O'Sullivan Sean S, Williams David R, Gallagher David A, Massey Luke A, Silveira-Moriyama Laura, Lees Andrew J
Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, United Kingdom.
Mov Disord. 2008 Jan;23(1):101-6. doi: 10.1002/mds.21813.
Nonmotor symptoms (NMS) are increasingly recognized as a significant cause of morbidity in later stages of Parkinson's disease (PD). Prodromal NMS are also a well recognized component of the clinical picture in some patients but the prevalence of NMS as presenting complaints, and their impact on clinical management, in pathologically-proven cases of PD is unknown. The presenting complaints of 433 cases of pathologically-proven PD archived at the Queen Square Brain Bank for Neurological Diseases were identified from the clinical case notes. 91/433 (21%) of patients with PD presented with NMS of which the most frequent were pain (15%), urinary dysfunction (3.9%), anxiety, or depression (2.5%). Presenting with NMS is associated with a delayed diagnosis of PD (Mann-Whitney U, P = 0.001). These patients were more likely to be misdiagnosed initially and were more likely to have been referred to orthopedic surgeons or rheumatologists than neurologists (nonmotor group 5.5% vs. motor group 44.2%, chi(2) P < 0.0001). NMS are commonly seen as presenting complaints in pathologically confirmed PD, and initial misdiagnosis may be associated with potentially inappropriate medical interventions. Presenting with NMS does not affect the motor response to medication, but is associated with shorter disease duration (chi(2) P = 0.016).
非运动症状（NMS）日益被认为是帕金森病（PD）晚期发病的一个重要原因。前驱性非运动症状在一些患者的临床表现中也是一个公认的组成部分，但在经病理证实的帕金森病病例中，以非运动症状作为首发主诉的发生率及其对临床管理的影响尚不清楚。从临床病例记录中确定了伦敦大学学院神经病学研究所皇后广场脑库存档的433例经病理证实的帕金森病患者的首发主诉。433例帕金森病患者中有91例（21%）以非运动症状为首发表现，其中最常见的是疼痛（15%）、排尿功能障碍（3.9%）、焦虑或抑郁（2.5%）。以非运动症状为首发表现与帕金森病的诊断延迟相关（曼-惠特尼U检验，P = 0.001）。这些患者最初更有可能被误诊，并且比起被转诊给神经科医生，他们更有可能被转诊给骨科医生或风湿病医生（非运动症状组为5.5%，运动症状组为44.2%，卡方检验P < 0.0001）。在经病理证实的帕金森病中，非运动症状常被视为首发主诉，最初的误诊可能与潜在的不适当医疗干预有关。以非运动症状为首发表现并不影响对药物的运动反应，但与疾病持续时间较短有关（卡方检验P = 0.016）。
