Buchman Aron S, Leurgans Sue E, Yu Lei, Wilson Robert S, Lim Andrew S, James Bryan D, Shulman Joshua M, Bennett David A
From Rush Alzheimer's Disease Center (A.S.B., S.E.L., L.Y., R.S.W., B.D.J., D.A.B.); Departments of Neurological Sciences (A.S.B., S.E.L., D.A.B.), Behavioral Sciences (R.S.W.), and Internal Medicine (B.D.J.), Rush University Medical Center, Chicago, IL; Department of Neurology (A.S.L.), University of Toronto, Canada; Departments of Neurology, Molecular and Human Genetics, Neuroscience, and Program in Developmental Biology (J.M.S.), Baylor College of Medicine; and Jan and Dan Duncan Neurological Research Institute (J.M.S.), Texas Children's Hospital, Houston.
Neurology. 2016 Sep 6;87(10):1036-44. doi: 10.1212/WNL.0000000000003059. Epub 2016 Aug 3.
To determine the incidence of parkinsonism in community-dwelling older adults without Parkinson disease.
Four parkinsonian signs were assessed with a modified motor portion of the Unified Parkinson's Disease Rating Scale in 2,001 older adults without parkinsonism. We used Cox proportional hazards models to determine the associations of age and sex with incident parkinsonism (2 or more signs). We calculated the number of events per 1,000 person-years of observation in 3 age strata. Next, we investigated several potential risk factors for incident parkinsonism. Then, we examined longitudinal progression of parkinsonism using discrete-time multistate Markov models.
Average age at baseline was 76.8 years (SD 7.62 years). During an average of 5 years of follow-up, 964/2,001 (48.2%) developed parkinsonism. Age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.08-1.10) but not male sex (HR 1.06, 95% CI 0.91-1.23) was associated with incident parkinsonism. The incidence of parkinsonism per 1,000 person-years of follow-up was 36.0 for adults <75 years of age, 94.8 for those 75-84, and 160.5 for those 85 years or older. Depressive symptoms, neuroticism, urinary incontinence, sleep complaints, and chronic health conditions were associated with incident parkinsonism. Secondary analyses suggest that risk factors are linked with incident parkinsonism via early motor signs of parkinsonism and cognitive function. Transition modeling suggests that while parkinsonism may fluctuate, it is progressive in most older adults and its risk factors increase the odds of its progression.
Parkinsonism is common in older adults and increases with age. Identifying modifiable risk factors may decrease the magnitude of this growing public health problem.
确定无帕金森病的社区居住老年人中帕金森综合征的发病率。
使用改良的统一帕金森病评定量表运动部分对2001名无帕金森综合征的老年人评估四项帕金森体征。我们使用Cox比例风险模型来确定年龄和性别与帕金森综合征（2项或更多体征）发病的关联。我们计算了3个年龄层每1000人年观察期内的发病数。接下来，我们调查了帕金森综合征发病的几个潜在风险因素。然后，我们使用离散时间多状态马尔可夫模型研究帕金森综合征的纵向进展情况。
基线时的平均年龄为76.8岁（标准差7.62岁）。在平均5年的随访期间，964/2001（48.2%）的人出现了帕金森综合征。年龄（风险比[HR]1.09，95%置信区间[CI]1.08 - 1.10）而非男性性别（HR 1.06，95%CI 0.91 - 1.23）与帕金森综合征发病有关。<75岁成年人每1000人年随访期内帕金森综合征的发病率为36.0，75 - 84岁者为94.8，85岁及以上者为160.5。抑郁症状、神经质、尿失禁、睡眠问题和慢性健康状况与帕金森综合征发病有关。二次分析表明，风险因素通过帕金森综合征的早期运动体征和认知功能与帕金森综合征发病相关。转换模型表明，虽然帕金森综合征可能有波动，但在大多数老年人中是进行性的，且其风险因素会增加病情进展的几率。
帕金森综合征在老年人中很常见，且随年龄增长而增加。识别可改变的风险因素可能会降低这一日益严重的公共卫生问题的严重程度。
