Department of Neurology and National Research Center for Aging and Medicine & National Center for Neurological Disorders, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Ann Clin Transl Neurol. 2021 Nov;8(11):2174-2183. doi: 10.1002/acn3.51475. Epub 2021 Oct 30.
New subtyping classification systems of Parkinson's disease (PD) have been proposed for phenotyping patients into three different subtypes: mild motor-predominant (PD-MMP), intermediate (PD-IM) and diffuse malignant (PD-DM). The quality of life (QoL) underlying the novel PD clinical subtypes is unknown. This study aimed explore the feasibility of the classification in Chinese PD patients and to investigate the potential heterogeneous determinants of QoL among the three subtypes.
298 PD patients were enrolled, including 129 PD-MMP patients, 121 PD-IM patients and 48 PD-DM patients. All patients completed the QoL assessment, clinical evaluations and neuropsychological tests. Univariate linear analysis and multiple stepwise regression analysis were performed to identify determinants of QoL.
Compared to PD-MMP patients, PD-IM and PD-DM patients had more impaired QoL. The Geriatric Depression Rating Scale (GDS) score, Non-Motor Symptoms Questionnaire (NMSQ) score, Unified Parkinson's Disease Rating Scale part III (UPDRS-III) score and Epworth Sleepiness Score (ESS) were independent contributors to QoL in PD-MMP patients. The GDS score, ESS and sniffin' sticks screening 12 test score were independent contributors to QoL in PD-IM patients. The GDS score and Mini Mental State Examination score were independent contributors to QoL in PD-DM patients.
The new novel subtyping classification is feasible for Chinese PD patients. Although depression was the most crucial determinant for QoL in PD-MMP, PD-IM and PD-DM patients, the other contributors of QoL in the three subtypes were heterogeneous. These findings may prompt clinicians to target specific factors for improving QoL depending on PD subtypes.
新的帕金森病（PD）亚型分类系统已被提出，将患者分为三种不同亚型：轻度运动为主型（PD-MMP）、中间型（PD-IM）和弥漫恶性型（PD-DM）。新型 PD 临床亚型的生活质量（QoL）尚不清楚。本研究旨在探讨该分类在我国 PD 患者中的可行性，并研究三种亚型之间 QoL 的潜在异质决定因素。
共纳入 298 例 PD 患者，包括 129 例 PD-MMP 患者、121 例 PD-IM 患者和 48 例 PD-DM 患者。所有患者均完成 QoL 评估、临床评估和神经心理学测试。采用单变量线性分析和多元逐步回归分析来确定 QoL 的决定因素。
与 PD-MMP 患者相比，PD-IM 和 PD-DM 患者的 QoL 更差。老年抑郁量表（GDS）评分、非运动症状问卷（NMSQ）评分、统一帕金森病评定量表第三部分（UPDRS-III）评分和 Epworth 嗜睡量表（ESS）是 PD-MMP 患者 QoL 的独立影响因素。GDS 评分、ESS 和嗅棒筛查 12 项测试评分是 PD-IM 患者 QoL 的独立影响因素。GDS 评分和简易精神状态检查评分是 PD-DM 患者 QoL 的独立影响因素。
新的新型亚分类对中国 PD 患者是可行的。虽然抑郁是 PD-MMP、PD-IM 和 PD-DM 患者 QoL 的最重要决定因素，但三种亚型 QoL 的其他决定因素存在异质性。这些发现可能促使临床医生根据 PD 亚型针对特定因素来提高 QoL。
