早期初诊帕金森病患者非运动症状的临床特征及影响因素分析

目的探讨早期帕金森病(PD)患者非运动症状(NMS)的临床特征及影响因素。方法收集门诊首次就诊且发病在1a内的早期PD患者105例和健康对照者100例,采用帕金森病非运动症状调查问卷(NMSQuest)进行NMS评估,结合临床特征等因素分析非运动症状发生的主要影响因素。结果 PD组NMS评分显著高于对照组(P0.05),发生率较高的症状依次为便秘(58例,55.2%)、记忆力下降(51例,48.6%)、情绪低落(43例,40.9%)。回归分析显示,H-Y分级、年龄及PD临床亚型是NMS评分的主要影响因素(P0.05),性别、文化程度、病程则与其无关。结论 NMS在早期PD患者中较常见且临床表现多样,需提高认识并及时干预。     

帕金森病患者非运动症状发生及相关影响因素的研究

目的 研究帕金森病(PD)非运动症状的发生和分布情况及其与多种相关因素的关系。方法 对68例原发性PD患者使用统一PD评分量表(uPDRs)、PD非运动症状30问卷量表(the PD NMS questionnaire,NMSQuest)、日常生活能力量表(ADL)和简易智能量表(MMsE)进行评分,并对非运动症状进行评估。结果 所有PD患者各个时期病程均有非运动症状的出现,平均每个PD患者出现9项左右不同的非运动症状,并且非运动症状的发生与PD疾病的进展相关,与Hoehn and yahr(H-Y)分级呈正相关(P<0.01),与UPDRsⅢ运动评分呈正相关(P<0.01),且影响患者的生活质量,与ADL评分呈负相关P<0.05),而与年龄、性别、PD发病类型和左旋多巴每日治疗量无关(P>0.05)。结论 非运动症状的发生在PD中很普遍,各项发生率随PD患者的临床特点及病程进展的情况变化,NMS发生数与PD的疾病严重程度呈正相关,对患者生活质量产生严重影响,需要全面认识和及时干预。     

帕金森病患者的非运动症状对其生活质量的影响

目的探讨帕金森病(PD)患者及不同亚群生活质量(QOL)的影响因素,分析非运动症状(NMS)的具体影响。方法用统一PD评定量表第Ⅲ、Ⅴ部分(UPDRS-Ⅲ、H-Y分级)评定185名原发性PD患者的运动症状,用PDNMS筛查问卷(NMSQ)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、PD睡眠量表(PDSS)和蒙特利尔认知测验(MOCA)评定NMS,用36条简化医疗结局调查问卷(SF-36)评价QOL。采用逐步多元线性回归分析探讨PD患者QOL的影响因素和NMS的具体作用。结果 PD患者SF-36各维度分值均较健康同龄老人下降。相关分析显示,SF-36总分与H-Y分级、UPDRSⅢ、HAMA、HAMD及NMSQ分值成负相关,与PDSS评分成正相关,与HAMD的6个因子(除日夜变化)和NMSQ的9个症状群(除性功能)均显著负相关。回归分析显示,UPDRSⅢ和强直分能解释SF-36总分变化的21.6%,加入各NMS量表分值后,NMSQ能单独解释SF-36总分变化的21.5%;引入HAMD和NMSQ的细项后,绝望感、泌尿道症状、认知损害、体质量减轻、和阻滞症状能解释SF-36总分变化的35.8%;≤65岁、66岁～75岁和>75岁患者的QOL影响因素不同。结论 NMS中的绝望感、泌尿道症状、认知、体质量减轻、阻滞症状以及运动障碍中的强直型对QOL的影响较大,且导致不同年龄段患者QOL下降的因素不同。故需重视上述NMS的诊治,以改善PD患者QOL。     

