PARKINSONISM - ONSET PROGRESSION AND MORTALITY
PARKINSONISM - ONSET PROGRESSION AND MORTALITY
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DOI：
10.1212/wnl.17.5.427
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发表时间：
1967-01-01
期刊：
影响因子：
9.9
通讯作者：
YAHR, MD
中科院分区：
文献类型：
--
作者：
HOEHN, MM;YAHR, MD
沿着提出了帕金森综合征类型的实用分类（原发性、继发性和不确定性）以及将严重程度分为5个阶段的系统。对1949年至1964年期间在范德比尔特诊所随访的802例帕金森综合征患者的自然史进行了研究。三分之二的原发性帕金森病患者的发病年龄在50岁至69岁之间，男性和女性的发病年龄相同。讨论了近年来逐渐向老年分布的转变。大约有四分之一的帕金森病患者患病不到5年，已经严重残疾或死亡。到5至9年，这一比例增加到三分之二，到10至14年，这一比例超过80%。在原发性帕金森综合征患者中，有一小群非典型患者，疾病进展缓慢，保持平衡和翻正反射10年或更长时间，并且在20年或更长时间内没有严重残疾。患者的性别、发病年龄、帕金森综合征发病前的严重感染或其他事件、帕金森综合征或其他神经系统疾病的阳性家族史与疾病进展速度之间无明显相关性。震颤是最常见的初始症状。有一些迹象表明，至少在疾病的前10年，以震颤为初始症状的帕金森症的进展速度比其他症状的帕金森症慢。帕金森综合症会大大缩短寿命，无论发病年龄或帕金森综合症的类型如何。观察到的死亡率是相同年龄、性别和肤色的一般人群的3倍。男性的相对死亡风险低于女性，并且对于以震颤为初始症状而非强直、运动迟缓或其他非震颤表现的患者，其相对死亡风险更低。没有证据表明，采用新的医疗方法和支持性护理大大延长了寿命。对于手术治疗的患者，随访时间尚不足以表明趋势。支气管肺炎和尿路感染是所有年龄段帕金森病患者的死亡原因，其发生率高于一般人群。在某些年龄和性别的帕金森病患者中，由于意外伤害、消化性溃疡和中枢神经系统血管病变而死亡的人数也较多。没有证据表明帕金森综合征患者对恶性肿瘤有任何抵抗力。
A practical classification of the types of parkinsonism (primary, secondary, and indeterminate) was presented along with a system for grading severity into 5 stages. The natural history of the syndrome of parkinsonism was studied in 802 patients followed in the Vanderbilt Clinic during the period 1949 to 1964. Two-thirds of all patients with primary parkinsonism have their onset of illness between the ages of 50 and 69 which was the same in men and women. The gradual shift to an older age distribution in recent years is discussed. Approximately one-quarter of the patients with Parkinson''s disease who had their disease for less than 5 years were already severely disabled or dead. By 5 to 9 years this had increased to two-thirds and by 10 to 14 years'' duration, to over 80%. Among patients with primary parkinsonism there is a small group of atypical patients who, with slow evolution of the disease process, maintain balance and righting reflexes for 10 or more years and are not severely disabled for 20 or more years. There were no definitely significant correlations among sex of the patient, age at onset of the disease, severe infections or other events preceding the onset of parkinsonism, positive family history of parkinsonism or other neurological disease, and the rate of progression of the disease. Tremor is most frequently the initial symptom. There is some indication that, at least during the 1st 10 years of illness, parkinsonism with tremor as the initial symptom progresses more slowly than parkinsonism with other symptoms. Parkinsonism shortens life substantially, regardless of the age at onset or the type of parkinsonism. The observed mortality is 3 times that of the general population of the same age, sex, and color. The relative mortality risk is less for men than women and less for those in whom tremor was the initial symptom rather than rigidity, bradykinesia, or other non-tremor manifestation. There is no evidence that the introduction of newer methods of medical treatment and supportive care has substantially prolonged life. For patients treated surgically, follow-ups are not yet sufficiently long to indicate a trend. Bronchopneumonia and urinary infections are causes of death more frequently in parkinsonian patients of all ages than they are in the general population. In certain age and sex groups of parkinsonian patients there are also more deaths due to accidental injury, peptic ulcer, and vascular lesions of the central nervous system. There is no evidence that patients with parkinsonism are in any way resistant to malignant neoplastic disease.