A 12-Year Population-Based Study of Psychosis in Parkinson Disease
A 12-Year Population-Based Study of Psychosis in Parkinson Disease
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DOI：
10.1001/archneurol.2010.166
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发表时间：
2010-08-01
影响因子：
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通讯作者：
Alves, Guido
中科院分区：
文献类型：
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作者：
Forsaa, Elin B.;Larsen, Jan Petter;Alves, Guido
目的：调查帕金森病（PD）相关精神病（PDP）在人群中的患病率、发病率、危险因素和伴随病。设计：前瞻性纵向队列研究。背景：挪威西南部社区研究。参与者：对230名社区PD患者进行了为期12年的前瞻性随访。在4岁和8岁时进行重新评估，然后每年进行一次。主要结果测量：PDP的严重程度由统一帕金森病评定量表思想障碍（UPDRS-TD）项目测量。UPDRS-TD评分为2分或以上的患者或因精神病症状而服用抗精神病药物的患者在每次就诊时均被归类为患有PDP。应用广义估计方程来调查12年间PDP发生的基线危险因素以及PDP的临床和人口统计学伴随因素。结果：研究结束时，137例患者（60%）出现幻觉或妄想。PDP的发病率为79.7 / 1000人年。较高的发病年龄、较高的基线左旋多巴当量剂量、基线时可能的快速眼动（REM）睡眠行为障碍和随访时间是发生PDP的独立危险因素。在12年的研究期间，PDP患者的显著伴随特征是日常生活功能活动（UPDRS 11）低、痴呆、高左旋多巴当量剂量和可能的REM睡眠行为障碍。结论：精神病性症状影响大多数PD患者，发病年龄越高、需要高剂量多巴胺能药物、可能存在REM睡眠行为障碍的患者风险越高。这种风险因素模式以及观察到的与残疾和痴呆增加的关联将PDP置于一种信号恶性疾病病程的症状复合体中。
Objective: To investigate the prevalence, incidence, risk factors, and concomitants of Parkinson disease (PD)-associated psychosis (PDP) in a population-based prevalent cohort.Design: Prospective longitudinal cohort study.Setting: Community-based study in southwestern Norway.Participants: Two hundred thirty community-based PD patients were followed up prospectively for 12 years. Re-assessments were conducted at 4 and 8 years and then annually.Main Outcome Measures: Severity of PDP was measured by the Unified Parkinson Disease Rating Scale thought disorder (UPDRS-TD) item. Patients with a UPDRS-TD score of 2 or more or those taking antipsychotic drugs owing to psychotic symptoms were categorized at each visit as having PDP. Generalized estimating equations were applied to investigate baseline risk factors for incident PDP and clinical and demographic concomitants of PDP during 12 years.Results: By study's end, 137 patients (60%) had developed hallucinations or delusions. The incidence rate of PDP was 79.7 per 1000 person-years. Higher age at onset, higher baseline levodopa-equivalent doses, probable rapid eye movement (REM) sleep behavior disorder at baseline, and follow-up time were independent risk factors of incident PDP. Significant concomitant features of patients with PDP during the 12-year study period were low activities of daily living function (UPDRS 11), dementia, high levodopa-equivalent dose, and probable REM sleep behavior disorder.Conclusions: Psychotic symptoms affect most patients with PD, with increased risk in those with higher age at onset, need for high doses of dopaminergic drugs, and probable REM sleep behavior disorder. This risk factor pattern and the observed associations with increased disability and dementia place PDP within a symptom complex signaling a malignant disease course.