Pacchetti Claudio, Manni Raffaele, Zangaglia Roberta, Mancini Francesca, Marchioni Enrico, Tassorelli Cristina, Terzaghi Michele, Ossola Maria, Martignoni Emilia, Moglia Arrigo, Nappi Giuseppe
Parkinson's Disease and Movement Disorders Unit, IRCCS C. Mondino Institute of Neurology, Pavia, Italy.
Mov Disord. 2005 Nov;20(11):1439-48. doi: 10.1002/mds.20582.
Psychotic symptoms are the main and the most disabling "nonmotor" complications of Parkinson's disease (PD), the pathophysiology of which is poorly recognized. Polysomnographic studies have shown a relationship between visual hallucinations and rapid eye movement (REM) sleep. The objective of this study is to clarify the relationship between psychotic symptoms and REM sleep behavior disorder (RBD) in PD. In a Parkinson's disease outpatient unit, 289 consecutive subjects with idiopathic PD were administered (in the period from January to December 2002) a multiple-choice questionnaire and structured interview on sleep and mental disorders. RBD was diagnosed in accordance with the minimal diagnostic criteria of the International Classification of Sleep Disorders. Hallucinations and delusional disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. The presence or absence of psychotic symptoms, of RBD, and of daytime sleepiness, as well as motor status, cognitive status, and mood were assessed. Approximately 32% (n = 92) of the subjects presented with psychotic disorders; 30% (n = 86) had experienced hallucinations; 2% (n = 6) had delusions without hallucinations. Sixty-two (72%) hallucinators reported nocturnal hallucinations. A total of 6.6% (n = 19) of the subjects complained of a delusional disorder. There were 26.6% (n = 77) of subjects who presented with RBD: 28 (36%) with onset before and 49 (63%) with onset after PD diagnosis. The presence of RBD was associated with an increased risk of manifesting hallucinations and delusions (odds ratio [OR], 2.73). Other independent clinical factors found to have an effect on psychotic disorders were cognitive impairment (OR, 3.92), disease duration (OR, 2.46), advanced age (OR, 2.34), and severity of motor symptoms (OR, 2.06). These results suggest that RBD is widely associated with psychosis in PD.
精神症状是帕金森病（PD）主要且最具致残性的“非运动”并发症，其病理生理学尚未得到充分认识。多导睡眠图研究表明视幻觉与快速眼动（REM）睡眠之间存在关联。本研究的目的是阐明PD患者精神症状与快速眼动睡眠行为障碍（RBD）之间的关系。在一个帕金森病门诊单元，289例连续的特发性PD患者（在2002年1月至12月期间）接受了一份关于睡眠和精神障碍的多项选择题问卷及结构化访谈。RBD根据《国际睡眠障碍分类》的最低诊断标准进行诊断。幻觉和妄想性障碍根据《精神障碍诊断与统计手册》第四版标准进行诊断。评估了精神症状、RBD、日间嗜睡的有无，以及运动状态、认知状态和情绪。约32%（n = 92）的患者出现精神障碍；30%（n = 86）有过幻觉；2%（n = 6）有妄想但无幻觉。62例（72%）有幻觉者报告有夜间幻觉。共有6.6%（n = 19）的患者主诉有妄想性障碍。26.6%（n = 77）的患者出现RBD：28例（36%）在PD诊断前发病，49例（63%）在PD诊断后发病。RBD的存在与出现幻觉和妄想的风险增加相关（优势比[OR]，2.73）。发现对精神障碍有影响的其他独立临床因素包括认知障碍（OR，3.92）、病程（OR，2.46）、高龄（OR，2.34）和运动症状严重程度（OR，2.06）。这些结果表明RBD在PD中与精神病广泛相关。
