Mätzold Sara, Geritz Johanna, Zeuner Kirsten E, Berg Daniela, Paschen Steffen, Hieke Johanne, Sablowsky Simone, Ortlieb Christian, Bergmann Philipp, Hofmann Werner, Espay Alberto J, Maetzler Walter
Department of Neurology, University Hospital Schleswig Holstein, Campus Kiel, Christian-Albrechts-University, Arnold-Heller-Str. 3, Haus 41, 24105, Kiel, Germany.
Department of Internal Medicine I, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany.
Z Gerontol Geriatr. 2019 Jul;52(4):324-329. doi: 10.1007/s00391-019-01562-y. Epub 2019 May 28.
The proportion of patients with functional movement disorders (FMD) is particularly high in neurology clinics. Treatment options have not been consistently developed, not well evaluated and not validated. This article presents the preliminary data on the prevalence and treatment response of patients with FMD who were treated within the framework of an early rehabilitative geriatric complex treatment at a university hospital for neurology.
From July 2017 to November 2018 the prevalence, demographic and clinical parameters, and response to treatment of FMD patients were documented and compared to non-FMD patients treated at the neurogeriatric ward of the University Hospital Schleswig-Holstein, in Kiel. Clinical endpoints were the Short Physical Performance Battery (SPPB) for mobility and the Barthel index for instrumented activity of daily life (iADL).
The prevalence of FMD was 11% (19/175) and predominantly observed in women (74%). Of the FMD patients nine also had a diagnosis of either idiopathic Parkinson's disease (N = 7), dementia with Lewy bodies (N = 1) or progressive supranuclear palsy (N = 1). At admission, neither the SPPB nor the iADL differed significantly between FMD and non-FMD patients. The treatment response was comparable between the groups: SPPB change was +0.3±1.8 (mean, standard deviation) in FMD and +0.4±1.9 in non-FMD patients (p = 0.83). The iADL change was +19±15 in FMD and +18±17 in non-FMD (p = 0.83).
The prevalence of FMD was unexpectedly high in the neurogeriatric ward of a German university hospital. There were comparable impairments and responses to multidisciplinary treatment in mobility and iADL between FMD and non-FMD geriatric patients, suggesting that specific and informed treatment provided by a multidisciplinary geriatric team is effective in geriatric FMD patients. Further studies of this underdiagnosed disorder in older age are warranted.
在神经科门诊中，功能性运动障碍（FMD）患者的比例特别高。治疗方案尚未得到持续开发、充分评估和验证。本文介绍了在一所大学医院神经科进行的早期康复老年综合治疗框架内接受治疗的FMD患者的患病率和治疗反应的初步数据。
2017年7月至2018年11月，记录了FMD患者的患病率、人口统计学和临床参数以及治疗反应，并与基尔市石勒苏益格-荷尔斯泰因大学医院神经老年病房治疗的非FMD患者进行比较。临床终点是用于评估活动能力的简短体能状况量表（SPPB）和用于评估日常生活工具性活动（iADL）的巴氏指数。
FMD的患病率为11%（19/175），主要见于女性（74%）。在FMD患者中，有9例还被诊断为特发性帕金森病（N = 7）、路易体痴呆（N = 1）或进行性核上性麻痹（N = 1）。入院时，FMD患者和非FMD患者之间的SPPB和iADL均无显著差异。两组的治疗反应相当：FMD患者的SPPB变化为+0.3±1.8（平均值，标准差），非FMD患者为+0.4±1.9（p = 0.83）。iADL变化在FMD患者中为+19±15，在非FMD患者中为+18±17（p = 0.83）。
在德国一所大学医院的神经老年病房中，FMD的患病率出乎意料地高。FMD老年患者和非FMD老年患者在活动能力和iADL方面对多学科治疗的损伤和反应相当，这表明多学科老年团队提供的特定且明智的治疗对老年FMD患者有效。有必要对这种在老年人中诊断不足的疾病进行进一步研究。
