Hertie Institute for Clinical Brain Research, Department of Neurodegeneration, University of Tuebingen, Tuebingen, Germany.
German Center for Neurodegenerative Diseases, Tuebingen, Germany.
Eur J Neurol. 2017 Nov;24(11):1369-1374. doi: 10.1111/ene.13397. Epub 2017 Sep 5.
The neuropathological process starts years before the diagnosis of Parkinson's disease (PD). Assessment of prodromal features in healthy individuals may help to define those with high risk for future PD. Our aim was to evaluate the presence and progression of prodromal markers in individuals with low risk [healthy controls (HC), n = 14] and high risk for PD (HR-PD, n = 34) and early PD (n = 14) patients.
Several risk or prodromal markers were combined to define HR-PD. Other prodromal markers were followed in 6-month intervals for 2 years. As recommended by the Movement Disorder Society Task Force, likelihood ratios (LRs) of markers, motor scores and PD probability scores were calculated and compared.
The baseline LR for non-motor prodromal markers was significantly higher in PD and HR-PD compared to HC. Within 2 years, changes in these LRs did not significantly differ between the groups. Motor worsening was significant only in the PD group (50% of the patients) against HR-PD (15%) and HC (7%). Change in the non-motor prodromal LR did not significantly correlate with motor worsening, but higher baseline non-motor LRs were associated with Unified Parkinson's Disease Rating Scale III values at 2 years of follow-up.
Our study shows that the frequency of non-motor prodromal markers is higher in the HR-PD group but does not increase within 2 years. The progression of motor and non-motor markers seems to be independent, but higher baseline non-motor burden is associated with the motor status after 2 years. Moreover, our data argue for a high impact of motor markers in the risk estimation for future PD.
帕金森病（PD）的神经病理学过程早在诊断前数年就已开始。对前驱特征的评估可能有助于确定那些未来患 PD 风险较高的个体。我们的目的是评估低风险个体[健康对照（HC），n=14]和 PD 高风险（HR-PD，n=34）和早期 PD（n=14）患者中前驱标志物的存在和进展。
将几种风险或前驱标志物结合起来定义 HR-PD。其他前驱标志物在 2 年内每 6 个月随访一次。根据运动障碍协会工作组的建议，计算并比较了标志物、运动评分和 PD 概率评分的似然比（LR）。
与 HC 相比，PD 和 HR-PD 的非运动前驱标志物的基线 LR 明显更高。在 2 年内，这些 LR 的变化在组间无显著差异。只有 PD 组（50%的患者）出现运动恶化，而 HR-PD（15%）和 HC（7%）没有。非运动前驱 LR 的变化与运动恶化无显著相关性，但较高的基线非运动 LR 与 2 年随访时的统一帕金森病评定量表 III 值相关。
我们的研究表明，HR-PD 组中出现非运动前驱标志物的频率更高，但在 2 年内没有增加。运动和非运动标志物的进展似乎是独立的，但较高的基线非运动负担与 2 年后的运动状态相关。此外，我们的数据表明运动标志物对未来 PD 的风险评估具有重要影响。
