Department of Neurology, Shuguang Hospital Affiliated with Shanghai University of TCM, 185 Pu-An Road, Shanghai 200021, China.
Physiol Behav. 2013 Jul 2;119:156-60. doi: 10.1016/j.physbeh.2013.05.044. Epub 2013 Jun 6.
Although the Unified Parkinson's Disease Rating Scale (UPDRS) is the "gold-standard" tool in assessing the severity of symptoms in patients with Parkinson's disease (PD), not all activity-related disease symptoms can be accurately captured by the well-established clinical rating scale. Using an alternative approach, this study examined the level of physical activity measured by actigraphy over time and whether change in physical activity was associated with disease severity assessed by UPDRS. We used a longitudinal design in which physical activity and disease severity were assessed repeatedly during a 4-month interval, over a 3-year observational period, in a sample of 61 patients with idiopathic PD and a control group of 32 neurologically intact individuals. Physical activity data during awake-time were analyzed using the power-law exponent (PLE) method. Correlational relationships between changes in maxima values of PLE and scores of total UPDRS, UPDRS-part II (Activities of Daily Living), and UPDRS-part III (Motor Examination) in patients with PD were examined. Results show an increase in maxima values of PLE and the UPDRS total score in PD patients and that there is a positive association between changes in maxima values and total UPDRS score (r=0.746, p=0.032), UPDRS-part II score (r=0.687, p=0.027), and UPDRS-part III score (r=0.893, p=0.018). There was no significant change in the level of physical activity over time for the controls. Findings from this study indicate that change in physical activity, as captured by actigraphy, is associated with increased severity in patients' clinical symptoms of PD over time. Thus, these data suggest that, when used in conjunction with the conventional UPDRS measure, an actigraphic measure of physical activity may provide clinicians an adjunct measurement approach to monitor patients' activity-based disease progression or responses to treatment in outpatient clinic settings.
虽然统一帕金森病评定量表（UPDRS）是评估帕金森病（PD）患者症状严重程度的“金标准”工具，但并非所有与活动相关的疾病症状都能被这一成熟的临床评定量表准确捕捉。本研究采用替代方法，通过一段时间的活动记录仪测量来评估患者的身体活动水平，并探讨身体活动的变化是否与 UPDRS 评估的疾病严重程度相关。在这项为期 3 年的观察研究中，我们采用纵向设计，在 4 个月的时间间隔内，对 61 名特发性 PD 患者和 32 名神经功能正常的对照组进行了反复的身体活动和疾病严重程度评估。在清醒时间内，使用幂律指数（PLE）方法分析身体活动数据。对 PD 患者 PLE 最大值的变化与 UPDRS 总分、UPDRS-Ⅱ（日常生活活动）和 UPDRS-Ⅲ（运动检查）评分之间的相关关系进行了检验。结果显示，PD 患者的 PLE 最大值和 UPDRS 总分均升高，且 PLE 最大值的变化与 UPDRS 总分（r=0.746，p=0.032）、UPDRS-Ⅱ评分（r=0.687，p=0.027）和 UPDRS-Ⅲ评分（r=0.893，p=0.018）呈正相关。对照组的身体活动水平在整个研究期间没有显著变化。这些研究结果表明，活动记录仪测量的身体活动变化与 PD 患者临床症状严重程度的随时间增加有关。因此，这些数据表明，当与传统的 UPDRS 测量方法结合使用时，活动记录仪测量的身体活动可能为临床医生提供一种辅助测量方法，以便在门诊环境中监测患者的基于活动的疾病进展或对治疗的反应。
