Dugoročno praćenje motornih i nemotornih simptoma u Parkinsonovoj bolesti

Abstract

Uvod: Parkinsonova bolest (PB) predstavlja progresivno neurodegenerativno oboljenje, prosečne dužine trajanja od oko 15 godina, koje se klinički ispoljava motornim i čitavim spektrom nemotornih manifestacija. Progresija same bolesti je strogo individualna, veoma heterogena i značajno brža u početnim stadijumima bolesti (Hoehn and Yarh (HiY) stadijumima 1-2) i sa trajanjem bolesti postaje sporija (HiY stadijumi 3-5). Najčešći neuropsihijatrijski poremećaji u pacijenata sa PB su apatija, depresija i anksioznost. Demencija u PB predstavlja 3- 4% svih degenerativnih demencija. Kumulativna prevalenca demencije u PB je velika i oko 80% pacijenata razvije demenciju nakon 10 godina trajanja bolesti. Cilj: Utvrditi stepen progresije motornih manifestacija bolesti u petogodišnjem intervalu praćenja u pacijenata sa PB u odnosu na kliničku formu bolesti ali i u korelaciji sa nemotornim manifestacijama bolesti i utvrditi stepen progresije nemotornih manifestacija bolesti u petogodišnjem intervalu praćenja pacijenata sa PB i njihov značaj u lečenju, kao i uticaj na kvalitet života obolelih. Metode: Uzorak ispitanika čini 3θ0 pacijenata sa dijagnozom Parkinsonove bolesti postavljene prema kriterijumima- UK Parkinson’s disease Society Brain Bank Criteria koji su pregledani u periodu od 01.01.2004. do 31.12. 2008. godine i sa praćenjem toka bolesti istih u narednom petogodišnjem intervalu. Praćenje progresije motornih simptoma podrazumevalo je primenu Unifikovane skale za procenu Parkinsonove bolesti kao i utvrđivanje Hoehn i Yarh stadijuma bolesti; praćenje nemotornih simptoma PB podrazumevalo je procenu poremećaja raspoloženja i ponašanja primenom Marinove Skale apatije, Hamiltonove skale anksioznosti i Hamiltonove skale depresivnosti, dok je u cilju procene kognitivnog statusa pacijenata primenjen Mini- Mental test i Klinička skala za procenu demencije...

Introduction. Parkinson’s disease (PD) is a chronic progressive neurodegenerative disease that is clinically manifested by a motor and non-motor symptoms; an average duration of approximately 15 years. PD is also a heterogeneous disease, with the disease progressing faster in patients at the early stage of disease (Hoehn and Yarh stages 1-2) than in patients with a longer disease duration (Hoehn and Yarh stages 3-5). The most common neuropsychiatric symptoms reported in PD are apathy, depression and anxiety. PD is often a ssociated with mild cognitive impairment and dementia. The cumulative prevalence of dementia in the PB is large and approximately 80% of patients develop dementia after 10 years of the disease. Objective. To deremine the progression of motor symptoms in the 5-year follow-up and correlation with the non-motor symptoms of PD. To deremine the progression of nonmotor symptoms in the 5-year follow-up and their importance in the treatment, as well as the impact on the quality of life of patients with PD. Methods. The clinical sample with 360 PD patients (UK Parkinson’s disease Society Brain Bank Criteria) examined during the period from 01.01.2004. to 31.12. 2008. and following the disease progression in the next 5 year. The assessment included comprehensive neurological examinations (motor scoring with Hoehn and Yahr staging and the Unified Parkinson´s Disease Rating Scale); psychiatric examinations with the Marin Apathy Scale (AS), Hamilton Depression Rating Scale (HDRS-17), Hamilton Anxiety Rating Scale (HAMA-S); and cognitive screening with the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating scale (CDR). Results. After five years in the monitoring remained 222 PD patients, lost to follow-up 33 patients (9,17%). Expected progression of motor symptoms of the disease with an increase in all parts ant total score of the UPDRS applied scales...