Wada-Isoe Kenji, Tanaka Kenichiro, Uemura Yusuke, Nakashita Satoko, Tajiri Yuki, Tagashira Shugo, Yamamoto Mikie, Yamawaki Mika, Kishi Masafumi, Nakashima Kenji
Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan.
Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan.
J Neurol Sci. 2016 Mar 15;362:7-13. doi: 10.1016/j.jns.2016.01.016. Epub 2016 Jan 9.
We aimed to clarify the longitudinal course of mild parkinsonian signs (MPS) and their association with dementia and functional disability by conducting a comprehensive epidemiological study, including brain MRI, and assessments of cognition, depression, and sleep, in people aged ≥65years living in Ama-cho. We diagnosed MPS and parkinsonism (PS) using a modified Unified Parkinson's Disease Rating Scale. The phase I study was conducted between 2008 and 2010 (n=729) and the phase II between 2011 and 2013 (n=436). By phase II, 8.5% of the phase I participants without PS had developed PS. In addition to older age, a lower Mini-Mental State Examination (MMSE) score, and lower body mass index, the MPS rigidity subtype was a significant independent predictor of PS onset. By phase II, 10.1% of the participants without dementia or PS at phase I had developed dementia. Older age, lower MMSE score, and the axial dysfunction and tremor MPS subtypes were significant independent predictors of dementia development. By phase II, 38.8% of participants with MPS at phase I showed no motor symptoms. Younger age and adequate sleep were significant predictors for this reversion. Periventricular and deep white matter hyperintensity Fazekas scores increased with the evolution of parkinsonian signs. MPS is therefore critically, although sometimes reversibly, associated with PS and dementia development in elderly people.
我们旨在通过开展一项全面的流行病学研究，包括脑部磁共振成像（MRI）以及对认知、抑郁和睡眠的评估，来阐明轻度帕金森氏征（MPS）的纵向病程及其与痴呆和功能残疾的关联，研究对象为居住在阿马町年龄≥65岁的人群。我们使用改良的统一帕金森病评定量表来诊断MPS和帕金森症（PS）。第一阶段研究于2008年至2010年进行（n = 729），第二阶段于2011年至2013年进行（n = 436）。到第二阶段时，第一阶段无PS的参与者中有8.5%患上了PS。除了年龄较大、简易精神状态检查表（MMSE）得分较低和体重指数较低外，MPS强直亚型是PS发病的一个重要独立预测因素。到第二阶段时，第一阶段无痴呆或PS的参与者中有10.1%患上了痴呆。年龄较大、MMSE得分较低以及轴向功能障碍和震颤MPS亚型是痴呆发展的重要独立预测因素。到第二阶段时，第一阶段患有MPS的参与者中有38.8%未出现运动症状。年龄较小和充足睡眠是这种逆转的重要预测因素。脑室周围和深部白质高信号的 Fazekas评分随着帕金森氏征的进展而增加。因此，MPS与老年人的PS和痴呆发展密切相关，尽管有时是可逆的。
