Smith Kara M, Xie Sharon X, Weintraub Daniel
Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Neurol Neurosurg Psychiatry. 2016 Aug;87(8):864-70. doi: 10.1136/jnnp-2015-311827. Epub 2015 Nov 3.
To describe the incidence of, and clinical and neurobiological risk factors for, new-onset impulse control disorder (ICD) symptoms and related behaviours in early Parkinson disease (PD).
The Parkinson's Progression Markers Initiative is an international, multicenter, prospective study of de novo patients with PD untreated at baseline and assessed annually, including serial dopamine transporter imaging (DAT-SPECT) and ICD assessment (Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease short form, QUIP). Participants were included if they screened negative on the QUIP at baseline. Kaplan-Meier curves and generalised estimating equations examined frequency and predictors of incident ICD symptoms.
Participants were seen at baseline (n=320), year 1 (n=284), year 2 (n=217) and year 3 (n=96). Estimated cumulative incident rates of ICD symptoms and related behaviours were 8% (year 1), 18% (year 2) and 25% (year 3) and increased each year in those on dopamine replacement therapy (DRT) and decreased in those not on DRT. In participants on DRT, risk factors for incident ICD symptoms were younger age (OR=0.97, p=0.05), a greater decrease in right caudate (OR=4.03, p=0.01) and mean striatal (OR=6.90, p=0.04) DAT availability over the first year, and lower right putamen (OR=0.06, p=0.01) and mean total striatal (OR=0.25, p=0.04) DAT availability at any post-baseline visit.
The rate of incident ICD symptoms increases with time and initiation of DRT in early PD. In this preliminary study, a greater decrease or lower DAT binding over time increases risk of incident ICD symptoms, conferring additional risk to those taking DRT.
NCT01141023.
描述帕金森病（PD）早期新发冲动控制障碍（ICD）症状及相关行为的发生率、临床和神经生物学危险因素。
帕金森病进展标志物倡议是一项针对基线时未接受治疗且每年进行评估的初发PD患者的国际多中心前瞻性研究，包括连续多巴胺转运体成像（DAT-SPECT）和ICD评估（帕金森病冲动控制障碍问卷简表，QUIP）。如果参与者在基线时QUIP筛查为阴性，则纳入研究。采用Kaplan-Meier曲线和广义估计方程来研究ICD症状的发生频率和预测因素。
在基线（n=320）、第1年（n=284）、第2年（n=217）和第3年（n=96）对参与者进行了观察。ICD症状及相关行为的估计累积发生率在第1年为8%，第2年为18%，第3年为25%，接受多巴胺替代疗法（DRT）的患者每年增加，未接受DRT的患者每年减少。在接受DRT的参与者中，ICD症状发生的危险因素包括年龄较小（OR=0.97，p=0.05）、第一年右侧尾状核（OR=4.03，p=0.01）和平均纹状体（OR=6.90，p=0.04）DAT可用性下降幅度较大，以及在基线后任何一次访视时右侧壳核（OR=0.06，p=0.01）和平均总纹状体（OR=0.25，p=0.04）DAT可用性较低。
在PD早期，ICD症状的发生率随时间和DRT的开始而增加。在这项初步研究中，随着时间的推移，DAT结合的更大下降或更低水平会增加ICD症状发生的风险，给接受DRT的患者带来额外风险。
NCT01141023。
