血管性帕金森综合征与帕金森病认知功能的比较

目的 比较血管性帕金森综合征(vascular parkinsonism,VaP)和帕金森病(Parkinson's disease,PD)患者的认知功能特点.方法 回顾性纳入2018年1月-2020年12月于华北理工大学附属医院首次就诊的VaP患者和PD患者.采用MMSE和MoCA量表评估PD患者和VaP患者的认知功...     

Medication dose reductions after pallidal versus subthalamic stimulation in patients with Parkinson's disease

Evidente VGH, Premkumar AP, Adler CH, Caviness JN, Driver‐Dunckley E, Lyons MK. Medication dose reductions after pallidal versus subthalamic stimulation in patients with Parkinson’s disease.
Acta Neurol Scand: 2011: 124: 211–214.
© 2010 John Wiley & Sons A/S. Objective – To compare the medication dose reduction between deep brain stimulation (DBS) of the globus pallidus interna (GPi) vs subthalamic nucleus (STN) in matched patients with Parkinson’s disease (PD). Materials and methods – Records of 12 patients with PD who underwent GPi‐DBS at our institution from 2002 to 2008 were matched by pre‐operative PD medication doses and pre‐operative motor Unified Parkinson’s Disease Rating Scale (UPDRS) scores to 12 cases of STN‐DBS. PD medication doses were converted to levodopa equivalent doses (LEDs). Results – GPi and STN groups had similar mean pre‐operative LEDs and motor UPDRS scores. At 6 months post‐DBS, there was no significant difference in percent reduction in LEDs between the GPi (47.95%) and STN (37.47%) groups (P = 0.52). The mean post‐operative ‘medication off/stimulation on’ motor UPDRS scores did not differ significantly between GPi (15.33) and STN (16.25) groups (P = 0.74). The mean percent reduction in motor UPDRS scores was also similar between GPi (58.44%) and STN (58.98%) patients (P = 0.94). Conclusions – We conclude that in disease‐matched patients with PD undergoing DBS, both GPi and STN may result in similar reduction in PD medication doses.     

The effect of l-Dopa administration on pursuit ocular movements in suspected Parkinson’s disease

The objective of this study is to evaluate pursuit ocular movements (POM) by using a vision-based non-intrusive eye tracker, in patients with suspected Parkinson’s disease (PD), before and after l-Dopa administration. We studied ten patients with suspected diagnosis of idiopathic PD. We compared POM values to those of a group of normal controls (NC), and evaluated them before and after l-Dopa administration. Unified Parkinson’s Disease Rating Scale (UPDRS) motor subscores improved significantly (p = 0.001). At baseline, values of POM were lower in suspected PD patients than in NC (p = 0.01). One hour after l-Dopa administration, POM values correlated with UPDRS motor subscore (p = 0.01). We used a recent method, a new vision-based non-intrusive eye tracker, previously described, which can be proposed as a possible tool for supporting the diagnosis of PD in association with levodopa test, as an add-on to the UPDRS score.     

Fatigue and excessive daytime sleepiness in idiopathic Parkinson’s disease differently correlate with motor symptoms,depression and dopaminergic treatment

Background and purpose: A comprehensive study of both fatigue and excessive daytime sleepiness (EDS) in association with Parkinson’s disease (PD)‐related symptoms and treatment has not been performed yet. To assess the frequency and severity of fatigue and EDS in patients with idiopathic PD and to study their relation to motor and non‐motor symptoms and dopaminergic treatment. Methods: We prospectively assessed Fatigue Severity Scale (FSS) scores, Epworth Sleepiness Scale (ESS) scores, Beck Depression Inventory (BDI) scores, severity (Unified PD Rating Scale, UPDRS, part III; Hoehn & Yahr staging) and duration of the disease, and the current dopaminergic treatment in 88 consecutive patients with idiopathic PD. Results: Fatigue was found in 52 (59%), EDS in 42 (48%), and both complaints in 31 (35%) patients. Fatigued patients had higher UPDRS III scores (23.5 ± 11.1 vs. 18.6 ± 7.6, P = 0.03), higher Hoehn & Yahr staging (2.4 ± 0.9 vs. 2.1 ± 0.7, P = 0.03), and higher BDI scores (13.4 ± 7.1 vs. 9.1 ± 5.8, P = 0.004) than non‐fatigued patients. In contrast, UPDRS III, Hoehn & Yahr, and BDI scores did not differ between patients with or without EDS. However, the type of dopaminergic treatment (levodopa monotherapy versus combination of levodopa/dopamine agonists) was associated with significant differences in ESS (8.5 ± 5.2 vs. 10.8 ± 4.3, P = 0.04), but not FSS scores (4.1 ± 1.5 vs. 4.3 ± 1.5, P = 0.55). Disease duration correlated with ESS scores (r = 0.32, P = 0.003), but not with FSS scores (r = ?0.02, P = 0.82). Conclusions: In PD, there is a significant overlap of fatigue and EDS, but the two symptoms are differently correlated with the severity of motor symptoms, disease duration, depression, and dopaminergic treatment.     

