From the Center of Parkinsonism and Movement Disorders (B.M., E.T., F.S.-D., T.W., J.E., M.S., E.L., C.T.), Paracelsus-Elena-Klinik, Kassel; Department of Neurosurgery (B.M., N.K.F., C.T.), University Medical Centre, Goettingen; Department of Psychology (E.T.), University Kassel; Section of Clinical and Molecular Neurogenetics at the Department of Neurology (K.R.K., K.L., C.K.), University of Luebeck; Departments of Neuropathology (B.M.) and Medical Statistics (T.F.), University Medical Centre, Goettingen, Germany; Program in Neuroscience (M.G.S.), Ottawa Hospital Research Institute; Division of Neurology, The Ottawa Hospital, University of Ottawa, Canada; and ReSearch Pharmaceutical Services (R.K.), Nuremberg, Germany.
Neurology. 2013 Oct 1;81(14):1226-34. doi: 10.1212/WNL.0b013e3182a6cbd5. Epub 2013 Aug 30.
To determine nonmotor signs (NMS) and evaluate the utility of several diagnostic tools in patients with de novo Parkinson disease (PD).
This is a large single-center study of the DeNoPa cohort, including frequency-matched healthy controls. This study covers motor signs, NMS, and a combination of diagnostic tests including olfactory testing, transcranial sonography of substantia nigra (TCS), and polysomnography (PSG). We report the frequency and characteristics of NMS and the outcomes of nonmotor tests at the time of diagnosis.
Cross-sectional analyses of baseline investigations identified significant differences in the NMS Questionnaire (NMSQuest) and the Scopa-AUT Gastrointestinal score in 159 drug-naïve PD patients vs 110 controls. In addition, patients with PD showed reduced olfactory function, hyperechogenicity on TCS, and higher frequency of REM sleep behavior disorder (RBD). In exploring predictive markers, we found that the combination of several investigations, i.e., the NMSQuest, Scopa-AUT Gastrointestinal score, and Smell Identification Test reached an area under the receiver operating characteristic curve (AUC) of 0.913 (95% confidence interval [CI] 0.878-0.948). With the addition of serum cholesterol and mean heart rate values, the AUC value reached 0.919 (95% CI 886-0.953); when TCS and PSG were added, the AUC increased to 0.963 (95% CI 0.943-0.982).
We show feasibility and utility of standardized data acquisition in a large, single-center cohort of patients with de novo PD and matched healthy controls. The baseline results from our prospective investigations reached a value of >0.9 sensitivity and specificity for biological markers when we added routine laboratory investigations and quantified nonmotor features including sleep.
确定新发帕金森病（PD）患者的非运动症状（NMS）并评估几种诊断工具的效用。
这是一项大型单中心 DeNoPa 队列研究，包括频率匹配的健康对照者。本研究涵盖运动症状、NMS 以及包括嗅觉测试、黑质经颅超声（TCS）和多导睡眠图（PSG）在内的组合诊断测试。我们报告 NMS 问卷（NMSQuest）和 Scopa-AUT 胃肠道评分在 159 例初发 PD 患者与 110 例对照者中的频率和特征，以及诊断时非运动测试的结果。
基线研究的横断面分析显示，159 例初发 PD 患者与 110 例对照者的 NMSQuest 和 Scopa-AUT 胃肠道评分存在显著差异。此外，PD 患者嗅觉功能降低、TCS 回声增强，以及 REM 睡眠行为障碍（RBD）的发生率较高。在探索预测标志物时，我们发现几项检查的组合，即 NMSQuest、Scopa-AUT 胃肠道评分和嗅觉识别测试的曲线下面积（AUC）达到 0.913（95%置信区间 [CI] 0.878-0.948）。当加入血清胆固醇和平均心率值时，AUC 值达到 0.919（95% CI 0.886-0.953）；当加入 TCS 和 PSG 时，AUC 增加至 0.963（95% CI 0.943-0.982）。
我们展示了在大型单中心初发 PD 患者和匹配的健康对照者队列中进行标准化数据采集的可行性和实用性。当我们加入常规实验室检查并量化包括睡眠在内的非运动特征时，我们的前瞻性研究的基线结果达到了 >0.9 的敏感性和特异性的生物标志物值。
