Poonja Sabrina, Miyasaki Janis, Fu Xilai, Camicioli Richard, Sang Tina, Yuan Yan, Ba Fang
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
School of Public Health, University of Alberta, Edmonton, AB, Canada.
Front Neurol. 2021 Aug 18;12:670567. doi: 10.3389/fneur.2021.670567. eCollection 2021.
Motor progression varies even among those with a single diagnosis such as Parkinson's disease (PD) and little is known about the trajectory of motor signs prior to death. Understanding deterioration patterns may help clinicians counsel patients and proactively plan interdisciplinary care, including palliative care. The objective of this study was to examine and describe Unified Parkinson's Disease Rating Scale motor score (UPDRS-III) trajectories at the end of life in PD. A retrospective chart review was performed for deceased PD patients who attended the Parkinson and Movement Disorders Program at the University of Alberta for at least 5 years between 1999 and 2018. UPDRS-III scores were recorded for all visits. Trajectory patterns were visualized with Loess curves stratified by sex and age at diagnosis. Piecewise linear models were used to individually model the UPDRS-III scores, and the trajectories obtained were clustered based on their features. Among the 202 charts reviewed, 84 meeting inclusion criteria were analyzed. The UPDRS-III increased over time regardless of sex and age. Distinct trajectory variations present in PD (e.g., Consistent Deterioration, Stability-Deterioration, Improvement-Deterioration, Deterioration-Improvement-Deterioration) were identified. Twenty-five percent of the patients were classified as Undetermined/Irregular trajectories. In addition, regardless of trajectory type, many patients experienced a steep increase in UPDRS-III approaching death. Those with disease diagnosis after age 65 years had a shorter survival time, compared to PD patients with a younger age of onset. Our study identified dominant types of motor trajectory in PD that can help clinicians understand their patients' course of illness. This information can help counsel patients regarding the variability in motor deterioration and should alert physicians to recognize a terminal decline. Age of disease onset was correlated with survival time.
即使在患有单一诊断疾病（如帕金森病（PD））的患者中，运动进展情况也存在差异，而且对于死亡前运动体征的变化轨迹知之甚少。了解病情恶化模式可能有助于临床医生为患者提供咨询，并积极规划跨学科护理，包括姑息治疗。本研究的目的是检查和描述帕金森病患者临终时统一帕金森病评定量表运动评分（UPDRS-III）的变化轨迹。对1999年至2018年间在阿尔伯塔大学帕金森与运动障碍项目就诊至少5年的已故PD患者进行了回顾性病历审查。记录每次就诊时的UPDRS-III评分。通过按诊断时的性别和年龄分层的局部加权回归散点平滑曲线（Loess曲线）来直观显示变化轨迹模式。使用分段线性模型分别对UPDRS-III评分进行建模，并根据其特征对获得的变化轨迹进行聚类。在审查的202份病历中，分析了84份符合纳入标准的病历。无论性别和年龄，UPDRS-III评分均随时间增加。识别出帕金森病中存在的不同变化轨迹类型（如持续恶化、稳定-恶化、改善-恶化、恶化-改善-恶化）。25%的患者被归类为不确定/不规则变化轨迹。此外，无论变化轨迹类型如何，许多患者在临近死亡时UPDRS-III评分急剧上升。与发病年龄较小的帕金森病患者相比，65岁以后确诊疾病的患者生存时间较短。我们的研究确定了帕金森病中主要的运动变化轨迹类型，这有助于临床医生了解患者的病程。这些信息有助于就运动恶化的变异性为患者提供咨询，并应提醒医生认识到终末期病情恶化。疾病发病年龄与生存时间相关。
