Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong, Gyeonggi, Republic of Korea.
Department of Urology, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong, Gyeonggi, Republic of Korea.
Eur J Neurol. 2024 Dec;31(12):e16497. doi: 10.1111/ene.16497. Epub 2024 Sep 30.
Lower urinary tract symptoms (LUTS) are frequently observed in patients with Parkinson's disease (PD), but the underlying mechanism remains elusive. The concept of "body-first" and "brain-first" subtypes in PD has been proposed, but the correlation of PD subtype with LUTS remains unclear. We aimed to investigate the disparities in urological dysfunctions between body-first and brain-first subtypes of PD using urodynamic studies (UDS).
We reviewed patients with PD (disease duration <3 years) who had undergone UDS and completed urological questionnaires (Overactive Bladder Symptom Score [OABSS] and International Prostate Symptom Score [IPSS]) and a voiding diary. Patients were categorized as having body-first or brain-first PD based on cardiac sympathetic denervation (CSD) using cardiac meta-iodobenzylguanidine (MIBG) uptake and the presence of rapid eye movement sleep behavior disorder (RBD), assessed using a questionnaire (PD with CSD and RBD indicating the body-first subtype).
A total of 55 patients with PD were categorized into body-first PD (n = 37) and brain-first PD (n = 18) groups. The body-first PD group exhibited smaller voiding volume and first desire volume (FDV) than the brain-first PD group (p < 0.05 in both). Also, the body-first PD group had higher OABSS and IPSS scores, and higher prevalence of overactive bladder diagnosed by OABSS, compared to the brain-first PD group. In multiple linear regression, cardiac MIBG uptake was positively correlated with FDV and voiding volume and negatively correlated with OABSS and IPSS (p < 0.05 in all).
Patients with the body-first PD subtype exhibited more pronounced overactive bladder symptoms and impaired storage function in the early stage of disease. Additionally, cardiac MIBG was significantly associated with urological dysfunction.
下尿路症状（LUTS）在帕金森病（PD）患者中很常见，但潜在机制仍不清楚。已经提出了 PD 的“身体优先”和“大脑优先”亚型的概念，但 PD 亚型与 LUTS 的相关性尚不清楚。我们旨在通过尿动力学研究（UDS）研究“身体优先”和“大脑优先”PD 亚型患者之间泌尿道功能障碍的差异。
我们回顾了接受过 UDS 并完成了尿动力学问卷（逼尿过度症状评分[OABSS]和国际前列腺症状评分[IPSS]）和排尿日记的 PD 患者（病程<3 年）。根据心脏去交感神经支配（CSD）使用心脏 meta-碘苄胍（MIBG）摄取和快速眼动睡眠行为障碍（RBD）的存在，将患者分为身体优先或大脑优先 PD（PD 伴 CSD 和 RBD 表示身体优先亚型）。
共有 55 名 PD 患者被分为身体优先 PD 组（n=37）和大脑优先 PD 组（n=18）。与大脑优先 PD 组相比，身体优先 PD 组的排尿量和第一欲望量（FDV）更小（p<0.05）。此外，与大脑优先 PD 组相比，身体优先 PD 组的 OABSS 和 IPSS 评分更高，并且通过 OABSS 诊断为逼尿过度的患病率更高。在多元线性回归中，心脏 MIBG 摄取与 FDV 和排尿量呈正相关，与 OABSS 和 IPSS 呈负相关（p<0.05）。
身体优先 PD 亚型患者在疾病早期表现出更明显的逼尿过度症状和储存功能障碍。此外，心脏 MIBG 与泌尿道功能障碍显著相关。
