Department of Neurology, School of Medicine, The Jikei University, 3-25-8 Nishi-Shimbashi Minato-Ku 105-8461, Tokyo, Japan.
Department of Neurology, The Jikei University Katsushika Medical Center, 6-42-1 Aoto Katsushika-Ku 125-8506, Tokyo, Japan.
Neurol Sci. 2023 Mar;44(3):913-918. doi: 10.1007/s10072-022-06499-6. Epub 2022 Nov 15.
Monotherapy with monoamine oxidase B (MAO-B) inhibitors enhances the level of endogenous dopamine in treatment for Parkinson's disease (PD) and provides some benefits. Certain neuropsychiatric functions are also regulated by central dopaminergic activity.
To investigate the relationship of the efficacy of monotherapy with MAO-B inhibitors on motor symptoms in PD with baseline cognitive function.
Outcomes were examined for 27 consecutive drug-naïve PD patients who received initial treatment with a MAO-B inhibitor (selegiline: 11, rasagiline: 16). Selegiline was titrated to an optimal dose. The dose of rasagiline was fixed at 1 mg/day. Motor symptoms were assessed using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III before treatment and after the efficacy reached a plateau within 19 weeks after drug initiation, and the % improvement in motor symptoms was calculated. Pre-treatment cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and Frontal Assessment Battery (FAB). Correlations of % improvement in motor symptoms and baseline cognitive assessments were examined using Spearman correlation coefficients and multiple regression analysis.
In all patients, the mean % improvement in motor symptoms was 46.5% (range 0-83.3%). Spearman correlation coefficients showed the % improvement in motor symptoms was correlated with FAB (r = 0.631, p < 0.001). In multiple regression analysis with patient background factors as independent variables, only FAB was associated with improvement in motor symptoms in the MAO-B group.
Better FAB scores predict a significant improvement in motor symptoms with treatment with MAO-B inhibitors, suggesting high activity of endogenous dopamine.
单胺氧化酶 B（MAO-B）抑制剂的单药治疗可提高帕金森病（PD）治疗中的内源性多巴胺水平，并带来一定益处。某些神经精神功能也受到中枢多巴胺活性的调节。
探讨 MAO-B 抑制剂单药治疗对 PD 患者运动症状的疗效与基线认知功能的关系。
连续纳入 27 例初始接受 MAO-B 抑制剂（司来吉兰：11 例，雷沙吉兰：16 例）单药治疗的药物初治 PD 患者。司来吉兰滴定至最佳剂量，雷沙吉兰剂量固定为 1mg/天。在治疗前和药物起始后 19 周内疗效达到平台期后，使用运动障碍协会统一帕金森病评定量表第 3 部分评估运动症状，并计算运动症状改善的百分比。使用蒙特利尔认知评估（MoCA）和额叶评估量表（FAB）评估治疗前认知功能。使用 Spearman 相关系数和多元回归分析评估运动症状改善百分比与基线认知评估的相关性。
所有患者的运动症状改善的平均百分比为 46.5%（范围 0-83.3%）。Spearman 相关系数显示，运动症状的改善与 FAB 呈正相关（r=0.631，p<0.001）。多元回归分析中以患者背景因素为自变量，仅 FAB 与 MAO-B 组运动症状的改善相关。
更好的 FAB 评分预示着 MAO-B 抑制剂治疗可显著改善运动症状，提示内源性多巴胺活性较高。
