Department of Neurosciences, Centre Hospitalier de Luxembourg, Luxembourg-City, Luxembourg.
Mov Disord. 2010 May 15;25(7):882-7. doi: 10.1002/mds.22963.
The objective of this study was to evaluate the discriminative power of different nonmotor signs for early diagnosis of Parkinson's disease (PD). Thirty patients with PD with <or=3 years of disease duration were compared with 30 healthy controls. Six deficit domains (DD) were defined: hyposmia, sleep abnormalities, dysautonomia, visual deficits, executive dysfunction, and depression. Plotting of Receiver operating characteristic (ROC) curves and exact conditional logistic modeling, followed by manual stepwise descending procedure were used to identify a model for nonmotor signs that detects early PD. Patients with PD and controls did not differ in terms of age, gender, and educational level. Several DD discriminated patients with PD from healthy controls. Visual deficits showed the largest area under the ROC curve (0.83), followed by hyposmia (0.81) and dysautonomia (0.80). When combining the DD visual deficits and dysautonomia, the best residual model was obtained; it maximized both sensitivity and specificity for PD at a level of 0.77. At an early disease stage, several nonmotor domains were already able to discriminate patients with PD from healthy controls. Visual deficits had the best discriminatory power. Being brief and inexpensive, visual tests should be further investigated in larger cohorts as potential screening tool for early PD.
本研究旨在评估不同非运动症状对帕金森病（PD）早期诊断的鉴别能力。将 30 名病程<或=3 年的 PD 患者与 30 名健康对照进行比较。定义了 6 个缺陷领域（DD）：嗅觉减退、睡眠异常、自主神经功能障碍、视觉缺陷、执行功能障碍和抑郁。绘制Receiver operating characteristic（ROC）曲线和精确条件逻辑模型，然后进行手动逐步降序程序，以确定一种用于检测早期 PD 的非运动症状模型。PD 患者和对照组在年龄、性别和教育水平方面没有差异。几个 DD 将 PD 患者与健康对照组区分开来。视觉缺陷的 ROC 曲线下面积最大（0.83），其次是嗅觉减退（0.81）和自主神经功能障碍（0.80）。当将 DD 视觉缺陷和自主神经功能障碍相结合时，获得了最佳的剩余模型；它以 0.77 的水平最大化了 PD 的敏感性和特异性。在疾病早期，几个非运动领域已经能够将 PD 患者与健康对照组区分开来。视觉缺陷具有最佳的鉴别能力。视觉测试简短且廉价，应在更大的队列中进一步研究，作为早期 PD 的潜在筛查工具。
