From the Department of Neurology (B.B.K., C.A.C., D.R.S., F.H.K., B.S., D.D., K.N., K.S.P., V.M.K., A.S.P., E.D.L.), Center for Neuroepidemiology and Clinical Neurologic Research (B.B.K., E.D.L.), Department of Psychiatry (J.M.d.F.), Yale University; and Department of Chronic Disease Epidemiology (E.D.L.), Yale School of Public Health, Yale University, New Haven, CT.
Neurology. 2018 May 1;90(18):e1613-e1617. doi: 10.1212/WNL.0000000000005425. Epub 2018 Apr 4.
To determine the prevalence and associated features of demoralization in Parkinson disease (PD).
Participants with PD and controls were prospectively recruited from outpatient movement disorder clinics and the community. Demoralization was defined as scoring positively on the Diagnostic Criteria for Psychosomatic Research, Demoralization questionnaire or Kissane Demoralization Scale score ≥24. Depression was defined as Patient Health Questionnaire-9 score ≥10. Forward stepwise logistic regression was used to determine the odds of having demoralization in the overall, control, and PD cohorts.
Demoralization occurred in 18.1% of 94 participants with PD and 8.1% of 86 control participants ( = 0.05). These 2 groups were otherwise comparable in age, sex, education, economics, race, and marital status. Although demoralization was highly associated with depression, there were individuals with one and not the other. Among participants with PD, 7 of 19 (36.8%) depressed individuals were not demoralized, and 5 of 17 (29.4%) demoralized individuals were not depressed. In the overall cohort, having PD (odds ratio 2.60, 95% confidence interval 1.00-6.80, = 0.051) was associated with demoralization, along with younger age and not currently being married. In the PD cohort, younger age and Unified Parkinson's Disease Rating Scale, part III score (per score 1) were associated with demoralization (odds ratio 1.06, 95% confidence interval 1.01-1.12, = 0.02).
Demoralization is common in PD and is associated with motor dysfunction. In demoralization, there is a prominent inability to cope, making it somewhat distinct from depression. Treatment approaches are also different, making it important to identify demoralization in patients with PD.
确定帕金森病（PD）患者中沮丧的发生率和相关特征。
前瞻性地从门诊运动障碍诊所和社区招募 PD 患者和对照组参与者。沮丧被定义为在身心研究诊断标准、沮丧问卷或 Kissane 沮丧量表上得分为阳性，得分≥24。抑郁定义为患者健康问卷-9 得分≥10。使用向前逐步逻辑回归确定总体、对照组和 PD 队列中出现沮丧的可能性。
94 名 PD 患者中有 18.1%（=0.05）和 86 名对照组参与者中有 8.1%（=0.05）出现沮丧。这两组在年龄、性别、教育、经济、种族和婚姻状况方面基本相似。尽管沮丧与抑郁高度相关，但有些患者只有其中之一而没有另一种。在 PD 患者中，19 名抑郁患者中有 7 名（36.8%）没有沮丧，17 名沮丧患者中有 5 名（29.4%）没有抑郁。在总体队列中，患有 PD（优势比 2.60，95%置信区间 1.00-6.80，=0.051）、年龄较小和未婚与沮丧有关。在 PD 队列中，年龄较小和统一帕金森病评定量表第 III 部分评分（每分 1）与沮丧有关（优势比 1.06，95%置信区间 1.01-1.12，=0.02）。
沮丧在 PD 中很常见，与运动功能障碍有关。在沮丧中，明显存在无法应对的情况，这使其与抑郁有些不同。治疗方法也不同，因此在 PD 患者中识别沮丧非常重要。
