Forsaa Elin Bjelland, Larsen Jan Petter, Wentzel-Larsen Tore, Herlofson Karen, Alves Guido
Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.
Mov Disord. 2008 Jul 30;23(10):1420-7. doi: 10.1002/mds.22121.
We investigated how health related quality of life (HRQL) changes over time in a population-based cohort of patients with Parkinson's disease (PD), and which factors predict a lower level of HRQL in these patients. Of 227 patients with PD assessed at baseline and followed prospectively, information on HRQL-status was obtained in 111 subjects 4 years and 82 patients 8 years after inclusion. HRQL was measured by the Nottingham Health Profile (NHP). Analyses were conducted using generalized estimating equation models. The NHP total score (P < 0.001) and scores in all NHP dimensions except for sleep worsened significantly during follow-up. Steepest slope was found for the domain physical mobility (3.16, 95% CI 2.39-3.92), followed by the domains social isolation (2.22, 95% CI 1.52-2.93) and emotional reactions (1.36, 95% CI 0.74-1.97). In addition to follow-up time, higher Hoehn and Yahr staging, higher Montgomery and Aasberg Depression Rating Scale scores, and presence of insomnia at baseline were associated with lower levels of overall HRQL during follow-up. We conclude that PD has an increasing impact on HRQL as the disease progresses. During long-term follow-up, deterioration in physical mobility was the most important single factor contributing to decline in HRQL in our cohort, although distress of nonmotor character as a whole outweighed the impact of distress in physical mobility on overall HRQL. More advanced disease, higher severity of depressive symptoms, and presence of insomnia were found to be important and independent predictors of poor HRQL. (c) 2008 Movement Disorder Society.
我们调查了帕金森病（PD）患者群体中与健康相关的生活质量（HRQL）随时间的变化情况，以及哪些因素可预测这些患者的HRQL水平较低。在227例基线时接受评估并进行前瞻性随访的PD患者中，纳入研究4年后，111名受试者获得了HRQL状况信息，纳入研究8年后，82例患者获得了相关信息。HRQL采用诺丁汉健康量表（NHP）进行测量。分析使用广义估计方程模型进行。NHP总分（P<0.001）以及除睡眠外所有NHP维度的得分在随访期间均显著恶化。身体活动能力领域的斜率最陡（3.16，95%CI 2.39 - 3.92），其次是社会隔离领域（2.22，95%CI 1.52 - 2.93）和情绪反应领域（1.36，95%CI 0.74 - 1.97）。除随访时间外，较高的Hoehn和Yahr分期、较高的蒙哥马利和阿斯伯格抑郁量表评分以及基线时存在失眠与随访期间较低的总体HRQL水平相关。我们得出结论，随着疾病进展，PD对HRQL的影响日益增加。在长期随访中，身体活动能力的恶化是导致我们队列中HRQL下降的最重要单一因素，尽管非运动性特征的痛苦总体上超过了身体活动能力方面的痛苦对总体HRQL的影响。发现疾病进展更严重、抑郁症状更严重以及存在失眠是HRQL较差的重要且独立的预测因素。（c）2008年运动障碍协会。
