Kristiansen Ida, Hiorth Ylva Hivand, Ushakova Anastasia, Tysnes Ole-Bjørn, Alves Guido
Center for Movement Disorders, Stavanger University Hospital, Stavanger, Norway; Department of Physical Medicine and Rehabilitation, Stavanger University Hospital, Stavanger, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway.
Center for Movement Disorders, Stavanger University Hospital, Stavanger, Norway; Department of Physical Medicine and Rehabilitation, Stavanger University Hospital, Stavanger, Norway; Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway.
Parkinsonism Relat Disord. 2024 Dec;129:107181. doi: 10.1016/j.parkreldis.2024.107181. Epub 2024 Oct 22.
Weight loss is considered a common complication of Parkinson's disease (PD), but there are few prospective longitudinal studies on weight loss in patients followed from time of PD diagnosis. We sought to determine the frequency, evolution and risk factors of weight loss in a representative incident PD cohort.
In this prospective population-based observational study, we followed 180 newly-diagnosed, initially drug-naïve PD patients and 161 controls with repetitive weight examinations over 9 years. We used Cox regression models with adjustment for potential confounders to identify independent risk factors of clinically significant (>10 %) weight loss.
Mean % weight change during follow-up was -3.9 (±11.2) in patients and -1.4 (±8.1) in controls (p = 0.016). Clinically significant weight loss was observed in 26.7 % of patients and 10.6 % of controls (RR 2.53; 95 % CI 1.52-4.21; p < 0.001). Age was the only independent baseline risk factor for weight loss (HR 1.06 per year; 95 % CI 1.03-1.10; p < 0.001). Additional time-dependent risk factors were presence of olfactory impairment (HR 2.42; 95 % CI 1.14-5.15; p = 0.021), presence of dyskinesias (HR 3.14; 95 % CI 1.58-6.23; p = 0.001), and cognitive impairment (HR per MMSE unit 0.90; 95 % CI 0.82-0.99; p = 0.036). Dopamine agonist use reduced the risk of weight loss during follow-up (HR 0.44; 95 % CI 0.24-0.82; p = 0.007).
The risk of weight loss is more than doubled in the general PD population and associated with both disease-related features and drug-related complications. This suggests a multifactorial nature of weight loss in PD, which is important to consider in research and clinical practice.
体重减轻被认为是帕金森病（PD）的常见并发症，但从PD诊断时起对患者进行随访的前瞻性纵向研究较少。我们试图确定一个代表性的新发PD队列中体重减轻的频率、演变情况和危险因素。
在这项基于人群的前瞻性观察性研究中，我们对180名新诊断的、最初未用药的PD患者和161名对照者进行了为期9年的重复体重检查。我们使用Cox回归模型并对潜在混杂因素进行调整，以确定临床上显著（>10%）体重减轻的独立危险因素。
随访期间患者的平均体重变化百分比为-3.9（±11.2），对照者为-1.4（±8.1）（p = 0.016）。26.7%的患者和10.6%的对照者出现了临床上显著的体重减轻（风险比2.53；95%置信区间1.52 - 4.21；p < 0.001）。年龄是体重减轻的唯一独立基线危险因素（每年风险比1.06；95%置信区间1.03 - 1.10；p < 0.001）。其他随时间变化的危险因素包括嗅觉障碍（风险比2.42；95%置信区间1.14 - 5.15；p = 0.021）、异动症（风险比3.14；95%置信区间1.58 - 6.23；p = 0.001）和认知障碍（每MMSE单位风险比0.90；95%置信区间0.82 - 0.99；p = 0.036）。使用多巴胺激动剂可降低随访期间体重减轻的风险（风险比0.44；95%置信区间0.24 - 0.82；p = 0.007）。
普通PD人群中体重减轻的风险增加了一倍多，且与疾病相关特征和药物相关并发症均有关。这表明PD患者体重减轻具有多因素性质，在研究和临床实践中对此加以考虑很重要。
