帕金森病的非运动症状及其对一组摩洛哥患者生活质量的影响
Non-Motor Symptoms of Parkinson's Disease and Their Impact on Quality of Life in a Cohort of Moroccan Patients.
作者信息
Tibar Houyam, El Bayad Khalil, Bouhouche Ahmed, Ait Ben Haddou El Hachmia, Benomar Ali, Yahyaoui Mohamed, Benazzouz Abdelhamid, Regragui Wafa
机构信息
Research Team in Neurology and Neurogenetics, Faculty of Medicine and Pharmacy, Genomics Center of Human Pathologies, University Mohammed V, Rabat, Morocco.
Department of Neurology and Neurogenetics, Hôpital des spécialités de Rabat, Rabat, Morocco.
出版信息
Front Neurol. 2018 Apr 4;9:170. doi: 10.3389/fneur.2018.00170. eCollection 2018.
BACKGROUND
Non-motor symptoms (NMSs) are a real burden in Parkinson's disease (PD). They may appear in early pre-symptomatic stage as well as throughout the disease course. However, their relationship with the deterioration of the patient's quality of life (QoL) is still under debate. This study aimed to investigate the prevalence of NMSs and their impact on the QoL in a cohort of Moroccan patients.
METHODS
We carried out a cross-transactional study, where a total of 117 patients were submitted to a structured clinical interview and examination investigating motor and NMSs based on common and conventional scales. Motor symptoms were assessed by the UPDRS I-VI during ON condition. The NMSs were evaluated with common scales and their relationship with the QoL was investigated.
RESULTS
The mean patient's age was 60.77 ± 11.36 years old, and the median disease duration was 6 years [2.5-9.5]. Motor's phenotype subtypes were the mixed form in 40.2% of patients, akinetic-rigid in 20.5% and a tremor-dominant form in 39.3%. The median Hoehn and Yahr staging was 2 [1-2.5]. Regarding NMSs, the most common were urinary dysfunctions (82.6%), sleep (80.6%), and gastrointestinal (80%) disorders. Other autonomic dysfunctions were also frequent: thermoregulatory dysfunctions 58.6%, cardiovascular troubles 50.9%, and sexual dysfunctions 47.9%. Depression was present in 47.9% and fatigue symptoms in 23.1%. The median score of SCOPA-AUT was 14 [7.75-21.80]. The median PD questionnaire 39-score index (PDQ39-SI) was 23.22% and the most affected dimension was "mobility." Univariate and multivariate analyses showed that the SCOPA-AUT score impacted the QoL ( = 0.001), especially the gastrointestinal ( = 0.007), and cardiovascular ( = 0.049) dimensions.
CONCLUSION
Our data show that all patients have presented at least one NMS. Autonomic and sleep disorders were the most frequent, and in contrast to other studies, digestive and cardiovascular disorders were rather the factors influencing negatively the QoL of patients. Understanding the pathophysiology of these NMSs should be placed at the forefront in order to develop new therapeutic approaches by improving the QoL of PD patients.
背景
非运动症状（NMSs）是帕金森病（PD）的一项实际负担。它们可能在症状前期的早期阶段以及整个疾病过程中出现。然而，它们与患者生活质量（QoL）恶化之间的关系仍存在争议。本研究旨在调查一组摩洛哥患者中非运动症状的患病率及其对生活质量的影响。
方法
我们进行了一项交叉研究，共有117名患者接受了结构化临床访谈和检查，基于常用和传统量表调查运动症状和非运动症状。在“开”状态下通过统一帕金森病评定量表（UPDRS）I - VI评估运动症状。使用常用量表评估非运动症状，并研究它们与生活质量的关系。
结果
患者的平均年龄为60.77±11.36岁，疾病持续时间中位数为6年[2.5 - 9.5]。运动表型亚型中，40.2%的患者为混合型，20.5%为少动 - 强直型，39.3%为震颤为主型。Hoehn和Yahr分期中位数为2[1 - 2.5]。关于非运动症状，最常见的是排尿功能障碍（82.6%）、睡眠障碍（80.6%）和胃肠道疾病（80%）。其他自主神经功能障碍也很常见：体温调节功能障碍58.6%、心血管问题50.9%和性功能障碍47.9%。47.9%的患者存在抑郁，23.1%的患者有疲劳症状。SCOPA - AUT量表的中位数得分是14[7.75 - 21.80]。帕金森病问卷39得分指数（PDQ39 - SI）中位数为23.22%，受影响最大的维度是“移动性”。单因素和多因素分析表明，SCOPA - AUT得分影响生活质量（P = 0.001），尤其是胃肠道维度（P = 0.007）和心血管维度（P = 0.049）。
结论
我们的数据表明，所有患者至少出现一种非运动症状。自主神经和睡眠障碍最为常见，与其他研究不同的是，消化和心血管疾病是对患者生活质量产生负面影响的因素。为了通过改善帕金森病患者生活质量来开发新的治疗方法，应将了解这些非运动症状的病理生理学置于首位。
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