Wang Chen Yu, Chan Lung, Wu Dean, Chi Wen-Chou, Yen Chia-Feng, Liao Hua-Fang, Hong Chien Tai, Liou Tsan-Hon
Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Front Neurol. 2020 Jan 9;10:1360. doi: 10.3389/fneur.2019.01360. eCollection 2019.
As the disease progresses to moderate to advanced stages, people with Parkinson's disease (PwP) are likely to have various degrees of disability due to the motor and non-motor symptoms, such as ambulatory difficulty and cognitive impairment. The objective of this study was to investigate the impact of cognition and ambulation status on the functioning and disability of PwP using the World Health Orgnaization Disability Assessment Schedule 2.0 (WHODAS 2.0). A group of 10,581 PwP with Hoehn and Yahr Staging 3 and above were collected from a database of disability evaluation and functional assessment using the Taiwan Data Bank of Persons with Disability between July 2012 and October 2018. WHODAS 2.0 was administered and all PwP were grouped based on their ambulatory status, which was assessed by 3-m back and forth walk and cognitive ability, assessed by WHODAS 2.0 first domain with cut-off level at 58. Non-ambulation and cognitive disability contributed independently to disability in all aspects of WHODAS 2.0 survey, including self-care, getting along with others, performing life activities and participation in society. Compared to ambulation status, cognitive disability had a greater negative impact on functioning in all aspects. Cognitive disability was associated with greater disability in moderate to advanced PwP than non-ambulatory status. The results of this study may indicate that cognition preservation is essential to ameliorate functional impairment and disability in moderate to advanced PwP.
随着帕金森病进展到中度至重度阶段，帕金森病患者（PwP）可能会由于运动和非运动症状而出现不同程度的残疾，如行走困难和认知障碍。本研究的目的是使用世界卫生组织残疾评定量表2.0（WHODAS 2.0）来调查认知和行走状态对帕金森病患者功能和残疾的影响。2012年7月至2018年10月期间，从台湾残疾人数据库中收集了一组10581名Hoehn和Yahr分期为3期及以上的帕金森病患者。对患者进行了WHODAS 2.0评估，并根据其行走状态（通过3米往返步行评估）和认知能力（通过WHODAS 2.0第一领域评估，临界值为58）对所有帕金森病患者进行分组。在WHODAS 2.0调查的所有方面，包括自我护理、与他人相处、进行生活活动和参与社会，无法行走和认知残疾都独立导致了残疾。与行走状态相比，认知残疾在所有方面对功能的负面影响更大。在中度至重度帕金森病患者中，认知残疾比无法行走状态与更大的残疾相关。本研究结果可能表明，保持认知对于改善中度至重度帕金森病患者的功能损害和残疾至关重要。
