快速眼动睡眠期行为障碍(RBD)的帕金森病临床特征分析

目的:探究合并不同发作形式的快速眼动睡眠期行为障碍(RBD)与帕金森病的临床特点及自主神经功能障碍变化。方法:采用快速眼动期睡眠行为障碍筛查量表及帕金森综合评分量表(Unified Parkinson's disease rating scale),对20例合并简单型(RBD)的帕金森病患者(RBD-简单组)与20例合并复杂型(RBD)的帕金森病患者(RBD-复杂组)进行研究。结果:两组帕金森病患者的一般情况、左旋多巴药物日剂量、疾病病程等无统计学差异(P>0.05)。合并复杂型(RBD)的帕金森病患者运动部分评分高于合并简单型(RBD)的帕金森病患者(P<0.05)。两组患者之间在非震颤、强直、运动减少症状均存在统计学差异(P<0.05),(RBD)复杂组评分均高于(RBD)简单组。多因素logistics回归显示,复杂型(RBD)的存在与UPDRS-Ш部分评分相关,而与年龄、病程、教育年限、左旋多巴药物日剂量等无显著相关,与运动减少症状最为相关,与震颤、非震颤、强直症状无相关性。两组患者运动障碍类型与(RBD)发作形式无明显相关性(P=0.108)。结论:合并复杂型(RBD)的帕金森病患者运动症状更重,并且累及运动障碍的诸多方面。帕金森病患者存在复杂型(RBD)症状主要与UPDRS-Ш评分相关,其中与运动减少方面显著相关。     

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。     

6-OHDA帕金森病大鼠快动眼睡眠状态下皮层脑电及基底节场电位的异常变化

目的：了解帕金森病（PD）模型大鼠在快动眼睡眠状态下皮层脑电和基底节场电位的异常变化。方法：用6-羟基多巴胺（6-OHDA）脑内两点注射法建立PD大鼠模型,并经阿扑吗啡注射诱发旋转对模型进行评价。通过多导宏电极在体电生理记录技术结合视频录像,对正常大鼠和6-OHDA大鼠PD模型进行苍白球场电位和皮层M1、M2区脑电的多部位24小时同时记录。功率谱分析和相干分析用于揭示快动眼睡眠状态下各记录位点信号的频率成分以及不N记录位点神经元集群之间的变化。结果：与正常大鼠相比,6-OHDA帕金森病模型大鼠在REM期间的皮层脑电在臼和y频段上都有变化：初级运动皮质M1区的θ频段成分消失,辅助运动区M2的θ频段成分略有增加,患侧苍白球的θ频段成分增大显著;M1区的γ频段成分增大,而γ频段成分在苍白球基本没有变化。结论：6-OHDA对中脑多巴胺能神经元的损害可造成大鼠双侧皮层M1区θ节律的消失和γ节律的增强,以及对侧M1-M2区之间在γ节律上的同步被显著增强,而γ节律在苍白球没有变化。这些异常电活动可能是由于VTA受损引起从而与帕金森病的快动眼睡眠行为障碍有关。     

6-OHDA 帕金森病大鼠快动眼睡眠状态下 皮层脑电及基底节场电位的异常变化

目的:了解帕金森病(PD)模型大鼠在快动眼睡眠状态下皮层脑电和基底节场电位的异常变化。方法:用6-羟基多巴胺(6-OHDA)脑内两点注射法建立PD大鼠模型,并经阿扑吗啡注射诱发旋转对模型进行评价。通过多导宏电极在体电生理记录技术结合视频录像,对正常大鼠和6-OHDA大鼠PD模型进行苍白球场电位和皮层M1、M2区脑电的多部位24小时同时记录。功率谱分析和相干分析用于揭示快动眼睡眠状态下各记录位点信号的频率成分以及不同记录位点神经元集群之间的变化。结果:与正常大鼠相比,6-OHDA帕金森病模型大鼠在REM期间的皮层脑电在θ和γ频段上都有变化:初级运动皮质M1区的θ频段成分消失,辅助运动区M2的θ频段成分略有增加,患侧苍白球的θ频段成分增大显著;M1区的γ频段成分增大,而γ频段成分在苍白球基本没有变化。结论:6-OHDA对中脑多巴胺能神经元的损害可造成大鼠双侧皮层M1区θ节律的消失和γ节律的增强,以及对侧M1-M2区之间在γ节律上的同步被显著增强,而γ节律在苍白球没有变化。这些异常电活动可能是由于VTA受损引起从而与帕金森病的快动眼睡眠行为障碍有关。     

