van der Heeden Jorine F, Marinus Johan, Martinez-Martin Pablo, van Hilten Jacobus J
Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Parkinsonism Relat Disord. 2016 Apr;25:39-44. doi: 10.1016/j.parkreldis.2016.02.016. Epub 2016 Feb 17.
In spite of the multisystem nature of Parkinson's disease (PD), the formal assessment of its impairments is focused on symptoms predominantly reflecting degeneration of dopaminergic neurons. The aim of this study was to develop a valid and reliable rating scale of predominantly non-dopaminergic (PND) symptoms, which can be used as an additional measure of severity and progression of PD.
Using data of the PROPARK (N = 396) and ELEP (N = 365) cohorts, three items were selected from each of six selected PND domains (cognitive impairment, depressive symptoms, excessive daytime sleepiness, psychotic symptoms, autonomic dysfunction and Postural-Instability-and-Gait-Difficulty), based on item-total correlations. Hereafter, we evaluated reliability and validity of the resulting scale.
The 18-item PND scale showed to be reliable and valid. Cronbach's alpha was 0.83. Principal component analysis using the six domain scores resulted in one factor, justifying the calculation of a sum score. Correlation coefficients of the sum score with severity of non-motor symptoms (non-motor part of MDS-UPDRS), motor symptoms (SPES/SCOPA scale), and Hoehn and Yahr stage were 0.63, 0.41 and 0.48, respectively (p < 0.001).
We developed a short, reliable and valid scale to evaluate severity of PND symptoms in PD. The score is expected to be largely insensitive to dopaminergic effects and may therefore more accurately reflect severity and progression of the underlying disease than currently used dopamine-sensitive measures. In combination with assessment of predominantly dopaminergic (motor) symptoms, a broad yet concise evaluation of PD is obtained, which better captures the widespread clinical consequences of the multisystem disease.
尽管帕金森病（PD）具有多系统性质，但其损伤的正式评估主要集中在主要反映多巴胺能神经元变性的症状上。本研究的目的是开发一种有效且可靠的主要非多巴胺能（PND）症状评定量表，该量表可作为评估PD严重程度和病情进展的额外指标。
利用PROPARK队列（N = 396）和ELEP队列（N = 365）的数据，基于项目与总分的相关性，从六个选定的PND领域（认知障碍、抑郁症状、日间过度嗜睡、精神症状、自主神经功能障碍和姿势不稳及步态困难）中各选取三个项目。此后，我们评估了所得量表的信度和效度。
18项PND量表显示出可靠且有效。克朗巴哈系数为0.83。使用六个领域得分进行主成分分析得到一个因子，证明可以计算总分。总分与非运动症状严重程度（MDS-UPDRS的非运动部分）、运动症状（SPES/SCOPA量表）以及Hoehn和Yahr分期的相关系数分别为0.63、0.41和0.48（p < 0.001）。
我们开发了一种简短、可靠且有效的量表来评估PD中PND症状的严重程度。预计该评分对多巴胺能效应在很大程度上不敏感，因此可能比目前使用的对多巴胺敏感的测量方法更准确地反映潜在疾病的严重程度和病情进展。结合对主要多巴胺能（运动）症状的评估，可以对PD进行广泛而简洁的评估，从而更好地捕捉这种多系统疾病广泛的临床后果。
