Cardiac sympathetic denervation and dementia in de novo Parkinson's disease: A 7-year follow-up study
Cardiac sympathetic denervation and dementia in de novo Parkinson's disease: A 7-year follow-up study
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DOI：
10.1016/j.jns.2017.09.010
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发表时间：
2017-10-15
影响因子：
4.4
通讯作者：
Yong, Suk Woo
中科院分区：
文献类型：
--
作者：
Choi, Mun Hee;Yoon, Jung Han;Yong, Suk Woo
背景：早期帕金森病（PD）患者存在明显的节后心脏交感神经失神经支配。心脏碘-123-间碘苄胍（MIBG）摄取与PD的非运动症状相关，表明心脏MIBG摄取低可能反映了更广泛的α-突触核蛋白病理。此外，低心脏MIBG可能与PD患者的直立性低血压相关，这可能影响认知。然而，基线MIBG脑电描记术在后续痴呆风险方面的预后有效性仍不清楚。我们调查了心脏MIBG摄取是否与以后的痴呆风险有关。方法：我们回顾性地招募了93名首次接受MIBG扫描的原发性PD患者。患者每3-6个月来我们的门诊就诊，并从开始服用多巴胺能药物起至少随访4年。使用考克斯的比例风险models.Results：在平均6.7年的随访期间，27例PD患者（29.0%）发展为痴呆症的基线MIBG心脏动脉造影数据的预测能力进行了评估。这些患者的基线MIBG摄取量低于其他患者（延迟H/M比值：1.19 vs. 1.31）。多变量考克斯的比例风险模型显示，无论是MIBG摄取（风险比[HR] 3.40; p = 0.004）和年龄（HR 1.08，p = 0.01）显着预测痴呆development.Conclusion：减少心脏MIBG摄取PD患者可能与随后的痴呆症的风险;减少摄取可能反映了更广泛的扩展α-突触核蛋白病理在PD。
Background: Postganglionic cardiac sympathetic denervation is evident in patients with early-stage Parkinson's disease (PD). Cardiac iodine-123-meta-iodobenzylguanidine (MIBG) uptake is correlated with the non-motor symptoms of PD, suggesting that low cardiac MIBG uptake may reflect wider alpha-synuclein pathology. In addition, low cardiac MIBG could be related to orthostatic hypotension in PD, which may affect cognition. However, the prognostic validity of baseline MIBG scintigraphy in terms of the risk of subsequent dementia remains unclear. We investigated whether cardiac MIBG uptake was associated with a later risk of dementia.Methods: We retrospectively enrolled 93 drug-naive patients with de novo PD who underwent MIBG scanning on initial evaluation. The patients visited our outpatient clinic every 3-6 months and were followed-up for a minimum of 4 years from the time they were begun on dopaminergic medication. The predictive powers of baseline MIBG cardiac scintigraphic data in terms of dementia development were evaluated using Cox's proportional hazard models.Results: During a mean follow-up period of 6.7 years, 27 patients with PD (29.0%) developed dementia. These patients had less baseline MIBG uptake than did others (delayed H/M ratios: 1.19 vs. 1.31). Multivariate Cox's proportional hazard modeling revealed that both MIBG uptake (hazard ratio [HR] 3.40; p = 0.004) and age (HR 1.08, p = 0.01) significantly predicted dementia development.Conclusion: A reduction in cardiac MIBG uptake by PD patients may be associated with a subsequent risk of dementia; reduced uptake may reflect wider extension of alpha-synuclein pathology in PD.