自主神经功能障碍对帕金森病运动、行为和认知波动的影响。
The Effect of Dysautonomia on Motor, Behavioral, and Cognitive Fluctuations in Parkinson's Disease.
作者信息
Mahajan Abhimanyu, Morrow Christopher B, Seemiller Joseph, Mills Kelly A, Pontone Gregory M
机构信息
Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
出版信息
Mov Disord. 2025 Jan;40(1):157-162. doi: 10.1002/mds.30044. Epub 2024 Oct 25.
BACKGROUND
Motor and nonmotor fluctuations adversely impact the quality of life in Parkinson's disease (PD). Dysautonomia, a feature frequently associated with PD and a possible adverse effect of dopaminergic therapy, may be comorbid with fluctuations.
OBJECTIVE
We sought to evaluate the effect of dysautonomia on motor and nonmotor fluctuations in PD.
METHODS
Two hundred subjects with PD were evaluated in both on and off dopamine states to assess changes in symptoms related to dopaminergic fluctuations. Multivariable logistic regression was performed to assess the association of dysautonomia with motor, cognitive, and psychiatric worsening from on to off states with adjustment for disease duration, levodopa equivalent daily dosage (LEDD), and dopamine-agonist LEDD.
RESULTS
Subjects with dysautonomia had greater odds of clinically meaningful change in motor features (odds ratio [OR]: 3.0), cognition (OR: 3.4), and anxiety (OR: 4.3) compared to those without dysautonomia.
CONCLUSIONS
Dysautonomia may be a contributory mechanism behind fluctuations in PD. The exact nature of this relationship deserves further evaluation. © 2024 International Parkinson and Movement Disorder Society.
背景
运动和非运动波动对帕金森病（PD）患者的生活质量产生不利影响。自主神经功能障碍是一种常与PD相关的特征，也是多巴胺能治疗可能产生的不良反应，可能与波动并存。
目的
我们旨在评估自主神经功能障碍对PD患者运动和非运动波动的影响。
方法
对200例PD患者在多巴胺开启和关闭状态下进行评估，以评估与多巴胺能波动相关的症状变化。进行多变量逻辑回归分析，以评估自主神经功能障碍与运动、认知和精神状态从开启到关闭状态恶化之间的关联，并对病程、左旋多巴等效日剂量（LEDD）和多巴胺激动剂LEDD进行校正。
结果
与无自主神经功能障碍的患者相比，有自主神经功能障碍的患者在运动特征（优势比[OR]：3.0）、认知（OR：3.4）和焦虑（OR：4.3）方面出现具有临床意义变化的几率更高。
结论
自主神经功能障碍可能是PD波动背后的一个促成机制。这种关系的确切性质值得进一步评估。© 2024国际帕金森和运动障碍协会。
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