Selected autonomic signs and symptoms as risk markers for phenoconversion and functional dependence in prodromal Parkinson's disease.
Selected autonomic signs and symptoms as risk markers for phenoconversion and functional dependence in prodromal Parkinson's disease.
复制标题
选择自主神经体征和症状作为帕金森病前驱期表型转变和功能依赖性的风险标记。
DOI：
10.1007/s10286-022-00889-8
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Willis,AllisonW
中科院分区：
文献类型：
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作者：
Miller-Patterson,Cameron;Hsu,JesseY;Chahine,LanaM;Morley,JamesF;Willis,AllisonW
PurposeTo确定是否dysautonomia可以分层个人与其他前驱标记的帕金森氏病（PD）的表型转换和功能下降的风险，这可能有助于确定亚群适合实验study.MethodsData从帕金森氏进展标记倡议。纳入了无PD但具有风险特征（嗅觉减退和/或快速眼动睡眠行为障碍、LRRK 2基因突变、GBA基因突变）的队列。自主神经功能障碍指标包括帕金森病自主神经结局量表（SCOPA-AUT）、7个SCOPA-AUT子量表和心血管功能障碍（仰卧位高血压、低脉压、神经源性直立性低血压）。结果指标为表型转换和Schwab-and-England日常生活活动（SE-ADL）≤ 70，表明功能依赖。使用考克斯比例风险回归评价每种自主神经功能障碍指标的表型转换生存期/SE-ADL ≤ 70。如果确定了显著相关性，则采用似然比检验来评估测量与队列之间是否存在显著相互作用。如果是这样，回归分析重复分层cohol.ResultsMedian随访时间为30个月。多变量分析显示，胃肠功能和女性性功能障碍与表型转换风险增加相关，而心血管功能和神经源性直立性低血压与SE-ADL ≤ 70的风险增加相关;相应的风险比（95%置信区间）分别为1.13（1.01-1.27）、3.26（1.39-7.61）、1.87（1.16-2.99）、5.45（1.40-21.25）。只有心血管子量表和SE-ADL ≤ 70之间的关联被修改cohol.ConclusionsSymptoms胃肠道和女性性功能障碍预测表型转换与其他风险标志物的个人PD，而心血管功能障碍的体征和症状可能与功能下降。
PurposeTo determine whether dysautonomia can stratify individuals with other prodromal markers of Parkinson’s disease (PD) for risk of phenoconversion and functional decline, which may help identify subpopulations appropriate for experimental studies.MethodsData were obtained from Parkinson’s Progression Markers Initiative. Cohorts without PD but with at-risk features were included (hyposmia and/or rapid-eye-movement-sleep behavior disorder, LRRK2 gene mutation, GBA gene mutation). Dysautonomia measures included Scales-for-Outcomes-in-Parkinson’s-Disease Autonomic (SCOPA-AUT), seven SCOPA-AUT subscales, and cardiovascular dysfunction (supine hypertension, low pulse pressure, neurogenic orthostatic hypotension). Outcome measures were phenoconversion and Schwab-and-England Activities-of-Daily-Living (SE-ADL) ≤ 70, which indicates functional dependence. Cox proportional-hazards regression was used to evaluate survival to phenoconversion/SE-ADL ≤ 70 for each dysautonomia measure. If a significant association was identified, a likelihood-ratio test was employed to evaluate whether a significant interaction existed between the measure and cohort. If so, regression analysis was repeated stratified by cohort.ResultsMedian follow-up was 30 months. On multivariable analysis, gastrointestinal and female sexual dysfunction subscales were associated with increased risk of phenoconversion, while the cardiovascular subscale and neurogenic orthostatic hypotension were associated with increased risk of SE-ADL ≤ 70; respective hazard ratios (95% confidence intervals) were 1.13 (1.01–1.27), 3.26 (1.39–7.61), 1.87 (1.16–2.99), 5.45 (1.40–21.25). Only the association between the cardiovascular subscale and SE-ADL ≤ 70 was modified by cohort.ConclusionsSymptoms of gastrointestinal and female sexual dysfunction predict phenoconversion in individuals with other risk markers for PD, while signs and symptoms of cardiovascular dysfunction may be associated with functional decline.