Schrag Anette
Royal Free and University College Medical School, University College London NW3 2PF, London, United Kingdom.
J Neurol Sci. 2006 Oct 25;248(1-2):151-7. doi: 10.1016/j.jns.2006.05.030. Epub 2006 Jun 21.
This paper reviews the literature on health-related quality of life (Hr-QoL) and depressive disorders, and the relationship between them, in patients with Parkinson's disease (PD). PD is associated with reduced Hr-QoL, including motor and non-motor physical consequences of the disease, emotional well-being and social functioning. While this effect is greater in advanced disease stages, there is no close relationship between disease duration and impact on quality of life, and the relationship between clinical rating scales and Hr-QoL scores is only moderate. On the other hand, presence and severity of depression in PD strongly correlates with Hr-QoL scores, and a number of studies have reported depression as the main determinant of poor HR-QoL scores. Despite being the main determinant of poor Hr-QoL and being recognized as an important problem by clinicians, until recently depression in PD has received relatively little attention in research studies. It is known that depression and anxiety occur more frequently in PD than in controls. Depression occurs in a bimodal pattern in PD, with increased rates at the onset and a later peak in advanced disease. Both anxiety and depression can also occur before the first motor symptoms of PD and predate the diagnosis of PD, indicating that these co-morbidities are manifestations of the underlying disease process of PD. Imaging studies have demonstrated abnormalities of dopaminergic, noradrenergic and serotonergic functioning with some correlation with severity of depression. The overall relationship between disease severity and rate of depression (except for off-period related depression) is poor, suggesting that nigrostriatal dysfunction alone is not sufficient to explain depressive symptoms in PD. Other factors are likely to contribute to occurrence and severity of depression in PD, either due to extrastriatal pathology or due to psychological and environmental factors leading to reactive depression. Thus, it is likely that depression in PD is multifactorial. The investigation of depression in PD is complicated by diagnostic difficulties in measuring and diagnosing depression in patients with PD due to the considerable overlap between symptoms of PD and depression. While a number of treatment approaches have been suggested, double-blind randomized controlled trials to demonstrate improvement of depression and overall Hr-QoL in PD are warranted.
本文综述了帕金森病（PD）患者中与健康相关的生活质量（Hr-QoL）和抑郁症及其两者之间关系的文献。PD与Hr-QoL降低相关，包括该疾病的运动和非运动身体后果、情绪健康和社会功能。虽然这种影响在疾病晚期更为显著，但病程与生活质量影响之间没有密切关系，且临床评定量表与Hr-QoL评分之间的关系仅为中等。另一方面，PD中抑郁症的存在和严重程度与Hr-QoL评分密切相关，许多研究报告抑郁症是Hr-QoL评分低的主要决定因素。尽管抑郁症是Hr-QoL低下的主要决定因素且被临床医生视为一个重要问题，但直到最近，PD中的抑郁症在研究中受到的关注相对较少。众所周知，PD患者中抑郁症和焦虑症的发生率高于对照组。抑郁症在PD中呈双峰模式出现，在疾病发作时发生率增加，在晚期出现后期高峰。焦虑症和抑郁症也可在PD的首个运动症状出现之前发生，并早于PD的诊断，这表明这些共病是PD潜在疾病过程的表现。影像学研究已证实多巴胺能、去甲肾上腺素能和5-羟色胺能功能异常，且与抑郁症严重程度有一定相关性。疾病严重程度与抑郁症发生率（与关期相关的抑郁症除外）之间的总体关系较差，这表明仅黑质纹状体功能障碍不足以解释PD中的抑郁症状。其他因素可能导致PD中抑郁症的发生和严重程度，这要么是由于纹状体以外的病理改变，要么是由于导致反应性抑郁症的心理和环境因素。因此，PD中的抑郁症很可能是多因素的。由于PD症状与抑郁症症状有相当大的重叠，PD患者抑郁症的测量和诊断存在困难，这使得PD中抑郁症的调查变得复杂。虽然已提出了多种治疗方法，但仍有必要进行双盲随机对照试验，以证明可改善PD患者的抑郁症和总体Hr-QoL。
