Baig Fahd, Lawton Michael, Rolinski Michal, Ruffmann Claudio, Nithi Kannan, Evetts Samuel G, Fernandes Hugo R, Ben-Shlomo Yoav, Hu Michele T M
Oxford Parkinson's Disease Centre, University of Oxford, Oxford, United Kingdom.
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
Mov Disord. 2015 Nov;30(13):1759-66. doi: 10.1002/mds.26281. Epub 2015 Jul 14.
Nonmotor symptoms (NMS) are an important prodromal feature of Parkinson's disease (PD). However, their frequency, treatment rates, and impact on health-related quality of life (HRQoL) in the early motor phase is unclear. Rates of NMS in enriched at-risk populations, such as first-degree PD relatives, have not been delineated. We assessed NMS in an early cohort of PD, first-degree PD relatives and control subjects to address these questions. In total, 769 population-ascertained PD subjects within 3.5 years of diagnosis, 98 first-degree PD relatives, and 287 control subjects were assessed at baseline across the following NMS domains: (1) neuropsychiatric; (2) gastrointestinal; (3) sleep; (4) sensory; (5) autonomic; and (6) sexual. NMS were much more common in PD, compared to control subjects. More than half of the PD cases had hyposmia, pain, fatigue, sleep disturbance, or urinary dysfunction. NMS were more frequent in those with the postural instability gait difficulty phenotype, compared to the tremor dominant (mean total number of NMS 7.8 vs. 6.2; P < 0.001). PD cases had worse HRQoL scores than controls (odds ratio: 4.1; P < 0.001), with depression, anxiety, and pain being stronger drivers than motor scores. NMS were rarely treated in routine clinical practice. First-degree PD relatives did not significantly differ in NMS, compared to controls, in this baseline study. NMS are common in early PD and more common in those with postural instability gait difficulty phenotype or on treatment. Despite their major impact on quality of life, NMS are usually under-recognized and untreated.
非运动症状（NMS）是帕金森病（PD）的一个重要前驱特征。然而，在运动症状出现的早期阶段，它们的发生率、治疗率以及对健康相关生活质量（HRQoL）的影响尚不清楚。在诸如帕金森病患者的一级亲属等高危人群中，非运动症状的发生率尚未明确。我们对一组早期帕金森病患者、一级亲属和对照受试者进行了非运动症状评估，以解决这些问题。在基线时，总共对769名确诊3.5年内的社区帕金森病患者、98名一级亲属和287名对照受试者进行了以下非运动症状领域的评估：（1）神经精神方面；（2）胃肠道方面；（3）睡眠方面；（4）感觉方面；（5）自主神经方面；（6）性功能方面。与对照受试者相比，非运动症状在帕金森病患者中更为常见。超过一半的帕金森病患者存在嗅觉减退、疼痛、疲劳、睡眠障碍或排尿功能障碍。与震颤为主型患者相比，姿势不稳步态障碍型患者的非运动症状更为频繁（非运动症状总数平均为7.8 vs. 6.2；P < 0.001）。帕金森病患者的健康相关生活质量得分比对照组差（优势比：4.1；P < 0.001），其中抑郁、焦虑和疼痛对生活质量的影响比运动症状得分更强。在常规临床实践中，非运动症状很少得到治疗。在这项基线研究中，一级亲属与对照组相比，非运动症状无显著差异。非运动症状在早期帕金森病中很常见，在姿势不稳步态障碍型患者或接受治疗的患者中更为常见。尽管非运动症状对生活质量有重大影响，但通常未得到充分认识和治疗。
