Hosoya Megumi, Toi Sono, Seki Misa, Hoshino Takao, Sato Yasuto, Yoshizawa Hiroshi, Iijima Mutsumi, Kitagawa Kazuo
Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
Department of Medicine, Tokyo Women's Medical University, Adachi Medical Center, Tokyo, Japan.
Cerebrovasc Dis. 2025;54(4):489-498. doi: 10.1159/000540639. Epub 2024 Sep 16.
The primary objective of this study was to elucidate the predictive role of subtle motor impairment evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) Part III on mortality and functional outcome. The secondary objective was to evaluate the association of motor impairment with small vessel disease (SVD) severity.
We derived data from a Japanese cohort of patients with evidence of SVD who were enrolled from 2015 to 2019, and followed until 2023. The present study included 586 participants who agreed for UPDRS Part III evaluation. The severity of white matter hyperintensities (WMHs) and the presence of lacunes were evaluated. Cox proportional hazard models and multiple logistic regression analysis were used to examine the association between UPDRS Part III score and all-cause death and functional outcome defined by the modified Rankin Scale (mRS) score at the last visit, respectively.
The median age was 71 years, and the median UPDRS Part III score was 2. The UPDRS Part III score was associated with the severity of WMH (r = 0.225, p < 0.001) and the number (0, 1, ≥2) of lacunes (p < 0.001). During a mean follow-up period of 4.8 years, 29 patients died. The Cox proportional hazard analysis revealed that high UPDRS Part III scores (≥5) were associated with a higher risk of all-cause death compared to low (score 0) and middle (score 1-4) scores (adjusted hazard ratio 3.04; 95% confidence interval, 1.50-7.34, p = 0.005). In multivariate logistic analysis, high UPDRS Part III scores were associated with poor functional outcome (mRS of ≥3) compared with low and middle scores after adjusting for confounding factors (adjusted odds ratio 1.86; 95% confidence interval 1.02-3.41, p = 0.043).
Subtle motor impairment was associated with the severity of WMH and number of lacunes and could predict mortality and poor functional outcome independently of vascular risk factors and severity of WMH and lacunes.
本研究的主要目的是阐明使用统一帕金森病评定量表（UPDRS）第三部分评估的细微运动障碍对死亡率和功能结局的预测作用。次要目的是评估运动障碍与小血管疾病（SVD）严重程度之间的关联。
我们从2015年至2019年入组的有SVD证据的日本患者队列中获取数据，并随访至2023年。本研究纳入了586名同意进行UPDRS第三部分评估的参与者。评估了白质高信号（WMH）的严重程度和腔隙的存在情况。分别使用Cox比例风险模型和多元逻辑回归分析来检验UPDRS第三部分评分与全因死亡以及末次随访时改良Rankin量表（mRS）评分所定义的功能结局之间的关联。
中位年龄为71岁，UPDRS第三部分的中位评分为2分。UPDRS第三部分评分与WMH的严重程度（r = 0.225，p < 0.001）以及腔隙数量（0、1、≥2个）（p < 0.001）相关。在平均4.8年的随访期内，有29名患者死亡。Cox比例风险分析显示，与低（评分为0）和中（评分为1 - 4）评分相比，高UPDRS第三部分评分（≥5）与全因死亡风险更高相关（调整后的风险比为3.04；95%置信区间，1.50 - 7.34，p = 0.005）。在多因素逻辑分析中，在调整混杂因素后，与低评分和中评分相比，高UPDRS第三部分评分与不良功能结局（mRS≥3）相关（调整后的优势比为1.8(6)；95%置信区间1.02 - 3.41，p = 0.043）。
细微运动障碍与WMH的严重程度和腔隙数量相关，并且可以独立于血管危险因素以及WMH和腔隙的严重程度来预测死亡率和不良功能结局。
