INSERM, Services de Pharmacologie Clinique et Neurosciences, Centre d'Investigation Clinique CIC 1436, NS-Park/FCRIN Network, NeuroToul COEN Center, Université de Toulouse UPS, CHU de Toulouse, Toulouse, France.
Institute of Cardiology Research, University of Buenos Aires, National Research Council (CONICET-ININCA), Buenos Aires, Argentina.
Eur J Neurol. 2017 Dec;24(12):1532-1538. doi: 10.1111/ene.13466. Epub 2017 Oct 9.
Studies assessing the correlations between L-DOPA-induced dyskinesias (LIDs) and motor fluctuations with health-related quality of life (HRQoL) in Parkinson's disease (PD) have yielded conflicting results. This study aimed to assess the relationship between LIDs and motor fluctuations with HRQoL in patients with PD, and to assess the relative contribution of their severity and duration in a large sample of patients with PD.
A total of 683 patients with PD from the COPARK survey were evaluated. HRQoL was assessed using the 39-Item Parkinson's Disease Questionnaire (PDQ-39) (primary outcome) and 36-Item Short Form Survey (SF-36). The daily duration and severity of LIDs were obtained from Unified Parkinson's Disease Rating Scale (UPDRS) IV items 32 and 33, respectively. The daily duration of motor fluctuations was obtained from UPDRS IV item 36 and severity was estimated as the difference between the UPDRS 2 (Activities of Daily Living) score in 'OFF' versus 'ON' condition.
A total of 235 patients with PD (35%) experienced motor fluctuations and 182 (27%) experienced LIDs. The PDQ-39 total and SF-36 physical scores were significantly worse in patients with LIDs, after adjusting for the presence of motor fluctuations. The PDQ-39 total score and SF-36 physical and mental score were significantly worse in patients with motor fluctuations, after adjusting for the presence of LIDs. The severity of LIDs and the duration of motor fluctuations significantly and independently affected PDQ-39 scores. The SF-36 physical score was affected only by the severity of motor fluctuations, whereas the mental score was not affected by any of the aforementioned variables.
Our findings suggest that LIDs (mainly their severity) and motor fluctuations (mainly their duration) correlate independently with HRQoL in patients with PD.
评估左旋多巴诱导的运动障碍（LIDs）与帕金森病（PD）患者的健康相关生活质量（HRQoL）之间的相关性的研究结果相互矛盾。本研究旨在评估 PD 患者中 LIDs 和运动波动与 HRQoL 的关系，并在大量 PD 患者样本中评估其严重程度和持续时间的相对贡献。
评估了 COPARK 调查中的 683 名 PD 患者。使用帕金森病问卷 39 项（PDQ-39）（主要结局）和 36 项简短健康调查问卷（SF-36）评估 HRQoL。LIDs 的每日持续时间和严重程度分别从统一帕金森病评定量表（UPDRS）IV 项 32 和 33 中获得。运动波动的每日持续时间从 UPDRS IV 项 36 中获得，严重程度估计为“OFF”与“ON”状态下 UPDRS 2（日常生活活动）评分之间的差值。
共有 235 名 PD 患者（35%）出现运动波动，182 名（27%）出现 LIDs。调整运动波动的存在后，LIDs 患者的 PDQ-39 总分和 SF-36 生理评分明显更差。调整 LIDs 的存在后，运动波动患者的 PDQ-39 总分和 SF-36 生理和心理评分明显更差。LIDs 的严重程度和运动波动的持续时间显著且独立地影响 PDQ-39 评分。SF-36 生理评分仅受运动波动严重程度的影响，而心理评分不受上述任何变量的影响。
我们的发现表明，LIDs（主要是其严重程度）和运动波动（主要是其持续时间）与 PD 患者的 HRQoL 独立相关。