Serum levels of coenzyme Q10 in patients with Parkinson's disease

Summary. We compared serum levels of coenzyme Q₁₀ and the coenzyme Q₁₀/cholesterol ratio in 33 patients with Parkinson's disease (PD) and 31 matched controls. The mean serum coenzyme Q₁₀ levels did not differ significantly between the 2 study groups. Coenzyme Q₁₀ levels were not correlated with age, age at onset, duration of the disease, scores of the Unified Parkinson Disease Rating Scale (UPDRS) or the Hoehn and Yahr staging in the PD group. The coenzyme Q₁₀/cholesterol ratio had a significant correlation (although low) with duration of the disease (r = −0.46), total UPDRS score (r = −0.39), motor examination of the UPDRS (r = 0.45). These values were not influenced significantly by therapy with levodopa or dopamine agonists. The normality of serum coenzyme Q₁₀ and coenzyme Q₁₀/cholesterol ratio suggest that these values are not related with the risk for PD. Received July 14, 1999; accepted August 3, 1999     

Progression of dysprosody in Parkinson's disease over time—A longitudinal study

Parkinsonian speech or hypokinetic dysarthria results from a multidimensional impairment of phonation, articulation, and prosody. Although the dysprosody in Parkinson's disease (PD) is well described (alterations in speech rate and pause time, speech intensity and pitch variation), little is known about alterations of these single prosodic parameters over a longer time course. The objective of this study is to analyze changes of speech rate and pitch variation in patients with PD over time and to compare these findings with healthy controls. Patients with PD (N = 50; 27 male and 23 female) and n = 50 age‐matched healthy controls (25 male, 25 female) were tested and retested after at least 7 months (mean: 25.02; median: 21; SD: 17.44; range: 7–79 months). In the PD group, motor impairment according to UPDRS motor score was similar at first and second visit. The participants had to accomplish a standardized four sentence reading task. The acoustical analysis was performed using a standard head‐worn microphone for voice recordings and commercial audio software (WaveLab®). For the determination of intonation based upon fundamental frequency (F₀) variation, we used a computer analysis program (Praat®). Articulatory velocity was determined by measurement of syllable rate and pause ratios. In the PD group, total speech rate (syllables per second related to total speech time/TSR) and net speech rate declined from first to second examination, especially in the male patients, but showed no significant differences to the control group. The course of pitch variation revealed some gender particularities. Whereas female patients' pitch variability declined over time, male patients' intonation variability remained relatively stable. F₀ variation in male and female patients with PD were significantly reduced compared with the control group in the first examination and the follow up as well. Progression of prosodic impairment over time showed no correlation to disease duration or UPDRS motor score. Some aspects of dysprosody in PD show characteristic changes over time, but show no clear correlation with general motor impairment as assessed by UPDRS motor score. Therefore, we suspect that the underlying mechanism could be independent from dopaminergic deficits. © 2008 Movement Disorder Society     

Relationship between age and subtypes of psychotic symptoms in Parkinson's disease

