Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China.
Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China.
Brain Behav. 2021 Aug;11(8):e2297. doi: 10.1002/brb3.2297. Epub 2021 Aug 1.
There is no clear time point for the onset of depression and anxiety in Parkinson's disease (PD), and their atypical physical symptoms often overlap with other nonmotor symptoms. Autonomic dysfunction usually appears earlier than motor symptoms, seriously impairing activities of daily living (ADL), even quality of life. Whether autonomic dysfunction can affect depression and anxiety in PD patients through ADL is still unclear.
We conducted three progressive autoregressive mediation models to evaluate whether ADL may mediate the association between autonomic symptom burden, where the mediation chain with autonomic function as an independent variable, ADL as a mediating variable, and anxiety and depression as dependent variables. The ADL of PD patients were measured by the Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) and Modified Schwab and England ADL scale, respectively, and the status of depression and anxiety were measured by the Geriatric Depression Scale (GDS) and State-Trait Anxiety Inventory (STAI).
There were 338 PD patients, including 220 males and 118 females. Demographic information, including age, gender, and education level, were not correlated with the depression and anxiety. Model III had the smallest AIC (AIC = 12,669.89), and the cross-lagged relations were not statistically significant, so we selected Model II as the optimal model. In Model II, longitudinal autoregressive mediated effect and longitudinal mediated effect of autonomic dysfunction affecting anxiety and depression through ADL were not statistically significant, suggesting longitudinal changes of autonomic dysfunction were independent of anxiety and depression through ADL. Contemporaneous mediated effects of autonomic dysfunction affecting anxiety and depression through ADL were statistically significant, suggesting contemporaneous autonomic dysfunction may contribute to anxiety and depression through ADL.
Targeted prevention and intervention measures for autonomic dysfunction and ADL should be taken to preserve and improve self-perceived life satisfaction in the clinical practice and preventive health care of PD.
帕金森病（PD）中抑郁和焦虑的发病时间尚不清楚，其非典型躯体症状常与其他非运动症状重叠。自主神经功能障碍通常早于运动症状出现，严重影响日常生活活动（ADL），甚至生活质量。自主神经功能障碍是否可以通过 ADL 影响 PD 患者的抑郁和焦虑尚不清楚。
我们进行了三个逐步自回归中介模型，以评估 ADL 是否可以介导自主症状负担与 ADL 之间的关联，该中介链以自主功能为自变量、ADL 为中介变量、焦虑和抑郁为因变量。PD 患者的 ADL 通过帕金森病自主功能量表（SCOPA-AUT）和改良 Schwab 和 England ADL 量表进行测量，抑郁和焦虑状态分别通过老年抑郁量表（GDS）和状态-特质焦虑量表（STAI）进行测量。
共有 338 名 PD 患者，包括 220 名男性和 118 名女性。人口统计学信息，包括年龄、性别和教育水平，与抑郁和焦虑无相关性。模型 III 的 AIC（AIC=12669.89）最小，自主神经功能障碍对焦虑和抑郁的纵向滞后关系和纵向中介效应不具有统计学意义，因此我们选择模型 II 作为最优模型。在模型 II 中，自主神经功能障碍通过 ADL 对焦虑和抑郁的纵向自回归中介效应和纵向中介效应不具有统计学意义，提示自主神经功能障碍的纵向变化独立于通过 ADL 对焦虑和抑郁的影响。自主神经功能障碍通过 ADL 对焦虑和抑郁的同期中介效应具有统计学意义，提示同期自主神经功能障碍可能通过 ADL 导致焦虑和抑郁。
在 PD 的临床实践和预防性保健中，应采取针对自主神经功能障碍和 ADL 的靶向预防和干预措施，以保持和改善患者的自我感知生活满意度。
