Moreau Caroline, Devos David, Baille Guillaume, Delval Arnaud, Tard Céline, Perez Thierry, Danel-Buhl Nicolas, Seguy David, Labreuche Julien, Duhamel Alain, Delliaux Marie, Dujardin Kathy, Defebvre Luc
Department of Neurology and Movement Disorders, CHU, Lille, France.
INSERM UMR_S 1171, Lille, France.
PLoS One. 2016 Sep 21;11(9):e0162904. doi: 10.1371/journal.pone.0162904. eCollection 2016.
Axial disorders are considered to appear late in the course of Parkinson's disease (PD). The associated impact on quality of life (QoL) and survival and the lack of an effective treatment mean that understanding and treating axial disorders is a key challenge. However, upper-body axial disorders (namely dysarthria, swallowing and breathing disorders) have never been prospectively assessed in early-stage PD patients.
To characterize upper-body axial symptoms and QoL in consecutive patients with early-stage PD.
We prospectively enrolled 66 consecutive patients with early-stage PD (less than 3 years of disease progression) and assessed dysarthria, dysphagia and respiratory function (relative to 36 controls) using both objective and patient-reported outcomes.
The mean disease duration was 1.26 years and the mean UPDRS motor score was 19.4 out of 108. 74% of the patients presented slight dysarthria (primarily dysprosodia). Men appeared to be more severely affected (i.e. dysphonia). This dysfunction was strongly correlated with low swallowing speed (despite the absence of complaints about dysphagia), respiratory insufficiency and poor QoL. Videofluorography showed that oral-phase swallowing disorders affected 60% of the 31 tested patients and that pharyngeal-phase disorders affected 21%. 24% of the patients reported occasional dyspnea, which was correlated with anxiety in women but not in men. Marked diaphragmatic dysfunction was suspected in 42% of the patients (predominantly in men).
Upper body axial symptoms were frequent in men with early-stage PD, whereas women presented worst non-motor impairments. New assessment methods are required because currently available tools do not reliably detect these upper-body axial disorders.
轴性障碍被认为在帕金森病（PD）病程后期出现。其对生活质量（QoL）和生存率的相关影响以及缺乏有效治疗手段意味着理解和治疗轴性障碍是一项关键挑战。然而，早期PD患者的上身轴性障碍（即构音障碍、吞咽和呼吸障碍）从未得到前瞻性评估。
描述连续的早期PD患者的上身轴性症状和生活质量。
我们前瞻性纳入了66例连续的早期PD患者（疾病进展少于3年），并使用客观和患者报告的结果评估了构音障碍、吞咽困难和呼吸功能（相对于36名对照者）。
平均病程为1.26年，平均UPDRS运动评分为108分中的19.4分。74%的患者存在轻度构音障碍（主要是韵律障碍）。男性似乎受影响更严重（即发声障碍）。这种功能障碍与吞咽速度低（尽管没有吞咽困难的主诉）、呼吸功能不全和生活质量差密切相关。视频荧光造影显示，31例受测患者中有60%存在口腔期吞咽障碍，21%存在咽期障碍。24%的患者报告偶尔出现呼吸困难，这与女性的焦虑相关，但与男性无关。42%的患者疑似存在明显的膈肌功能障碍（主要是男性）。
早期PD男性患者中上身轴性症状常见，而女性存在最严重的非运动功能损害。由于现有工具不能可靠地检测这些上身轴性障碍，因此需要新的评估方法。
