老年帕金森病患者睡眠障碍的危险因素及其对认知功能、心理状态和衰弱的影响

摘要 目的：探讨老年帕金森病（PD）患者睡眠障碍的危险因素，并观察睡眠障碍对认知功能、心理状态和衰弱的影响。方法：选取2018年3月~2021年9月期间中国人民解放军海军青岛特勤疗养中心收治的91例老年PD患者作为研究对象，根据是否存在睡眠障碍将入选的91例患者分为睡眠障碍组（n=56）及非睡眠障碍组（n=35）。采用蒙特利尔认知评估量表（MoCA）评估所有患者的认知功能状况。采用汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评价患者焦虑、抑郁情况。采用Tilburg衰弱评估量表评估所有患者的衰弱情况。采用多因素Logistic回归分析探讨老年PD患者睡眠障碍的危险因素，并观察睡眠障碍对认知功能、心理状态和衰弱的影响。结果：睡眠障碍组的视空间与执行功能、语言、命名、延迟回忆、注意、抽象、定向评分及总分均低于非睡眠障碍组（P<0.05）。睡眠障碍组的HAMA、HAMD评分均高于非睡眠障碍组（P<0.05）。睡眠障碍组的心理衰弱、躯体衰弱、社会衰弱评分及总分均高于非睡眠障碍组（P<0.05）。多因素Losgistic回归分析结果显示：HAMA评分偏高、多巴丝肼片等效剂量偏高、HAMD评分偏高、Hcy偏高是老年PD患者睡眠障碍的危险因素（P<0.05）。结论：HAMA评分偏高、Hcy偏高、多巴丝肼片等效剂量偏高、HAMD评分偏高是老年PD患者睡眠障碍的危险因素。同时，睡眠障碍可加重老年PD患者的认知功能障碍和衰弱程度，增加抑郁焦虑情绪。

Risk Factors for Sleep Disorders in Elderly Patients with Parkinson's Disease and Their Effects on Cognitive Function, Mental Status and Frailty

ABSTRACT Objective: To explore the risk factors of sleep disorders in elderly patients with Parkinson''s disease (PD), and to observe the effects of sleep disorders on cognitive function, mental status and frailty. Methods: 91 elderly patients with PD who were admitted to Chinese People''s Liberation Army Navy Qingdao Special Service Healing Center from March 2018 to September 2021 were selected as research objects. According to whether they had sleep disorders, 91 patients were divided into sleep disorder group(n=56) and non-sleep disorder group (n=35). The Montreal Cognitive Assessment Scale (MoCA) was used to assess the cognitive function status of all patients. Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate the anxiety and depression condition of the patients. The Tilburg frailty Assessment Scale was used to assess frailty condition of all patients. Multivariate Logistic regression analysis was used to explore the risk factors of sleep disorders in elderly patients with PD, and the effects of sleep disorders on cognitive function, mental status and frailty were observed. Results: The visual space and executive function, language, naming, delayed recall, attention, abstraction, orientation score and total score in the sleep disorder group were all lower than those in the non-sleep disorder group(P<0.05). The HAMA and HAMD scores in the sleep disorder group were higher than those in the non-sleep disorder group (P<0.05). The mental frailty, physical frailty, social frailty score and total score in the sleep disorder group were higher than those in the non-sleep disorder group (P<0.05). The results of multivariate Losgistic regression analysis showed that higher HAMA score, higher equivalent dose of doxiazid tablets, higher HAMD score and higher Hcy were risk factors for sleep disorders in elderly patients with PD (P<0.05). Conclusion: The higher HAMA score, higher Hcy score, higher equivalent dose of doxiazid tablets and higher HAMD score are risk factors for sleep disorders in elderly patients with PD. At the same time, sleep disorders can aggravate cognitive dysfunction and degree of frailty in elderly patients with PD, and increase depression and anxiety.