Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA.
Division of Biostatistics and Epidemiology, Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
J Neurol Neurosurg Psychiatry. 2018 Jun;89(6):566-571. doi: 10.1136/jnnp-2017-317378. Epub 2018 Mar 16.
To ascertain demographic and clinical features of Parkinson disease (PD) associated with functional neurological features.
A standardised form was used to extract data from electronic records of 53 PD patients with associated functional neurological disorders (PD-FND) across eight movement disorders centres in the USA, Canada and Europe. These subjects were matched for age, gender and disease duration to PD patients without functional features (PD-only). Logistic regression analysis was used to compare both groups after adjusting for clustering effect.
Functional symptoms preceded or co-occurred with PD onset in 34% of cases, nearly always in the most affected body side. Compared with PD-only subjects, PD-FND were predominantly female (68%), had longer delay to PD diagnosis, greater prevalence of dyskinesia (42% vs 18%; P=0.023), worse depression and anxiety (P=0.033 and 0.025, respectively), higher levodopa-equivalent daily dose (972±701 vs 741±559 mg; P=0.029) and lower motor severity (P=0.019). These patients also exhibited greater healthcare resource utilisation, higher use of [(123)I]FP-CIT SPECT and were more likely to have had a pre-existing psychiatric disorder (P=0.008) and family history of PD (P=0.036).
A subtype of PD with functional neurological features is familial in one-fourth of cases and associated with more psychiatric than motor disability and greater use of diagnostic and healthcare resources than those without functional features. Functional manifestations may be prodromal to PD in one-third of patients.
确定与功能性神经特征相关的帕金森病（PD）的人口统计学和临床特征。
使用标准化表格从美国、加拿大和欧洲 8 个运动障碍中心的 53 名 PD 伴发功能性神经障碍（PD-FND）患者的电子病历中提取数据。这些患者按照年龄、性别和疾病持续时间与无功能性特征的 PD 患者（PD-only）相匹配。采用逻辑回归分析，在调整聚类效应后比较两组患者。
功能性症状在 34%的病例中先于或与 PD 发病同时出现，几乎总是在受影响最严重的身体一侧。与 PD-only 患者相比，PD-FND 患者主要为女性（68%），PD 诊断延迟时间更长，更普遍存在运动障碍（42%对 18%；P=0.023），抑郁和焦虑更为严重（P=0.033 和 0.025），左旋多巴等效日剂量更高（972±701 对 741±559mg；P=0.029），运动严重程度更低（P=0.019）。这些患者还表现出更高的医疗保健资源利用，更频繁地使用 [(123)I]FP-CIT SPECT，并更有可能存在先前存在的精神障碍（P=0.008）和 PD 家族史（P=0.036）。
有四分之一的 PD 伴发功能性神经特征的亚型为家族性，与精神障碍比运动障碍更为相关，与无功能性特征的患者相比，使用诊断和医疗保健资源更多。三分之一的患者功能性表现可能是 PD 的前驱症状。
