www.medenosrce.net/arhimed   arhimed(a-t>medenosrce.net   [22/04/2026 01:21:28] http://www.medenosrce.net/arhimed/poglej.asp?id=112 Kako izboljšati kvaliteto življenja pri bolnikih s parkinsonizmom? Avtor: Andreja Avberšek, Gregor Recnik Mentor: doc. dr. Zvezdan Pirtošek IZHODIŠCE. Parkinsonizem je motnja v delovanju osrednjega živcevja. Patomorfološka osnova te bolezni je propadanje dopaminskih nevronov v kompaktnem delu crne substance, kar povzroci pomanjkanje dopamina v striatumu. To privede do nastanka klasicnih motoricnih znakov (tremor, rigidnost, akinezija, motnje ravnotežja). V zadnjih desetletjih pa patologi opisujejo tudi spremembe v limbicnem in prefrontalnem korteksu, ki povzrocajo nemotoricne simptome (demenca, depresija). NAMEN. Pri zdravljenju parkinsonizma so se nevrologi dolgo posvecali zgolj obvladovanju motoricnih motenj. Parkinsonizem spremlja vrsta nemotoricnih motenj (depresija, demenca, vegetativne motnje), ki so za bolnika prav tako motece in lahko vplivajo na kvaliteto življenja. Na podrocju Slovenije ni bila izvedena še nobena študija o vplivu razlicnih dejavnikov na kvaliteto življenja bolnikov s parkinsonizmom. Namen najine naloge je bil ugotoviti te dejavnike in na osnovi teh ugotovitev pripraviti predloge ukrepov, ki bi na relativno preprost, hiter in poceni nacin izboljšali kvaliteto življenja bolnikov s parkinsonizmom. HIPOTEZA. Kvaliteto življenja bolnikov s parkinsonizmom doloca stopnja motoricne prizadetosti (motoricni znaki bolezni). METODE. Raziskavo smo zasnovali kot prospektivno študijo na ljudeh. 71 bolnikov je kvaliteto svojega življenja ocenilo na vidni analogni lestvici in s testom EQ-5D. Na osnovi ocene na vidni analogni lestvici sva bolnike s parkinsonizmom razdelila v dve skupini. V skupini A je bilo 12 bolnikov, ki so ocenili kvaliteto svojega življenja kot visoko; v skupini B je bilo 11 bolnikov, ki so kvaliteto svojega življenja ocenili kot nizko. Pri preiskovancih obeh skupin smo ocenjevali motoricno prizadetost, zmožnost opravljanja vsakodnevnih aktivnosti, spoznavne sposobnosti, prisotnost depresivnosti in dojemanje lastnega zdravja, pri skrbnikih pa prisotnost depresivnosti. REZULTATI. Podatke smo obdelali z neparametricnim dvosmernim testom Mann-Whitney U. Statisticno znacilna razlika med skupinama (p<0,05) je bila v indeksu EQ-5D, depresivnosti, samooceni zdravja, zmožnosti opravljanja vsakodnevnih aktivnosti bolnika in v depresivnosti skrbnika. Preiskovanci skupine A in B se ne razlikujejo pomembno po spoznavnih sposobnostih in motoricnih težavah. Za ugotavljanje povezave med parametri smo uporabili Spearmanovo metodo korelacije. Ugotovila sva, da so z indeksom EQ-5D statisticno znacilno (abs[R]>0,5) povezani kazalci depresivnosti bolnika in stopnja depresivnosti skrbnika. ZAKLJUCKI. Na osnovi rezultatov raziskave sva hipotezo zavrnila. Pokazala sva, da sta pomembna dejavnika, ki vplivata na kvaliteto življenja, depresivnost bolnika in zmožnost opravljanja vsakodnevnih aktivnosti, ne pa motoricne težave. Prav tako nisva dokazala vpliva spoznavnih sposobnosti na kvaliteto življenja. Predlagava, da se pri klinicnem pregledu bolnika s parkinsonizmom preverjanje motorike dopolni z ocenjevanjem depresivnosti. Olajšanje opravljanja vsakodnevnih aktivnosti pa lahko dosežemo z multidisciplinarnim timskim pristopom. «» [Abstract / English version] Kako izboljšati kvaliteto življenja pri bolnikih s parkinsonizmom? Author: Andreja Avberšek, Gregor Recnik Mentor: doc. dr. Zvezdan Pirtošek BACKGROUND. Parkinsonism is a chronic disorder of the central nervous system characterized pathologically by degeneration of dopamine neurons in substantia nigra pars compacta. Consequently, striatal dopamine levels decrease resulting in classical motor signs (tremor, rigidity, akinesia, postural impairment). Recently, pathological changes have been described also in limbic and prefrontal cortices which may explain non-motor parkinsonian symptoms (dementia, depression). AIM. Practical management of PB has for a long time been limited to the treatment of motor symptoms. Non-motor aspects of the disease can be equally disturbing and can considerably affect quality of life. As yet there has been no study in Slovenia on how various factors influence quality of life (QoL) in Parkinsonian patients. The aim of the present work was to identify these factors and to propose certain measures which would improve patients' QoL in a simple, quick and inexpensive way. HYPOTHESIS. QoL in Parkinsonian patients is determined by the level of motor disability (motor signs of the disease). METHODS. We implemented the research as a prospective study on human subjects. 71 patients were asked to assess quality of their life on a visual analogue scale and with EQ-5D instrument. According to the results on the VAS they were divided into two groups: in group A there were 12 patients with high QoL and in group B there were 11 patients with low QoL. The following parameters were studied in all patients: motor disability, impairment in daily activities, cognitive abilities, depression and self-assessment of their health state. Depression was assessed in carers. RESULTS. Data was analysed statistically with non-parametric Mann-Whitney U test. The two groups differed significantly in EQ-5D summary index, depression of patients, depression of carers, self-assessment of their health state and in impairment of daily activities. There were no differences between the groups in cognitive abilities and motor impairment. Spearman correlation method was used to assess the association between various parameters. It was shown that EQ-5D summary index reliably correlated with depression in patients and with depression in carers. CONCLUSIONS. The hypothesis was rejected. Our results show that depression and impairment in daily activities, but not motor or cognitive disability, influence QoL in patients with parkinsonism. We propose that clinical examination of the patients includes not only motor assessment but also assessment of mood in patients and occasionally carers. Improvement in daily activities can be reached with a multidisciplinary team management of the patient.