Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.
Department of Neurology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China; MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 114 16th Street, Charlestown, MA, 02129, United States.
J Affect Disord. 2020 May 1;268:118-126. doi: 10.1016/j.jad.2020.02.046. Epub 2020 Feb 28.
BACKGROUND: Depressive disturbances in Parkinson's disease (dPD) have been identified as the most important determinant of quality of life in patients with Parkinson's disease (PD). Prediction models to triage patients at risk of depression early in the disease course are needed for prognosis and stratification of participants in clinical trials. METHODS: One machine learning algorithm called extreme gradient boosting (XGBoost) and the logistic regression technique were applied for the prediction of clinically significant depression (defined as The 15-item Geriatric Depression Scale [GDS-15] ≥ 5) using a prospective cohort study of 312 drug-naïve patients with newly diagnosed PD during 2-year follow-up from the Parkinson's Progression Markers Initiative (PPMI) database. Established models were assessed with out-of-sample validation and the whole sample was divided into training and testing samples by the ratio of 7:3. RESULTS: Both XGBoost model and logistic regression model achieved good discrimination and calibration. 2 PD-specific factors (age at onset, duration) and 4 nonspecific factors (baseline GDS-15 score, State Trait Anxiety Inventory [STAI] score, Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire [RBDSQ] score, and history of depression) were identified as important predictors by two models. LIMITATIONS: Access to several variables was limited by database. CONCLUSIONS: In this longitudinal study, we developed promising tools to provide personalized estimates of depression in early PD and studied the relative contribution of PD-specific and nonspecific predictors, constituting a substantial addition to the current understanding of dPD.
背景:帕金森病(PD)中的抑郁障碍已被确定为 PD 患者生活质量的最重要决定因素。需要预测模型来在疾病早期对有抑郁风险的患者进行分诊,以便对预后和临床试验参与者进行分层。
方法:我们应用了一种名为极端梯度提升(XGBoost)的机器学习算法和逻辑回归技术,对来自帕金森进展标志物倡议(PPMI)数据库的 312 名新诊断的、未经药物治疗的 PD 患者在 2 年随访期间进行前瞻性队列研究,以预测临床上显著的抑郁(定义为 15 项老年抑郁量表[GDS-15]≥5)。使用外部样本验证评估了既定模型,并且通过 7:3 的比例将整个样本分为训练和测试样本。
结果:XGBoost 模型和逻辑回归模型都实现了良好的区分度和校准度。两个 PD 特异性因素(发病年龄、病程)和 4 个非特异性因素(基线 GDS-15 评分、状态特质焦虑量表[STAI]评分、快速眼动睡眠行为障碍筛查问卷[RBDSQ]评分和抑郁史)被两个模型确定为重要预测因素。
局限性:由于数据库的限制,对多个变量的访问受到限制。
结论:在这项纵向研究中,我们开发了有前途的工具,可用于对早期 PD 中的抑郁进行个性化估计,并研究了 PD 特异性和非特异性预测因素的相对贡献,这对理解 dPD 有了实质性的补充。
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