Buchman Aron S, Yu Lei, Oveisgharan Shahram, Zammit Andrea R, Wang Tianhao, Shulman Joshua M, VanderHorst Veronique, Nag Sukrit, Bennett David A
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
J Alzheimers Dis. 2024;100(s1):S197-S209. doi: 10.3233/JAD-240593.
The interrelationship of parkinsonism, Parkinson's disease (PD) and other Alzheimer's disease (AD) and Alzheimer's disease and related dementias (ADRD) pathologies is unclear.
We examined the progression of parkinsonian signs in adults with and without parkinsonism, and their underlying brain pathologies.
Annual parkinsonian signs were based on a modified Unified Parkinson's Disease Rating Scale. We used linear mixed effects models to compare the progression of parkinsonian signs in 3 groups categorized based on all available clinical evaluations: Group1 (never parkinsonism or clinical PD), Group2 (ever parkinsonism, but never clinical PD), Group3 (ever clinical PD). In decedents, we examined the progression of parkinsonian signs with PD and eight other AD/ADRD pathologies.
During average follow-up of 8 years, parkinsonian signs on average increased by 7.3% SD/year (N = 3,807). The progression of parkinsonian signs was slowest in Group1 (never parkinsonism or clinical PD), intermediate in Group2, and fastest in Group3. In decedents (n = 1,717) pathologic PD and cerebrovascular (CVD) pathologies were associated with a faster rate of progressive parkinsonian signs (all p values <0.05). However, pathologic PD was rare in adults without clinical PD (Group1, 5%; Group2, 7% versus Group3, 55%). Yet, 70% of adults in Group2 without pathologic PD showed one or more CVD pathologies. In Group2, adults with pathologic PD showed faster progression of parkinsonian signs compared with those without evidence of pathologic PD and their rate of progression was indistinguishable from adults with clinical PD.
Parkinsonism in old age is more commonly related to cerebrovascular pathologies relative to pathologic PD and only a minority manifest prodromal PD.
帕金森综合征、帕金森病（PD）与其他阿尔茨海默病（AD）以及阿尔茨海默病和相关痴呆症（ADRD）病理之间的相互关系尚不清楚。
我们研究了有和没有帕金森综合征的成年人帕金森体征的进展情况及其潜在的脑病理学特征。
年度帕金森体征基于改良的统一帕金森病评定量表。我们使用线性混合效应模型比较了根据所有可用临床评估分类的3组人群中帕金森体征的进展情况：第1组（从未患帕金森综合征或临床PD）、第2组（曾患帕金森综合征，但从未患临床PD）、第3组（曾患临床PD）。在已故者中，我们研究了患有PD以及其他八种AD/ADRD病理的帕金森体征的进展情况。
在平均8年的随访期间，帕金森体征平均每年增加7.3%标准差（N = 3807）。帕金森体征的进展在第1组（从未患帕金森综合征或临床PD）中最慢，在第2组中居中，在第3组中最快。在已故者（n = 1717）中，病理性PD和脑血管（CVD）病理与帕金森体征的更快进展相关（所有p值<0.05）。然而，在没有临床PD的成年人中病理性PD很少见（第1组为5%；第2组为7%，而第3组为55%）。然而，第2组中70%没有病理性PD的成年人表现出一种或多种CVD病理。在第2组中，有病理PD的成年人与没有病理PD证据的成年人相比，帕金森体征进展更快，并且他们的进展速度与患有临床PD的成年人没有区别。
相对于病理性PD，老年帕金森综合征更常与脑血管病理相关，只有少数表现为前驱性PD。
