Whitehead Daisy L, Davies Ann D M, Playfer Jeremy R, Turnbull Christopher J
King's College London, Institute of Psychiatry, MRC Centre for Neurodegeneration, London, United Kingdom.
Mov Disord. 2008 Jun 15;23(8):1137-45. doi: 10.1002/mds.22057.
The sleep-wake cycle in Parkinson's Disease (PD) is profoundly disrupted, but less is known about circadian rhythm in PD and its relationship to other important clinical features. This study compared rest-activity rhythms in healthy older adults and PD patients with and without hallucinations. Twenty-nine older adults and 50 PD patients (27 with hallucinations, 23 without) were assessed using wrist-worn actigraphy for 5 days. Disease-related and cognitive data were also collected. PD patients demonstrated reduced amplitude of activity (F = 12.719, P < 0.01) and increased intradaily variability (F = 22.005, P < 0.001), compared to healthy older adults, independently of age, and cognitive status. Hallucinators showed lower interdaily stability (F = 7.493, P < 0.01) significantly greater activity during "night-time" (F = 6.080, P < 0.05) and significantly reduced relative amplitude of activity (F = 5.804, P < 0.05) compared to nonhallucinators, independently of clinical factors including motor fluctuations. PD patients with hallucinations display altered rest-activity rhythm characterized by an unpredictable circadian pattern across days, likely arising from damage to brainstem and hypothalamic sleep centers. Treatment of sleep and rest-activity rhythm disturbance is an important target in Parkinson's Disease.
帕金森病（PD）的睡眠-觉醒周期受到严重破坏，但关于PD的昼夜节律及其与其他重要临床特征的关系却知之甚少。本研究比较了有幻觉和无幻觉的健康老年人与PD患者的静息-活动节律。使用腕部活动记录仪对29名老年人和50名PD患者（27名有幻觉，23名无幻觉）进行了为期5天的评估。还收集了与疾病相关和认知方面的数据。与健康老年人相比，PD患者的活动幅度降低（F = 12.719，P < 0.01），日内变异性增加（F = 22.005，P < 0.001），且不受年龄和认知状态的影响。与无幻觉者相比，有幻觉者的日间稳定性较低（F = 7.493，P < 0.01），“夜间”活动明显增加（F = 6.080，P < 0.05），活动相对幅度明显降低（F = 5.804，P < 0.05），且不受包括运动波动在内的临床因素影响。有幻觉的PD患者表现出静息-活动节律改变，其特征是日间昼夜模式不可预测，这可能源于脑干和下丘脑睡眠中心受损。睡眠和静息-活动节律紊乱的治疗是帕金森病的一个重要目标。