视动震颤(OKN)眼动控制系统中的颜色通道

用亮度相等的不同颜色构成的等亮度彩色运动条纹(Isoluminant chromatic moving gratings)来进行OKN眼动跟踪实验,探讨它是否与由亮度差别构成的黑白运动条纹图象一样引起OKN反应。实验结果表明在等亮度彩色运动条纹图象(没有亮度差别只有颜色差别)刺激下,视动系统可产生与黑白运动条纹刺激下同样的OKN反应,并且与各单原色运动条纹刺激下的OKN反应也一致。说明0KN眼动跟踪中的运动检测存在颜色通道。本文并提出了一种基于颜色的运动检测模型。     

快速眼动睡眠产生的神经机制:蓝斑核神经元停止发放是一个必要的条件

两种类型的神经元参与了快速眼动（rapid eye movement,REM）睡眠的调节：快速眼动一发放（REM-ON）神经元和快速眼动-沉寂神经元（REM-OFF）。快速眼动-沉寂神经元属去甲肾上腺素能神经元,正如名字表示的那样——在快速眼动睡眠期间停止发放。已有研究表明,这些神经元放电活动的停止是导致快速眼动睡眠的前提条件,γ-氨基丁酸（γ-aminobutyric acid,GABA）可使它们停止发放。如果这嗤神经元不停止发放,脑中的去甲肾上腺素水平将升高,不出现快速眼动睡眠。剥夺快速眼动睡眠所引起的去甲肾上腺素增加,至少是快速眼动睡眠丧失引起Na^＋-K^＋ATP酶活性增加的原因,而这可能是导致快速眼动睡眠剥夺所引发的各种效应的主要因素。     

民航飞行人员视眼动功能试验和前庭眼动反射试验结果分析

目的:分析我国民航飞行驾驶员和乘务员视眼动功能试验和前庭眼动反射试验检查结果的特征,并探讨视眼动功能试验和前庭眼动反射试验检查运用于民航飞行人员日常体检的可能性.方法:应用美国EDI公司的红外视频眼震电图仪,对我国40名民航飞行驾驶员和40名乘务员,进行视眼动功能试验(包括平稳跟踪试验、视动试验和扫视跟踪试验)和前庭眼动反射试验检查,并对检查结果进行比较分析.结果:前庭眼动反射试验结果与视眼动功能试验结果一致性较好,且与视眼动功能试验相比前庭眼动反射试验具有更高的敏感性.结论:前庭眼动反射试验检查技术有高频、宽频和操作方法简便等优点,适合应用到民航飞行人员的年度体检中,对民航飞行人员的前庭功能状态进行初步评定.     

分眼刺激时家兔的交替OKN眼动跟踪特性

本工作用不同运动图形分别同时刺激家兔左右眼,通过检测正常及单侧前庭迷路损伤后家兔的ＯＫＮ反应,证明在这种刺激情况下,正常家兔的眼动反应为交替的ＯＫＮ反应,为进一步探讨交替ＯＫＮ的控制机制及控制部位建立了动物模型。     

视觉图像辨认眼动中的Top－down信息处理

在视觉图像辨认过程中,眼球不是均匀地扫描全幅图像,而是通过一系列快速的眼球跳动来改变注视点位置,有选择地通过注视停顿来采集图象中的关键信息。通过实验对不同图像刺激时的眼动轨迹进行记录与分析,发现：（１）对于简单的几何图形,眼动注视停顿主要集中在图像中几何特征之处,亦即与周围不同的奇异点上;（２）对复杂图象刺激,眼动注视点位置决定于受试者的已有概念模型及其兴趣所在;（３）对中文单字进行辩认时,其眼动模式也是取决于受试者对该单字的知识（也即概念模型）。以上结果提示,视觉图象辨认主要是通过自上而下（ｔｏｐ－ｄｏｗｎ）的信息处理方式才完成．由中枢控制眼球运动,将注视点落到中枢决定的图形奇点上来,通过注视停顿对中枢认为的关键信息之处进行抽提,以实现辨认。这种处理方式不是只取决于输入的图像信息,也不必对目标图像的每个象素进行处理,而只需对图象中少量的关键信息部位进行重点的检测和处理,从而提高了图象信息处理的能力及效率。     