Abstract Objective Psychotic symptoms (PS) in Parkinson's disease (PD) usually develop as a side effect of the dopaminergic therapy and consist of hallucinations and delusions. We observed that PD patients who developed delusions tend to be younger than those with hallucinations and we aimed to investigate the validity of this observation. Methods The medical records of 127 PD patients with PS were reviewed and 76 patients who were on treatment with dopamine agonists with or without levodopa at the time of developing PS were included. Patients were stratified into 3 groups according to the subtypes of PS: patients with solely hallucinations (n = 46), solely delusions (n = 18), and both types (n = 12). The groups were compared with respect to the age-at-onset of PD and PS, duration of PD, Activities of Daily Living (ADL) and motor subscale scores of Unified PD Rating Scale (UPDRS), and levodopa equivalent dose of the dopaminergic agents administered at the time of PS onset. Results The mean age-atonset of PD and PS was significantly younger (p = 0.0001) in patients with delusions (49 and 55.9 years) than those with hallucinations (61.9 and 68.9 years). The same parameters were also significantly different (p = 0.002 and p = 0.001, respectively) between the groups of patients with concurrent delusions and hallucinations (51.7 and 57.2 years) and those with only hallucinations. ADL and motor subscale scores were higher in patients with hallucinations (p = 0.016 and p = 0.013) compared with those noted in patients with delusions despite similar disease duration. The mean levodopa equivalent doses of the dopaminergic agents administered at the time of onset of PS did not differ between the groups. Conclusion This study supported an association of delusions with younger onset of both PD and psychosis as compared with hallucinations. However, additional factors related to this association remain to be elucidated.     

Interactions between four gene polymorphisms and their association with patients with Parkinson's disease in a Chinese Han population

The four previously reported Parkinson's disease (PD)-related single-nucleotide polymorphisms (SNPs) – rs1775143, rs823114, rs2071746 and rs62063857 – have rarely been studied in Chinese Han populations. To examine the association between these SNPs and PD, we conducted a case-control study of 158 patients with PD and 210 controls. All participants were Chinese Han from Northern China. With covariate adjustment for clinical characteristics, logistic regression analysis revealed no differences in genotype or allele frequencies for the four SNPs. Stratified by age of disease onset, sex, smoking status, duration of disease, baseline UPDRS, Hoehn–Yahr Stage, PD subtypes, scores of Hamilton anxiety scale, Hamilton depression scale and activity of daily living, all of the p values did not remain significant after Bonferroni correction. However, the haplotype rs1775143T-rs823114G-rs2071746T-rs62063857A was associated with increased risk of developing PD (p = 0.003, OR = 456.88, 95% CI: 27.40–7619.75) in our case-control sample set. The haplotype rs1775143T-rs823114G-rs2071746T was also associated with increased risk of developing PD (p = 0.003, OR = 338.43, 95% CI: 20.68–5538.27). Although the haplotype rs1775143T-rs823114G-rs62063857A was associated with increased risk of PD (p = 0.03), the 95% CI was 0.993–22.469. Our data demonstrate that although specific SNPs were not related with PD patients, certain haplotypes were associated with increased risk for PD in the Chinese Han population. These results provide further evidence that the etiology of PD is multifactorial, although the underling mechanism needs further study.     

Effect of rasagiline as adjunct therapy to levodopa on severity of OFF in Parkinson's disease

Background: The LARGO study demonstrated that rasagiline 1 mg/day as adjunct to levodopa significantly reduces OFF time to the same magnitude as adjunct entacapone. This substudy of LARGO aimed to assess the effect of rasagiline and entacapone on the motor symptoms of PD during the practically defined OFF state. Methods: LARGO was a randomized, double‐blind, multicenter trial that assessed the efficacy and safety of rasagiline (1 mg/day), entacapone (200 mg with each levodopa dose), and placebo in 687 levodopa‐treated PD patients with motor fluctuations. A substudy of LARGO measured UPDRS motor scores in the practically defined OFF state in 32 rasagiline, 36 entacapone, and 37 placebo patients. Results: Treatment with rasagiline produced a significant improvement over placebo of 5.64 units in UPDRS motor OFF score (P = 0.013 vs. placebo). By contrast, the effect of adjunct entacapone was not significant (P = 0.14 vs. placebo). Whereas rasagiline also showed a trend in reducing the UPDRS‐ADL OFF score (P = 0.058 vs. placebo), no such trend was noted for entacapone (P = 0.26 vs. placebo). Retrospective analysis, using the Bonferroni correction, of UPDRS motor subdomains further revealed that rasagiline, but not entacapone, significantly improved bradykinesia (P < 0.001) and showed trends for improvements in facial expression, speech, and axial impairment during OFF time. Conclusions: This study provides the first objectively measured evidence that adjunct rasagiline 1 mg/day is effective in reducing the severity of motor symptoms in the OFF state. This suggests a continuous effect of rasagiline 1 mg/day throughout the day and night and is consistent with its extended duration of therapeutic action.     