早期帕金森病患者健康相关生活质量

目的 研究中国早期帕金森病(PD)患者健康相关生活质量(health related quality of life,HR-QOL)的特点;探讨运动症状和非运动症状对早期PD患者HR-QOL的影响.方法 在全国范围内共筛选出391例早期PD患者入组.采用统一帕金森病评分表(UPDRS)和Hoehn-Yahr评价运动症状,采用流行病学研究中心编制的抑郁量表(CES-D)、匹兹堡睡眠质量指数(PSQI)、疲劳量表(FSS)、阿尔茨海默病评定量表的认知部分(ADAS-Cog)和便秘量表分别对抑郁、睡眠障碍、疲劳、认知功能和便秘等非运动症状进行评价;采用36条目简化医疗结局调查问卷(SF-36)评价HR-QOL.比较PD患者与同龄健康老年人SF-36分值的差异.采用逐步多元线性回归分析深入探讨各种运动及非运动症状变量对HR-QOL的影响.结果 早期PD患者除SF-36躯体疼痛维度外,其余各维度分值较同龄健康老年人均下降.UPDRS第3部分分值(23.8±11.8)、Hoehn-Yahr分期(2.0±0.7)和强直分值(4.4±3.1)仅能解释SF-36总分变化的18.9%(R2=0.189).CES-D、FSS和PSQI分值等非运动症状变量引入回归方程后,SF-36总分可被解释的部分由18.9%增加至61.7%(R2=0.617).并且,引入CES-D分值后,SF-36总分可被解释的部分增加了43.3%(R2=0.433).结论 PD症状严重影响早期患者的HR-QOL.运动症状对HR-QOL存在影响,但影响作用有限.抑郁、疲劳和睡眠障碍这3个非运动症状是导致早期PD患者HR-QOL恶化的主要原因.其中,抑郁症状是HR-QOL恶化的最强预测因素.临床上,应重视非运动症状,运动和非运动症状兼治,才能真正提高疗效显著改善患者的HR-QOL.     

帕金森病非运动症状的临床研究

目的 探讨帕金森病(PD)非运动症状(NMS)的发生率、分布情况,及其与PD病情、病程间的关系.方法 用Hoehn-Yahr(H-Y)分期将170例原发性PD患者分为轻度(H-Y 1～2期)、中度(H-Y 2.5～3期)、重度(H-Y 4～5期)3组,同时应用统一PD评分量表UPDRS-Ⅲ、PDNMS 30问卷量表(NMSQuest)、简易精神状态检查(MMSE)量表进行评估,并与102名正常对照者的NMS相比较.结果 PD组伴NMS 168例(98.8%),正常对照组伴NMS 80人(78.4%),两组比较差异有统计学意义(P<0.01).PD组NMSQuest平均得分(11.92 ±5.03)明显高于正常对照组(4.39±3.78);中度组(15.05±4.28)、重度组(14.87±4.23)明显高于轻度组(10.04±4.51)(均P<0.01).PD组NMSQuest以近记忆下降(71.8%)、便秘(68.2%)、注意力下降(62.4%)的发生率最高;NMS的发生与年龄(r=0.235,P<0.05)、性别(r=0.431,P<0.01)、病程(r=0.278,P<0.01)、UPDRS-Ⅲ评分(r=0.440,P<0.01)、H-Y分期(r=0.423,P<0.01)呈正相关;与MMSE评分(r=-0.329,P<0.01)呈负相关;与发病年龄(r=0.094,P>0.05)无相关性.结论 PD患者NMS极其普遍,影响患者的生活质量,需要全面认识和及时干预.     

帕金森病伴抑郁和焦虑共病的研究

目的探讨帕金森病(PD)患者伴抑郁和焦虑共病的发生率及其相关因素。方法采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)对480名PD患者和105名正常对照者进行评分,采用统一PD评定量表第Ⅲ部分(UPDRSⅢ)、Hoehn-Yahr(H-Y)分期评定PD患者的运动症状,采用PD非运动症状(NMS)筛查问卷(NMSQ)、PD睡眠量表(PDSS)和蒙特利尔认知测验(MOCA)评定PD患者的NMS。结果 PD组中抑郁的发生率(19.4%)明显高于正常对照组(5.7%),焦虑的发生率(30.4%)明显高于正常对照组(14.3%),抑郁和焦虑共病的发生率(15.8%)也明显高于正常对照组(5.7%)(均P<0.01)。多元Logistc回归分析显示,抑郁的发生与NMSQ评分呈正相关(OR=1.21,95%CI:1.07~1.37);焦虑的发生与女性(OR=1.91,95%CI:1.04~3.50)、H-Y分期(OR=2.87,95%CI:1.23~6.70)、UPDRSⅢ评分(OR=1.03,95%CI:1.00~1.06)及NMSQ评分(OR=1.18,95%CI:1.10~1.26)呈正相关,而与PD...     

