Abstract: Background　Rapid eye movement（REM） sleep behavior disorder（RBD） is important not only as a preclinical symptom but also an aggravating symptom of Parkinson's disease（PD）.However，it is not known whether the onset of RBD in relation to PD affects the clinical characteristics of PD.Objective　To study the clinical characteristics of PD between patients with RBD occurring before and after the onset of PD.Methods　Participants were recruited from Dalian Friendship Hospital between October 2013 and May 2018，including 136 PD patients from Department of Neurology，and 30 volunteered health examinees with normal cognitive function（control group） from the Physical Examination Center.Descriptive variables including age，sex ratio，dose of dopaminergic agents〔levodopa dose equivalents（LEDs）〕，duration of PD morbidity，Hoehn and Yahr stage，prevalence of tremor，laterality of PD symptoms，Mini-Mental State Examination（MMSE） score，prevalence of OH，self-reported hallucinations，and dementia were compared across PD patients with and without RBD and controls，and across PD patients with RBD before and after the onset of PD and controls.Results　PD patients included 47 with RBD（consisting of 9 with RBD before the onset of PD，and 38 with RBD after the onset of PD） and 89 without RBD.Those with RBD had longer mean duration of PD morbidity，higher prevalence of advanced Hoehn-Yahr stages，using greater dosage of LEDs，hallucinations，OH，and dementia，and lower mean MMSE score than those without RBD（P<0.05）.PD patients with RBD had higher prevalence of hallucination，OH and dementia than the controls，and so did PD patients without RBD（P<0.05）.PD patients with RBD before the onset of PD had lower mean MMSE score and higher prevalence of dementia than those with RBD after the onset of PD（P<0.05）.The mean MMSE score was lower and the prevalence of dementia was greater in PD patients with RBD before or after the onset of PD compared to controls（P<0.05）.Conclusion　The occurrence of RBD after the onset of PD might be an important factor aggravating cognitive function.

Key words: Parkinson disease, REM sleep behavior disorder, Dementia, Disease attributes

摘要： 背景　快速眼动睡眠行为障碍（RBD）不仅是帕金森病（PD）重要的临床前期症状之一，也是帕金森病病情进展的促进因素。然而，RBD的不同出现时间与PD临床特征是否存在相关性目前尚不清楚。目的　研究不同RBD 发生时间帕金森病患者的临床特征。方法　选取2013年10月—2018年5月大连市友谊医院神经内科收治的PD患者136例。同期选取本院体检中心体检健康志愿者30例为对照组，根据是否发生RBD将PD患者分为伴RBD组和不伴RBD组，根据RBD发生时间分为先发RBD亚组和后发RBD亚组。比较各组患者年龄、性别、多巴胺药物用量（左旋多巴剂量当量LEDs）、PD病程、Hoehn-Yahr分级、有无震颤、帕金森病症状偏重侧、简易智能精神状态检查量表（MMSE）评分、有无直立性低血压（OH）、是否存在幻觉、是否痴呆。结果　伴RBD组47例，不伴RBD组89例；先发RBD亚组9例，后发RBD亚组38例。伴RBD组较不伴RBD组PD病程长，Hoehn-Yahr分级高，LEDs剂量大，幻觉、OH和痴呆发生率高，MMSE评分低（P<0.05）。伴RBD和不伴RBD组幻觉、OH、痴呆发生率高于对照组（P<0.05）。后发RBD亚组较先发RBD组的MMSE评分下降、痴呆发生率高（P<0.05）。与对照组相比，先发RBD亚组与后发RBD亚组MMSE评分低，痴呆发生率高（P<0.05）。结论　PD运动症状后出现RBD可能是加重认知功能损伤的重要因素。

关键词: 帕金森病, REM睡眠行为障碍, 痴呆, 疾病特征