Subjective and perceptual analysis of voice quality and relationship with neurological disfunction in multiple sclerosis patients

ObjectiveThe aim of the present study was to evaluate subjective voice changes by voice handicap index (VHI) and voice related quality of life questionnaire (VRQL) and perceptual voice changes by Grade Roughness Breathiness Asthenia Strain (GRBAS) scale and to compare these findings with expanded disability status scale (EDSS) in multiple sclerosis (MS) patients.MethodsThe patient group was composed of 36 MS patients, (mean age 45.2 ± 12.9, 13 male and 23 female) and compared with 32 healthy sex and age match individuals without neurological and voice symptoms.ResultsThe mean VHI was significantly higher in patients group (15.64 to 5.43; p = 0.043). Forty-four percent of MS patients (52% of female patients) report voice problems. According to the GRBAS scale, differences between two groups were significant for Grade, Roughness, Breathiness and Strain items. The mean EDSS was 2.69 ± 1.1, for a male patients 2.54 ± 1.1 and for female 2.78 ± 1.3. There was no correlation between the EDSS and the total VHI score, between the EDSS and each of the three item of VHI, between the EDSS and VRQL, nor between the EDSS and components of GRBAS scale except for EDSS and asthenia item, (r = ?0.5213, p = 0.011).ConclusionsSignificant number of MS patients experienced voice problems. We did not establish any significant correlation between the intensity of the voice disorders and EDSS, except between EDSS and asthenia item of the GRBAS scale. The patients with low EDSS may have serious voice problems and vice versa.     

Serum uric acid levels in patients with Parkinson's disease: Their relationship to treatment and disease duration

There is evidence to support that oxidative stress is increased in Parkinson's disease (PD) and contributes to degeneration of dopaminergic neurons. Uric acid (UA), a natural antioxidant in blood and brain tissue, scavenging superoxide, peroxynitrite and hydroxyl radical, was found reduced in the serum of PD patients. In addition low plasma uric acid (UA) levels have been associated with an increased risk of PD.

Objectives

The aim of our study was to investigate serum UA levels in PD patients compared with age-matched healthy controls and their possible relationship with several clinical parameters of PD and pharmaceutical treatment.

Patients and methods

We measured serum UA levels in 43 PD patients and 47 healthy volunteers, age and sex-matched. UA levels were correlated with disease duration, severity and treatment.

Results

Low UA levels were observed in PD patients compared with controls (p = 0.009). Age, Body Mass Index (BMI) and UPDRS III score did not significantly affect serum UA concentrations, whereas gender was found to contribute significantly to UA level (p < 0.000). Strong and significant inverse correlations of UA with disease duration (R_s = −0.397, p = 0.009) and daily levodopa dosage (R_p = −0.498, p = 0.026) were observed. These associations were significant for men (R_s = −0.441, p = 0.04 and R_s = −0.717, p = 0.03 respectively), but not for women (R_s = −0.221, p = 0.337 and R_s = −0.17, p = 0.966 respectively).

Conclusion

Our results suggest that there may be increased consumption of UA as a scavenger in PD, possibly heightened by dopaminergic drug treatment. Given the antioxidant properties of UA, manipulation of its concentrations should be investigated for potential therapeutic strategies of the disease.     

