Parkinson's Disease Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Parkinson's Disease Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Parkinsonism Relat Disord. 2022 Nov;104:15-20. doi: 10.1016/j.parkreldis.2022.09.007. Epub 2022 Sep 17.
The Parkinson Associated Risk Syndrome (PARS) study was designed to evaluate whether screening with olfactory testing and dopamine transporter (DAT) imaging could identify participants at risk for developing Parkinson's disease (PD).
Hyposmia on a single test has been associated with increased risk of PD, but, taken alone, lacks specificity. We evaluated whether repeating olfactory testing improves the diagnostic characteristics of this screening approach.
Participants completed up to 10 years of clinical and imaging evaluations in the PARS cohort. Olfaction was assessed with the University of Pennsylvania Smell Identification Test at baseline and on average 1.4 years later. Multiple logistic regression and Cox proportional hazards regression were used to estimate the hazard of development of clinical PD or abnormal DAT imaging.
Of 186 participants who were initially hyposmic, 28% reverted to normosmia on repeat testing (reverters). No initially normosmic subjects and only 2% of reverters developed DAT imaging progression or clinical PD, compared to 29% of subjects with persistent hyposmia who developed abnormal DAT and 20% who developed clinical PD. The relative risk of clinical conversion to PD was 8.3 (95% CI:0.92-75.2, p = 0.06) and of abnormal DAT scan was 12.5 (2.4-156.2, p = 0.005) for persistent hyposmia, compared to reversion.
Persistent hyposmia on serial olfactory testing significantly increases the risk of developing clinical PD and abnormal DAT imaging, compared to hyposmia on a single test. Repeat olfactory testing may be an efficient and cost-effective strategy to improve identification of at-risk patients for early diagnosis and disease modification studies.
帕金森相关风险综合征（PARS）研究旨在评估嗅觉测试和多巴胺转运体（DAT）成像筛查是否能识别出有患帕金森病（PD）风险的参与者。
单次嗅觉测试出现嗅觉减退与 PD 风险增加有关，但单独使用时特异性不足。我们评估了重复嗅觉测试是否能提高这种筛查方法的诊断特征。
参与者在 PARS 队列中完成了长达 10 年的临床和影像学评估。在基线和平均 1.4 年后，使用宾夕法尼亚大学嗅觉识别测试评估嗅觉。采用多变量逻辑回归和 Cox 比例风险回归估计发展为临床 PD 或异常 DAT 成像的风险。
在最初嗅觉减退的 186 名参与者中，28%在重复测试中恢复正常嗅觉（逆转者）。没有最初嗅觉正常的受试者，只有 2%的逆转者出现 DAT 成像进展或临床 PD，而持续嗅觉减退的受试者中有 29%出现异常 DAT 和 20%出现临床 PD。与持续嗅觉减退相比，临床转化为 PD 的相对风险为 8.3（95%CI：0.92-75.2，p=0.06），DAT 扫描异常的相对风险为 12.5（2.4-156.2，p=0.005）。
与单次嗅觉测试相比，连续嗅觉测试出现持续性嗅觉减退显著增加了发展为临床 PD 和异常 DAT 成像的风险。重复嗅觉测试可能是一种有效且具有成本效益的策略，可以提高识别高危患者的能力，从而进行早期诊断和疾病修饰研究。
