Liu Rui, Umbach David M, Peddada Shyamal D, Xu Zongli, Tröster Alexander I, Huang Xuemei, Chen Honglei
From the Epidemiology Branch (R.L., Z.X., H.C.) and Biostatistics and Computational Biology Branch (D.M.U., S.D.P.) of the National Institute of Environmental Health Sciences, Research Triangle Park, NC; Barrow Neurological Institute (A.I.T.), Phoenix, AZ; Department of Neurology (X.H.), Pennsylvania State University-Milton S. Hershey Medical Center, Hershey, PA.
Neurology. 2015 May 26;84(21):2107-15. doi: 10.1212/WNL.0000000000001609. Epub 2015 Apr 29.
To examine potential sex differences in nonmotor symptoms (NMS) among drug-naive patients with Parkinson disease (PD), and to identify NMS that can best differentiate patients with early PD from controls.
Our cross-sectional analysis included 414 newly diagnosed, untreated patients with PD (269 men and 145 women) and 188 healthy controls (121 men and 67 women) in the Parkinson's Progression Markers Initiative Study. NMS were measured using well-validated instruments covering sleep, olfactory, neurobehavioral, autonomic, and neuropsychological domains.
Male and female patients with PD were fairly comparable on motor presentations but differed on several nonmotor features. Male patients with PD had significantly more pronounced deficits in olfaction (p = 0.02) and in certain cognitive measurements (all p < 0.01) than female patients, whereas female cases experienced higher trait anxiety (p = 0.02). Multiple stepwise logistic regression analysis showed that the combination of NMS measures-University of Pennsylvania Smell Identification Test (UPSIT), Montreal Cognitive Assessment (MoCA), Scales for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT), and state anxiety from the State-Trait Anxiety Inventory-effectively differentiated patients with PD from controls with an area under the receiver operating characteristic curve (AUC) of 0.913 (95% confidence interval [CI]: 0.89-0.94). UPSIT, MoCA, and SCOPA-AUT were the most predictive NMS measurements in men (AUC = 0.919; 95% CI: 0.89-0.95) as compared to UPSIT, MoCA, and REM Sleep Behavior Disorder Screening Questionnaire in women (AUC = 0.903; 95% CI: 0.86-0.95).
Our analysis revealed notable sex differences in several nonmotor features of patients with de novo PD. Furthermore, we found a parsimonious NMS combination that could effectively differentiate de novo cases from healthy controls.
研究初发帕金森病（PD）患者非运动症状（NMS）的潜在性别差异，并确定最能区分早期PD患者与对照组的NMS。
我们的横断面分析纳入了帕金森病进展标志物倡议研究中的414例新诊断、未治疗的PD患者（269例男性和145例女性）以及188例健康对照者（121例男性和67例女性）。使用经过充分验证的涵盖睡眠、嗅觉、神经行为、自主神经和神经心理领域的工具来测量NMS。
PD男性和女性患者在运动表现方面相当，但在一些非运动特征上存在差异。与女性患者相比，PD男性患者在嗅觉（p = 0.02）和某些认知测量方面（均p < 0.01）有更明显的缺陷，而女性患者特质焦虑水平更高（p = 0.02）。多步逻辑回归分析表明，NMS测量指标——宾夕法尼亚大学嗅觉识别测试（UPSIT）、蒙特利尔认知评估（MoCA）、帕金森病自主神经功能结局量表（SCOPA - AUT）以及状态 - 特质焦虑量表中的状态焦虑——的组合能够有效区分PD患者与对照组，受试者工作特征曲线下面积（AUC）为0.913（95%置信区间[CI]：0.89 - 0.94）。与女性患者中的UPSIT、MoCA和快速眼动睡眠行为障碍筛查问卷相比，UPSIT、MoCA和SCOPA - AUT在男性患者中是最具预测性的NMS测量指标（AUC = 0.919；95% CI：0.89 - 0.95）（女性患者中AUC = 0.903；95% CI：0.86 - 0.95）。
我们的分析揭示了初发PD患者在几个非运动特征方面存在显著的性别差异。此外，我们发现了一种简洁的NMS组合，能够有效区分初发病例与健康对照者。