加速度记录仪定量化评价运动障碍性疾病

目的 利用不同方法解析加速度记录仪记录的身体活动,定量化评价神经科不同疾病所致运动障碍的程度.方法 81例帕金森病(Parkinson’sdisease,PD)患者以及61例伴有上肢功能障碍的急性脑梗死(acute cerebral infarction,ACI)患者,根据PD与ACI国际治疗指南常规治疗,于治疗前与治疗后(PD患者24～38 d后,脑梗死患者约28 d后)分别将加速度记录仪佩戴于同一例患者利手侧手腕连续记录6d.同时利用统一PD评分量表(UPDRS)评价治疗前后PD患者的临床评分,应用Fugl-Meyer量表(FMA)和功能独立性评定量表(FIM)评价ACI患者上肢运动功能和进食、梳洗、穿脱上衣等功能;解析加速度记录仪记录的身体活动数据,用幂型自相关指数(power-law exponent,PLE)以及去趋势波动分析指数(detrended fluctuation analysis,DFA)分别评价PD患者与ACI患者用药前后的指数变化,并分析各组患者的临床量表评分与PLE和DFA的相关性.结果 与用药前比较治疗后PD患者的UPDRS总分与UPDRS运动障碍部分(UPDRSⅢ)评分以及PLE指数均显著改善(UPDRS总分:32.8±16.2、28.8±14.7,Z=2.080,P=0.038;UPDRSⅢ:18.6±8.2、15.7±6.8,Z=2.155,P=0.031;PLE:0.98±0.25、0.82±0.21;Z=2.212,P=0.027),PLE指数的改善率与UPDRS总分、UPDRSⅢ评分的改善率呈直线相关(r=0.699、0.823,均P＜0.05);ACI患者FMA评分、FIM评分以及DFA指数较治疗前显著改善(FMA:12.39±8.21、30.28±7.29,Z=3.016,P=0.004;FIM:8.98±7.29、13.21±7.6,Z=2.282,P=0.038; DFA:0.86±0.31、0.98 ±0.27,Z=2.360,P=0.036),DFA指数与ACI患者的FMA、FIM评分的改善率呈直线相关(r=0.638、0.712,均P＜0.05);PLE指数与ACI的临床量表评分、DFA指数与PD的临床量表评分无相关性.结论 解析加速度记录仪所记录的身体活动的PLE指数可能能够定量化评价肢体僵硬、运动迟缓类型运动障碍的程度,而DFA则可能对肢体瘫痪或无力类型运动障碍的评价有较高的特异性,利用针对性的分析方法解析加速度记录仪记录的身体活动可作为运动障碍性疾病患者使用的定量化评价工具.     

Factors predicting response to dopaminergic treatment for resting tremor of Parkinson's disease

We aimed to evaluate the clinical factors predicting response to dopaminergic treatment for resting tremor in patients with Parkinson's disease (PD). Eighty‐five PD patients with prominent resting tremor, defined as tremors of score greater than 3 in at least one limb on the Unified Parkinson's Disease Rating Scale (UPDRS), were divided into those responsive or nonresponsive to dopaminergic treatment. Responsiveness was defined as a reduction of at least two points for more than 3 months in the UPDRS tremor score. Of the 85 patients, 36 (42.4%) were responsive and 49 (57.6%) were nonresponsive to dopaminergic treatment. Initial UPDRS III score (P = 0.015) and Hoehn and Yahr stage (P = 0.010) were each significantly higher in the RG than in the NRG. UPDRS subscores for rigidity (P = 0.012), bradykinesia (P = 0.021) and postural impairment (P = 0.018) also correlated with responsiveness to dopaminergic treatment. Resting tremor in PD patients was more responsive to dopaminergic treatment when accompanied by moderate degrees of bradykinesia and rigidity than in patients without other prominent parkinsonian features. © 2007 Movement Disorder Society     

Efficacy,safety and tolerability of rasagiline as adjunctive therapy in elderly patients with Parkinson’s disease

Background: Rasagiline, an MAO‐B inhibitor, is indicated for the treatment of Parkinson’s disease (PD). In this post hoc analysis, the efficacy, safety and tolerability of rasagiline as an adjunct to levodopa were compared with placebo in elderly (≥70 years) and younger (<70 years) patients with PD. Methods: Data were pooled from the Parkinson’s Rasagiline: Efficacy and Safety on the Treatment of ‘OFF’ and Lasting effect in Adjunct therapy with Rasagiline Given Once daily randomized, double‐blind, placebo‐controlled trials with the primary efficacy end‐point being the reduction from baseline in daily OFF time. Secondary efficacy end‐points included scores for Clinical Global Improvement (CGI)‐Examiner during ON time, Unified Parkinson’s Disease Rating Scale (UPDRS)‐ADL during OFF time, UPDRS‐Motor during ON time and total daily ON time with and without troublesome dyskinesia. Tolerability was evaluated from adverse events (AEs) in the two age groups. Results: Rasagiline decreased daily OFF time versus placebo (P < 0.01) and improved CGI‐Examiner score (P = 0.001) and UPDRS‐Motor ON score (P < 0.05). Changes in UPDRS‐ADL OFF score and total daily ON time without dyskinesia also favoured rasagiline but were not significant. Between‐group comparisons (≥70 vs. <70 years) showed that efficacy was unaffected by age for all end‐points (P > 0.1), and rasagiline was well tolerated amongst both groups of patients with a comparable incidence of total and dopaminergic AEs (P > 0.1). Conclusions: Adjunct rasagiline is efficacious and well tolerated in elderly non‐demented patients (≥70 years) with moderate to advanced PD. Confirmation of the efficacy and safety of rasagiline in the elderly patient subgroup is especially relevant because of the increasing number of elderly patients with PD.     