帕金森病患者快速眼球运动睡眠行为障碍临床特征及相关因素

目的分析伴快速眼球运动睡眠行为障碍(REM sleep behavior disorder,RBD)帕金森病(Parkinson’s disease,PD)患者的临床特征,探讨RBD的相关因素。方法连续入组PD患者63例,根据REM睡眠行为异常问卷-香港版(RBDQ-HK)分为PD+RBD组(n=28)和PD-RBD组(n=35)。采用统一帕金森病评定量表(UPDRS)、HoehnYahr(H-Y)分级比较两组运动症状严重程度;采用非运动症状问卷(NMS±quest)比较非运动症状发生情况;采用蒙特利尔认知评估(MOCA)、贝克焦虑量表(BAI)、贝克抑郁量表(BDI)、Epworth嗜睡评分量表(ESS)比较认知、焦虑、抑郁和日间思睡等情况。结果 PD患者中RBD发生率为44.4%(28/63),PD+RBD组病程显著长于PD-RBD组(χ~2=12.733,P=0.002),年龄更大(t=-2.292,P=0.025),H-Y分级更高(χ~2=7.014,P=0.008),但在性别、发病年龄、起病类型、左旋多巴等效剂量上两组差异无统计学意义;在运动症状方面,PD+RBD组UPDRSⅡ、Ⅲ评分更高(t=-2.734,P=0.008;U=3.329,P=0.001);在非运动症状方面,PD+RBD组胃肠道功能及睡眠障碍、精神相关症状等方面发生率均显著高于PD-RBD组(P0.05),焦虑及抑郁在PD+RBD组中更常见(χ~2=3.958,P=0.047;χ~2=10.338,P=0.001),但在认知功能、日间思睡上两组差异无统计学意义。此外,便秘(OR=7.257)、长病程(OR=5.389)、高UPDRSⅢ评分(OR=1.060)与PD患者RBD相关。结论病程更长、年龄更大、运动症状及非运动症状受累更严重的PD患者易伴发RBD。便秘、长病程、高UPDRSⅢ评分可能是RBD的危险因素。     

脑深部电刺激对帕金森病非运动症状的疗效(附102例病例分析)

目的 探讨丘脑底核(STN)脑深部电刺激(DBS)对帕金森病(PD)非运动症状的治疗作用.方法 102例PD病人接受STN-DBS手术,手术前后分别进行非运动症状(NMS)量表评估,随访时间6个月至6年.结果 PD患者术前有NMS症状3～18项,平均7.1项.NMS评分与患者的Hoehn-Yahr分级明显相关(相关系数r=0.49,P<0.01).手术后频数明显下降的NMS症状是:疼痛、感觉异常、失眠、多梦、不安腿、体质量下降.结论 所有PD患者都具有NMS症状,出现在PD病程的各个时期.随疾病严重程度的进展,PD患者平均NMS评分明显提高.DBS手术不能改善PD患者的所有NMS症状,但可以减少疼痛、感觉异常、失眠、多梦、不安腿、体质量下降等症状.     

帕金森病患者的非运动症状三年随访

目的 随访观察帕金森病(PD)非运动症状的发生、发展及变化情况,研究其对患者生活质量的影响.方法 应用统一PD评分量表(UPDRS)第Ⅲ部分和第Ⅳ部分、PD非运动症状30问卷、PD生活质量问卷(PDQ-39)等量表,在基线和3年随访末对87例原发性PD患者进行评估,采用配对t检验、卡方检验、Spearman等级相关分析及分层回归分析等对各项数据进行统计.结果 随着疾病的进展,基线和3年随访末比较,患者的UPDRSⅢ评分由(22.21±11.31)分升至(30.49±11.68)分、UPDRSⅣ评分从(1.00±1.54)分到(2.94±3.12)分,非运动症状评分由(7.98±3.96)分至(12.35±5.12)分,PDQ-39评分由(28.11±22.88)分升至(36.65±26.95)分,均明显升高(t=-5.54、-5.75、-6.46、-5.29,均P=0.000).运动症状与非运动症状的加重均对生活质量的下降有影响.发生率较高的非运动症状如便秘、记忆障碍、夜尿等症状和发生率居中的抑郁焦虑症状在疾病早期就持续存在,而疼痛、多汗等非特异性症状(△R2=21.6％),流涎、排便不尽感等消化系统症状(△R2=23.4％)在随访过程中发生率明显上升,是导致随访中生活质量下降的主要原因.结论 PD非运动症状在疾病早期就出现,随着病程延长无论运动还是非运动症状均加重,生活质量下降.     

