Stuebner E, Vichayanrat E, Low D A, Mathias C J, Isenmann S, Haensch C A
Autonomic Laboratory, Department of Neurology and Clinical Neurophysiology, Faculty of Health, University of Witten/Herdecke, HELIOS-Klinikum Wuppertal, Wuppertal, Germany.
Clin Auton Res. 2015 Apr;25(2):109-16. doi: 10.1007/s10286-015-0270-5. Epub 2015 Feb 18.
Non-motor symptoms are increasingly recognized in Parkinson disease (PD) and include physical as well as psychological symptoms. A psychological condition that has been well studied in PD is psychosis. Cardiovascular autonomic dysfunction in PD can include a reversed or loss of blood pressure (BP) circadian rhythm, referred to as nocturnal non-dipping. The aim of this study was to determine the relationship between 24 h ambulatory blood pressure measurements (ABPM), i.e., absence or presence of nocturnal dipping, and psychosis scores in PD.
Twenty-one patiens with PD underwent 24 h ABPM using an autonomic protocol. A decrease in nocturnal mean arterial blood pressure of less than 10% was defined as non-dipping. Patients were interviewed (including the brief psychiatric rating scale; BPRS) for the assessment of psychosis.
Eleven patients were dippers and 10 were non-dippers. BPRS scores were higher in non-dippers, who, on average, met the criteria for psychosis (mean non-dipper BPRS: 34.3 ± 7.3 vs mean dipper BPRS: 27.5 ± 5.3; cutoff for "mildly ill" 31). There was a correlation between BPRS scores and non-dipping, indicating that those patients who had a blunted nocturnal fall in BP were more prone to psychotic symptoms (Pearson's Correlation = 0.554, p = 0.009).
These results suggest that, among PD patients, a non-dipping circadian rhythm is associated with more severe symptoms of psychosis than is a dipping circadian rhythm. This association warrants further investigation.
帕金森病（PD）中非运动症状越来越受到重视，包括身体和心理症状。PD中一项得到充分研究的心理状况是精神病。PD中的心血管自主神经功能障碍可包括血压（BP）昼夜节律的逆转或丧失，即夜间非勺型血压。本研究的目的是确定24小时动态血压测量（ABPM），即夜间勺型血压的有无，与PD患者精神病评分之间的关系。
21例PD患者按照自主神经方案进行24小时ABPM。夜间平均动脉血压下降小于10%被定义为非勺型血压。对患者进行访谈（包括简明精神病评定量表；BPRS）以评估精神病。
11例患者为勺型血压，10例为非勺型血压。非勺型血压患者的BPRS评分更高，平均而言，他们符合精神病标准（平均非勺型血压患者BPRS：34.3±7.3，而平均勺型血压患者BPRS：27.5±5.3；“轻度患病”的临界值为31）。BPRS评分与非勺型血压之间存在相关性，表明夜间血压下降不明显的患者更容易出现精神病症状（Pearson相关性=0.554，p=0.009）。
这些结果表明，在PD患者中，与勺型昼夜节律相比，非勺型昼夜节律与更严重的精神病症状相关。这种关联值得进一步研究。
