Uitti R J, Baba Y, Whaley N R, Wszolek Z K, Putzke J D
Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA.
Neurology. 2005 Jun 14;64(11):1925-30. doi: 10.1212/01.WNL.0000163993.82388.C8.
To determine the proportion of individuals in a clinic-based setting that present with asymmetric Parkinson disease (PD) and identify predictive factors associated with asymmetric symptoms.
The authors examined right vs left difference scores on the Unified Parkinson Disease Rating Scale motor subscale in a consecutive clinical series of 1,277 individuals diagnosed with PD. Predictors of asymmetry included sex, symptomatic disease duration, age at onset, initial motor symptom laterality, handedness, and medical history variables (e.g., family history of PD).
Nearly half the sample (46%) met criteria for asymmetric disease based on a right vs left difference score of > or =5 points, and 12% of the sample had a difference score of > or =10 (difference score: mean = 4, SD = 3.4). All three cardinal features of PD showed characteristics of asymmetric disease presentation. Multiple regression analyses showed that an increased discrepancy between right- and left-sided symptoms was significantly associated with a shorter disease duration, younger age at symptomatic onset, asymmetric initial symptom onset, hand dominance, and a positive self-reported family history of "other" neurodegenerative disorder. Hand dominance was related to the side of asymmetric disease such that left-handed individuals tended to have more severe disease on the left side of the body.
Asymmetric presentation of Parkinson disease features was a common occurrence in the clinical cohort. Asymmetry was reliably predicted by several clinical characteristics, although the moderate level of explained variance (i.e., between 16 and 23%) highlighted the need for additional research examining predictive models of asymmetric disease. Recommendations for the classification and measurement of asymmetric disease are discussed.
确定在以诊所为基础的环境中出现非对称性帕金森病（PD）的个体比例，并识别与非对称性症状相关的预测因素。
作者在连续的1277例被诊断为PD的个体临床系列中，检查了统一帕金森病评定量表运动子量表上的右侧与左侧差异分数。非对称性的预测因素包括性别、症状性疾病持续时间、发病年龄、初始运动症状的偏侧性、利手以及病史变量（如PD家族史）。
基于右侧与左侧差异分数≥5分，近一半的样本（46%）符合非对称性疾病标准，12%的样本差异分数≥10分（差异分数：均值 = 4，标准差 = 3.4）。PD的所有三个主要特征均表现出非对称性疾病的特征。多元回归分析表明，右侧和左侧症状之间差异的增加与较短的疾病持续时间、症状性发病时较年轻的年龄、非对称性初始症状发作、手的优势以及自我报告的“其他”神经退行性疾病阳性家族史显著相关。手的优势与非对称性疾病的一侧有关，即左利手个体往往身体左侧的疾病更严重。
帕金森病特征的非对称性表现在临床队列中很常见。尽管解释方差的适度水平（即16%至23%之间）突出表明需要进一步研究非对称性疾病的预测模型，但非对称性可通过多种临床特征可靠地预测。讨论了非对称性疾病的分类和测量建议。
