Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center, Boston, Massachusetts, USA.
Department of Neurology, Tufts Medical Center, Boston, Massachusetts, USA.
Ann Neurol. 2022 Oct;92(4):620-630. doi: 10.1002/ana.26458. Epub 2022 Aug 17.
This study aimed to examine the relationship between covert cerebrovascular disease, comprised of covert brain infarction and white matter disease, discovered incidentally in routine care, and subsequent Parkinson disease.
Patients were ≥50 years and received neuroimaging for non-stroke indications in the Kaiser Permanente Southern California system from 2009 to 2019. Natural language processing identified incidentally discovered covert brain infarction and white matter disease and classified white matter disease severity. The Parkinson disease outcome was defined as 2 ICD diagnosis codes.
230,062 patients were included (median follow-up 3.72 years). A total of 1,941 Parkinson disease cases were identified (median time-to-event 2.35 years). Natural language processing identified covert cerebrovascular disease in 70,592 (30.7%) patients, 10,622 (4.6%) with covert brain infarction and 65,814 (28.6%) with white matter disease. After adjustment for known risk factors, white matter disease was associated with Parkinson disease (hazard ratio 1.67 [95%CI, 1.44, 1.93] for patients <70 years and 1.33 [1.18, 1.50] for those ≥70 years). Greater severity of white matter disease was associated with increased incidence of Parkinson disease(/1,000 person-years), from 1.52 (1.43, 1.61) in patients without white matter disease to 4.90 (3.86, 6.13) in those with severe disease. Findings were robust when more specific definitions of Parkinson disease were used. Covert brain infarction was not associated with Parkinson disease (adjusted hazard ratio = 1.05 [0.88, 1.24]).
Incidentally discovered white matter disease was associated with subsequent Parkinson disease, an association strengthened with younger age and increased white matter disease severity. Incidentally discovered covert brain infarction did not appear to be associated with subsequent Parkinson disease. ANN NEUROL 2022;92:620-630.
本研究旨在探讨在常规护理中偶然发现的隐匿性脑血管病（包括隐匿性脑梗死和白质病）与随后发生的帕金森病之间的关系。
患者年龄≥50 岁，并在 2009 年至 2019 年期间在 Kaiser Permanente 南加州系统接受非中风原因的神经影像学检查。自然语言处理识别出偶然发现的隐匿性脑梗死和白质病，并对白质病严重程度进行分类。帕金森病的结果定义为 2 个 ICD 诊断代码。
共纳入 230062 例患者（中位随访时间 3.72 年）。共确定了 1941 例帕金森病病例（中位事件时间为 2.35 年）。自然语言处理在 70592 例（30.7%）患者中识别出隐匿性脑血管病，其中 10622 例（4.6%）为隐匿性脑梗死，65814 例（28.6%）为白质病。在调整已知危险因素后，白质病与帕金森病相关（年龄<70 岁的患者的风险比为 1.67 [95%CI，1.44，1.93]，年龄≥70 岁的患者为 1.33 [1.18，1.50]）。白质病严重程度越高，帕金森病的发病率越高（每 1000 人年），从无白质病患者的 1.52（1.43，1.61）到严重白质病患者的 4.90（3.86，6.13）。当使用更具体的帕金森病定义时，这些发现是稳健的。隐匿性脑梗死与帕金森病无关（调整后的风险比=1.05 [0.88，1.24]）。
偶然发现的白质病与随后发生的帕金森病相关，这种关联在年龄较小和白质病严重程度增加时更为强烈。偶然发现的隐匿性脑梗死似乎与随后发生的帕金森病无关。
