Sydney multicenter study of Parkinson's disease: non-L-dopa-responsive problems dominate at 15 years
Sydney multicenter study of Parkinson's disease: non-L-dopa-responsive problems dominate at 15 years
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DOI：
10.1002/mds.20324
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发表时间：
2005-02-01
影响因子：
8.6
通讯作者：
Trafficante, R
中科院分区：
文献类型：
--
作者：
Hely, MA;Morris, JGL;Trafficante, R
15至18年前，在悉尼多中心帕金森病研究中招募的149人中，有三分之一幸存下来。最初的研究比较了低剂量左旋多巴和低剂量溴隐亭。我们现在报告的问题所经历的人谁生存15年的诊断。标准化死亡率显著升高至1.86，治疗组间无显著差异。81%的患者发生福尔斯，23%的患者持续骨折。84%的患者存在认知能力下降，48%的患者符合痴呆症的标准。50%的人会出现幻觉和抑郁。50%发生窒息，35%发生症状性体位性低血压，41%发生尿失禁。没有病人仍然就业，40%的病人住在老年护理机构。虽然大约95%的患者经历过左旋多巴诱导的运动障碍/肌张力障碍和药物给药失败，但在大多数情况下，这些症状并不致残。早期使用溴隐亭可延迟运动障碍和肌张力障碍，但一旦加入左旋多巴，剂量终末失败出现在相似的时间。研究的两组中疾病进展的速率相似。我们的结论是，帕金森病最致残的长期问题与左旋多巴不能改善的症状的出现有关。帕金森病的神经保护性干预措施应根据其改善疾病的非左旋多巴反应方面的能力来判断，而不仅仅是延迟左旋多巴的引入或减少其相关副作用的能力。(C)2004年，《运动障碍协会》。
One-third of the 149 people recruited 15 to 18 years ago in the Sydney Multicentre Study of Parkinson's disease have survived. The original study compared low-dose levodopa with low-dose bromocriptine. We now report the problems experienced by people who survive 15 years from diagnosis. The standardized mortality ratio is significantly elevated at 1.86 and is not significantly different between treatment arms. Falls occur in 81% of patients, and 23% sustained fractures. Cognitive decline is present in 84%, and 48% fulfill the criteria for dementia. Hallucinations and depression are experienced by 50%. Choking has occurred in 50%, symptomatic postural hypotension in 35%, and urinary incontinence in 41%. No patient is still employed, and 40% of patients live in aged care facilities. Although approximately 95% have experienced L-dopa-induced dyskinesia/dystonia and end of dose failure of medication, in the majority, these symptoms are not disabling. Dyskinesia and dystonia were delayed by early use of bromocriptine, but end-of-dose failure appeared at a similar time once L-dopa was added. The rate of disease progression is similar in both arms of the study. We conclude that the most disabling long-term problems of Parkinson's disease relate to the emergence of symptoms that are not improved by L-dopa. Neuroprotective interventions in Parkinson's disease should be judged by their ability to improve non-L-dopa-responsive aspects of the disease, rather than just by their capacity to delay the introduction Of L-dopa or reduce its associated side effects. (C) 2004 Movement Disorder Society.