汉化版MDS-UPDRS与传统UPDRS评测帕金森病的比较分析

目的研究汉化版国际帕金森和运动障碍协会(MDS)-统一帕金森病评定量表(UPDRS)的信度和效度,及其与传统UPDRS的比较分析。方法 2016年5月至2018年12月,分别对225例帕金森病患者进行两个量表的测评,评价MDS-UPDRS的信度和效度,进一步对两个量表作相关分析。结果 MDS-UPDRS整体Cronbachα系数为0.734。秩相关系数为0.905。因子分析KMO统计量为0.728。Pearson相关分析,两个量表的公因子相关系数为0.969,两个量表的总分相关系数为0.972。且MDS-UPDRS相比UPDRS,增加了许多非运动症状,调整了度量标准从而提高了对疾病早期评估的精确度,增加了大量指导语从而规范测评。结论汉化版MDS-UPDRS具有较好的信度和效度,与传统UPDRS相关性较高,且比UPDRS更适合用于中国帕金森病患者进行临床评定。     

太极拳对早期帕金森病运动控制的影响

目的比较太极拳与步行对帕金森病患者运动控制的效果。方法将40例帕金森病患者按随机数字表分太极拳组(n=20)和步行组(n=20),分别采用太极拳与步行锻炼法进行康复治疗,疗程4周。采用统一帕金森病评定量表(UPDRS)中UPDRSⅢ运动检查评分和Berg平衡量表(BBS)评分于治疗前后分别对患者进行评定。结果疗程结束时两组各脱落1例。与治疗前相比,太极拳组的UPDRSⅢ评分、Berg平衡量表评分均明显改善(P<0.01);治疗后,太极拳组的UPDRSⅢ评分、疗效、Berg平衡量表评分均明显优于步行组(P<0.01)。结论太极拳一定程度上可加强对帕金森患者的运动控制,有效缓解症状,改善平衡功能。     

帕金森病后抑郁的相关因素研究

目的：探讨帕金森病（PD）后抑郁发病的相关因素。方法：收集门诊及住院的PD患者共100例，所有患者按ICD-10 F06.32器质性抑郁障碍诊断标准进行诊断，并应用抑郁自评量表（SDS）、Hamilton抑郁量表（HAMD）评定后，筛选出抑郁症患者，随机分为抑郁组和非抑郁组。应用一般情况调查表、SDS、HAMD、PD综合评分量表（UPDRS）评定，对相关因素进行单因素及多因素偏相关分析。结果：100例PD患者中出现抑郁症状42例，占42.0%。女性、丧偶、家庭不支持配合、UPDRSⅢ评分高、未应用多巴胺受体激动剂治疗为PD后抑郁的相关因素。结论：帕金森病后抑郁发病率高，其相关因素复杂，抑郁的发生可能是社会心理、神经生物学多种因素作用的结果。     

功能性步态评价在帕金森病患者中的效度

目的检验功能性步态评价(FGA)在帕金森病患者中的结构效度和同时效度。方法 2011年3月至12月,住院帕金森病患者121例(平均年龄61.9岁)行FGA评定,同时采用Berg平衡量表、功能性步态分级、计时起立-走测验、特异性活动平衡自信量表、运动障碍学会统一帕金森病评定量表第3部分、改良Barthel指数、最大步行速度和改良Hoehn and Yahr量表进行评定。采用主成分法正交旋转法分析其结构效度,计算FGA与其他评价方法之间的相关性分析同时效度。结果 FGA提取到1个公因子,解释总变异64.0%;FGA与其他评价之间的相关系数0.57～0.85。结论 FGA在帕金森病患者中效度较好。     

帕金森病患者情绪抑郁的相关性探讨

目的 :探讨帕金森病患者与情绪抑郁的相关性。方法 :对帕金森病组 5 6例病人与健康对照组入选者进行心理测验量表评定 ,并比较测验结果。结果 :5 6例病人中出现抑郁症状 2 5例 ,占 44 6 %。与健康对照组比较有显著差别。同时帕金森病病程越长 ,UPDRS评分和Hoehn Yahr分期越高 ,抑郁发生率越高。结论 :抑郁在帕金森病中具有较高的发病率 ,对帕金森病既要针对病因进行治疗 ,又要重视心理治疗     

