Post Bart, Merkus Maruschka P, de Haan Rob J, Speelman Johannes D
Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands.
Mov Disord. 2007 Oct 15;22(13):1839-51; quiz 1988. doi: 10.1002/mds.21537.
The purpose of this systematic review is to summarize studies that describe the course of Parkinson's disease (PD) and to identify factors that predict change in motor impairment, disability, and quality of life. A literature search was conducted in MEDLINE, EMBASE, CINAHL, and Web of Science limited to the English, French, German, Spanish, and Dutch language. Reports were selected if the study involved subjects with PD, the outcome measures described impairment, disability, or quality of life and follow-up was at least 6 months. All included studies were scored for methodological quality. Data were extracted and summarized in a best evidence synthesis. We screened 1,535 titles and abstracts, of which 27 fulfilled our inclusion criteria. A meta-analysis to quantitatively aggregate progression scores of motor impairment and disability was not possible because of the wide variety of outcome measures used and the heterogeneous study populations. Limited evidence is found for lower UPDRS-ME at baseline, dementia and SE < 70% as prognostic factors for future motor impairment. There is strong evidence for higher age at onset and higher PIGD-score; and limited evidence for higher bradykinesia-score, non-tremor dominant subtype, symmetrical disease at baseline, and depression as prognostic factors for progression of disability. Prognostic factors were identified for impairment and disability. The literature on prognosis in PD is not fulfilling the high methodological standards applied nowadays. There is a need for prospective cohorts of PD patients assembled at a common early point in the disease with long time follow-up.
本系统评价的目的是总结描述帕金森病（PD）病程的研究，并确定预测运动障碍、残疾和生活质量变化的因素。在MEDLINE、EMBASE、CINAHL和Web of Science数据库中进行了文献检索，检索范围限于英语、法语、德语、西班牙语和荷兰语。如果研究涉及PD患者，结局指标描述了损伤、残疾或生活质量，且随访时间至少为6个月，则纳入该报告。对所有纳入研究的方法学质量进行评分。数据通过最佳证据综合法进行提取和总结。我们筛选了1535篇标题和摘要，其中27篇符合我们的纳入标准。由于所使用的结局指标种类繁多且研究人群异质性大，因此无法进行荟萃分析以定量汇总运动障碍和残疾的进展评分。发现基线时较低的统一帕金森病评定量表-运动检查（UPDRS-ME）、痴呆和低于70%的简易精神状态检查表（SE）作为未来运动障碍的预后因素的证据有限。有强有力的证据表明发病年龄较大和姿势不稳-步态障碍（PIGD）评分较高；而运动迟缓评分较高、非震颤为主亚型、基线时对称性疾病和抑郁作为残疾进展的预后因素的证据有限。确定了损伤和残疾的预后因素。关于PD预后的文献未达到当今应用的高方法学标准。需要在疾病的共同早期阶段收集PD患者的前瞻性队列并进行长期随访。