帕金森病非运动症状及其治疗的流行病学调查

目的 调查帕金森病(Parkinson’s Disease, PD)非运动症状(Non-motor symptom, NMS)的发生率、严重程度、持续时间、治疗情况及其对生活质量的影响。方法 2014年1月～2016年4月对139例PD患者和87例健康成人(对照组)运用非运动症状评分(Non-Motor Symptoms Scale,NMSS)调查NMS,运用帕金森病生活质量问卷39项(39-item Parkinson’s Disease Questionnaire,PDQ-39)评估生活质量,运用Hoehn& Yahr(H-Y)分级评定PD患者运动症状的严重程度,并记录研究对象的一般情况和治疗情况,分析PD患者生活质量的影响因素。结果 98.6%的PD患者存在NMS,平均NMSS总分[(61.46±41.92),(0～208)]。在PD患者中发生率超过50%的NMS依次如下:夜尿、便秘、不宁腿、性欲下降、性功能障碍、失眠、乏力; 平均NMSS≥3分的NMS依次如下:便秘、性欲下降、性功能障碍、乏力、失眠、不宁腿、尿频、夜尿; 平均持续时间≥2年的NMS依次如下:便秘、性欲改变、夜尿、勃起障碍、快速动眼睡眠行为异常(REM Sleep Behavior Disorder Questionnaire,RBD)、嗅觉障碍。PD患者中通便药、安眠药、抗抑郁药和排尿困难药的使用率分别为47.8%(43/90)、19.7%(13/66)、2.7%(2/74)、2.6%(2/76)。PD患者中通便药使用率显著多于正常人群(P<0.0001),2组安眠药使用率比较无明显差异(P=0.736),对照组无人使用改善情绪和排尿困难的药物。多重线性回归分析发现,调查时年龄、H-Y分级和NMS总分是PD患者日常生活质量的预测因素。结论 NMS几乎见于每例PD患者,自主神经功能紊乱、嗅觉障碍和RBD等NMS可用于辅助PD早期诊断,NMS降低PD患者的生活质量,需要加强对NMS的关注。     

GPi pallidotomy for Parkinson's disease with drug-induced psychosis

Levodopa-induced psychosis may seriously threaten the ability of patients with Parkinson's disease (PD) to continue leading an independent life. A retrospective assessment of the therapeutic effects of the globus pallidus internus (GPi) pallidotomy on the activities of daily living (ADL) of seven PD patients presenting with mild or moderate degrees of psychosis was carried out. Their scores according to the Unified Parkinson's Disease Rating Scale (UPDRS) Part I-2 (maximum=4) were 2 or 3 (mean +/- SD=2.4 +/- 0.5). Bilateral procedure was needed in 5 out of 7 patients to obtain sufficient improvement of motor symptoms. At 3 months after surgery, UPDRS part III motor scores in the 'off' state were significantly decreased and motor fluctuations were abolished. Nevertheless, their score of Schwab and England (S-E) ADL scale scores responded poorly to the surgery, while the scores in other 12 patients without psychosis was significantly improved after pallidotomy. The data indicate that GPi pallidotomy ameliorates the motor symptoms in patients with drug-induced psychosis (DIP), but has no significant impact on their consequent daily activities. A regression model for all 19 patients who underwent pallidotomy revealed that postoperative S-E scale was affected by the preoperative UPDRS Part I-2 rather than by Part III motor score. The present study suggested that DIP, even if its degree is not severe, may be a limiting factor of the therapeutic potential of pallidotomy in patients with PD.     

帕金森病患者自主神经功能障碍评估

目的：评估帕金森病（PD）患者中自主神经功能障碍症状发生比例、各症状分布的差异，及其与PD临床特点之间的关系。方法：应用SCOPA-AUT量表、统一帕金森病评分量表（UPDRS）、日常生活能力量表（ADL）、Hamilton抑郁量表和简易智能量表（MMSE）对116例原发性PD患者进行评估。结果：SCOPA-AUT总分和消化系统（GI）症状、排尿（UR）症状、体温调节（TH）症状、性功能（SX）症状评分均高于对照组，差异有极显著统计学意义（P=0．0001）。SCOPA-AUT总分与UPDRS评分、Hamilton抑郁量表评分呈正相关（P〈0．001），与生活质量ADL评分呈负相关（P〈0．001）。结论：自主神经功能障碍在PD早期就会出现，并随着疾病进展而加重，影响患者的生活质量。     

Minimal clinically important change on the unified Parkinson's disease rating scale.