帕金森病运动功能评分量表的一致性和敏感性检验及其优越性体现

目的：对反映帕金森病患者运动功能障碍的评分量表——帕金森病运动功能评分量(motor dysfunction rating scale for Parkinson’s diseaese，NDRSPD)的一致性和敏感性的评定，体现其优越性。方法：对5个评定者之间用MDRSPD评价20例帕金森病患者的运动功能的评分结果做Kappa检验；对另20例帕金森病患者治疗前后的评分结果进行t检验。结果：该量表15个项目的Kappa检验，最低K=0．66，最高K=0．97；20例帕金森病患者治疗前后得分分别为(19，68&;#177;7．94)，(16．03&;#177;7．19)分，治疗前后评分结果差异有显著性意义(t=7．13，P&;lt;0．001)。结论：MDRSPD评定者之间一致性良好，且能敏感地反映出病情变化，可用于帕金森病患者的病情严重程度和治疗疗效的评定.     

帕宁治疗肝肾阴虚型帕金森病的临床研究

目的:观察帕宁治疗帕金森病的运动症状、非运动症状及中医证候方面的临床疗效;方法 :将符合标准的60例肝肾阴虚型帕金森病患者随机分为2组,治疗组与对照组各30例。2组均给予基础治疗的同时,治疗组加以帕宁方药,进行临床疗效的评定;结果:治疗组的肝肾阴虚中医证候积分量表评定、UPDRS量表评定、24项汉密尔顿抑郁量表(HAMD)评定、蒙特利尔认知评估(Mo CA)量表评定、帕金森病睡眠量表(PDSS)评定均较治疗前有明显改善(P0.01);结论:帕宁方药能较好的改善帕金森病患者的运动症状和非运动症状,提高患者的生活质量,值得临床进一步应用。     

多巴丝肼联合普拉克索治疗帕金森病的疗效与安全性

目的探讨多巴丝肼、普拉克索联合治疗帕金森病的有效性、安全性。方法随机选取2013年6月至2018年6月帕金森病患者66例,依据治疗方案将其分为研究组与对照组,每组33例。对照组帕金森病患者单用多巴丝肼治疗,研究组帕金森病患者予以多巴丝肼、普拉克索联合治疗。结果两组治疗前UPDRS量表评分比较,差异未见统计学意义(P0.05),治疗后研究组UPDRS量表评分较之前下降降幅度大于对照组(P0.05);研究组帕金森病患者用药期间药物所致不良反应发生率(9.09%)低于对照组(33.33%),P0.05。结论多巴丝肼、普拉克索联合治疗帕金森病有一定的有效性与安全性。     

渐进性抗阻训练联合普拉克索治疗改善帕金森病患者肌张力

目的:探讨普拉克索联合渐进性抗阻训练对帕金森病患者肌张力的疗效。方法:选取帕金森病患者125例,随机分为对照组45例、抗阻训练组40例、帕金森操组40例,3组均给予普拉克索药物治疗,抗阻训练组和帕金森操组还分别给予抗阻训练和帕金森操康复。对3组患者分别在不同随访时间点进行帕金森评分量表(UPDRS)、帕金森病Webster评分量表及Berg平衡量表进行评分;同时使用改良的Ashworth量表评价肌张力的变化水平。结果:3组中,抗阻训练组的UPDRS得分最高(P0.05),抗阻训练组和帕金森操组的随访UPDRS得分逐渐增高(P0.05)。3组4个时间点的Berg平衡量表得分、Webster症状评分入组时最高,随访18月水平最低(P0.05);随访3月、12月和18月的得分均可见差异有统计学意义,抗阻训练组得分最低(P0.05)。抗阻训练组和对照组各有1例嗜睡和1例恶心患者。3组4个时间点的Ashworth量表评分差异均有统计学意义,入组时最高,随访18月最低(均P0.05),随访3月、12月和18月的Ashworth量表评分均可见差异有统计学意义,抗阻训练组得分最低,对照组得分最高(P0.05)。结论:普拉克索联合渐进性抗阻训练对于改善帕金森病患者肌张力的效果优于普拉克索联合帕金森操的干预效果和单纯使用普拉克索药物治疗的效果。     

