Clinical Neurosciences, University of Turku and Neurocenter, Turku University Hospital, Turku, Finland.
Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland.
Mov Disord. 2021 Jun;36(6):1353-1361. doi: 10.1002/mds.28484. Epub 2021 Jan 6.
PD comorbid with schizophrenia has been considered rare because these diseases associate with opposite alterations in the brain dopamine system. The objective of this study was to investigate the risk of PD after a diagnosis of a schizophrenia spectrum disorder.
Regionally, this was a retrospective record-based case-control study. The cohort included 3045 PD patients treated 2004-2019 in southwestern Finland. Nationally this was a nested case-control study using registers to examine Finnish patients who received a clinically confirmed PD diagnosis 1996-2015 (n = 22,189). PD patients with previously diagnosed schizophrenia spectrum disorder (separate analysis for schizophrenia) were included. Comparable non-PD control groups were derived from both data sets. All PD diagnoses were based on individual clinical examinations by certified neurologists.
In PD patients, the prevalence of earlier schizophrenia spectrum disorder was 0.76% in regional data and 1.50% in nationwide data. In age-matched controls, the prevalence in the regional and national data was 0.16% and 1.31%, respectively. The odds ratio for PD after schizophrenia spectrum disorder diagnosis was 4.63 (95% CI, 1.76-12.19; P < 0.01) in the regional data and 1.17 (95% CI, 1.04-1.31; P < 0.01) in the national data.
Schizophrenia spectrum disorder increases the risk of PD later in life. This association was observed in both individual patient data and nationwide register data. Therefore, despite the opposite dopaminergic disease mechanisms, schizophrenia spectrum disorder increases rather than decreases the risk of PD. The increased PD risk could be related to risk-altering effects of dopamine receptor antagonists or to the increased vulnerability of the dopamine system induced by illness phase-dependent dopamine dysregulation in schizophrenia/schizophrenia spectrum disorder. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
精神分裂症合并帕金森病（PD）的情况较为少见，因为这两种疾病与大脑多巴胺系统的相反改变有关。本研究旨在调查精神分裂症谱系障碍（SZD）诊断后发生 PD 的风险。
在区域层面，这是一项回顾性基于记录的病例对照研究。该队列纳入了 2004 年至 2019 年在芬兰西南部接受治疗的 3045 例 PD 患者。在全国范围内，这是一项使用登记数据嵌套病例对照研究，旨在检查 1996 年至 2015 年期间临床确诊的 PD 患者（n=22189）。纳入了先前诊断为精神分裂症谱系障碍的 PD 患者（对精神分裂症进行单独分析）。从两个数据集得出了可比的非 PD 对照组。所有 PD 诊断均基于由认证神经病学家进行的个体临床检查。
在 PD 患者中，区域数据中 SZD 的患病率为 0.76%，全国数据中为 1.50%。在年龄匹配的对照组中，区域和全国数据中的患病率分别为 0.16%和 1.31%。区域数据中 SZD 诊断后发生 PD 的比值比为 4.63（95%CI，1.76-12.19；P<0.01），全国数据中为 1.17（95%CI，1.04-1.31；P<0.01）。
精神分裂症谱系障碍会增加晚年 PD 的发病风险。这种关联在个体患者数据和全国登记数据中均有观察到。因此，尽管多巴胺能疾病机制相反，但 SZD 会增加而不是降低 PD 的发病风险。PD 发病风险增加可能与多巴胺受体拮抗剂的风险改变作用有关，也可能与精神分裂症/精神分裂症谱系障碍的疾病阶段相关的多巴胺失调导致多巴胺系统易感性增加有关。© 2021 国际帕金森病和运动障碍学会。