Magnetic resonance imaging findings of shoulders in Parkinson's disease

The aim of this study is to evaluate shoulder disturbances in Parkinson's disease (PD) patients using magnetic resonance imaging (MRI) which is the best tool in the demonstration of complex shoulder pathologies; and to determine probable relations between shoulder pathologies and PD clinical features. Twenty‐eight PD patients with a total of 56 shoulders were used as the study group while 13 age‐matched cases with 26 shoulders were used as the control group (CG) in the study. Both patients with PD and the CG underwent shoulder MRI. The Hoehn and Yahr (H&Y) disability scale and Unified Parkinson's Disease Rated Scale (UPDRS) were used to determine the severity of the disease. Our results showed that patients with full‐thickness supraspinatus (SSP) tear have statistically significant higher UPDRS (P = 0.012), tremor (P = 0.023), rigidity (P = 0.023), and total (P = 0.002) scores. Mild group patients (P = 0.045) showed significantly higher frequency resting tremor and subcoracoid effusion than those of severe group patients (P = 0.002). Subcoracoid effusion was observed in patients with significantly higher UPDRS (P = 0.045) and rigidity (P = 0.022) scores. When the resting tremor and subcoracoid effusion groups were compared according to the severity of the resting tremor but not according to the H&Y, higher frequency of full‐thickness tear in SSP tendon was detected in the group of resting tremor (P = 0.053). Longer duration of disease was also observed in patients with full‐thickness SSP tear (P = 0.029) and acromioclavicular joint changes (P = 0.018). Higher UPDRS, tremor, rigidity and total scores and longer PD duration appear as the predisposing factors for the development of shoulder disturbances in PD in this study. © 2010 Movement Disorder Society     

Development of a prediction formula of Parkinson disease severity by optical coherence tomography

The aims of this study were to assess the peripapillary retinal nerve fiber layer (RNFL) thickness in patients with Parkinson's disease (PD), to determine its correlation with disease severity, and to define a simple biomarker for predicting clinical severity. One hundred two eyes from 52 patients affected by PD were compared with 97 eyes from 50 age‐comparable controls. In all patients, peripapillary RNFL thickness was measured by optical coherence tomography (OCT). We used the Unified Parkinson's Disease Rating Scale (UPDRS) total score and measured responses in the on medication state. Eyes from patients with PD had a statistically significant decrease in average peripapillary RNFL thickness compared with control eyes (P < 0.001). This reduction was observed in every quadrant (inferior, superior, nasal [P < 0.001], and temporal [P = 0.017]) in patients with PD. Furthermore, a strong inverse correlation was found between the PD severity measured according to the UPDRS score and the average peripapillary RNFL thickness (r = ?0.615; P < 0.001) and PD duration (r = ?0.303; P = 0.002). From these results, we defined a regression equation that predicts the UPDRS score from the above‐mentioned variables: UPDRS = 81.6 + 29.6 * log PD duration (years) ? 0.6 * RFNL thickness (μm). We observed that, as the evolution and severity of PD progress, the peripapillary RNFL layer thickness, as evaluated by OCT, gradually diminishes. These results suggest that the average peripapillary RNFL thickness measured by OCT might be useful as a biomarker to detect the early onset and progression of PD. © 2013 International Parkinson and Movement Disorder Society     

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。     

Association of daytime sleepiness with nigrostriatal dopaminergic degeneration in early Parkinson's disease

