Caffeine for treatment of Parkinson disease A randomized controlled trial
Caffeine for treatment of Parkinson disease A randomized controlled trial
复制标题
DOI：
10.1212/wnl.0b013e318263570d
复制
发表时间：
2012-08-01
期刊：
影响因子：
9.9
通讯作者：
Shah, Binit
中科院分区：
文献类型：
--
作者：
Postuma, Ronald B.;Lang, Anthony E.;Shah, Binit
目的：流行病学研究一致认为咖啡因（一种非选择性腺苷拮抗剂）可降低帕金森病（PD）的风险。然而，咖啡因在PD的症状的影响还没有得到充分evaluated.Methods：我们进行了为期6周的随机对照试验，咖啡因在PD评估影响后，白天嗜睡，运动的严重程度，和其他非运动功能。患有白天嗜睡的PD患者（埃普沃思> 10）给予咖啡因100 mg每日两次× 3周，然后给予200 mg每日两次× 3周，或匹配的安慰剂。主要结局是埃普沃思嗜睡量表评分。次要结果包括运动严重程度、睡眠标志物、疲劳、抑郁和生活质量。咖啡因的影响进行了分析与贝叶斯分层模型，调整研究网站，基线分数，年龄和sex.Results：61例患者中，31例随机接受安慰剂和30咖啡因。在主要意向治疗分析中，咖啡因导致埃普沃思嗜睡量表评分无显著性降低（-1.71分; 95%置信区间[CI]-3.57，0.13）。然而，嗜睡改善了临床总体印象变化（+0.64; 0.16，1.13，意向治疗），符合方案分析的埃普沃思嗜睡量表评分显著降低（-1.97;-3.87，-0.05）。咖啡因降低了统一帕金森病评定量表的总分（-4.69分;-7.7，-1.6）和客观运动成分（-3.15分;-5.50，-0.83）。除了全球健康指标略有改善外，生活质量、抑郁或睡眠质量没有变化。不良事件在咖啡因和安慰剂groups.Conclusions：咖啡因只提供了模糊的过度嗜睡在PD的边界改善，但改善了客观的运动措施。这些潜在的运动的好处表明，一个更大的长期试验咖啡因是warranted.Classification的证据：这项研究提供了I类证据，咖啡因，高达200毫克BID 6周，有没有显着的好处过度白天嗜睡的PD患者。神经病学（R）2012;79：651-658
Objective: Epidemiologic studies consistently link caffeine, a nonselective adenosine antagonist, to lower risk of Parkinson disease (PD). However, the symptomatic effects of caffeine in PD have not been adequately evaluated.Methods: We conducted a 6-week randomized controlled trial of caffeine in PD to assess effects upon daytime somnolence, motor severity, and other nonmotor features. Patients with PD with daytime somnolence (Epworth > 10) were given caffeine 100 mg twice daily x 3 weeks, then 200 mg twice daily x 3 weeks, or matching placebo. The primary outcome was the Epworth Sleepiness Scale score. Secondary outcomes included motor severity, sleep markers, fatigue, depression, and quality of life. Effects of caffeine were analyzed with Bayesian hierarchical models, adjusting for study site, baseline scores, age, and sex.Results: Of 61 patients, 31 were randomized to placebo and 30 to caffeine. On the primary intention-to-treat analysis, caffeine resulted in a nonsignificant reduction in Epworth Sleepiness Scale score (-1.71 points; 95% confidence interval [CI] -3.57, 0.13). However, somnolence improved on the Clinical Global Impression of Change (+0.64; 0.16, 1.13, intention-to-treat), with significant reduction in Epworth Sleepiness Scale score on per-protocol analysis (-1.97; -3.87, -0.05). Caffeine reduced the total Unified Parkinson's Disease Rating Scale score (-4.69 points; -7.7, -1.6) and the objective motor component (-3.15 points; -5.50, -0.83). Other than modest improvement in global health measures, there were no changes in quality of life, depression, or sleep quality. Adverse events were comparable in caffeine and placebo groups.Conclusions: Caffeine provided only equivocal borderline improvement in excessive somnolence in PD, but improved objective motor measures. These potential motor benefits suggest that a larger long-term trial of caffeine is warranted.Classification of evidence: This study provides Class I evidence that caffeine, up to 200 mg BID for 6 weeks, had no significant benefit on excessive daytime sleepiness in patients with PD. Neurology (R) 2012;79:651-658