Prediagnostic presentations of Parkinson's disease in primary care: a case-control study
Prediagnostic presentations of Parkinson's disease in primary care: a case-control study
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DOI：
10.1016/s1474-4422(14)70287-x
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发表时间：
2015-01-01
期刊：
影响因子：
48
通讯作者：
Petersen, Irene
中科院分区：
文献类型：
--
作者：
Schrag, Anette;Horsfall, Laura;Petersen, Irene
背景帕金森病起病隐匿，当出现典型的运动特征时即可确诊。一些运动和非运动特征可以在诊断前，在疾病过程的早期发生。我们的目的是评估在初级保健和随后的帕金森病诊断的几个预诊断功能的第一个介绍之间的关联，并绘制这些第一个介绍之前diagnosis.Methods的时间轴，我们确定了个人与帕金森病的第一次诊断和那些没有帕金森病从1996年1月1日，2012年12月31日，健康改善网络英国初级保健数据库。代码提取了一系列可能的预诊断或早期症状，包括运动功能（震颤、僵硬、平衡障碍、颈部疼痛或僵硬、肩部疼痛或僵硬）、自主神经功能（便秘、低血压、勃起功能障碍、排尿功能障碍和头晕）、神经精神障碍（记忆问题、迟发性焦虑或抑郁、认知下降和冷漠），以及其他特征（疲劳、失眠、嗅觉丧失、多涎和快速眼动睡眠行为障碍）。我们报告的发病率超过1%的情况下，每1000人年和发病率风险比（RR）的个人与帕金森氏病在2，5，10年前diagnosis.Findings 8166个人与46 755个人没有帕金森氏病被列入研究。冷漠、REM睡眠行为障碍、嗅觉缺失、多涎和认知能力下降的报告率均低于1%/1000人年，并从进一步分析中排除。在帕金森病诊断前2年，除颈部疼痛或僵硬外，所有研究的诊断前特征的发生率在帕金森病患者中（n=7232）高于对照组（n=40 541）。诊断前5年，与对照组相比，（n= 25544），继续发展为帕金森病的患者（n=4769）有更高的震颤发生率（RR 13.70，95% CI 7.82-24.31），平衡障碍（2.19，1.09-4.16），便秘（2.24，2.04-2.46），低血压（3.23，1.85-5.52）、勃起功能障碍（1.30，1.11-1.51）、排尿功能障碍（1.96，1.34-2.80）、头晕（1.99，1.67-2.37）、疲劳（1.56，1.27-1.抑郁（1.76，1.41-2.17）和焦虑（1.41，1.09-1.79）。在帕金森病诊断前10年，震颤的发生率（RR 7.59，95% CI 1.11-44.83）和便秘（2.01，1.62-2.49）在帕金森病患者（n=1680）中高于对照组（n=8305）解释在初级保健中，在帕金森病诊断前几年，可以检测到一系列的前驱特征。这些数据可以被纳入正在进行的努力，以确定在疾病的最早阶段的个人在未来的试验中，并帮助了解帕金森病的最早阶段的进展。
Background Parkinson's disease has an insidious onset and is diagnosed when typical motor features occur. Several motor and non-motor features can occur before diagnosis, early in the disease process. We aimed to assess the association between first presentation of several prediagnostic features in primary care and a subsequent diagnosis of Parkinson's disease, and to chart the timeline of these first presentations before diagnosis.Methods We identified individuals with a first diagnosis of Parkinson's disease and those without Parkinson's disease from Jan 1, 1996, to Dec 31, 2012, from The Health Improvement Network UK primary care database. Codes were extracted for a range of possible prediagnostic or early symptoms, comprising motor features (tremor, rigidity, balance impairments, neck pain or stiffness, and shoulder pain or stiffness), autonomic features (constipation, hypotension, erectile dysfunction, urinary dysfunction, and dizziness), neuropsychiatric disturbances (memory problems, late-onset anxiety or depression, cognitive decline, and apathy), and additional features (fatigue, insomnia, anosmia, hypersalivation and rapid-eye-movement sleep behaviour disorder) in the years before diagnosis. We report the incidence of symptoms recorded in more than 1% of cases per 1000 person-years and incidence risk ratios (RRs) for individuals with and without Parkinson's disease at 2, 5, and 10 years before diagnosis.Findings 8166 individuals with and 46 755 individuals without Parkinson's disease were included in the study. Apathy, REM sleep behaviour disorder, anosmia, hypersalivation, and cognitive decline were all reported in less than 1% of people per 1000 person-years and were excluded from further analyses. At 2 years before Parkinson's disease diagnosis, the incidence of all studied prediagnostic features except neck pain or stiffness was higher in patients who went on to develop Parkinson's disease (n=7232) than in controls (n=40 541). At 5 years before diagnosis, compared with controls (n=25 544), patients who went on to develop Parkinson's disease (n=4769) had a higher incidence of tremor (RR 13.70, 95% CI 7.82-24.31), balance impairments (2.19, 1.09-4.16), constipation (2.24, 2.04-2.46), hypotension (3.23, 1.85-5.52), erectile dysfunction (1.30, 1.11-1.51), urinary dysfunction (1.96, 1.34-2.80), dizziness (1.99, 1.67-2.37), fatigue (1.56, 1.27-1. 91), depression (1.76, 1.41-2.17), and anxiety (1.41, 1.09-1.79). At 10 years before diagnosis of Parkinson's disease, the incidence of tremor (RR 7.59, 95% CI 1.11-44.83) and constipation (2.01, 1.62-2.49) was higher in those who went on to develop Parkinson's disease (n=1680) than in controls (n=8305).Interpretation A range of prediaoostic features can be detected several years before diagnosis of Parkinson's disease in primary care. These data can be incorporated into ongoing efforts to identify individuals at the earliest stages of the disease for indusion in future trials and to help understand progression in the earliest phase of Parkinson's disease.