Johansen Mette Niemann, Handberg Anna, El Haddouchi Mohamed, Grundtvig Josefine, Jensen Steen Rusborg, Salvesen Lisette, Løkkegaard Annemette
Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark.
Emergency Department, Zealand University Hospital Køge, Køge, Denmark.
Parkinsons Dis. 2024 Feb 21;2024:2649578. doi: 10.1155/2024/2649578. eCollection 2024.
The latest Movement Disorder Society (MDS) diagnostic criteria require a good and sustained response to medication to get a diagnosis of Parkinson's disease, PD.
The aim of this study was to evaluate levodopa response in a group of patients with probable PD, diagnosed by movement disorder specialists.
An acute levodopa challenge test (LDCT) was performed after pausing the dopaminergic medication for 6 half-times. The motor part of the Unified Parkinson's Disease Rating Scale was performed in the OFF-state and after LDCT (ON). A good effect was defined as >30% improvement. A video-protocol was used to secure standardized motor examination with blinded assessments of the UPDRS-III OFF and ON. An age-matched group of control subjects (CS) was included but did not go through LDCT. All participants were evaluated with Montreal Cognitive Assessment (MoCA) and Beck's Depression Inventory (BDI).
In the statistical analysis, 37 patients were included. Twenty-one patients showed an improvement ≤30%, while 16 patients showed an improvement >30%. LDCT showed an overall mean improvement of 27.3% of motor UPDRS. In 43.2%, there was a discrepancy between the effect seen with the LDCT and the patients' self-perceived medicine evaluation. Patients with PD had a significantly lower MoCA score and more depressive symptoms compared to CS.
We showed an acute effect of levodopa using LDCT that was around 30% improvement. While it lends support to the use of this limit in the MDS diagnostic criteria, an acute effect of less than 30% should be considered acceptable in some patients. Our study highlights a discrepancy in the objective measure of medicine effect on motor symptoms and the patient's subjective evaluation.
最新的运动障碍协会（MDS）诊断标准要求对药物有良好且持续的反应才能诊断为帕金森病（PD）。
本研究旨在评估一组由运动障碍专家诊断为可能患有PD的患者对左旋多巴的反应。
在停用多巴胺能药物6个半衰期后进行急性左旋多巴激发试验（LDCT）。在关状态和LDCT后（开状态）进行统一帕金森病评定量表的运动部分评估。良好效果定义为改善>30%。使用视频协议确保标准化的运动检查，并对UPDRS-III关状态和开状态进行盲法评估。纳入了年龄匹配的对照组（CS），但未进行LDCT。所有参与者均接受蒙特利尔认知评估（MoCA）和贝克抑郁量表（BDI）评估。
在统计分析中，纳入了37例患者。21例患者改善≤30%，而16例患者改善>30%。LDCT显示运动UPDRS总体平均改善27.3%。43.2%的患者中，LDCT显示的效果与患者自我感觉的药物评估之间存在差异。与CS相比，PD患者的MoCA评分显著更低，抑郁症状更多。
我们通过LDCT显示左旋多巴的急性效果约为改善30%。虽然这支持在MDS诊断标准中使用这一界限，但在某些患者中，小于30%的急性效果也应被视为可接受。我们的研究突出了药物对运动症状的客观测量与患者主观评估之间的差异。