复合运动条纹刺激下的视动震颤（OKN）眼动反应

研究视动震颤眼动系统在同时包含两个二维运动的复合运动条纹刺激下的反应特性,并探讨两种子条纹运动方向的夹角和运动速度的影响。实验结果发现,在一定参数范围内,复合运动条纹引起了双重交替ＯＫＮ反应,即ＫＯＮ交替地跟踪合成运动和分别运动;在跟踪分别运动中,又是交替地跟踪两种子条纹的运动。     

Molecular mechanism of tumour necrosis factor alpha regulates hypocretin (orexin) expression,sleep and behaviour

Hypocretin 1 and hypocretin 2 (orexin A and B) regulate sleep, wakefulness and emotion. Tumour necrosis factor alpha (TNF‐α) is an important neuroinflammation mediator. Here, we examined the effects of TNF‐α treatment on hypocretin expression in vivo and behaviour in mice. TNF‐α decreased hypocretin 1 and hypocretin 2 expression in a dose‐dependent manner in cultured hypothalamic neurons. TNF‐α decreased mRNA stability of prepro‐hypocretin, the single precursor of hypocretin 1 and hypocretin 2. Mice challenged with TNF‐α demonstrated decreased expression of prepro‐hypocretin, hypocretin 1 and hypocretin 2 in hypothalamus. In response to TNF‐α, prepro‐hypocretin mRNA decay was increased in hypothalamus. TNF‐α neutralizing antibody restored the expression of prepro‐hypocretin, hypocretin 1 and hypocretin 2 in vivo in TNF‐α challenged mice, supporting hypocretin system can be impaired by increased TNF‐α through decreasing hypocretin expression. Repeated TNF‐α challenge induced muscle activity during rapid eye movement sleep and sleep fragmentation, but decreased learning, cognition and memory in mice. TNF‐α neutralizing antibody blocked the effects of TNF‐α; in contrast, hypocretin receptor antagonist enhanced the effects of TNF‐α. The data support that TNF‐α is involved in the regulation of hypocretin expression, sleep and cognition. The findings shed some lights on the role of neuroinflammation in neurodegenerative diseases including Alzheimer's disease and Parkinson's disease.     

帕金森病单纯淡漠的临床特征及发生机制

帕金森病(Parkinson disease,PD)是常见的神经变性疾病,除静止性震颤、运动迟缓、肌强直、步态和姿势障碍等运动症状外,近年研究发现其还存在神经精神、睡眠、感觉及自主神经障碍等多种非运动症状。PD单纯淡漠是不伴痴呆和抑郁的淡漠,其与运动症状及多种非运动症状相关,严重影响患者的日常生活能力及生活质量。PD单纯淡漠的发生涉及神经解剖、神经病理、神经生化及神经免疫炎症等机制。本文将对PD单纯淡漠的临床特征及发生机制进行阐述。     

多巴胺能药物对早期帕金森病患者睡眠障碍发生的影响

目的:探讨多巴胺能药物及其它因素与早期帕金森病患者睡眠障碍之间的关系。方法:选择84名早期帕金森病患者作为病例组,87名健康人作为对照组。采用帕金森病睡眠量表(PDSS)评价患者的睡眠状况。采用非条件Logistic回归分析早期帕金森病患者睡眠障碍的影响因素。结果:早期帕金森病组PDSS总评分显著低于对照组(P=0.000);HAMD评分则显著高于对照组(P=0.000)。早期帕金森病患者睡眠障碍的主要类型为失眠。使用多巴胺能药物(OR=5.50,95%CI:1.96-15.81)是早期帕金森病患者发生睡眠障碍的危险因素;而较低的HAMD评分(OR=0.35,95%CI:0.13-0.93)则显著降低其睡眠障碍风险。结论:早期帕金森病患者存在睡眠障碍,多巴胺能药物和抑郁可能促进和加重其睡眠障碍。     