罗匹尼罗与溴隐亭治疗帕金森病临床疗效对比分析

目的比较罗匹尼罗与溴隐亭治疗帕金森病临床疗效和安全性。方法研究对象来自神经内科2010年9月至2013年9月收治的80例帕金森病患者,采用计算机随机分组的方式将帕金森病患者分为对照组和观察组各40例,两组患者分别在既往服药的基础上加用溴隐亭或罗匹尼罗治疗,采用帕金森病统一评分量表（UPDRS）评价临床疗效,比较两组患者临床治疗效果和安全性。结果入组时,两组患者间UPDRS得分比较差异无统计学意义（P均〉0．05）,干预后,两组患者UPDRS得分均较入组时显著改善,观察组患者UPDRS得分均显著低于对照组患者（P均〈0．05）。两组患者均未发生明显不良反应。结论罗匹尼罗治疗帕金森病有较好的疗效,优于溴隐亭。     

Clinical tests for the evaluation of postural instability in patients with parkinson's disease

OBJECTIVE: To determine which test for postural instability in Parkinson's disease (PD) is reliable, valid, and easy to perform in a clinical setting. DESIGN: Cross-sectional reliability and validity study. SETTING: Academic center for movement disorders. PARTICIPANTS: Forty-two patients with PD and 15 controls. Based on the results of a structured interview, the patients were divided in PD-unstable (n=22) and PD-stable (n=20) groups. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Several variants of the retropulsion test with differences in execution and scoring. Responses were scored on 5 different rating scales (ratings of Nutt, Bloem, Pastor; the Unified Parkinson's Disease Rating Scale [UPDRS]; the Short Parkinson Evaluation Scale). These tests were compared with steady-stance positions. RESULTS: The interrater reliability was high for most ratings, with weighted kappa ranging from.63 for the UPDRS to.98 for both the Pastor rating and steady-stance positions. Most ratings distinguished between the groups. However, the Nutt rating had the highest overall predictive accuracy, with a sensitivity of.63 and a specificity of.88. CONCLUSIONS: The most valid test for postural stability in PD was an unexpected shoulder pull, executed once, with taking more than 2 steps backward considered abnormal. This retropulsion test is easy to use in a clinical setting.     

Assessment of idiopathic Parkinson's disease in physical medicine and rehabilitation]

Parkinson's disease (PD) is a chronic disease associated with motor impairments (bradykinesia, rigidity, tremor and postural disorders), cognitive disorders and dysautonomia. Most symptoms are greatly improved by dopatherapy during the first stages, then signs of treatment ineffectiveness or intolerance occur that signal the beginning of motor and cognitive decline. This evolution signified the need to develop an effective tool to measure the effectiveness of drugs or surgery in PD and has had the Movement Disorder Society to propose 20 years ago a tool to assess such patients: the Unified Parkinson's Disease Rating Scale (UPDRS). This scale has a good internal consistency and a good interrater reliability. Yet, some impairments, especially of cognitive origin, are evaluated too succinctly and need complementary scales. As well, other disorders such as bladder disorders are not included, nor is quality of life studied despite the impact of PD on daily life. Specific scales have been proposed. UPDRS may be well-adapted to PD follow-up in the physical medicine and rehabilitation context by measuring treatment effectiveness, detecting Dopa ineffectiveness or complications and assessing patients' handicap in daily activities. The evolution of UPDRS will improve the qualities of the scale and contribute to better determining the various stages of the disease.     

Reliability and validity of the Tinetti Mobility Test for individuals with Parkinson disease

BACKGROUND AND PURPOSE: This study examined the interrater and intrarater reliability, concurrent validity, and criterion validity of the Tinetti Mobility Test (TMT) as a fall risk screening tool in individuals with Parkinson disease (PD). SUBJECTS: Thirty individuals with PD voluntarily participated in the study, and data from a retrospective review of 126 patient records were included. METHODS: Physical therapists and physical therapist students rated live and videotaped performances of the TMT. Tinetti Mobility Test scores were correlated with Unified Parkinson's Disease Rating Scale (UPDRS) motor scores and comfortable gait speed. The ability of the TMT to accurately assess fall risk was determined. RESULTS: Interrater and intrarater reliability was good to excellent (intraclass correlation coefficient of >.80). Tinetti Mobility Test scores correlated with UPDRS motor scores (r(s)=-.45) and gait speed (r(s)=.53). The sensitivity and specificity of the TMT to identify fallers were 76% and 66%, respectively. DISCUSSION AND CONCLUSION: The TMT is a reliable and valid tool for assessing the mobility status of and fall risk for individuals with PD.     

