating Scale Part Ⅲ(UPDRS-Ⅲ),the 39-item PD Quality of Life Questionnaire in the off state(PDQ-39),Hamilton Anxiety Rating Scale(HAMA),Hamilton Depression Rating Scale(HAMD),Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA);the L-dopa equivalent daily dose(LED)was calculated.We compared the changes in scores of patients and the LEDD before and after surgery,and analyze the correlation between the improvement of motor symptoms(UPDRS-Ⅲ score),quality of life(PDQ-39 score)and the improvement rate of MMSE,MoCA,HAMA,and HAMD scores.Results Compared with those before surgery,the patient's UPDRS-Ⅲ score(off period),LEDD,PDQ-39 score,HAMA score,and HAMD score at 6 months,1,2,3,4,and 5 years after surgery were all significantly reduced,the MoCA scores were all higher than those before surgery,and the differences were statistically significant(all P＜0.05).The MMSE scores at 6 months,1,2,3,and 4 years after surgery were higher than those before surgery,and the differences were statistically significant(all P＜0.05),while the MMSE scores at 5 years after surgery were not different from those before surgery(P＞0.05).Spearman rank correlation analysis results showed that there was a positive correlation between the patient's MMSE score improvement rate at 1,3,and 5 years after surgery and the PDQ-39 score improvement rate at the same time points(1 year after surgery:rs=0.26,P=0.026;3 years after surgery:rs=0.23,P=0.043;5 years after surgery:rs=0.35,P=0.002).There was a positive correlation(rs=0.28,P=0.014)between the MoCA score improvement rate 5 years after surgery and the PDQ-39 score improvement rate corresponding to the same time point.There was no significant correlation between the patient's MMSE,MoCA,HAMA,and HAMD score improvement rates at 1,3,and 5 years after surgery and the UPDRS-Ⅲ score improvement rate at the corresponding time points(all P＞0.05).Conclusions Bilateral STN-DBS is long-term effective in improving anxiety,depression and overall cognitive function in PD patients.The improvement in overall cognitive function in PD patients is related to the improvement in quality of life.
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