Peripheral neuropathy is associated with more frequent falls in Parkinson's disease.

Peripheral neuropathy is associated with more frequent falls in Parkinson's disease.
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周围神经病与帕金森氏病更频繁的跌倒有关。

DOI:
10.1016/j.parkreldis.2018.04.006
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发表时间:
2018-09
影响因子:
4.1
通讯作者:
Bohnen NI
Bohnen NI
中科院分区:
医学2区
文献类型:
--
作者:
Beaulieu ML;Müller MLTM;Bohnen NI

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周围神经病是老年人的一种常见疾病,会影响平衡和步态。因此,帕金森氏病(PD)的姿势失衡和步态困难不仅可能源于初级神经退变过程,还可能源于与年龄相关的内科合并症。阐明周围神经病变对帕金森病患者这些困难的影响,对于提供更有针对性和有效的治疗具有重要意义。这项研究的目的是在考虑疾病特定因素的情况下,调查帕金森病患者的下肢周围神经病变与跌倒和步态表现之间的关系。在总共140名帕金森病患者中,14名男性参与者符合周围神经病变的标准,并在Hoehn&Yahr分期和病程方面与14名没有周围神经病变的男性参与者1:1匹配。所有参与者都接受了跌倒(回顾性)和步态评估,这是一项临床评估,并分别进行了[11C]二氢四苯肼和[11C]甲基哌啶-4-丙酸甲酯PET成像,以评估多巴胺能和胆碱能失神经。周围神经病变的存在与更多的跌倒(50%比14%,p=0.043)以及较短的步长(p=0.011)和更大的步长变异性(p=0.004)显著相关,这导致水平行走时步速较慢(p=0.016)。黑质纹状体多巴胺能失神经、皮质和丘脑胆碱能失神经、MDS-UPDRS运动检查评分组间差异无统计学意义。在帕金森病患者中,下肢周围神经病变与更多的跌倒和步态困难显著相关。因此,治疗这种神经病可能会减少帕金森病患者的跌倒和/或改善步态表现。
Peripheral neuropathy is a common condition in the elderly that can affect balance and gait. Postural imbalance and gait difficulties in Parkinson’s disease (PD), therefore, may stem not only from the primary neurodegenerative process but also from age-related medical comorbidities. Elucidation of the effects of peripheral neuropathy on these difficulties in PD is important to provide more targeted and effective therapy. The purpose of this study was to investigate the association between lower-limb peripheral neuropathy and falls and gait performance in PD while accounting for disease-specific factors. From a total of 140 individuals with PD, 14 male participants met the criteria for peripheral neuropathy and were matched 1:1 for Hoehn & Yahr stage and duration of disease with 14 male participants without peripheral neuropathy. All participants underwent fall (retrospectively) and gait assessment, a clinical evaluation, and [11C]dihydrotetrabenazine and [11C]methylpiperidin-4-yl propionate PET imaging to assess dopaminergic and cholinergic denervation, respectively. The presence of peripheral neuropathy was significantly associated with more falls (50% vs. 14%, p=0.043), as well as a shorter stride length (p=0.011) and greater stride length variability (p=0.004), which resulted in slower gait speed (p=0.016) during level walking. There was no significant difference in nigrostriatal dopaminergic denervation, cortical and thalamic cholinergic denervation, and MDS-UPDRS motor examination scores between groups. Lower-limb peripheral neuropathy is significantly associated with more falls and gait difficulties in PD. Thus, treating such neuropathy may reduce falls and/or improve gait performance in PD.
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