Department of Neurology, Daisan Hospital, The University School of Medicine, 4-11-1, Izumihoncho, Komae, Tokyo 201-8601, Japan.
J Neurol. 2010 Jun;257(6):969-76. doi: 10.1007/s00415-009-5447-1. Epub 2010 Jan 30.
Several studies have reported that olfactory dysfunction is an early neuropathological manifestation of Parkinson's disease (PD). Reduced cardiac meta-iodobenzylguanidine ((123)I-MIBG) uptake may be one of the earliest signs of PD. We studied the relation of olfactory dysfunction to cardiovascular dysautonomia in patients with PD. The study group comprised 66 patients with PD (70.5 years) and 26 controls (70.3 years) for olfactory assessment, 21 controls (72.1 years) for cardiac (123)I-MIBG scintigraphy and heart rate variability (HRV), assessed using the coefficient of variation for RR intervals (HRV), and 23 controls (69.2 years) for orthostatic blood pressure response. Olfactory function was assessed by the odor stick identification test Japan (OSIT-J), and cardiovascular autonomic function was evaluated by (123)I-MIBG scintigraphy of the heart, the fall in orthostatic blood pressure, and HRV. Patients with PD had a significantly lower OSIT-J score than did the controls (4.1 +/- 3.0 vs. 9.9 +/- 1.7, p = 0.001). The OSIT-J score was unrelated to variables other than gender, including age, disease duration, motor score on the unified Parkinson's disease rating scale, score on the mini-mental state examination, motor phenotype, visual hallucinations, and dopaminergic medication on multiple regression and logistic regression analyses. The OSIT-J score was related to the heart/mediastinum ratio of cardiac (123)I-MIBG uptake, the fall in orthostatic blood pressure, and HRV, after adjustment for other clinical variables. Olfactory dysfunction in PD was, thus, significantly related to both cardiac sympathetic and parasympathetic dysfunction, as well as vascular sympathetic dysfunction. As non-motor symptoms of PD, olfactory dysfunction and autonomic network failure appear to be closely related in PD.
几项研究报告指出，嗅觉功能障碍是帕金森病（PD）的早期神经病理学表现之一。心脏去甲碘代苄胍（123I-MIBG）摄取减少可能是 PD 的最早迹象之一。我们研究了 PD 患者嗅觉功能障碍与心血管自主神经功能障碍的关系。研究组包括 66 名 PD 患者（70.5 岁）和 26 名对照组（70.3 岁）进行嗅觉评估，21 名对照组（72.1 岁）进行心脏 123I-MIBG 闪烁显像和心率变异性（HRV）评估，使用 RR 间期的变异系数（HRV），以及 23 名对照组（69.2 岁）进行直立血压反应。嗅觉功能通过日本气味棒识别测试（OSIT-J）进行评估，心血管自主神经功能通过心脏 123I-MIBG 闪烁显像、直立血压下降和 HRV 进行评估。PD 患者的 OSIT-J 评分明显低于对照组（4.1 ± 3.0 对 9.9 ± 1.7，p = 0.001）。在多元回归和逻辑回归分析中，OSIT-J 评分与性别以外的其他变量无关，包括年龄、疾病持续时间、统一帕金森病评定量表的运动评分、简易精神状态检查评分、运动表型、视觉幻觉和多巴胺能药物。在调整其他临床变量后，OSIT-J 评分与心脏/纵隔比值的心脏 123I-MIBG 摄取、直立血压下降和 HRV 相关。因此，PD 中的嗅觉功能障碍与心脏交感和副交感功能障碍以及血管交感功能障碍显著相关。作为 PD 的非运动症状，嗅觉功能障碍和自主神经网络衰竭在 PD 中似乎密切相关。
