Department of Neurology, Haukeland University Hospital, Bergen, Norway; Institute for Clinical Medicine, University of Bergen, Bergen, Norway.
Parkinsonism Relat Disord. 2013 Nov;19(11):1027-32. doi: 10.1016/j.parkreldis.2013.07.010. Epub 2013 Aug 2.
The relative impact of motor- and non-motor symptoms on health-related quality of life in early Parkinson's disease is poorly documented.
188 patients with incident Parkinson's disease from a population-based study were examined at the time of diagnosis, before initiation of dopaminergic treatment, with follow-up of 166 patients three years later. Health-related quality of life was assessed by the 36-item Short-form Health Survey (SF-36). Motor and non-motor variables were derived from the Unified Parkinson's disease rating scale and other established scales.
Multiple regression analyses showed that the non-motor symptoms strongest associated with reduced SF-36 scores at diagnosis and three years later were depression, fatigue and sensory complaints. The motor symptoms most related to impaired SF-36 scores were problems with gait and activities of daily living that cover personal needs. The variance of SF-36 mental summary scores was much better explained by non-motor vs. motor symptoms, both at baseline (R(2) = 0.384 vs. 0.095) and 3 years later (R(2) = 0.441 vs. 0.195). Also SF-36 physical summary scores were better explained by non-motor vs. motor symptoms with R(2) = 0.372 vs. 0.322 at baseline and R(2) = 0.468 vs. 0.315 after 3 years.
In early PD, including the phase before dopaminergic treatment is initiated, non-motor symptoms are more important for reduced health-related quality of life than motor symptoms. Fatigue, depression, sensory complaints and gait disturbances emerge as the most relevant symptoms and should be given corresponding attention in the management of patients with early PD.
运动和非运动症状对早期帕金森病患者健康相关生活质量的相对影响记录甚少。
对一项基于人群的研究中，188 例新诊断的帕金森病患者在诊断时（即尚未开始多巴胺治疗时）进行了检查，166 例患者在 3 年后进行了随访。采用 36 项简明健康调查问卷（SF-36）评估健康相关生活质量。运动和非运动变量来自统一帕金森病评定量表和其他已建立的量表。
多元回归分析显示，在诊断时和 3 年后与 SF-36 评分降低最相关的非运动症状是抑郁、疲劳和感觉障碍。与 SF-36 评分受损最相关的运动症状是步态和日常生活活动问题，这些问题涉及个人需求。SF-36 心理总评分的方差主要由非运动症状而非运动症状来解释，基线时（R(2) = 0.384 比 0.095）和 3 年后（R(2) = 0.441 比 0.195）均如此。SF-36 生理总评分也主要由非运动症状而非运动症状来解释，基线时 R(2) = 0.372 比 0.322，3 年后 R(2) = 0.468 比 0.315。
在早期帕金森病中，包括开始多巴胺治疗之前的阶段，非运动症状对健康相关生活质量的降低比运动症状更为重要。疲劳、抑郁、感觉障碍和步态障碍是最相关的症状，在早期帕金森病患者的管理中应给予相应关注。
