Zhang LingYu, Cao Bei, Zou Yutong, Wei Qian-Qian, Ou RuWei, Zhao Bi, Yang Jing, Wu Ying, Shang HuiFang
Department of Neurology and National Clinical Research Center for Geriatrics (West China Hospital), West China Hospital, Sichuan University, Chengdu, Sichuan, China.
West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
Restor Neurol Neurosci. 2019;37(1):11-19. doi: 10.3233/RNN-180862.
Cognitive impairment is an important and common symptom in patients with multiple system atrophy (MSA).
The objective of the study was to explore the potential relationships among frontal lobe function, behavioral changes and quality of life (QoL) in patients with MSA.
A total of 203 MSA patients were enrolled and evaluated using the Frontal Assessment Battery (FAB), the Frontal Behavioral Inventory (FBI) and the Parkinson's disease Questionnaire-39 item version (PDQ-39). Seventy-eight age-, sex-, and education-matched healthy controls were recruited to complete the FAB.
Among MSA patients, those with frontal lobe dysfunction were older (P = 0.005), had older age of onset (P = 0.002), lower educational level (P < 0.001), higher scores in the PDQ-39 domains of mobility (P = 0.042), ADL (P = 0.020), cognition (P < 0.001) and communication compared to those with normal frontal lobe function. The most common frontal behavioral changes were logopenia followed by apathy and inflexibility. The severity of frontal behavioral changes was associated with MSA subtype (P = 0.015), disease severity (Unified Multiple System Atrophy Rating Scale-I (UMSARS-I), UMSARS-II, UMSARS-IV, and total UMSARS scores) (P < 0.001), orthostatic hypotension (P = 0.022), severity of depressive symptoms and total score on the PDQ-39 (P < 0.001). Binary logistic regression showed that the determinants of poor QoL in patients with MSA were disease severity (UMSARS-I and total UMSARS scores) (P < 0.05), depression (P = 0.013) and total FBI score (P = 0.003).
Frontal behavioral changes were potential determinants of poor QoL in MSA, in addition to the disease severity and depressive symptoms. Early discovery and management of frontal behavioral changes in addition to motor and depressive symptoms will help to improve the QoL of MSA patients.
认知障碍是多系统萎缩（MSA）患者重要且常见的症状。
本研究旨在探讨MSA患者额叶功能、行为改变与生活质量（QoL）之间的潜在关系。
共纳入203例MSA患者，使用额叶评估量表（FAB）、额叶行为量表（FBI）和帕金森病问卷39项版本（PDQ-39）进行评估。招募78名年龄、性别和教育程度匹配的健康对照者完成FAB。
在MSA患者中，与额叶功能正常者相比，额叶功能障碍者年龄更大（P = 0.005）、起病年龄更大（P = 0.002）、教育程度更低（P < 0.001），在PDQ-39的活动能力（P = 0.042）、日常生活活动能力（P = 0.020）、认知（P < 0.001）和沟通领域得分更高。最常见的额叶行为改变是言语减少，其次是冷漠和僵化。额叶行为改变的严重程度与MSA亚型（P = 0.015）、疾病严重程度（统一多系统萎缩评定量表-I（UMSARS-I）、UMSARS-II、UMSARS-IV和UMSARS总分）（P < 0.001）、直立性低血压（P = 0.022）、抑郁症状严重程度和PDQ-39总分（P < 0.001）相关。二元逻辑回归显示，MSA患者生活质量差的决定因素是疾病严重程度（UMSARS-I和UMSARS总分）（P < 0.05）、抑郁（P = 0.013）和FBI总分（P = 0.003）。
除疾病严重程度和抑郁症状外，额叶行为改变是MSA患者生活质量差的潜在决定因素。除运动和抑郁症状外，早期发现和处理额叶行为改变将有助于改善MSA患者的生活质量。
