Kim Ryul, Shin Jung Hwan, Park Sangmin, Kim Han-Joon, Jeon Beomseok
Department of Neurology, Inha University Hospital, Incheon, Republic of Korea.
Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Neurol Sci. 2020 Nov 15;418:117157. doi: 10.1016/j.jns.2020.117157. Epub 2020 Sep 24.
To investigate the longitudinal change of non-motor symptoms according to the age at onset in Parkinson's disease (PD).
This cohort study using the Parkinson's Progression Markers Initiative data included 405 patients with early PD. They were classified into late-onset (age at onset ≥ 70 years, n = 63), middle-onset (50 to 69 years, n = 268), and young-onset (<50 years, n = 74) groups. Non-motor symptoms were assessed with well-validated instruments covering neuropsychiatric, sleep-related, and autonomic symptoms yearly over 5 years of follow-up. Dopamine transporter imaging was also performed at baseline and the 1-, 2-, and 4-year follow-up visits.
The late-onset group had a mean decrease of 0.35 more points per year in the Montreal Cognitive Assessment (MoCA) scores (p = 0.008) and increases of 0.32 more points in the 15-item Geriatric Depression Scale scores (p = 0.002) and 0.72 more points in the State-Trait Anxiety Inventory-state scores (p = 0.022) compared to the middle-onset group. The young-onset group had a mean decrease of 0.22 fewer points per year in the MoCA scores (p = 0.002) than the middle-onset group. The other non-motor progression did not differ among the groups. No significant differences were found between the late-onset, middle-onset, and young-onset groups in the changes of striatal DAT binding ratios.
Compared to middle-onset PD, late-onset PD showed a faster progression of cognitive impairment along with depression and anxiety, and young-onset PD showed a slower progression of cognitive impairment in the early phases of the disease. These differences do not appear to be associated with the longitudinal changes in striatal dopaminergic activities.
根据帕金森病（PD）的发病年龄，研究非运动症状的纵向变化。
这项队列研究使用帕金森病进展标志物计划的数据，纳入了405例早期PD患者。他们被分为晚发型（发病年龄≥70岁，n = 63）、中发型（50至69岁，n = 268）和早发型（<50岁，n = 74）组。在5年的随访期间，使用经过充分验证的工具对非运动症状进行评估，这些工具涵盖神经精神、睡眠相关和自主神经症状。在基线以及第1、2和4年的随访时还进行了多巴胺转运体成像。
与中发型组相比，晚发型组蒙特利尔认知评估（MoCA）评分每年平均下降幅度多0.35分（p = 0.008），15项老年抑郁量表评分增加幅度多0.32分（p = 0.002），状态-特质焦虑量表-状态评分增加幅度多0.72分（p = 0.022）。早发型组MoCA评分每年平均下降幅度比中发型组少0.22分（p = 0.002）。其他非运动症状的进展在各组之间没有差异。晚发型、中发型和早发型组在纹状体多巴胺转运体（DAT）结合率变化方面未发现显著差异。
与中发型PD相比，晚发型PD在认知障碍以及抑郁和焦虑方面进展更快，而早发型PD在疾病早期认知障碍进展较慢。这些差异似乎与纹状体多巴胺能活动的纵向变化无关。
