Barasa Ashley, Wang Jijia, Dewey Richard B
Department of Neurology, UT Southwestern Medical Center, Dallas, TX, United States.
Department of Applied Clinical Research, Southwestern School of Health Professions, UT Southwestern Medical Center, Dallas, TX, United States.
Front Neurol. 2021 Apr 7;12:651157. doi: 10.3389/fneur.2021.651157. eCollection 2021.
The literature is conflicting on whether rapid eye movement sleep behavior disorder (RBD) is associated with more rapid progression of Parkinson disease (PD). We aimed to determine (1) how stable probable RBD (pRBD) is over time and (2) whether it predicts faster PD progression. We evaluated participants in the Parkinson's Disease Biomarker Project (PDBP) who were prospectively assessed every 6-12 months with a series of motor, non-motor, disability, and health status scales. For aim 1, we calculated the incidence and disappearance rates of pRBD and compared stability of pRBD in PD with control subjects. For aim 2, we developed multiple regression models to determine if pRBD at baseline influenced the rate of change or average value at 48 months of 10 outcome variables. We found that pRBD was a less stable diagnosis for PD than controls. In pRBD+ subjects, the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III score progressed 2.78 points per year faster ( < 0.01), MDS-UPDRS total score progressed 3.98 points per year faster ( < 0.01), a global composite outcome (GCO) worsened by 0.09 points per year faster ( = 0.02), and Parkinson's Disease Questionnaire (PDQ-39) mobility score progressed 2.57 percentage points per year faster ( < 0.01). The average scores at 48 months were 8.89 ( = 0.02) and 14.3 ( = 0.01) points higher for pRBD+ in MDS-UPDRS part III and total scores, respectively. Our study confirms that pRBD detected at the start of a study portends more rapid progression of PD. Knowing this could be useful for enriching clinical trials with fast progressors to accelerate discovery of a disease modifying agent.
关于快速眼动睡眠行为障碍（RBD）是否与帕金森病（PD）的进展加快相关，文献中的观点存在冲突。我们旨在确定：（1）疑似RBD（pRBD）随时间的稳定性如何；（2）它是否能预测PD的更快进展。我们评估了帕金森病生物标志物项目（PDBP）的参与者，他们每6 - 12个月接受一系列运动、非运动、残疾和健康状况量表的前瞻性评估。对于目标1，我们计算了pRBD的发病率和消失率，并比较了PD患者与对照受试者中pRBD的稳定性。对于目标2，我们建立了多元回归模型，以确定基线时的pRBD是否会影响10个结局变量在48个月时的变化率或平均值。我们发现，对于PD患者，pRBD的诊断稳定性低于对照受试者。在pRBD阳性的受试者中，运动障碍协会赞助修订的统一帕金森病评定量表（MDS - UPDRS）第三部分得分每年进展快2.78分（<0.01），MDS - UPDRS总分每年进展快3.98分（<0.01），一个综合总体结局（GCO）每年恶化快0.09分（=0.02），帕金森病问卷（PDQ - 39）活动能力得分每年进展快2.57个百分点（<0.01）。在MDS - UPDRS第三部分和总分中，pRBD阳性患者在48个月时的平均得分分别高出8.89分（=0.02）和14.3分（=0.01）。我们的研究证实，在研究开始时检测到的pRBD预示着PD的进展更快。了解这一点可能有助于在临床试验中纳入进展较快的患者，以加速发现疾病修饰药物。