The Unified Parkinson's Disease Rating Scale (UPDRS) is the main outcome measure in clinical trials of Parkinson's disease (PD). The minimal change that represents a clinically meaningful improvement is unknown. The objective of this study was to determine the minimal change on the UPDRS that represents a clinically meaningful improvement in early PD after 6 months of treatment. Data from two independent randomized treatment trials over 6 months involving 603 patients with de novo PD were analyzed to determine the minimal clinically important change (MCIC), referred to the status before treatment, for the UPDRS motor, activities of daily living (ADL), and total scores. An anchor-based method using ratings on a seven-point global clinical improvement was used. A change of five points on the UPDRS motor part was found to be the most appropriate cutoff score for all Hoehn and Yahr stages I to III, and a change of eight points for the UDPRS total score. For the UDPRS ADL score, an MCIC of two points for Hoehn and Yahr stages I/I.5 and II and of three points for Hoehn and Yahr stage II.5/III was the most appropriate cutoff score. These data give the first estimate for cutoffs defining clinically important changes in UPDRS ADL and motor scores. Further studies using larger databases from more diverse study populations are encouraged to better define and solidify the MCIC for the UPDRS.     

Test-retest reliability of the unified Parkinson's disease rating scale in patients with early Parkinson's disease: results from a multicenter clinical trial.

Our objective was to assess the test-retest reliability of the Unified Parkinson's Disease Rating Scale (UPDRS). The UPDRS is the most widely used instrument for measuring severity of parkinsonian symptoms in clinical research and in practice. The validity and inter-rater reliability of this scale have been previously studied. We examined the test-retest (intrarater) reliability of the UPDRS and derived subscales. Four hundred patients with early-stage Parkinson's disease (PD) who were participating in a multicenter clinical trial were evaluated using the UPDRS on two separate occasions (screening and baseline visits) prior to receiving treatment. The same neurologist at each center rated the subjects at both examinations that were, on average, 14.6 +/- 7.6 days apart (range 3-36 days). Test-retest reliability was estimated using the intraclass correlation coefficient (ICC) for the total UPDRS score, the mental, ADL, and motor subscale scores, and other derived subscale scores. Weighted kappa statistics were calculated for individual UPDRS items. The ICCs for the UPDRS scores were as follows: total score, 0.92; mental, 0.74; ADL, 0.85; motor, 0.90. ICCs for derived symptom-based scales ranged from 0.69-0.88. Reliability of specific items was generally lower than for summary scales. Reliability was slightly better in patients for whom the testing interval was within 14 days. Based on conventional standards, the UPDRS scores were found to have excellent test-retest reliability in this sample of patients with early PD rated by academic movement disorder specialists. The findings are in agreement with previous reports on interrater reliability.     

The generic 15D instrument is valid and feasible for measuring health related quality of life in Parkinson's disease

OBJECTIVES: To test the validity and feasibility of the generic 15D health related quality of life (HRQoL) instrument in Parkinson's disease (PD) and compare parkinsonian patients with the general population. Much effort has gone into developing disease specific HRQoL measures for PD, but only generic measures allow comparisons with the general population. New HRQoL tools are needed for PD because earlier ones have low feasibility in elderly patients. METHODS: The study comprised 260 patients with idiopathic PD and age and sex matched controls. HRQoL was evaluated using the disease specific questionnaire PDQ-39 and the 15D generic instrument. PD severity was assessed by Hoehn and Yahr staging, and the activities of daily living (ADL) and motor section of the Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS: The mean 15D score (scale 0-1; overall HRQoL) was lower in PD (0.77) than in controls (0.86). Patients with PD had significantly lower scores than controls in 13 of the 15 dimensions of 15D. Scores of the corresponding dimensions of PDQ-39 and 15D correlated significantly, confirming the convergent validity of 15D. In multiple stepwise regression analysis, the UPDRS ADL score explained 55% of the variation in the 15D score. CONCLUSIONS: 15D is a valid, feasible, and sensitive tool to assess quality of life in PD. PD has a major impact on HRQoL, which is related to disease progression. Mobility, eating, speech, and sexual functions are most affected. The ADL measure of the UPDRS and the 15D provide an easily assessable view of HRQoL in PD.     

Patient-perceived involvement and satisfaction in Parkinson's disease: effect on therapy decisions and quality of life.

