PARS 队列的临床和影像学进展：长期随访。

Clinical and Imaging Progression in the PARS Cohort: Long-Term Follow-up.

机构信息

Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Institute for Neurodegenerative Disorders, New Haven, Connecticut, USA.

出版信息

Mov Disord. 2020 Sep;35(9):1550-1557. doi: 10.1002/mds.28139. Epub 2020 Jul 13.

DOI:10.1002/mds.28139

PMID:32657461

Abstract

BACKGROUND AND OBJECTIVES

The PARS (Parkinson Associated Risk Syndrome) study was designed to test whether screening for hyposmia followed by dopamine transporter imaging can identify risk for conversion to clinical PD, and to evaluate progression markers during the prodromal period.

METHODS

Subjects with hyposmia completed annual clinical evaluations and biennial [ I]ß-CIT single-photon emission computed tomography scans. Subjects were categorized as normal (>80% age-expected tracer uptake; n = 134), indeterminate (>65-80%; n = 30), and dopamine transporter deficit (≤65%; n = 21) by their baseline scan, and survival analysis was used to compare risk of conversion to motor PD. Progressing to a scan with a dopamine transporter deficit was assessed for those subjects with either normal or indeterminate baseline imaging.

RESULTS

Over a mean of 6.3 [standard deviation: 2.2] years of follow-up, 67% (n = 14) of dopamine transporter deficit subjects, 20% (n = 6) of dopamine transporter indeterminate subjects, and 4% (n = 6) of dopamine transporter normal subjects converted to a PD diagnosis (P < 0.0001). Among subjects without dopamine transporter deficit at baseline, a reduction to ≤65% age-expected uptake occurred in 12 of 30 (40%) with indeterminate dopamine transporter and 7 of 134 (5%) with no dopamine transporter DAT deficit (P < 0.0001). Imaging conversion during follow-up was associated with subsequent clinical conversion (hazard ratio: 9.6; P = 0.0157).

DISCUSSION AND CONCLUSIONS

Long-term follow-up of the PARS cohort demonstrated a high rate of conversion to clinical PD in subjects who either had abnormal dopamine transporter imaging at baseline or developed abnormal imaging during follow-up. These data extend the earlier PARS findings and present new results showing the sequence of incident imaging deficit, imaging progression, and clinical changes that occur in prodromal PD. © 2020 International Parkinson and Movement Disorder Society.

摘要

背景与目的

PARS（帕金森相关风险综合征）研究旨在测试嗅觉障碍筛查后进行多巴胺转运体成像是否可以识别临床 PD 转化的风险，并在前驱期评估进展标志物。

方法

嗅觉障碍患者完成年度临床评估和每两年一次的[I]β-CIT 单光子发射计算机断层扫描。根据基线扫描将患者分为正常（>80%年龄预期示踪剂摄取；n=134）、不确定（>65-80%；n=30）和多巴胺转运体缺陷（≤65%；n=21），并使用生存分析比较向运动 PD 转化的风险。对于基线成像为正常或不确定的患者，评估进展为多巴胺转运体缺陷扫描的情况。

结果

在平均 6.3[标准差：2.2]年的随访中，67%（n=14）的多巴胺转运体缺陷患者、20%（n=6）的多巴胺转运体不确定患者和 4%（n=6）的多巴胺转运体正常患者转化为 PD 诊断（P<0.0001）。在基线时无多巴胺转运体缺陷的患者中，30 例多巴胺转运体不确定患者中有 12 例（40%）和 134 例多巴胺转运体无缺陷患者中 7 例（5%）下降至≤65%年龄预期摄取（P<0.0001）。随访期间的影像学转换与随后的临床转换相关（危险比：9.6；P=0.0157）。