Cao Yu, Li Gongfeng, Xue Jinsheng, Zhang Guijuan, Gao Sensen, Huang Yuling, Zhu Aiqin
Institute of Geriatric, Qinghai Provincial People's Hospital, Xining, People's Republic of China.
Foreign Cooperation Office, Chengdu Fifth People's Hospital, Chengdu, People's Republic of China.
Neuropsychiatr Dis Treat. 2021 May 6;17:1353-1362. doi: 10.2147/NDT.S300596. eCollection 2021.
Depression seems to aggravate progression of Parkinson's disease (PD). Hypoxia stress may be one of the pathogenic factors leading to PD. We investigated the characteristics of PD and factors related to Parkinson's disease depression (PDD) at high altitude (mean altitude ≥2300 m).
Totally 221 PD patients of three different nationalities (Han, Hui, and Tibetan) were recruited in a high-altitude hospital. Depression was present in 55.6% of them. Patient data were examined, including demographic information, medical history, disease duration and family history. Psychopathological characteristics and motor signs were assessed by the Hamilton Depression scale (HAMD) and scales for motor and non-motor symptoms in the Unified Parkinson's Disease Rating Scale (UPDRS). Progression of PD was evaluated by the modified Hoehn and Yahr (H-Y) staging system.
Mean age (47.1% men) was 68.25±13.67 years old, with disease duration of 4.18±5.13 years and median H-Y scores 2.07±0.97 points. Among three different nationalities, PD rate was 69.2% in Han nationals, 17.6% in Hui nationals and 13.1% in Tibetans of 221 PD patients. Compared with the non-depressed PD group, female, no-smoking and living alone rates, and dysphagia, pain, H-Y stage, ADL, UPDRS-I, UPDRS-III, HAMA, and PSQI scores were significantly increased in the PDD group, while MMSE scores were significantly decreased (P<0.05 or P<0.01). PD patients of Han and Hui nationalities had increased depression rates compared with Tibetan individuals (P<0.05). Compared with the mild depression group, the moderate and severe depression groups had significantly increased salivation, dysphagia, H-Y stage, UPDRS-I, UPDRS-III, HAMA, and PSQI scores (P<0.05 or P<0.01). Living alone rates and ADL scores were increased in the severe depression group (P<0.05). Logistic regression analysis showed that living alone (OR=19.833, 95% CI: 2.758-142.624, P<0.01), UPDRS-III score (OR=1.079, 95% CI: 1.009-1.153, P<0.05), and PSQI score (OR=1.538, 95% CI: 1.347-1.755, P<0.001) were risk factors for PDD. Male gender (OR=0.292, 95% CI: 0.112-0.763, P<0.05) was a protective factor in PDD.
PDD is associated with gender, ethnicity, loneliness, non-motor symptoms (NMSs), motor symptoms, and disease severity, and depression severity. Living alone, dyskinesia, and sleep disorder are risk factors for PDD at high altitude. A relative protection against depression was observed in the Tibetan population.
抑郁症似乎会加剧帕金森病（PD）的进展。低氧应激可能是导致PD的致病因素之一。我们研究了高海拔地区（平均海拔≥2300米）PD的特征以及与帕金森病抑郁（PDD）相关的因素。
在一家高海拔医院招募了221例来自三个不同民族（汉族、回族和藏族）的PD患者。其中55.6%存在抑郁。检查了患者数据，包括人口统计学信息、病史、病程和家族史。通过汉密尔顿抑郁量表（HAMD）以及统一帕金森病评定量表（UPDRS）中的运动和非运动症状量表评估心理病理特征和运动体征。采用改良的 Hoehn 和 Yahr（H-Y）分期系统评估PD的进展。
平均年龄（男性占47.1%）为68.25±13.67岁，病程为4.18±5.13年，H-Y评分中位数为2.07±0.97分。在221例PD患者中，三个不同民族的PD患病率分别为：汉族69.2%，回族17.6%，藏族13.1%。与非抑郁PD组相比，PDD组的女性、不吸烟和独居比例，以及吞咽困难、疼痛、H-Y分期、日常生活活动能力（ADL）、UPDRS-I、UPDRS-III、汉密尔顿焦虑量表（HAMA）和匹兹堡睡眠质量指数（PSQI）评分显著升高，而简易精神状态检查表（MMSE）评分显著降低（P<0.05或P<0.01）。汉族和回族PD患者的抑郁发生率高于藏族患者（P<0.05）。与轻度抑郁组相比，中度和重度抑郁组的流涎、吞咽困难、H-Y分期、UPDRS-I、UPDRS-III、HAMA和PSQI评分显著升高（P<0.05或P<0.01）。重度抑郁组的独居比例和ADL评分升高（P<0.05）。Logistic回归分析显示，独居（比值比[OR]=19.833，95%置信区间[CI]：2.758 - 142.624，P<0.01）、UPDRS-III评分（OR=1.079，95%CI：1.009 - 1.153，P<0.05）和PSQI评分（OR=1.538，95%CI：1.347 - 1.755，P<0.001）是PDD的危险因素。男性（OR=0.292，95%CI：0.112 - 0.763，P<0.05）是PDD的保护因素。
PDD与性别、种族、孤独感、非运动症状（NMSs）、运动症状以及疾病严重程度和抑郁严重程度相关。独居、运动障碍和睡眠障碍是高海拔地区PDD的危险因素。在藏族人群中观察到对抑郁有相对的保护作用。
