Hwang Yun Su, Jo Sungyang, Park Kye Won, Lee Seung Hyun, Lee Sangjin, Chung Sun Ju
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, Korea.
J Mov Disord. 2023 Jan;16(1):68-78. doi: 10.14802/jmd.22091. Epub 2022 Dec 20.
Depression in Parkinson's disease (PD) affects the quality of life of patients. Postural instability and gait disturbance are associated with the severity and prognosis of PD. We investigated the association of depression with axial involvement in early-stage PD patients.
This study involved 95 PD patients unexposed to antiparkinsonian drugs. After a baseline assessment for depression, the subjects were divided into a depressed PD group and a nondepressed PD group. Analyses were conducted to identify an association of depression at baseline with the following outcome variables: the progression to Hoehn and Yahr scale (H-Y) stage 3, the occurrence of freezing of gait (FOG), levodopa-induced dyskinesia, and wearing-off. The follow-up period was 53.40 ± 16.79 months from baseline.
Kaplan-Meier survival curves for H-Y stage 3 and FOG showed more prominent progression to H-Y stage 3 and occurrences of FOG in the depressed PD group than in the nondepressed PD group (log-rank p = 0.025 and 0.003, respectively). Depression in drug-naïve, early-stage PD patients showed a significant association with the progression to H-Y stage 3 (hazard ratio = 2.55; 95% confidence interval = 1.32-4.93; p = 0.005), as analyzed by Cox regression analyses. In contrast, the occurrence of levodopa-induced dyskinesia and wearing-off did not differ between the two groups (log-rank p = 0.903 and 0.351, respectively).
Depression in drug-naïve, early-stage PD patients is associated with an earlier occurrence of postural instability. This suggests shared nondopaminergic pathogenic mechanisms and potentially enables the prediction of early development of postural instability.
帕金森病（PD）中的抑郁会影响患者的生活质量。姿势不稳和步态障碍与PD的严重程度及预后相关。我们研究了早期PD患者中抑郁与轴性受累之间的关联。
本研究纳入了95例未服用抗帕金森病药物的PD患者。在对抑郁进行基线评估后，将受试者分为抑郁PD组和非抑郁PD组。进行分析以确定基线时的抑郁与以下结局变量之间的关联：进展至Hoehn和Yahr分级（H-Y）3期、步态冻结（FOG）的发生、左旋多巴诱导的运动障碍以及疗效减退。从基线开始的随访期为53.40±16.79个月。
H-Y 3期和FOG的Kaplan-Meier生存曲线显示，抑郁PD组比非抑郁PD组进展至H-Y 3期和发生FOG的情况更为突出（对数秩检验p值分别为0.025和0.003）。通过Cox回归分析，未服用药物的早期PD患者中的抑郁与进展至H-Y 3期显著相关（风险比=2.55；95%置信区间=1.32-4.93；p=0.005）。相比之下，两组之间左旋多巴诱导的运动障碍和疗效减退的发生率没有差异（对数秩检验p值分别为0.903和0.351）。
未服用药物的早期PD患者中的抑郁与姿势不稳的较早发生相关。这提示了共同的非多巴胺能致病机制，并可能有助于预测姿势不稳的早期发展。
