Hong Sang Bin, Ahn Jeeyun, Yoo Dalla, Shin Joo Young, Jeon Beomseok, Lee Jee-Young
Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center & Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Shindaebang-dong, Seoul, 07061, South Korea.
Department of Neurology, Seoul National University Hospital & Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea.
Neurol Sci. 2020 Jul;41(7):1837-1842. doi: 10.1007/s10072-020-04289-6. Epub 2020 Feb 15.
To investigate the contrast sensitivity function in drug-naïve Parkinson's disease (PD) patients and its predictive value with longitudinal follow-up data.
We included newly diagnosed non-demented PD patients who performed contrast sensitivity test between 2013 and 2014. Contrast sensitivity function at drug-naïve state in PD patients was compared with age-matched normal control data of our center. Correlation between contrast sensitivity function and parkinsonian motor and non-motor features including the Mini-Mental State Exam (MMSE) score at the time of diagnosis were analyzed by linear regression. With longitudinal follow-up data after initiating anti-parkinsonian therapy, the risk conferred on subsequent visual hallucinations and cognitive impairment requiring anti-dementia drugs was analyzed by dichotomizing PD group based on the initial contrast sensitivity function.
Forty-eight patients were finally included, and mean follow-up periods were 43 months. Contrast sensitivity function in drug-naïve PD patients was significantly worse than controls. Contrast sensitivity function correlated with sleep disturbance (p = 0.001) and global cognitive status reflected by the MMSE score (p = 0.020). It also associated with further decline in the MMSE during the follow-ups (p = 0.029). Patients with below average contrast sensitivity function at the time of diagnosis showed higher risk of cognitive decline requiring anti-dementia drugs (adjusted odds ratio = 4.68, p = 0.04) and of visual hallucinations (adjusted odds ratio = 12.54, p = 0.04) than those above average function during the follow-up.
Contrast sensitivity impairment in drug-naïve PD patients associates with clinical demand for therapeutic intervention of cognitive decline as well as development of visual hallucinations in the early course of the disease.
研究未经药物治疗的帕金森病（PD）患者的对比敏感度函数及其纵向随访数据的预测价值。
纳入2013年至2014年间进行对比敏感度测试的新诊断非痴呆PD患者。将PD患者未经药物治疗状态下的对比敏感度函数与本中心年龄匹配的正常对照数据进行比较。通过线性回归分析对比敏感度函数与帕金森运动和非运动特征（包括诊断时的简易精神状态检查表（MMSE）评分）之间的相关性。利用开始抗帕金森治疗后的纵向随访数据，根据初始对比敏感度函数对PD组进行二分法分析，以分析后续出现视幻觉和需要抗痴呆药物治疗的认知障碍的风险。
最终纳入48例患者，平均随访期为43个月。未经药物治疗的PD患者的对比敏感度函数明显差于对照组。对比敏感度函数与睡眠障碍（p = 0.001）和MMSE评分所反映的整体认知状态（p = 0.020）相关。它还与随访期间MMSE的进一步下降相关（p = 0.029）。诊断时对比敏感度函数低于平均水平的患者在随访期间出现需要抗痴呆药物治疗的认知下降（调整优势比 = 4.68，p = 0.04）和视幻觉（调整优势比 = 12.54，p = 0.04）的风险高于对比敏感度函数高于平均水平的患者。
未经药物治疗的PD患者的对比敏感度损害与疾病早期认知下降的治疗干预临床需求以及视幻觉的发生相关。
