Santos García Diego, de Deus Fonticoba Teresa, Cores Bartolomé Carlos, Naya Ríos Lucía, García Roca Lucía, Martínez Miró Cristina, Canfield Hector, Jesús Silvia, Aguilar Miquel, Pastor Pau, Cosgaya Marina, García Caldentey Juan, Caballol Nuria, Legarda Inés, Hernández Vara Jorge, Cabo Iria, López Manzanares Lydia, González Aramburu Isabel, Ávila Rivera María A, Gómez Mayordomo Víctor, Nogueira Víctor, Puente Víctor, Dotor Julio, Borrué Carmen, Solano Vila Berta, Álvarez Sauco María, Vela Lydia, Escalante Sonia, Cubo Esther, Carrillo Padilla Francisco, Martínez Castrillo Juan C, Sánchez Alonso Pilar, Alonso Losada Maria G, López Ariztegui Nuria, Gastón Itziar, Kulisevsky Jaime, Blázquez Estrada Marta, Seijo Manuel, Rúiz Martínez Javier, Valero Caridad, Kurtis Mónica, de Fábregues Oriol, González Ardura Jessica, Alonso Redondo Ruben, Ordás Carlos, López Díaz Luis M, McAfee Darrian, Martinez-Martin Pablo, Mir Pablo
CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain.
CHUF, Complejo Hospitalario Universitario de Ferrol, 15405 A Coruña, Spain.
Diagnostics (Basel). 2021 Sep 29;11(10):1801. doi: 10.3390/diagnostics11101801.
The aim of this study was to compare the progression of independence in activities of daily living (ADL) in Parkinson's disease (PD) patients versus a control group, as well as to identify predictors of disability progression and functional dependency (FD).
PD patients and control subjects, who were recruited from 35 centers of Spain from the COPPADIS cohort between January 2016 and November 2017 (V0), were included. Patients and subjects were then evaluated again at the 2-year follow-up (V2). Disability was assessed with the Schwab & England Activities of Daily Living Scale (S&E-ADLS) at V0 and V2. FD was defined as an S&E-ADLS score less than 80%.
In the PD group, a significant decrease in the S&E-ADLS score from V0 to V2 (N = 507; from 88.58 ± 10.19 to 84.26 ± 13.38; < 0.0001; Cohen's effect size = -0.519) was observed but not in controls (N = 124; from 98.87 ± 6.52 to 99.52 ± 2.15; = 0.238). When only patients considered functional independent at baseline were included, 55 out of 463 (11.9%) converted to functional dependent at V2. To be a female (OR = 2.908; = 0.009), have longer disease duration (OR = 1.152; = 0.002), have a non-tremoric motor phenotype at baseline (OR = 3.574; = 0.004), have a higher score at baseline in FOGQ (OR = 1.244; < 0.0001) and BDI-II (OR = 1.080; = 0.008), have a lower score at baseline in PD-CRS (OR = 0.963; = 0.008), and have a greater increase in the score from V0 to V2 in UPDRS-IV (OR = 1.168; = 0.0.29), FOGQ (OR = 1.348; < 0.0001) and VAFS-Mental (OR = 1.177; = 0.013) (adjusted R-squared 0.52; Hosmer and Lemeshow test = 0.94) were all found to be independent predictors of FD at V2.
In conclusion, autonomy for ADL worsens in PD patients compared to controls. Cognitive impairment, gait problems, fatigue, depressive symptoms, more advanced disease, and a non-tremor phenotype are independent predictors of FD in the short-term.
本研究旨在比较帕金森病（PD）患者与对照组在日常生活活动（ADL）中独立性的进展情况，同时确定残疾进展和功能依赖（FD）的预测因素。
纳入2016年1月至2017年11月期间从西班牙35个中心的COPPADIS队列中招募的PD患者和对照受试者（V0）。然后在2年随访时（V2）对患者和受试者再次进行评估。在V0和V2时使用施瓦布与英格兰日常生活活动量表（S&E-ADLS）评估残疾情况。FD定义为S&E-ADLS评分低于80%。
在PD组中，观察到从V0到V2时S&E-ADLS评分显著降低（N = 507；从88.58±10.19降至84.26±13.38；P<0.0001；科恩效应量=-0.519），而对照组未出现这种情况（N = 124；从98.87±6.52升至99.52±2.15；P = 0.238）。当仅纳入基线时被认为功能独立的患者时，463例中有55例（11.9%）在V2时转变为功能依赖。女性（OR = 2.908；P = 0.009）、病程较长（OR = 1.152；P = 0.002）、基线时具有非震颤性运动表型（OR = 3.574；P = 0.004）、基线时在FOGQ（OR = 1.244；P<0.0001）和BDI-II（OR = 1.080；P = 0.008）中得分较高、基线时在PD-CRS中得分较低（OR = 0.963；P = 0.008）以及从V0到V2时UPDRS-IV（OR = 1.168；P = 0.029）、FOGQ（OR = 1.348；P<0.0001）和VAFS-精神量表（OR = 1.177；P = 0.013）得分增加幅度较大（调整后R平方=0.52；霍斯默和莱梅肖检验=0.94）均被发现是V2时FD的独立预测因素。
总之，与对照组相比，PD患者的ADL自主性恶化。认知障碍、步态问题、疲劳、抑郁症状、疾病进展更严重以及非震颤表型是短期内FD的独立预测因素。
