Subtyping of early-onset Parkinson's disease using cluster analysis: A large cohort study.
Subtyping of early-onset Parkinson's disease using cluster analysis: A large cohort study.
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DOI：
10.3389/fnagi.2022.1040293
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发表时间：
2022
影响因子：
4.8
通讯作者：
中科院分区：
文献类型：
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越来越多的证据表明，早发性帕金森病（EOPD）的临床表现和进展是异质性的。需要定义EOPD的亚型，以更好地了解潜在的机制，预测疾病进程，并最终设计更有效的个性化管理策略。识别EOPD的临床亚型，评估每种EOPD亚型的临床特征，并比较EOPD亚型之间的进展。在2017年1月至2021年9月期间，从帕金森病和运动障碍多中心数据库和中国协作网络（PD-MDCNC）的大型EOPD队列中共招募了1，217例患者。在基线时评估了运动和非运动特征的综合谱。使用人口统计学、运动症状和体征以及其他非运动表现的数据进行聚类分析。在平均随访1.5年后，对454例患者进行了重新评估，以比较不同亚型之间的进展。定义了三种亚型：轻度运动和非运动功能障碍/缓慢进展，中度和重度运动和非运动功能障碍/恶性。与轻度亚型患者相比，重度亚型患者更容易出现快速眼动睡眠行为障碍、疲劳和运动障碍，在基线时调整年龄和疾病持续时间后，并且在统一帕金森病评定量表（UMRS）总分中显示出更快的进展（P = 0.002），在前瞻性随访时，APPLICARS第II部分（P = 0.014）和III部分（P = 0.001）评分，Hoehn和Yahr分期（P = 0.001）和帕金森病问卷-39项版本评分（P = 0.012）。我们首次在大型EOPD队列中使用聚类分析确定了三种不同的临床亚型（轻度、中度和重度），这对于为EOPD个体定制治疗非常重要。
Increasing evidence suggests that early-onset Parkinson’s disease (EOPD) is heterogeneous in its clinical presentation and progression. Defining subtypes of EOPD is needed to better understand underlying mechanisms, predict disease course, and eventually design more efficient personalized management strategies. To identify clinical subtypes of EOPD, assess the clinical characteristics of each EOPD subtype, and compare the progression between EOPD subtypes. A total of 1,217 patients were enrolled from a large EOPD cohort of the Parkinson’s Disease & Movement Disorders Multicenter Database and Collaborative Network in China (PD-MDCNC) between January 2017 and September 2021. A comprehensive spectrum of motor and non-motor features were assessed at baseline. Cluster analysis was performed using data on demographics, motor symptoms and signs, and other non-motor manifestations. In 454 out of total patients were reassessed after a mean follow-up time of 1.5 years to compare progression between different subtypes. Three subtypes were defined: mild motor and non-motor dysfunction/slow progression, intermediate and severe motor and non-motor dysfunction/malignant. Compared to patients with mild subtype, patients with the severe subtype were more likely to have rapid eye movement sleep behavior disorder, wearing-off, and dyskinesia, after adjusting for age and disease duration at baseline, and showed a more rapid progression in Unified Parkinson’s Disease Rating Scale (UPDRS) total score (P = 0.002), UPDRS part II (P = 0.014), and III (P = 0.001) scores, Hoehn and Yahr stage (P = 0.001), and Parkinson’s disease questionnaire-39 item version score (P = 0.012) at prospective follow-up. We identified three different clinical subtypes (mild, intermediate, and severe) using cluster analysis in a large EOPD cohort for the first time, which is important for tailoring therapy to individuals with EOPD.
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