Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
VA Western NY Healthcare System, Buffalo, NY, USA.
J Parkinsons Dis. 2018;8(4):539-552. doi: 10.3233/JPD-181375.
In Parkinson's disease (PD), postural instability-gait disorder (PIGD) has been associated with more rapid cognitive decline, dementia, and greater non-motor symptom (NMS) burden.
To assess the importance of balance-gait disorder, relative to and in combination with other clinical measures, as a risk factor for cognitive impairment, dementia and NMS burden in PD.
164 PD subjects were evaluated in a retrospective cross-sectional study using the MDS-UPDRS scale, MMSE and Clinical Dementia Rating Scale. Using univariate comparisons followed by multiple stepwise regression, we identified factors most closely associated with NMS burden and concurrent dementia. Nominal logistic regression and linear discriminant analysis was used to compute receiver operating characteristic curves and to measure sensitivity and specificity of predictors of dementia.
Dementia was more frequent in those with the PIGD phenotype (χ2 = 11.49, p = 0.003). The MDS-UPDRS balance-gait measure, excluding freezing of gait, was the single best predictor not only of concurrent cognitive impairment and dementia (F = 37.16, p < 0.001) but also of NMS burden, predicting 29% of the MDS-UPDRS total non-motor experiences of daily living score (F = 67.14, p < 0.0001). This measure, together with combined severity of hallucinations/psychosis, daytime sleepiness and urinary problems, a closely correlated symptom cluster (r = 0.63 p < 0.0001), accurately classified 84% of patients with dementia.
In PD, balance-gait impairment is closely associated with dementia and NMS burden, particularly the linked symptoms of cognitive impairment, psychosis, daytime sleepiness and urinary dysfunction. This phenotype characterizes patients likely to require closer surveillance and more comprehensive care. Confirmation of these findings in prospective longitudinal studies might help refine predictive algorithms designed to identify PD patients more likely to progress from mild cognitive impairment to dementia.
在帕金森病（PD）中，姿势不稳-步态障碍（PIGD）与认知能力下降、痴呆和更大的非运动症状（NMS）负担相关。
评估平衡-步态障碍相对于其他临床指标的重要性，以及作为 PD 认知障碍、痴呆和 NMS 负担的危险因素。
在一项回顾性横断面研究中，164 名 PD 患者使用 MDS-UPDRS 量表、MMSE 和临床痴呆评定量表进行评估。通过单变量比较和多步逐步回归，我们确定了与 NMS 负担和并发痴呆最密切相关的因素。名义逻辑回归和线性判别分析用于计算接受者操作特征曲线，并测量痴呆预测因子的敏感性和特异性。
PIGD 表型患者痴呆更常见（χ2 = 11.49，p = 0.003）。MDS-UPDRS 平衡-步态测量值，不包括冻结步态，不仅是认知障碍和痴呆的最佳预测指标（F = 37.16，p < 0.001），也是 NMS 负担的最佳预测指标，预测 MDS-UPDRS 非运动性日常生活体验总分的 29%（F = 67.14，p < 0.0001）。该测量值与幻觉/精神病、白天嗜睡和尿失禁的综合严重程度相结合，这是一个密切相关的症状群（r = 0.63，p < 0.0001），准确地将 84%的痴呆患者分类。
在 PD 中，平衡-步态障碍与痴呆和 NMS 负担密切相关，特别是认知障碍、精神病、白天嗜睡和尿功能障碍等相关症状。这种表型特征是患者需要更密切监测和更全面护理的原因。前瞻性纵向研究的验证可以帮助完善预测算法，以识别更有可能从轻度认知障碍进展为痴呆的 PD 患者。
