Takáts Annamária, Aschermann Zsuzsanna, Vécsei László, Klivényi Péter, Dézsi Lívia, Zádori Dénes, Valikovics Attila, Varannai Lajos, Onuk Koray, Kinczel Beatrix, Kovács Norbert
Semmelweis Egyetem, Általános Orvostudományi Kar, Neurológiai Klinika, Budapest.
Pécsi Tudományegyetem, Általános Orvostudományi Kar, Neurológiai Klinika, Pécs.
Ideggyogy Sz. 2020 Jul 30;73(7-08):261-268. doi: 10.18071/isz.73.0261.
The majority of patients with advanced Parkinson's disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson's disease; the proportion of Parkinson's patients with advanced Parkinson's disease, the referral process, and the clinical features used to characterize advanced Parkinson's disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson's patients identified as advanced patients according to physician's judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients.
The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson's disease status was assessed with Unified Parkinson's Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson's disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method.
Overall, 2627 patients with Parkinson's disease from 126 sites were documented. In Hungary, 100 patients with Parkinson's disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson's disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson's disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9).
Physicians in Hungarian movement disorder centers assessed that half of the Parkinson's patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson's disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.
大多数晚期帕金森病患者在专门的运动障碍中心接受治疗。目前，对于如何定义帕金森病的阶段尚无明确共识；帕金森病患者中晚期帕金森病的比例、转诊流程以及用于表征晚期帕金森病的临床特征都没有得到很好的界定。这项观察性研究的主要目的是评估在整个研究中所有参与的运动障碍中心根据医生判断被认定为晚期患者的帕金森病患者比例。在此，我们评估参与研究患者中的匈牙利子集。
该研究以横断面、非干预、多国家、多中心的形式在18个国家进行。数据在单次患者就诊期间收集。使用统一帕金森病评定量表（UPDRS）第二、三、四和五部分（改良Hoehn和Yahr分期）评估当前帕金森病状态。使用帕金森病非运动症状量表（NMSS）评估非运动症状；使用帕金森病8项生活质量问卷（PDQ - 8）评估生活质量。根据医生评估以及通过德尔菲法制定的问题，将帕金森病分为晚期和非晚期。
总体而言，记录了来自126个地点的2627例帕金森病患者。在匈牙利，四个运动障碍中心记录了100例帕金森病患者，根据医生评估，这些患者中有50%患有晚期帕金森病。与未患晚期帕金森病的患者相比，他们的平均得分在以下方面显示出明显更高的损害：UPDRS第二部分（14.1对9.2）、UPDRS第四部分问题32（1.1对0.0）和问题39（1.1对0.5）、UPDRS第五部分（2.8对2.0）以及PDQ - 8（29.1对18.9）。
匈牙利运动障碍中心的医生评估认为，一半的帕金森病患者患有晚期疾病，其运动和非运动症状严重程度以及生活质量比未患晚期帕金森病的患者更差。尽管被归类为有资格接受侵入性/器械辅助治疗，但这些患者中有25%尚未开始接受该治疗。