Validating the Berg Balance Scale for patients with Parkinson's disease: a key to rehabilitation evaluation

OBJECTIVE: To assess the criterion-related validity of the Berg Balance Scale (BBS) in subjects with Parkinson's disease (PD). DESIGN: Prospective, correlational analysis between the BBS and accepted measures of PD motor and functional impairment. SETTING: The federally funded PD research center, an interdisciplinary center of excellence for people with PD within a Veterans Affairs medical center. PARTICIPANTS: Thirty-eight men (average +/- standard deviation, 71.1+/-10.5 y) with confirmed PD. Their initial diagnosis had been made on average 5.8+/-3.6 years earlier. All could stand or walk unassisted and had mild to moderate disability. Patients who could not ambulate without assistive devices were excluded. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Correlational analyses between the BBS and the Unified Parkinson's Disease Rating Scale (UPDRS) motor scale, Modified Hoehn and Yahr Staging (Hoehn and Yahr) Scale, and the Modified Schwab and England Capacity for Daily Living Scale (S&E ADL Scale). RESULTS: BBS score showed significant correlations with indicators of motor functioning, stage of disease, and daily living capacity. BBS score was inversely associated with the UPDRS motor score (-.58, P <.005), Hoehn and Yahr Scale staging (-.45, P <.005), and S&E ADL Scale rating (.55, P <.005). In all 3 correlations, lower scores on the BBS (indicating greater balance deficits) correlated with higher UPDRS scores (indicating greater motoric or functional impairment). CONCLUSIONS: Results support the criterion-related validity of the BBS. Its utility in other balance conditions of older adults has been established. Rehabilitation interventions have been shown to improve the balance deficits associated with PD. Early referral and periodic reassessment is vital to achieving and maintaining improvements. Our research results agree with other published research in suggesting that the BBS may be used as a screening tool and ongoing assessment tool for patients with PD.     

Rating scale and functional prognosis of Parkinson's disease

Parkinson's disease is a progressive neurodegenerative disorder. Motor functions of patients with Parkinson's disease are determined by its cardinal symptoms: akinesia, tremor, rigidity and disturbed righting reflexes. To evaluate degree of disability and rate of its progression in Parkinson disease, simple but reliable and reproducible rating scales are essential. Those that essentially fulfil such conditions are Hoehn and Yahr Scale, Schwab and England Scale, and Unified Parkinson's Disease Rating Scale (UPDRS). Levodopa, the major anti-parkinsonian agent, has greatly improved the motor functions of the Parkinson's disease patients and prolonged their life expectancy. Studies using the above mentioned scales compared the rate of disability progression and the motor functional prognosis between pre- and post-levodopa era, and always demonstrated the levodopa's benefits for the prognosis. Side effects of long administration of levodopa such as motor fluctuation, dyskinesia, wearing-off or on-off phenomenon, and psychosis, however, are disability factors to the patients' motor functions. Rating scales that can integrate the side effects to evaluate the functions will be required.     

Effect of exercise on perceived quality of life of individuals with Parkinson's disease

The purpose of this study was to determine if individuals with Parkinson's disease (PD) who completed an 8-week, supervised PoleStriding exercise program would undergo significant improvements in cognitive skills, activities of daily living, motor function, and quality of life. The Unified Parkinson's Disease Rating Scale (UPDRS) and the Parkinson's Disease Questionnaire (PDQ-39) were used to measure functional independence. Six male volunteers (72.7+/-3.7 years of age) performed PoleStriding exercise three times per week for 37+/-3 minutes. Differences in the participants' pre- and post-training scores on the UPDRS and PDQ-39 were analyzed using the Wilcoxin Signed Ranks Test. A statistically significant improvement occurred in the UPDRS (P<0.026) and PDQ-39 (P<0.028) scores following the moderate-intensity exercise intervention. The results of this nonrandomized clinical trial indicate that an 8-week individualized PoleStriding exercise program increases perceived functional independence and quality of life in individuals with PD.     