Patient-centered consultation styles are associated with higher patient satisfaction and improved health outcomes in diabetes and hypertension. In outpatient neurology, dissatisfaction with communication relates significantly to noncompliance. We undertook a single-center study in Parkinson's disease (PD) using standardized questionnaires to score patient-perceived involvement in therapy decisions (score 4 = low to 25 = high) and satisfaction with the consultation (score 1 = low to 7 = high). Correlation was tested against health outcomes of Unified Parkinson's Disease Rating Scale (UPDRS) Motor score, activities of daily living (UPDRS 2 and Schwab and England), Parkinson's disease quality of life (PDQ-39), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS). Of 117 patients enrolled, 107 (91%) fully completed the questionnaires. Mean patient-perceived involvement scored 14.4 (SD, 2.8). Mean satisfaction scored 5.3 (SD 0.7). Higher involvement was associated with increased satisfaction (r = 0.28; P = 0.003), particularly distress relief (r = 0.38; P < 0.0001). Communication scores correlated significantly with compliance intent (r = 0.6; P < 0.0001). There was no correlation between either involvement or satisfaction and UPDRS, Schwab and England, MMSE, or GDS. Quality of life was significantly associated with depression, UPDRS, duration of PD, compliance intent, and satisfaction. The significant positive association between compliance intent and quality of life in the more satisfied patient replicates findings in other disease areas. Due attention to these aspects in delivering care to the PD patient is appropriate.     

普拉克索治疗帕金森病运动并发症的临床研究

目的 探讨普拉克索对经复方左旋多巴治疗并且已经出现运动并发症的中晚期帕金森病(PD)患者的疗效和安全性.方法 42例PD患者在原有复方左旋多巴治疗的基础上加用普拉克索1.5～3.0mg/d,为期12周.疗效指标为治疗前后统一PD评定量表(Unified Parkinson's Disease Rating Scale,UPDRS)及汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分,其中UPDBS Ⅰ及HAMD用于评价精神、行为、情绪等非运动症状;UPDRS Ⅱ评价日常生活活动能力;UPDRS Ⅲ、Ⅳ及"开"期和"关"期时间的变化用于评价运动功能,并对患者的临床疗效进行整体评价.安全性指标为不良反应、血压、脉搏、实验室检查、心电图及对认知功能的影响.结果 治疗12周后,UPDRS各项评分均减少,差异具有统计学意义(UPDRS总分:52.05±7.69与39.26±7.64,t=25.378,P＜0.05).UPDRS运动评分改善22.61%,"开"期持续时间增加约1.64 h;复方左旋多巴用最平均减少129.46 mg/d;治疗并发症评分变化均值下降1.45分;HAMD评分均值下降6.14分.不良反应主要有头晕、嗜睡、恶心、便秘、厌食等.结论 普拉克索对运动症状和非运动症状均有较好的疗效,不良反应发生率低,中晚期PD患者加用普拉克索是安全而有效的.     

Amantadine reduces the duration of levodopa-induced dyskinesia: a randomized, double-blind, placebo-controlled study

We evaluated the effects of amantadine on levodopa-induced dyskinesia (LID) in eighteen consecutive Parkinson's disease (PD) patients in a randomized, double-blind, placebo-controlled study. The primary outcomes were the Clinical Dyskinesia Rating Scale (CDRS) and the Unified Parkinson's Disease Rating Scale (UPDRS) part IVa score changes. The secondary outcomes were the UPDRS II and III score changes. Amantadine did not change the CDRS score for hyperkinesia or dystonia, but decreased the duration of LID and its influence on daily activities (p=0.04) and the UPDRS II score (p=0.01) more than placebo. These findings show that amantadine reduces the duration of LID and improves motor disability in PD.     

UPDRS activity of daily living score as a marker of Parkinson's disease progression

The activities of daily living (ADL) subscore of the Unified Parkinson's Disease Rating Scale (UPDRS) captures the impact of Parkinson's disease (PD) on daily function and may be less affected than other subsections by variability associated with drug cycle and motor fluctuations. We examined UPDRS mentation, ADL and motor subscores in 888 patients with idiopathic PD. Multiple linear regression analyses determined the association between disease duration and UPDRS subscores as a function of medication status at examination and in a subset of patients with multiple examinations. Independent of medication status and across cross‐sectional and longitudinal analyses, ADL subscores showed a stronger and more stable association with disease duration than other UPDRS subscores after adjusting for age of disease onset. The association between disease duration and the motor subscore depended on medication status. The strong association between ADL subscore and disease duration in PD suggests that this measure may serve as a better marker of disease progression than signs and symptoms assessed in other UPDRS sections. © 2008 Movement Disorder Society