HM-CINAC. HM Puerta del Sur University Hospital, Móstoles, and CEU-San Pablo University, Madrid, Spain.
Department of Anatomy, Histology and Neuroscience, Universidad Autónoma Madrid, Madrid, Spain.
Mov Disord. 2021 Apr;36(4):905-915. doi: 10.1002/mds.28462. Epub 2021 Jan 20.
To define the motor onset and progression of Parkinson's disease (PD) in a prospective cohort of early unmedicated patients.
We enrolled a consecutive cohort of recently diagnosed (<18 months) PD patients with unilateral manifestations using age and gender-matched controls. The most affected body region was determined using various clinical standard metrics and objective quantitative kinematic measurements. Parkinson's Progression Markers Initiative data were used for external validation of the results.
Twenty-five drug-naive patients and 21 controls were studied. Upper limbs were (92%) the most affected body region at onset as ascertained by patients' self-assessment, neurologists' impression, and Movement Disorders Society Unified Parkinson's Disease Rating Scale score. The upper limb (ie, hand) was the site of onset in 80% of patients. Motor features progressed to involve the lower limb but remained limited to the initially affected body side over a 2-year follow-up. Agreement among the different metrics (96%) confirmed focal upper limb predominant motor impairment at onset. The findings were confirmed by quantitative kinematic analyses and from a cohort of 34 similar patients from the Parkinson's Progression Markers Initiative database.
Motor manifestations in PD start distally in one upper limb. The complexity of the motor repertoire and, consequently, the presumed larger dopaminergic striatal demand for maintaining skillful motor function in the upper limb, may contribute to greater vulnerability of dopaminergic striatal terminals. Recognition of this motor pattern could be used to monitor the evolution of nigrostriatal degeneration and the putative impact of therapies. © 2021 International Parkinson and Movement Disorder Society.
在一个前瞻性的早期未经药物治疗的队列中，定义帕金森病（PD）的运动起始和进展。
我们招募了一组连续的、新近诊断（<18 个月）的单侧表现的 PD 患者，以及年龄和性别匹配的对照组。使用各种临床标准指标和客观的定量运动学测量来确定最受影响的身体部位。帕金森进展标志物倡议（Parkinson's Progression Markers Initiative）的数据用于外部验证结果。
共研究了 25 名未经药物治疗的患者和 21 名对照组。根据患者的自我评估、神经科医生的印象和运动障碍协会统一帕金森病评定量表评分，上肢（92%）是发病时最受影响的身体部位。上肢（即手）是 80%患者的发病部位。在 2 年的随访中，运动特征进展到累及下肢，但仍局限于最初受影响的身体侧。不同指标之间（96%）的一致性证实了发病时上肢以局灶性为主的运动障碍。定量运动学分析和帕金森进展标志物倡议数据库中的 34 例类似患者队列的结果证实了这一发现。
PD 的运动表现始于一个上肢的远端。上肢运动 repertoire 的复杂性，以及因此对维持熟练运动功能的纹状体内多巴胺能末梢的更大需求，可能导致纹状体内多巴胺能末梢更容易受到影响。认识到这种运动模式可以用于监测黑质纹状体变性的演变和治疗的潜在影响。© 2021 国际帕金森病和运动障碍协会。