影响帕金森病患者生活质量的因素

目的：调查帕金森病（PD）患者的认知功能、抑郁和影响生活质量的因素。方法：老年PD患者（PD组）与非PD患者（对照组）各50例,采用自填结合个人访谈法,选用老年抑郁量表（ODI）、简易精神状态量表（MMSE）、帕金森病统一评分量表（UPDRS）、Hoehn-Yahr分级及Schwab-England量表评定患者抑郁状态功能、认知功能及可能影响生活质量的因素。结果：①PD组患者的认知功能和生活质量均低于对照组,抑郁程度高于对照组（P〈0.05）。结论：ADL、认知功能及抑郁程度是影响PD患者生活质量的主要因素,在诊治过程中应重视改善这3方面的症状。     

Validity and inter-rater reliability of the Lindop Parkinson's Disease Mobility Assessment: a preliminary study

Objectives

To assess the validity and inter-rater reliability of the Lindop Parkinson's Disease Mobility Assessment (LPA); a scale developed to gather objective information on gait and bed mobility in patients with Parkinson's disease.

Design

Two therapists scored a group of patients with Parkinson's disease using the motor examination section of the Unified Parkinson's Disease Rating Scale (UPDRS-ME) and the LPA scale. The association between scores obtained using the two scales was calculated, and the scores obtained by the therapists using each scale were compared.

Setting

A Parkinson's disease clinic in a day hospital in a district general hospital.

Participants

Forty-nine subjects with Parkinson's disease were recruited (33 males, 16 females, mean age 75.84 ± 7.16 years).

Results

There was a significant association between the LPA and UPDRS-ME data for both raters (Rater A, rho −0.67; Rater B, rho −0.63; P < 0.001). The limits of agreement showed that the two raters scored within two scale points of each other on 95% of occasions, and that there was no systematic bias between raters. Percentage agreement between raters ranged from 82% to 100% for the LPA. The LPA took significantly less time to complete [mean 7.7 (standard deviation 2.9) minutes] than the UPDRS-ME [mean 10.5 (standard deviation 2.2) minutes; P < 0.001].

Conclusions

The results suggest that the LPA is a valid measure with good inter-rater reliability. It is quick and easy to administer, and provides objective information about the gait and bed mobility of elderly patients with Parkinson's disease.     

Pramipexole safely replaces ergot dopamine agonists with either rapid or slow switching

This prospective, open-label, multicentre study examined the efficacy and safety of rapidly (overnight) or slowly (after 2 weeks of concomitant usage) switching patients with Parkinson's disease (PD) from conventional ergot dopamine agonists (DAs) to the non-ergot DA, pramipexole. Fifty-nine early-to-advanced PD patients with motor symptoms that were inadequately controlled by ergot DAs were enrolled. Patients were switched from ergot derivatives to pramipexole and evaluated every 2 weeks for 12 weeks by Hoehn and Yahr staging, Unified Parkinson's Disease Rating Scale (UPDRS) and a modified Epworth Sleepiness Scale (mESS). The UPDRS III subscores and total UPDRS scores significantly improved, independent of switching method. Adverse events, all of which were mild, occurred in 29.2% of patients. No sudden onset of excessive daytime sleepiness or significant worsening in mESS was seen. Switching patients with PD from ergot DA to pramipexole, using either a slow or rapid switching method, appeared to be well tolerated and effective, although further dose adjustment may be necessary in some patients after the switch.     

How do I sound to me? Perceived changes in communication in Parkinson's disease

OBJECTIVE: To examine self and carer perceived changes in communication associated with Parkinson's disease and relate these to speech intelligibility, gender, age and other disease measures. DESIGN: Cross-sectional survey of a hospital- and community-based sample of 176 people with Parkinson's disease and their carers using a questionnaire based on semantic differential techniques. PARTICIPANTS: One hundred and four people with Parkinson's disease with no history of communication difficulties prior to onset of their Parkinson's disease and 45 primary carers who returned completed questionnaires. MAIN OUTCOME MEASURES: Differences in ratings for ;before' the onset of Parkinson's disease versus present status. RESULTS: There was a strong perception of negative impact on communication between 'before' and 'now', irrespective of age and gender and largely independent of disease severity and duration, intelligibility and cognitive status. Activities of daily living (assessed by Unified Parkinson's Disease Rating Scale (UPDRS) II) and depression rating scale scores had the strongest association with change (adjusted R(2) 0.27). There was a significant correlation between the rank order of perceived change in features examined in people with Parkinson's disease versus their carers, though in general carers rated change as having less impact. CONCLUSIONS: Parkinson's disease exercises a strong influence on communication even before apparent alterations to intelligibility or motor status (UPDRS).