Ren Jingru, Pan Chenxi, Li Yuqian, Li Lanting, Hua Ping, Xu Ligang, Zhang Li, Zhang Wenbin, Xu Pingyi, Liu Weiguo
Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
Department of Geriatrics, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
Front Neurosci. 2021 Mar 1;15:637896. doi: 10.3389/fnins.2021.637896. eCollection 2021.
Patients with Parkinson's disease (PD) are commonly classified into subtypes based on motor symptoms. The aims of the present study were to determine the consistency between PD motor subtypes, to assess the stability of PD motor subtypes over time, and to explore the variables influencing PD motor subtype stability.
This study was part of a longitudinal study of PD patients at a single center. Based on three different motor subtype classification systems proposed by Jankovic, Schiess, and Kang, patients were respectively categorized as tremor-dominant/indeterminate/postural instability and gait difficulty (TD/indeterminate/PIGD), TD /mixed /akinetic-rigid (ARS), or TD /mixed /AR at baseline evaluation and then re-assessed 1 month later. Demographic and clinical characteristics were recorded at each evaluation. The consistency between subtypes at baseline evaluation was assessed using Cohen's kappa coefficient (κ). Additional variables were compared between PD subtype groups using the two-sample -test, Mann-Whitney -test or Chi-squared test.
Of 283 newly diagnosed, untreated PD patients, 79 were followed up at 1 month. There was fair agreement between the Jankovic, Schiess, and Kang classification systems (κ = 0.383 ± 0.044, κ = 0.360 ± 0.042, κ = 0.368 ± 0.038). Among the three classification systems, the Schiess classification was the most stable and the Jankovic classification was the most unstable. The non-motor symptoms questionnaire (NMSQuest) scores differed significantly between PD patients with stable and unstable subtypes based on the Jankovic classification ( = 0.008), and patients with a consistent subtype had more severe NMSQuest scores than patients with an inconsistent subtype.
Fair consistency was observed between the Jankovic, Schiess, and Kang classification systems. For the first time, non-motor symptoms (NMSs) scores were found to influence the stability of the TD/indeterminate/PIGD classification. Our findings support combining NMSs with motor symptoms to increase the effectiveness of PD subtypes.
帕金森病（PD）患者通常根据运动症状分为不同亚型。本研究的目的是确定PD运动亚型之间的一致性，评估PD运动亚型随时间的稳定性，并探讨影响PD运动亚型稳定性的变量。
本研究是对单中心PD患者进行的纵向研究的一部分。根据扬科维奇（Jankovic）、席斯（Schiess）和康（Kang）提出的三种不同运动亚型分类系统，在基线评估时将患者分别归类为震颤为主型/不确定型/姿势不稳和步态障碍型（TD/不确定型/PIGD）、TD/混合型/运动不能-强直型（ARS）或TD/混合型/AR，然后在1个月后重新评估。每次评估时记录人口统计学和临床特征。使用科恩kappa系数（κ）评估基线评估时亚型之间的一致性。使用两样本t检验、曼-惠特尼U检验或卡方检验比较PD亚型组之间的其他变量。
在283例新诊断、未治疗的PD患者中，79例在1个月时进行了随访。扬科维奇、席斯和康分类系统之间存在中等程度的一致性（κ = 0.383±0.044，κ = 0.360±0.042，κ = 0.368±0.038）。在这三种分类系统中，席斯分类最稳定，扬科维奇分类最不稳定。根据扬科维奇分类，稳定和不稳定亚型的PD患者之间非运动症状问卷（NMSQuest）评分差异显著（P = 0.008），亚型一致的患者比亚型不一致的患者NMSQuest评分更严重。
扬科维奇、席斯和康分类系统之间观察到中等程度的一致性。首次发现非运动症状（NMS）评分会影响TD/不确定型/PIGD分类的稳定性。我们的研究结果支持将NMS与运动症状相结合以提高PD亚型分类的有效性。