Abstract Introduction Many patients with Parkinson's disease (PD) report daytime sleepiness. Its etiology, however, is still not fully understood. The aim of this study was to examine if the amount of nigrostriatal dopaminergic degeneration is associated with subjective daytime sleepiness in patients with PD. Patients and methods We investigated 21 patients with PD clinically and by means of [¹²³I] FP-CIT-SPECT (DaTSCAN^R). Each patient filled in the Epworth sleepiness scale (ESS), the Parkinson's Disease Sleep Scale (PDSS), and the self-rating depression scale according to Zung (SDS) to assess sleepiness, sleep quality, and depressive symptoms. Results The mean specific dopamine transporter binding in the 21 PD patients (60.8 ± 10.4 years, nine females, median Hoehn and Yahr stage 2.0) was decreased. Nine patients were in Hoehn and Yahr stage 1 (58.7 ± 6.6 years, four females; ESS score 7.4 ± 4.5; PDSS score 105.1 ± 30.9), the other 12 patients were in Hoehn and Yahr stage 2 (62.4 ± 12.6 years, five females; ESS score 6.7 ± 4.7, PDSS score 97.1 ± 25.6). Age, gender, ESS, and PDSS scores were not significantly different in both groups. However, ESS scores showed an inverse correlation with mean DAT binding in the striatum (r = -0.627, p = 0.03), the caudate nucleus (r = -0.708, p = 0.01), and the putamen (r = -0.599, p = 0.04) in patients with Hoehn and Yahr stage 2. There was no correlation of the ESS score with age, disease duration, UPDRS motor score, PDSS score, or depression score. Conclusion Subjective daytime sleepiness seems to be associated with dopaminergic nigrostriatal degeneration in early PD.     

Substantia nigra echogenicity correlated with clinical features of Parkinson's disease

BackgroundTranscranial sonography can display structural alterations in the substantia nigra (SN) of patients with Parkinson's disease (PD), and is considered to be a potential useful tool for the diagnosis of PD. The aim of this study was to assess the correlation between SN echogenicity and clinical features in Chinese patients with PD.MethodsA total of 420 subjects including 290 patients with PD and 130 controls were recruited from the neurological clinic or the community. Transcranial sonographic evaluations of the SN were performed in all subjects, and motor and non-motor symptoms were thoroughly assessed by a series of rating scales in PD patients.ResultsTwo hundred and one patients were successfully assessed by transcranial sonography. SN hyperechogenicity was found to be associated with male sex (p = 0.004), higher scores on the Unified Parkinson's Disease Rating Scale (UPDRS) part II (p = 0.001) and autonomic symptoms scores (p = 0.003). Moreover, regression analysis revealed that UPDRS part II scores (odds ratio = 1.141, p < 0.001) and gender (odds ratio = 2.409, p = 0.007) could be the independent predictors for SN hyperechogenicity; in addition, among all items of UPDRS part II, speech, dressing, hygiene, and turning in bed and adjusting bed clothes significantly correlated with SN hyperechogenicity.ConclusionsThis is the first report suggesting the correlation between SN echogenicity and UPDRS part II, and we conclude that increased SN echogenicity might reflect more severe disease disability or poorer medical response.     

帕金森病患者和健康对照者的纵向CSF生物标志物对比研究

目的 探讨帕金森病(Parkinson's disease,PD)患者脑脊液(CSF)生物标志物的水平变化及其临床意义。方法 选取本院2018年3月-2019年3月收治的70例PD患者,并根据改良PD综合评分量表(UPDRS量表)及Hoehn-Yahr评分标准将患者分为轻度组(n=38)、中度组(n=18)和重度组(n=14)。另选择同期于本院接受体检健康人员70例作为对照组,检测并比较4组研究对象CSF生物标志物蛋白α-突触核蛋白(α-syn)、磷酸化Tau蛋白(P-Tau)及总Tau蛋白(T-Tau),微小RNA133 b(miR-133b)及C反应蛋白(CRP)、白细胞介素-8(IL-8)水平。结果 各组性别、年龄比较无明显差异(P>0.05); 不同病情严重程度PD患者UPDRS评分比较有明显差异,且均显著高于对照组(P<0.05); PD患者轻度组、中度组及重度组H-Y评分比较有明显差异(P<0.05)。各组α-syn、P-Tau、T-Tau、miR-133b、CRP及IL-8水平比较有明显差异(P<0.05),且随着PD患者病情严重程度加重,α-syn水平显著降低,P-Tau、T-Tau、miR-133b、CRP及IL-8水平显著升高(P<0.05)。Pearson相关分析显示,α-syn与UPDRS评分呈显著正相关,P-Tau、T-Tau、miR-133b、CRP及IL-8与UPDRS呈显著负相关(P<0.05)。受试者工作曲线(ROC)显示α-syn、P-Tau、T-Tau、miR-133b、CRP及IL-8水平诊断PD的曲线下面积(AUC)分别为0.755、0.785、0.742、0.746、0.779、0.755,联合诊断的AUC为0.905。结论 脑脊液生物标志物的水平变化是PD发生与发展的重要参考指标,其对于PD的诊断和病情严重程度判断具有重要价值