Sorbonne Université, Assistance Publique Hôpitaux de Paris, Institut du Cerveau et de la Moelle épinière, ICM, Inserm U 1127, CNRS UMR 7225, Department of Neurology, Hôpital Pitié-Salpêtrière, F-75013, Paris, France.
Sorbonne University, CNRS, Institut de Biologie Paris Seine, Adaptation Biologique et Vieillissement, UMR8256, Paris, France.
Parkinsonism Relat Disord. 2019 Jul;64:226-234. doi: 10.1016/j.parkreldis.2019.04.012. Epub 2019 Apr 25.
Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's. The French clinical research network for PD (NS-Park) has created a national patient registry to i)report medical activity of Parkinson Expert Centers (PECs) to the Ministry of Health, ii)facilitate PD patients pre-screening for clinical trials, iii) provide a source for pharmaco-epidemiology studies.
Assess the French Parkinsonian population at a nation-wide level and discover new clinical characteristics.
In this feasibility study, PECs prospectively collected clinical data in a standardized manner. The population main clinical characteristics are described, focusing on motor and non-motor symptoms and treatments, assessing its representativeness. By using an unbiased clustering with multiple correspondence analysis (MCA), we also investigate potential relationships between multiple variables like symptoms and treatments, as clues for future studies.
Between 2012 and 2016, among 11,157 included parkinsonian syndromes, 9454 (85%) had PD. MCA identified various profiles depending on disease duration. Occurrences of motor complications, axial signs, cognitive disorders and Levodopa use increase over time. Neurovegetative symptoms, psychiatric disorders, sleep disturbances and impulse control disorders (ICDs) seem stable over time. As expected, ICDs were associated to dopaminergic agonist use but other associations, such as ICDs and sleep disturbances for instance, or anxiety and depression, were found.
Our results report one of the biggest PD registries ever reported and demonstrate the feasibility of implementing a nation-wide registry of PD patients in France, a potent tool for future longitudinal studies and clinical trials' population selection, and for pharmaco-epidemiology and cost-effectiveness studies.
帕金森病(PD)是仅次于阿尔茨海默病的第二大常见神经退行性疾病。法国帕金森病临床研究网络(NS-Park)创建了一个国家患者登记处,以 i)向卫生部报告帕金森专家中心(PECs)的医疗活动,ii)为临床试验筛选 PD 患者提供便利,iii)为药物流行病学研究提供来源。
在全国范围内评估法国帕金森人群,并发现新的临床特征。
在这项可行性研究中,PEC 以标准化方式前瞻性地收集临床数据。描述了人群的主要临床特征,重点关注运动和非运动症状和治疗,评估其代表性。通过使用多对应分析(MCA)的无偏聚类,我们还调查了症状和治疗等多个变量之间的潜在关系,作为未来研究的线索。
在 2012 年至 2016 年期间,在纳入的 11157 例帕金森综合征患者中,9454 例(85%)为 PD。MCA 根据疾病持续时间确定了不同的特征。运动并发症、轴性体征、认知障碍和左旋多巴的使用发生率随时间增加。神经植物性功能障碍、精神障碍、睡眠障碍和冲动控制障碍(ICD)似乎随时间稳定。正如预期的那样,ICD 与多巴胺激动剂的使用有关,但也发现了其他关联,例如 ICD 与睡眠障碍,或焦虑和抑郁有关。
我们的结果报告了迄今为止最大的 PD 登记之一,并证明了在法国实施全国性 PD 患者登记处的可行性,这是未来纵向研究和临床试验人群选择以及药物流行病学和成本效益研究的有力工具。