Rosqvist Kristina, Odin Per
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Neurology, Lund, Sweden.
Skåne University Hospital, Department of Neurology, Rehabilitation Medicine, Memory and Geriatrics, Lund, Sweden.
Parkinsons Dis. 2023 Oct 10;2023:6667339. doi: 10.1155/2023/6667339. eCollection 2023.
National as well as international Parkinson's disease (PD) treatment guidelines are available to guide clinicians. Previous research has shown that nonmotor symptoms (NMS) are pronounced in late-stage PD and has suggested that current treatment is insufficient and could be improved.
The aim of this study was to investigate to which degree the national and international treatment guidelines are followed in the treatment of NMS in late-stage PD.
This Swedish cohort was part of the Care of Late-Stage Parkinsonism (CLaSP) study. Late-stage PD was defined as Hoehn and Yahr stages IV-V in "on" and/or ≤50% on the Schwab and England Activities of Daily Living (ADL) scale. NMS were assessed with the NMS scale (NMSS), cognition with the Mini-Mental State Examination (MMSE), and depressive symptoms with the Geriatric Depression Scale (GDS-30). Symptomatic individuals were defined as ≥ 6 on an item of the NMSS; for dementia, a cutoff of ≤18 on the MMSE; for depression, a cutoff of ≥10 on the GDS.
All 107 participants exhibited NMS to various degrees and severities; the median NMSS score was 91. Among symptomatic individuals, for depressive symptoms, 37/63 (59%) were treated with antidepressants; for hallucinations and delusions, 9/18 (50%) and 5/13 (38%) were treated with antipsychotics; and for dementia, 9/27 (33%) were treated with rivastigmine and 1 (4%) was treated with donepezil. For orthostatic hypotension, 11/19 (58%) with lightheadedness and 7/8 (88%) with fainting were treated with antihypotensives; for sialorrhea, 2/42 (5%) were treated with botulinum toxin; and for constipation, 19/35 (54%) were treated with laxatives. For insomnia, 4/16 (25%) were treated with hypnotics, and for daytime sleepiness, 1/29 (3%) was treated with psychostimulants.
The present analyses suggest a need for clinicians to further screen for and treat NMS. Optimizing treatment of NMS according to the national and international treatment guidelines may improve symptomatology and enhance quality of life in late-stage PD.
国内外均有帕金森病（PD）治疗指南可供临床医生参考。以往研究表明，非运动症状（NMS）在晚期PD中较为突出，提示目前的治疗并不充分，仍有改进空间。
本研究旨在调查在晚期PD的NMS治疗中，国内外治疗指南的遵循程度。
这个瑞典队列是晚期帕金森病护理（CLaSP）研究的一部分。晚期PD定义为处于“开”状态时Hoehn和Yahr分期为IV - V期，和/或在施瓦布和英格兰日常生活活动（ADL）量表上得分≤50%。NMS采用NMS量表（NMSS）进行评估，认知功能采用简易精神状态检查表（MMSE）评估，抑郁症状采用老年抑郁量表（GDS - 30）评估。有症状个体的定义为NMSS某一项目得分≥6分；痴呆的定义为MMSE得分≤18分；抑郁的定义为GDS得分≥10分。
所有107名参与者均表现出不同程度和严重程度的NMS；NMSS得分中位数为91分。在有症状的个体中，对于抑郁症状，63例中有37例（59%）接受了抗抑郁药治疗；对于幻觉和妄想，18例中有9例（50%）和13例中有5例（38%）接受了抗精神病药物治疗；对于痴呆，27例中有9例（33%）接受了 rivastigmine治疗，1例（4%）接受了多奈哌齐治疗。对于体位性低血压，有头晕症状的19例中有11例（58%）和有晕厥症状的8例中有7例（88%）接受了抗低血压药物治疗；对于流涎，42例中有2例（5%）接受了肉毒杆菌毒素治疗；对于便秘，35例中有19例（54%）接受了泻药治疗。对于失眠，16例中有4例（25%）接受了催眠药治疗，对于日间嗜睡，29例中有1例（3%）接受了精神兴奋药治疗。
目前的分析表明临床医生需要进一步筛查和治疗NMS。根据国内外治疗指南优化NMS治疗可能会改善症状并提高晚期PD患者的生活质量。
