Motor impairment in PD - Relationship to incident dementia and age
Motor impairment in PD - Relationship to incident dementia and age
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DOI：
10.1212/wnl.55.4.539
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发表时间：
2000-08-22
期刊：
影响因子：
9.9
通讯作者：
Marder, K
中科院分区：
文献类型：
--
作者：
Levy, G;Tang, MX;Marder, K
目的：分析特发性PD患者特异性运动障碍与痴呆的关系。背景：总的统一PD评定量表（UPDRS）运动评分基线与PD患者发生痴呆的风险增加有关。方法：对214名非痴呆性社区PD患者每年进行神经学和神经心理学评估。使用Cox比例风险模型分析基线运动障碍与痴呆的关系。面部表情、震颤、僵硬和运动迟缓作为A分的一部分进行分析（表明多巴胺能缺乏症）；言语和轴向障碍作为B分的一部分进行分析（表明主要是非多巴胺能缺乏症）。分析了6个运动域与年龄的关系。结果：173例患者随访至少1年，其中50例根据精神障碍诊断与统计手册第三版修订版（DSM III-R）标准出现痴呆（平均随访3.6±2.2年）。当将A分和B分同时输入Cox模型时，除性别、年龄和教育程度外，B分与痴呆发生率相关（相对风险= 1.19;95% CI, 1.09 ~ 1.30; p = 0.0001），而A分与痴呆发生率无关（相对风险= 1.03;95% CI, 0.99 ~ 1.07; p = 0.19）。在六个运动域中，言语和运动迟缓与痴呆的发生率相关（p < 0.05），轴向障碍接近显著性（p = 0.06）。只有轴向损伤与年龄相关（相关系数= 0.32;p < 0.001）。结论：研究结果提示，非多巴胺能系统介导的运动障碍与帕金森病痴呆的发生有关。轴向损伤可能是疾病和衰老过程共同作用的结果。
Objective: To analyze the relationship of specific motor impairment in idiopathic PD to incident dementia. Background: The total Unified PD Rating Scale (UPDRS) motor score at baseline has been associated with an increased risk of developing dementia in PD. Methods: A cohort of 214 nondemented community-dwelling patients with PD was followed annually with neurologic and neuropsychological evaluations. The association of baseline motor impairment with incident dementia was analyzed using Cox proportional hazards models. Facial expression, tremor, rigidity, and bradykinesia were analyzed as part of subscore A (indicative of dopaminergic deficiency); speech and axial impairment were analyzed as part of subscore B (indicative of predominantly nondopaminergic deficiency). The correlation between the six motor domains and age was also analyzed. Results: Of 173 patients followed for at least 1 year, 50 became demented according to the Diagnostic and Statistical Manual of Mental Disorders, revised 3rd edition (DSM III-R) criteria (mean follow-up, 3.6 +/- 2.2 years). When both subscores A and B were entered into the Cox model, subscore B was associated with incident dementia (relative risk = 1.19; 95% CI, 1.09 to 1.30; p = 0.0001), in addition to gender, age, and education, whereas subscore A was not (relative risk = 1.03; 95% CI, 0.99 to 1.07; p = 0.19). Of the six motor domains, speech and bradykinesia were associated with incident dementia (p < 0.05), and axial impairment approached significance (p = 0.06). Only axial impairment was correlated with age (correlation coefficient = 0.32; p < 0.001). Conclusion: The findings suggest that motor impairment mediated predominantly by nondopaminergic systems is associated with incident dementia in PD. Axial impairment may be the result of a combined effect of the disease and the aging process.