Department of Neurology, Brain Science Center, Sapporo City General Hospital, Kita 11-nishi 13, Chuo Ku, Sapporo, Hokkaido 060-8604, Japan.
Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
Clin Neurol Neurosurg. 2020 Sep;196:105960. doi: 10.1016/j.clineuro.2020.105960. Epub 2020 May 26.
The aim of the present study was to determine the relations of clinical symptoms with nigrostriatal neuron loss in drug-naïve patients with Parkinson's disease (PD). We examined the severity of motor symptoms and freezing of gait (FOG), falls and overactive bladder (OAB) in PD patients and their relations with striatal dopamine transporter (DAT) binding.
Thirty-two untreated PD patients (14 men and 18 women with a mean age of 71.4 ± 7.2 years) were included in this study. Clinical assessments were performed by using Unified Parkinson's Disease Rating Scale (UPDRS) and overactive bladder symptom score (OABSS), and striatal dopamine transporter (DAT) binding was measured byI-FP-CIT SPECT.
The results showed that striatal DAT availability was significantly lower in the high UPDRS motor score group, high akinetic-rigid score group, FOG group, and OAB group than in the low UPDRS motor score group, low akinetic-rigid score group, non-FOG group, and non-OAB group. However, the results also showed that there was no significant difference in striatal DAT availability between the high tremor score group and low tremor score group or between the faller group and non-faller group.
The severity of bradykinesia and axial symptoms and the existence of FOG and OAB in untreated PD patients are related to a decrease in striatal DAT availability. Severity of tremors and occurrence of falls are not related to a decrease in striatal DAT availability. The mechanisms underlying the clinical symptoms of PD involve not only dopaminergic pathways but also non-dopaminergic pathways.
本研究旨在确定未经药物治疗的帕金森病（PD）患者的临床症状与黑质纹状体神经元丢失的关系。我们检查了 PD 患者运动症状和冻结步态（FOG）、跌倒和过度活跃膀胱（OAB）的严重程度及其与纹状体多巴胺转运体（DAT）结合的关系。
本研究纳入了 32 名未经治疗的 PD 患者（14 名男性，18 名女性，平均年龄 71.4±7.2 岁）。临床评估采用统一帕金森病评定量表（UPDRS）和过度活跃膀胱症状评分（OABSS）进行，纹状体多巴胺转运体（DAT）结合通过 I-FP-CIT SPECT 进行测量。
结果显示，高 UPDRS 运动评分组、高无动性-僵硬评分组、FOG 组和 OAB 组的纹状体 DAT 可用性明显低于低 UPDRS 运动评分组、低无动性-僵硬评分组、非 FOG 组和非 OAB 组。然而，结果还表明，高震颤评分组和低震颤评分组之间或跌倒组和非跌倒组之间的纹状体 DAT 可用性没有显著差异。
未经治疗的 PD 患者的运动迟缓和轴性症状严重程度以及 FOG 和 OAB 的存在与纹状体 DAT 可用性降低有关。震颤严重程度和跌倒发生与纹状体 DAT 可用性降低无关。PD 临床症状的发生机制不仅涉及多巴胺能途径，还涉及非多巴胺能途径。
