Turcano Pierpaolo, Stang Cole D, Bower James H, Ahlskog J Eric, Boeve Bradley F, Mielke Michelle M, Savica Rodolfo
Department of Neurology (PT, CDS, JHB, JEA, BFB, RS) and Department of Health Sciences Research (MMM, RS), Mayo Clinic, Rochester, MN.
Neurol Clin Pract. 2020 Apr;10(2):156-161. doi: 10.1212/CPJ.0000000000000703.
To investigate the frequency of levodopa-induced dyskinesia in dementia with Lewy bodies (DLBs) and Parkinson disease with dementia (PDD) and compare these frequencies with patients with incident Parkinson disease (PD) through a population-based cohort study.
We identified all patients with DLB, PDD, and PD without dementia in a 1991-2010 population-based parkinsonism-incident cohort, in Olmsted County, Minnesota. We abstracted information about levodopa-induced dyskinesia. We compared patients with DLB and PDD with dyskinesia with patients with PD from the same cohort.
Levodopa use and dyskinesia data were available for 141/143 (98.6%) patients with a diagnosis of either DLB or PDD; 87 (61.7%), treated with levodopa. Dyskinesia was documented in 12.6% (8 DLB and 3 PDD) of levodopa-treated patients. Among these patients, median parkinsonism diagnosis age was 74 years (range: 64-80 years); 63.6%, male. The median interval from levodopa initiation to dyskinesia onset was 2 years (range: 3 months-4 years); the median daily levodopa dosage was 600 mg (range: 50-1,600 mg). Dyskinesia severity led to levodopa adjustments in 5 patients, and all improved. Patients with dyskinesia were diagnosed with parkinsonism at a significantly younger age compared with patients without dyskinesia ( < 0.001). Levodopa dosage was unrelated to increased risk of dyskinesias among DLB and PDD. In contrast, 30.1% of levodopa-treated patients with PD developed dyskinesia. In age-, sex-, and levodopa dosage-adjusted models, Patients with DLB and PDD each had lower odds of developing dyskinesia than patients with PD (odds ratio = 0.42, 95% CI 0.21-0.88; = 0.02).
The dyskinesia risk for levodopa-treated patients with DLB or PDD was substantially less than for levodopa-treated patients with PD.
通过一项基于人群的队列研究，调查路易体痴呆（DLB）和帕金森病痴呆（PDD）中左旋多巴诱发的异动症的发生率，并将这些发生率与新发帕金森病（PD）患者进行比较。
我们在明尼苏达州奥尔姆斯特德县1991 - 2010年基于人群的帕金森症新发队列中，识别出所有患有DLB、PDD和无痴呆的PD患者。我们提取了有关左旋多巴诱发异动症的信息。我们将患有异动症的DLB和PDD患者与同一队列中的PD患者进行比较。
143例诊断为DLB或PDD的患者中有141例（98.6%）可获得左旋多巴使用和异动症数据；其中87例（61.7%）接受了左旋多巴治疗。在接受左旋多巴治疗的患者中，12.6%（8例DLB和3例PDD）记录到异动症。在这些患者中，帕金森症诊断的中位年龄为74岁（范围：64 - 80岁）；63.6%为男性。从开始使用左旋多巴到异动症发作的中位间隔时间为2年（范围：3个月 - 4年）；左旋多巴的中位日剂量为600毫克（范围：50 - 1600毫克）。5例患者因异动症严重程度导致左旋多巴调整，且所有患者症状均有改善。与无异动症的患者相比，患有异动症的患者被诊断为帕金森症时年龄显著更小（<0.001）。在DLB和PDD患者中，左旋多巴剂量与异动症风险增加无关。相比之下，接受左旋多巴治疗的PD患者中有30.1%出现异动症。在年龄、性别和左旋多巴剂量调整模型中，DLB和PDD患者发生异动症的几率均低于PD患者（比值比 = 0.42，95%置信区间0.21 - 0.88；P = 0.02）。
接受左旋多巴治疗的DLB或PDD患者的异动症风险显著低于接受左旋多巴治疗的PD患者。
