Girges Christine, de Roquemaurel Alexis, Vijiaratnam Nirosen, Foley Jennifer, Candelario Joseph, Salazar Maricel, Milabo Catherine, Esperida John, Grover Tim, Akram Harith, Hyam Jonathan, Krüger Marie T, Zrinzo Ludvic, Limousin Patricia, Foltynie Thomas
Department of Clinical and Movement Neurosciences, University College London, London, UK.
UCL Functional Neurosurgery Unit, National Hospital for Neurology and Neurosurgery, London, UK.
J Parkinsons Dis. 2025 Jun 26:1877718X251354933. doi: 10.1177/1877718X251354933.
BackgroundDepression can negatively influence an individual's perception of their disease. Although subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for Parkinson's disease (PD), some patients do not appreciate benefits despite showing objective improvements in motor function.ObjectiveWe explored the impact of depressive symptoms on self-reported outcomes of PD severity in patients who underwent STN-DBS.MethodsAssessments took place preoperatively and 2-years after surgery. Patients completed the Hospital Anxiety and Depression Scale (HADS), Unified Parkinson's Disease Rating Scale (UPDRS) Parts 2 and 4, Gait and Falls Questionnaire, Parkinson's Disease Questionnaire-39 (PDQ-39), and the Non-motor Symptoms Scale. The UPDRS Part 3 (motor examination) was also performed. Patients were dichotomized into two groups (normal or high) based on their postoperative follow-up HADS depression score.ResultsEighteen patients (33.3%) were assigned to the high group (hHADS-D), and 36 patients (66.7%) were assigned to the normal group (nHADS-D). The UPDRS Part 3 OFF-medication score improved to a similar extent in both groups, and participants experienced a similar reduction in their levodopa equivalent daily dose following STN-DBS. Unlike the nHADS-D group, however, hHADS-D patients did not self-report improvements on any clinical outcome measure at follow-up from baseline, and instead indicated a significant worsening on the UPDRS Part 2 ON-medication and PDQ-39 cognition domain. This was not explicable by their preoperative non-motor symptom burden, nor changes in dopaminergic medications. There were no differences between groups in terms of proportion using anti-depressants, surgical complications or postoperative side effects.ConclusionsDepressive symptoms may play a significant role in subjective self-reporting, and should be carefully considered when evaluating STN-DBS effectiveness and managing patients postoperatively.
背景
抑郁症会对个体对自身疾病的认知产生负面影响。尽管丘脑底核深部脑刺激（STN-DBS）是治疗帕金森病（PD）的一种有效方法，但一些患者尽管运动功能有客观改善，却并未感受到益处。
目的
我们探讨了抑郁症状对接受STN-DBS治疗的PD患者自我报告的PD严重程度结果的影响。
方法
评估在术前和术后2年进行。患者完成医院焦虑抑郁量表（HADS）、统一帕金森病评定量表（UPDRS）第2部分和第4部分、步态与跌倒问卷、帕金森病问卷-39（PDQ-39）以及非运动症状量表。还进行了UPDRS第3部分（运动检查）。根据患者术后随访的HADS抑郁评分将其分为两组（正常或高分）。
结果
18名患者（33.3%）被分配到高分组（hHADS-D），36名患者（66.7%）被分配到正常组（nHADS-D）。两组的UPDRS第3部分未服药评分改善程度相似，且STN-DBS后参与者的左旋多巴等效日剂量减少程度相似。然而，与nHADS-D组不同，hHADS-D患者在随访时未自我报告任何临床结局指标从基线起有改善，反而表示UPDRS第2部分服药时和PDQ-39认知领域有显著恶化。这无法用他们术前的非运动症状负担或多巴胺能药物的变化来解释。两组在使用抗抑郁药的比例、手术并发症或术后副作用方面没有差异。
结论
抑郁症状可能在主观自我报告中起重要作用，在评估STN-DBS的有效性和术后管理患者时应仔细考虑。
