Neurology Department, Hospital General Yagüe, Burgos, Spain.
Mov Disord. 2010 Jan 15;25(1):70-5. doi: 10.1002/mds.22896.
In patients with Parkinson's disease (PD), asymmetric motor signs provide an interesting model to evaluate whether asymmetric nigrostriatal degeneration can affect neuropsychological function and other nonmotor symptoms (NMS). This study was designed to evaluate the predominant laterality of motor symptoms and its relationship with cognition and other NMS in idiopathic PD.
Nationwide, longitudinal, and multicenter study (ELEP Registry) using outpatients with PD. Left PD (LPD) and right PD (RPD) was defined based on the motor signs on the SCOPA-motor scale. To include the clinical spectrum of asymmetric PD patients, we considered two groups of patients with mild-moderate and extreme asymmetry. Predominant LPD or RPD with mild-moderate versus extreme asymmetry were compared using the following scales: cognition, psychosis (Parkinson Psychosis Rating Scale), anxiety/depression, sleep (and autonomic dysfunction at baseline and 1 year later. Nonparametric tests were used for comparison.
One hundred forty-nine PD patients (74 RPD and 75 LPD) with mild-moderate asymmetry and 90 (47 RPD and 43 LPD) with extreme asymmetry and a mean age of 64.5 (10.4) years were included. Extreme RPD had higher Parkinson Psychosis Rating Scale scores over time (P = 0.005) compared with LPD, but no significant differences were observed between LPD and RPD in terms of other NMS.
These findings suggest that damage to left-hemisphere plays a disproportionately greater role in PD-related psychosis over time. In contrast, motor laterality does not consistently affect other NMS, suggesting that NMS are related to a more widespread brain disorder.
在帕金森病(PD)患者中,不对称的运动症状为评估不对称黑质纹状体变性是否会影响神经心理学功能和其他非运动症状(NMS)提供了一个有趣的模型。本研究旨在评估特发性 PD 患者运动症状的主要偏侧性及其与认知和其他 NMS 的关系。
本研究采用全国性、纵向、多中心研究(ELEP 登记研究),纳入 PD 门诊患者。根据 SCOPA-motor 量表上的运动体征,将左侧 PD(LPD)和右侧 PD(RPD)定义为左 PD(LPD)和右 PD(RPD)。为了包括不对称 PD 患者的临床谱,我们考虑了两组轻度至中度和极度不对称的患者。使用以下量表比较轻度至中度和极度不对称的主要 LPD 或 RPD:认知、精神病(帕金森精神病评定量表)、焦虑/抑郁、睡眠(以及自主神经功能障碍)。采用非参数检验进行比较。
共纳入 149 例轻度至中度不对称的 PD 患者(74 例 RPD 和 75 例 LPD)和 90 例极度不对称的 PD 患者(47 例 RPD 和 43 例 LPD),平均年龄为 64.5(10.4)岁。与 LPD 相比,极度 RPD 随着时间的推移帕金森精神病评定量表评分更高(P = 0.005),但 LPD 和 RPD 之间在其他 NMS 方面没有显著差异。
这些发现表明,左侧半球的损伤随着时间的推移在 PD 相关精神病中起着不成比例的更大作用。相比之下,运动偏侧性并不一致地影响其他 NMS,这表明 NMS 与更广泛的脑障碍有关。