经颅直流电刺激对帕金森病伴快速眼动相睡眠行为障碍患者认知功能及神经功能的影响

摘要 目的：探讨经颅直流电刺激对帕金森病伴快速眼动相睡眠行为障碍患者认知功能及神经功能的影响。方法：选择2018年9月-2019年9月在我院接受治疗的69例帕金森病伴快速眼动相睡眠行为障碍患者，采用随机数表法分为电刺激组（n=35）和对照组（n=34）。对照组给予常规抗帕金森病治疗，观察组在对照组的基础上给予经颅直流电刺激治疗。比较两组临床疗效、蒙特利尔认知评估量表（MoCA）、自主神经症状量表（SCOPA-AUT）、睡眠情况、汉密尔顿抑郁量表(HAMD)、Epworth嗜睡量表（ESS）评分、匹兹堡睡眠指数（PSQI）、帕金森氏病综合评分量表（UPDRS）变化情况。结果：治疗后，电刺激组有效率91.43%（32/35）较对照组70.59%（24/34）显著升高，差异显著（P<0.05）；治疗前，电刺激组与对照组之间认知功能及神经功能结果无差异；治疗后，电刺激组与对照组MoCA均随着时间的推移均呈上升趋势，且电刺激组上升程度较较组更低，SCOPA-AUT均随着时间的推移均呈下降趋势，且电刺激组下降程度较对照组更低（P<0.05）；治疗前，电刺激组与对照组之间临床睡眠情况结果无差异；治疗后，电刺激组与对照组总睡眠时间、睡眠效率均随着时间的推移均呈上升趋势，且电刺激组上升程度较对照组更低，醒觉指数均随着时间的推移呈下降趋势，且电刺激组下降程度较对照组更低（P<0.05）；治疗前，电刺激组与对照组之间抑郁、嗜睡情况无差异；治疗后，电刺激组与对照组抑郁、嗜睡均随着时间的推移均呈下降趋势，且电刺激组下降程度较对照组更低（P<0.05）；治疗前，电刺激组与对照组之间PSQI、UPDRS评分无差异；治疗后，电刺激组与对照组PSQI、UPDRS评分均随着时间的推移均呈下降趋势，且电刺激组下降程度较对照组更低（P<0.05）。结论：在帕金森病伴快速眼动相睡眠行为障碍患者中应用经颅直流电刺激效果显著，可有效改善认知功能及神经功能水平。

Effects of Transcranial Direct Current Stimulation on Cognitive and Neurological Functions in Patients with Parkinson's Disease with REM Sleep Behavior Disorder

ABSTRACT Objective: To study Effects of transcranial direct current stimulation on cognitive and neurological functions in patients with Parkinson''s disease with REM sleep behavior disorder. Methods: 69 patients with Parkinson''s disease and REM sleep behavior disorder who were treated in our hospital from September 2018 to September 2019 were selected and divided into electrical stimulation group (n=35) and control group (n=34) by random number table method. The control group received routine anti-Parkinson disease treatment, and the observation group received transcranial direct current stimulation treatment on the basis of the control group. The clinical efficacy, Montreal Cognitive Assessment Scale (MoCA), Autonomic neurological Symptoms Scale (SCOPa-AUT), sleep status, Hamilton Depression Scale (HAMD), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Index (PSQI), and Parkinson''s disease Comprehensive Scale (UPDRS) were compared between the two groups. Results: After treatment, the effective rate of the electric stimulation group was 91.43% (32/35), significantly higher than that of the control group (70.59% (24/34), with a significant difference (P<0.05). Before treatment, there was no difference in cognitive function and neurological function between the stimulation group and the control group. After treatment, MoCA of both the electrical stimulation group and the control group showed an increasing trend over time, and the increase degree of the electrical stimulation group was lower than that of the control group. Scopa-aut showed a decreasing trend over time, and the decrease degree of the electrical stimulation group was lower than that of the control group (P<0.05). Before treatment, there was no difference in clinical sleep between the electrical stimulation group and the control group. After treatment, the total sleep time and sleep efficiency of both the electric stimulation group and the control group showed an upward trend with the passage of time, and the degree of increase of the electric stimulation group was lower than that of the control group, and the wake index showed a downward trend with the passage of time, and the degree of decrease of the electric stimulation group was lower than that of the control group (P<0.05). Before treatment, there was no difference in depression and drowsiness between the electric stimulation group and the control group. After treatment, depression and drowsiness in both the electric stimulation group and the control group showed a downward trend over time, and the degree of decline in the electric stimulation group was lower than that in the control group (P<0.05). Before treatment, there was no difference in PSQI and UPDRS scores between the electrical stimulation group and the control group. After treatment, PSQI and UPDRS scores in both the electric stimulation group and the control group showed a downward trend over time, and the degree of decline in the electric stimulation group was lower than that in the control group (P<0.05). Conclusion: Transcranial direct current (TDC) stimulation is effective in Parkinson''s disease patients with REM sleep behavior disorder, which can effectively improve cognitive and neurological functions.