Elbaz A
Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, Inserm, Villejuif, France.
Rev Neurol (Paris). 2016 Aug-Sep;172(8-9):503-511. doi: 10.1016/j.neurol.2016.07.001. Epub 2016 Aug 5.
In recent years, there has been a major shift in our understanding of the course of Parkinson's disease (PD) from a disease of the brain to a disease of long latency, characterized by the progressive emergence of multiple non-motor symptoms, including hyposmia, constipation, depression, anxiety, rapid eye movement (REM) sleep behavior disorder and excessive daytime sleepiness, as well as subtle motor signs, before the typical motor signs appear. Epidemiological studies have made major contributions by allowing better characterization of subsequent PD risk in relation to non-motor symptoms. Such findings have profound implications for the conduct of epidemiological studies examining risk and protective factors in PD, and the interpretation of their findings. Given the length of the prodromal period, reverse causation in particular is a major concern with many reported associations. One striking feature of PD etiology, compared with other diseases, is the presence of numerous inverse associations. If these associations are truly causal, they would have major implications for disease prevention and for slowing disease progression. However, whether these associations are truly causal remains to be demonstrated in future studies. Experimental studies play an important role by offering a better understanding of the underlying mechanisms. Well-designed epidemiological studies using innovative approaches will also be key in elucidating whether these intriguing associations are causal or a consequence of reverse causation.
近年来，我们对帕金森病（PD）病程的理解发生了重大转变，从一种脑部疾病转变为一种具有长潜伏期的疾病，其特征是在典型运动症状出现之前，多种非运动症状逐渐出现，包括嗅觉减退、便秘、抑郁、焦虑、快速眼动（REM）睡眠行为障碍和日间过度嗜睡，以及细微的运动体征。流行病学研究通过更好地描述与非运动症状相关的后续PD风险做出了重大贡献。这些发现对开展研究PD风险和保护因素的流行病学研究及其结果的解释具有深远影响。鉴于前驱期的时长，特别是反向因果关系是许多已报道关联的主要关注点。与其他疾病相比，PD病因的一个显著特征是存在众多反向关联。如果这些关联是真正的因果关系，它们将对疾病预防和减缓疾病进展产生重大影响。然而，这些关联是否真正具有因果关系仍有待未来研究证实。实验研究通过提供对潜在机制的更好理解发挥着重要作用。使用创新方法进行精心设计的流行病学研究对于阐明这些有趣的关联是因果关系还是反向因果关系的结果也至关重要。
