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Yıl:2017; Cilt: 54; Sayı: 2>> Özet
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Nöropsikiyatri Arşivi; 2017;54(2):143-148
İdiyopatik Parkinson Hastalığında Motor ve Non-motor Semptomlar ve Yaşam Kalitesine Etkileri
E Gökçal, VE Gür, R Selvitop, GB Yıldız, T Asil
Bezmialem Vakıf Üniversitesi, İstanbul
Amaç: Bu çalışmada; İdiyopatik Parkinson Hastalığında (İPH) motor ve non-motor semptomların birlikte sorgulanması ve var olan semptomların yaşam kalitesine ne düzeyde etki ettiğinin hastanın kendi ifadesine göre belirlenmesi amaçlanmıştır. Yöntem: İPH tanısıyla takip edilen ve kognitif yakınması bulunmayan hastaların sosyo-demografik ve klinik özellikleri, medikal tedavileri ile Modifiye Hoehn-Yahr Ölçeği (mH&Y) skorları kaydedildi. Tüm hastalarda 20 farklı motor ve non-motor belirti sorgulandı ve hastadan bu semptomların yaşam kalitesini ne kadar etkilediğini puanlaması istendi. Hastalar, hastalık süresi 5 yıl ve altı olanlar Grup 1, 5 yılın üzerinde olanlar ise grup 2 olarak ayrıldı. Gruplar arasında sosyodemografik ve klinik özellikler, var olan semptomlar ile bu semptomların yaşam kalitesine etkileri sıralanarak karşılaştırıldı. Bulgular: Beş yıl ve altı hastalık süreye sahip 63 hasta, 5 yıl üzerinde süreye sahip ise 37 hasta bulunmaktaydı. Bu iki grup arasında sosyodemografik özellikler ile mH&Y skorları istatistiksel farklılık göstermedi. Her iki grupta en sık görülen motor semptomlar tremor ve bradikinezi iken, ağrı-kramp, konstipasyon ve gün içi aşırı uyuma yine her iki grupta en sık görülen non-motor semptomlardı. Yine tüm hastalarda en çok rahatsız edici semptomlar tremor ve bradikinezi iken, daha az sıklıkta görülen sık idrara çıkma/kaçırma yaşam kalitesini en çok bozan non-motor semptomdu. Sık görülen non-motor semptomlardan ağrı-kramp, konstipasyon ve gün içi aşırı uyuma ise rahatsız edici olma açısından daha geri plandaydı. Sonuç: Parkinson hastalığında yaşam kalitesini motor semptomların belirlediği yaygın olarak kabul görmüş bir düşüncedir. Ancak non-motor semptomlar hastalığın her evresinde görülür. Parkinson hastalarında non-motor semptomların yaşam kalitesine etkisi azımsanmayacak düzeydedir. Bu nedenle, Parkinson hastalarında yaşam kalitesinin mümkün olduğunca düzeltilmesi amacıyla yaygın olarak bilinen motor semptomların yanında, klinik muayenede gözden kaçabilecek ancak hastanın hayat kalitesini belirgin etkileyen non-motor semptomların da sorgulanarak uygun tedavileri sağlanmalıdır.
Motor and Non-Motor Symptoms in Parkinson’s Disease: Effects on Quality of Life
Introduction: This study aimed to evaluate motor and non-motor symptoms in idiopathic Parkinson’s disease (IPD) patients and to determine the self-reported influence of all existing symptoms on their quality of life (QoL). Methods: The sociodemographic and clinical characteristics, medical treatments, and Modified Hoehn and Yahr (mH&Y) scores of IPD patients without cognitive impairment were recorded. A survey questioning different motor and non-motor symptoms was administered to the patients. The patients were asked to rate their symptoms by number from the greatest influence to the least influence on their QoL. Subjects were divided into two groups: those suffering from IPD for =5 years (Group 1) and those suffering from IPD for >5 years (Group 2). These groups were compared in terms of sociodemographic and clinical characteristics, existing symptoms, and influences of these symptoms on their QoL. Results: There were 63 patients in Group 1 and 37 patients in Group 2. No statistically significant differences were detected between the groups with respect to sociodemographic characteristics or mH&Y scores. The most common motor symptoms in both of these groups were tremor and bradykinesia; meanwhile, the non-motor symptoms most frequently encountered in these groups were pain-cramps, constipation, and excessive daytime sleepiness (EDS). Again, while the symptoms that most greatly disturbed QoL in all patients were reported to be tremor and bradykinesia, the most disturbing non-motor symptom was frequent voiding/incontinence, which was a less common symptom. Pain-cramp, constipation, and EDS, which were the most frequent nonmotor symptoms, were the symptoms that least disturbed QoL. Conclusion: It is widely accepted that motor symptoms determine QoL in IPD. However, non-motor symptoms are seen during all phases of the disease. The impact of non-motor symptoms on the QoL of IPD patients remains substantial. Therefore, in addition to the well-known motor symptoms, non-motor symptoms, which may be overlooked during physical examination yet may profoundly impact QoL, should be questioned and treated appropriately to improve QoL in PD patients as much as possible.

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