Light Exposure Among Adolescents With Delayed Sleep Phase Disorder: A Prospective Cohort Study

The objective of this study was to compare light exposure and sleep parameters between adolescents with delayed sleep phase disorder (DSPD; n?=?16, 15.3?±?1.8 yrs) and unaffected controls (n?=?22, 13.7?±?2.4 yrs) using a prospective cohort design. Participants wore wrist actigraphs with photosensors for 14 days. Mean hourly lux levels from 20:00 to 05:00?h and 05:00 to 14:00?h were examined, in addition to the 9-h intervals prior to sleep onset and after sleep offset. Sleep parameters were compared separately, and were also included as covariates within models that analyzed associations with specified light intervals. Additional covariates included group and school night status. Adolescent delayed sleep phase subjects received more evening (p?<?.02, 22:00–02:00?h) and less morning (p?<?.05, 08:00–09:00?h and 10:00–12:00?h) light than controls, but had less pre-sleep exposure with adjustments for the time of sleep onset (p?<?.03, 5–7?h prior to onset hour). No differences were identified with respect to the sleep offset interval. Increased total sleep time and later sleep offset times were associated with decreased evening (p?<?.001 and p?=?.02, respectively) and morning (p?=?.01 and p?<?.001, respectively) light exposure, and later sleep onset times were associated with increased evening exposure (p?<?.001). Increased total sleep time also correlated with increased exposure during the 9?h before sleep onset (p?=?.01), and a later sleep onset time corresponded with decreased light exposure during the same interval (p?<?.001). Outcomes persisted regardless of school night status. In conclusion, light exposure interpretation requires adjustments for sleep timing among adolescents with DSPD. Pre- and post-sleep light exposures do not appear to contribute directly to phase delays. Sensitivity to morning light may be reduced among adolescents with DSPD. (Author correspondence: auger.raymond1@mayo.edu)     

A Laboratory Study of Sleep and Dreaming in a Case of Asperger's Syndrome

Asperger's Syndrome (AS) is a pervasive developmental disorder whose continuity with High-Functioning Autism is still a matter of debate. Clinical observations suggest that patients with AS may present the same sleep disorders as autistic patients, including difficulties in initiating and maintaining sleep as well as poor dream recall. We recorded the sleep of a 25-year-old male patient with AS for two nights using a full EEG montage and compared the second night to that of a group of normal participants. We found low levels of slow wave sleep (SWS: stages 3 + 4), high levels of stage 1, and a large number of awakenings. The organization of REM sleep was unremarkable, including normal REM density. Analyses of phasic EEG events revealed a very low incidence of sleep spindles and a normal number of K-complexes over bilateral frontal and central EEG leads. In order to collect dream reports, the patient was awakened three times over two nights following at least 15 minutes of REM sleep in each case. On each occasion the patient was not aware of any mental activity happening just prior to awakening. These observations are discussed with regards to the connections that may exist between EEG sleep spindle activity, selective attention, and the capacity to generate a dream report.     

Nighttime Blood Pressure and White Matter Hyperintensities in Patients With Parkinson Disease

Increasing evidence indicates that nocturnal blood pressure level and/or loss of nocturnal blood pressure dips are sensitive markers of cardiovascular morbidity and mortality. Several studies have suggested that blunted heart rate variability and nocturnal decline in heart rate are also associated with target organ damage. These phenomena occur relatively commonly in patients with Parkinson disease (PD); however, few studies have assessed the consequences of these abnormalities in patients with PD. We investigated the influence of circadian changes in blood pressure and heart rate on white matter hyperintensities (WMHs) in patients with PD. The presence of nocturnal hypertension was associated with increased WMH score, and nighttime systolic pressure was closely related with white matter changes. Blunted heart rate variability and nocturnal decline in heart rate were also related to increasing WMH scores. The non-dipping phenomenon did not influence WMHs. These findings suggest that white matter changes are related to circadian autonomic dysfunction, particularly nocturnal hypertension in patients with PD. Therefore, it is important to monitor nocturnal blood pressure status, because modifying these circadian regulatory disturbances can be beneficial to protect against vascular brain damage in patients with PD. (Author correspondence: neuronet@catholic.ac.kr)