Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, C/Villarroel 170, 08036, Barcelona, Spain.
J Neurol. 2015 Jun;262(6):1568-78. doi: 10.1007/s00415-015-7742-3. Epub 2015 May 1.
Parkinson disease (PD) patients may experience nonmotor symptoms (NMS) before Parkinsonism onset. Patients with idiopathic REM sleep behavior disorder (IRBD) eventually develop PD and may represent premotor PD. We aimed to evaluate the prevalence and perceived timeline of NMS in IRBD through validated scales and questionnaires used in PD research. In 44 IRBD patients and 40 matched controls, overall NMS evaluation was assessed by NMS questionnaire for Parkinson disease, olfaction by University of Pennsylvania Smell Identification Test, dysautonomia by scales for outcomes in Parkinson's disease-autonomic, constipation by Rome III criteria, depression by Hospital Anxiety and Depression Scale, cognitive impairment by Montreal cognitive assessment (MoCA) and hypersomnia by Epworth Sleepiness Scale. Patients were asked to report the perceived time of onset of hyposmia, constipation, and depression. Hyposmia (52.3 vs. 20.0 %, p = 0.002) and constipation (56.8 vs. 20.0 %, p = 0.001) were more frequent in patients than in controls. Patients reported more memory problems and showed a trend toward lower score in MoCA. Depression and hypersomnia were not more frequent in patients. The first symptom perceived was RBD in 38.6 % patients, hyposmia in 15.9 %, constipation in 11.4 %, and depression in 6.8 %. The temporal course of the NMS studied was heterogeneous. The three most common presentations were RBD followed by hyposmia; hyposmia followed by RBD; and hyposmia followed by RBD and constipation occurring at the same time span. IRBD patients frequently exhibit NMS that occur in premotor PD, particularly hyposmia and constipation. In IRBD, the perceived timeline of NMS is highly variable. This variability may suggest that pathological changes occurring in IRBD subjects are also heterogeneous and not restricted to the structures that regulate REM sleep.
帕金森病（PD）患者在出现帕金森症之前可能会经历非运动症状（NMS）。特发性 REM 睡眠行为障碍（IRBD）患者最终会发展为 PD，可能代表前驱 PD。我们旨在通过 PD 研究中使用的经过验证的量表和问卷来评估 IRBD 中 NMS 的患病率和感知时间线。在 44 名 IRBD 患者和 40 名匹配的对照者中，通过帕金森病 NMS 问卷、宾夕法尼亚大学嗅觉识别测试评估嗅觉、帕金森病自主功能障碍量表评估自主神经功能障碍、罗马 III 标准评估便秘、医院焦虑和抑郁量表评估抑郁、蒙特利尔认知评估（MoCA）评估认知障碍和 Epworth 嗜睡量表评估嗜睡，对整体 NMS 进行评估。患者被要求报告嗅觉减退、便秘和抑郁的感知发病时间。患者中嗅觉减退（52.3%比 20.0%，p=0.002）和便秘（56.8%比 20.0%，p=0.001）的发生率高于对照组。患者报告有更多的记忆问题，且在 MoCA 中的得分较低。患者中抑郁和嗜睡的发生率没有增加。38.6%的患者首先出现 RBD，15.9%的患者首先出现嗅觉减退，11.4%的患者首先出现便秘，6.8%的患者首先出现抑郁。所研究的 NMS 的时间进程是异质的。最常见的三种表现是 RBD 后出现嗅觉减退；嗅觉减退后出现 RBD；以及同时出现嗅觉减退、RBD 和便秘。IRBD 患者经常出现发生在前驱 PD 中的 NMS，特别是嗅觉减退和便秘。在 IRBD 中，NMS 的感知时间线变化很大。这种可变性可能表明，IRBD 患者发生的病理变化也具有异质性，并且不限于调节 REM 睡眠的结构。
