Li Xin, Dong Zhao-Ying, Dong Meng, Chen Lei
Tianjin Medical University, Tianjin, China.
Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China.
Front Hum Neurosci. 2024 May 9;18:1325324. doi: 10.3389/fnhum.2024.1325324. eCollection 2024.
Parkinson's disease (PD) generally progresses slowly, but it is controversial whether delaying treatment accelerates the progression.
Determine the correlation between the time of dopaminergic replacement treatment initiation and the severity of clinical symptoms in PD, including motor and non-motor symptoms.
PD patients were divided between 155 people who were diagnosed and 165 PD patients receiving dopamine replacement therapy. Basic patient characteristics included gender, age, age at onset, disease duration, and the time of dopaminergic replacement treatment initiation. We used MDS-UPDRS scores to evaluate the severity of motor symptoms and we also used the scale to assess the severity of non-motor symptoms such as cognition, mood, sleep, and quality of life.
The mean time between symptom onset and the initiation of drug treatment was 31.0 (22.5) months. After adjusting for age, sex, age at onset, and disease duration, we found that the MDS-Unified Parkinson's Disease Rating Scale (UPDRS)-III score increased faster in the group with a similar disease duration (F = 8.7, = 0.0034) than the treatment group. The cumulative incidence of progression to H-Y score 3 in de novo PD group over disease duration was 39.7% in 50months and 92.2% in 100 months, while in treated group such cumulative incidence was 15.5% in 50 months, 51.4% in 100 months and 81.5% in 150 months. The cumulative incidence of patients in the PD group was higher than that in the treated group ( = 0.001), suggesting that untreated patients were more likely to progress to the advanced stages. Symptoms onset, the time between symptom onset and treatment initiation, age, sex, and disease duration explained 28.95% of the total variation in the MDS-UPDRS-III score for motor symptoms. In drug-naïve patients, the time between symptom onset and treatment initiation explained 20.1% of the total variation in the MDS-UPDRS-III score for motor symptoms ( = 6.15, < 0.001).
These data in our study showed that early dopaminergic replacement treatment have played a positive role in PD patients, while dopaminergic replacement delayed treatment might be detrimental to motor symptoms and non-motor state of PD patient. Recognizing early stage symptoms of PD and early diagnosis are of great significance to treatment.
帕金森病（PD）通常进展缓慢，但延迟治疗是否会加速疾病进展仍存在争议。
确定多巴胺能替代治疗开始时间与PD临床症状严重程度之间的相关性，包括运动和非运动症状。
将PD患者分为155例初诊患者和165例接受多巴胺替代治疗的患者。患者的基本特征包括性别、年龄、发病年龄、病程以及多巴胺能替代治疗开始时间。我们使用MDS-UPDRS评分评估运动症状的严重程度，还使用该量表评估认知、情绪、睡眠和生活质量等非运动症状的严重程度。
症状出现至开始药物治疗的平均时间为31.0（22.5）个月。在调整年龄、性别、发病年龄和病程后，我们发现病程相似的初诊组中MDS统一帕金森病评定量表（UPDRS）-III评分升高速度比治疗组更快（F = 8.7，P = 0.0034）。初发PD组在病程中进展至H-Y分级3级的累积发生率在50个月时为39.7%，100个月时为92.2%，而治疗组在50个月时为15.5% , 100个月时为51.4%，150个月时为81.5%。初诊PD组患者的累积发生率高于治疗组（P = 0.001），表明未治疗患者更易进展至晚期。症状出现、症状出现至治疗开始的时间、年龄、性别和病程解释了运动症状MDS-UPDRS-III评分总变异的28.95%。在未用药患者中，症状出现至治疗开始的时间解释了运动症状MDS-UPDRS-III评分总变异的20.1%（P = 6.15，P < 0.001）。
我们研究中的这些数据表明，早期多巴胺能替代治疗对PD患者起到了积极作用，而多巴胺能替代治疗延迟可能对PD患者的运动症状和非运动状态有害。识别PD早期症状并早期诊断对治疗具有重要意义。
