Evatt Marian L, Chaudhuri K Ray, Chou Kelvin L, Cubo Ester, Hinson Vanessa, Kompoliti Katie, Yang Chengwu, Poewe Werner, Rascol Olivier, Sampaio Cristina, Stebbins Glenn T, Goetz Christopher G
Section of Movement Disorders, Department of Neurology, Emory University School of Medicine, Atlanta, Georgia 30329, USA.
Mov Disord. 2009 Apr 15;24(5):635-46. doi: 10.1002/mds.22260.
Upper and lower gastrointestinal dysautonomia symptoms (GIDS)--sialorrhea, dysphagia, and constipation are common in Parkinson's disease (PD) and often socially as well as physically disabling for patients. Available invasive quantitative measures for assessing these symptoms and their response to therapy are time-consuming, require specialized equipment, can cause patient discomfort and present patients with risk. The Movement Disorders Society commissioned a task force to assess available clinical rating scales, critique their clinimetric properties, and make recommendations regarding their clinical utility. Six clinical researchers and a biostatistician systematically searched the literature for scales of sialorrhea, dysphagia, and constipation, evaluated the scales' previous use, performance parameters, and quality of validation data (if available). A scale was designated "Recommended" if the scale was used in clinical studies beyond the group that developed it, has been specifically used in PD reports, and clinimetric studies have established that it is a valid, reliable, and sensitive. "Suggested" scales met at least part of the above criteria, but fell short of meeting all. Based on the systematic review, scales for individual symptoms of sialorrhea, dysphagia, and constipation were identified along with three global scales that include these symptoms in the context of assessing dysautonomia or nonmotor symptoms. Three sialorrhea scales met criteria for Suggested: Drooling Severity and Frequency Scale (DSFS), Drooling Rating Scale, and Sialorrhea Clinical Scale for PD (SCS-PD). Two dysphagia scales, the Swallowing Disturbance Questionnaire (SDQ) and Dysphagia-Specific Quality of Life (SWAL-QOL), met criteria for Suggested. Although Rome III constipation module is widely accepted in the gastroenterology community, and the earlier version from the Rome II criteria has been used in a single study of PD patients, neither met criteria for Suggested or Recommended. Among the global scales, the Scales for Outcomes in PD-Autonomic (SCOPA-AUT) and Nonmotor Symptoms Questionnaire for PD (NMSQuest) both met criteria for Recommended, and the Nonmotor Symptoms Scale (NMSS) met criteria for Suggested; however, none specifically focuses on the target gastrointestinal symptoms (sialorrhea, dysphagia, and constipation) of this report. A very small number of rating scales have been applied to studies of gastrointestinal-related dysautonomia in PD. Only two scales met "Recommended" criteria and neither focuses specifically on the symptoms of sialorrhea, dysphagia, and constipation. Further scale testing in PD among the scales that focus on these symptoms is warranted, and no new scales are needed until the available scales are fully tested clinimetrically.
上下消化道自主神经功能障碍症状（GIDS）——流涎、吞咽困难和便秘在帕金森病（PD）中很常见，并且常常给患者带来社交和身体上的不便。现有的用于评估这些症状及其对治疗反应的侵入性定量方法耗时、需要专门设备、会给患者带来不适并使患者面临风险。运动障碍协会委托一个特别工作组评估现有的临床评定量表，批评其测量特性，并就其临床实用性提出建议。六名临床研究人员和一名生物统计学家系统地在文献中搜索流涎、吞咽困难和便秘的量表，评估这些量表以前的使用情况、性能参数以及验证数据的质量（如果有）。如果一个量表在其开发团队之外的临床研究中使用过，专门用于PD报告，并且测量学研究已确定它是有效、可靠且敏感的，则该量表被指定为“推荐”。“建议”量表至少满足上述部分标准，但未全部满足。基于系统评价，确定了流涎、吞咽困难和便秘单个症状的量表以及三个综合量表，这些综合量表在评估自主神经功能障碍或非运动症状的背景下包含这些症状。三个流涎量表符合“建议”标准：流涎严重程度和频率量表（DSFS）、流涎评定量表以及PD流涎临床量表（SCS-PD）。两个吞咽困难量表，吞咽障碍问卷（SDQ）和吞咽特异性生活质量量表（SWAL-QOL），符合“建议”标准。尽管罗马III便秘模块在胃肠病学界被广泛接受，并且罗马II标准的早期版本已在一项PD患者研究中使用，但两者均未达到“建议”或“推荐”标准。在综合量表中，PD自主神经功能障碍结局量表（SCOPA-AUT）和PD非运动症状问卷（NMSQuest）均符合“推荐”标准，非运动症状量表（NMSS）符合“建议”标准；然而，没有一个量表专门关注本报告的目标胃肠道症状（流涎、吞咽困难和便秘）。极少数评定量表已应用于PD中与胃肠道相关的自主神经功能障碍研究。只有两个量表符合“推荐”标准，且均未专门关注流涎、吞咽困难和便秘症状。有必要在专注于这些症状的量表中对PD进行进一步的量表测试，在现有量表进行充分的测量学测试之前不需要新的量表。
