The progression of non-motor symptoms in Parkinson's disease and their contribution to motor disability and quality of life

被引：182

作者：

Antonini, Angelo ^{[1
,2
]}

Barone, Paolo ^{[3
,4
]}

Marconi, Roberto ^{[5
]}

Morgante, Letterio ^{[6
]}

Zappulla, Salvatore ^{[7
]}

Pontieri, Francesco Ernesto ^{[8
]}

Ramat, Silvia ^{[9
]}

Ceravolo, Maria Gabriella ^{[10
]}

Meco, Giuseppe ^{[11
,12
]}

Cicarelli, Giulio ^{[13
]}

Pederzoli, Massimo ^{[14
]}

Manfredi, Michela ^{[15
]}

Ceravolo, Roberto ^{[16
]}

Mucchiut, Marco ^{[17
]}

Volpe, Giampiero ^{[18
]}

Abbruzzese, Giovanni ^{[19
]}

Bottacchi, Edo ^{[20
]}

Bartolomei, Luigi ^{[21
]}

Ciacci, Giuseppe ^{[22
]}

Cannas, Antonino ^{[23
]}

Randisi, Maria Giovanna ^{[24
]}

Petrone, Alfredo ^{[25
]}

Baratti, Mario ^{[26
]}

Toni, Vincenzo ^{[27
]}

Cossu, Giovanni ^{[28
]}

Del Dotto, Paolo ^{[29
]}

Bentivoglio, Anna Rita ^{[30
]}

Abrignani, Michele ^{[31
]}

Scala, Rossana ^{[32
]}

Pennisi, Franco ^{[33
]}

Quatrale, Rocco ^{[34
,35
]}

Gaglio, Rosa Maria ^{[36
]}

Nicoletti, Alessandra ^{[37
]}

Perini, Michele ^{[38
]}

Avarello, Tania ^{[39
]}

Pisani, Antonio ^{[40
]}

Scaglioni, Augusto ^{[41
]}

Martinelli, Paolo Emilio ^{[42
]}

Iemolo, Francesco ^{[43
]}

Ferigo, Laura ^{[44
,45
]}

Simone, Pasqualino ^{[46
]}

Soliveri, Paola ^{[47
]}

Troianiello, Biagio ^{[48
]}

Consoli, Domenico ^{[49
]}

Mauro, Alessandro ^{[50
]}

Lopiano, Leonardo ^{[51
]}

Nastasi, Giuseppe ^{[52
]}

Colosimo, Carlo ^{[53
]}

机构：

[1] IRCCS San Camillo, Dept Parkinsons Dis, Venice, Italy

[2] Ist Clin Perfezionamento, Ctr Parkinson, Milan, Italy

[3] Univ Salerno, Ctr Parkinson, Scuola Med Salernitana, Dipartimento Sci Neurol, I-84100 Salerno, Italy

[4] IDC Hermitage Capodimonte, Naples, Italy

[5] Osped Misericordia, Grosseto, Italy

[6] Univ Messina, Dipartimento Neurosci Sci Psichiatr & Anestesiol, Messina, Italy

[7] Osped Umberto I, Enna, Italy

[8] Univ Roma La Sapienza, Osped St Andrea, Fac Med & Chirurg 2, Rome, Italy

[9] Latter Day St Hosp, Dip Sci Neurol & Psichiat, Florence, Italy

[10] Osped Umberto I, Ancona, Italy

[11] Univ Roma La Sapienza, Ctr Parkinson, CIMS, Rome, Italy

[12] Univ Roma La Sapienza, Dipartimento Neurol & Psichiat, Rome, Italy

[13] AORN San Giuseppe Moscati, Avellino, Italy

[14] Osped Civile, Vimercate, Italy

[15] Fdn Poliambulanza, Brescia, Italy

[16] Univ Pisana, Azienda Osped, Pisa, Italy

[17] Policlin Univ Udine, Udine, Italy

[18] Presidio Osped S Luca, Vallo Della Lucania, Italy

[19] Univ Genoa, Genoa, Italy

[20] Osped Reg, Aosta, Italy

[21] Osped Civile San Bortolo, Vicenza, Italy

[22] Policlin Le Scotte, Siena, Italy

[23] Policlin Univ Monserrato, Monserrato, Italy

[24] Azienda Osped S Elia, Caltanissetta, Italy

[25] Presidio Osped Annunziata, Cosenza, Italy

[26] Osped Ramazzini, Carpi, Italy

[27] PO F Ferrari, Casarano, Italy

[28] Azienda Osped G Brotzu, Cagliari, Italy

[29] Osped Versilia, Camajore, Italy

[30] Univ Cattolica S Cuore Policlin Gemelli, Rome, Italy

[31] Osped Marsala ASP TP 2, Marsala, Italy

[32] Osped S Maria Loreto Nuovo, Naples, Italy

[33] Osped Castelvetrano, Castelvetrano, Italy

[34] Osped St Anna, Ferrara, Italy

[35] Osped Angelo ULS12 Veneziana, Venice, Italy

[36] Az Osp S Giovanni di Dio, Agrigento, Italy

[37] Policlin Univ, Catania, Italy

[38] Osped S Antonio Abate Gallarate, Gallarate, Italy

[39] OR Villa Sofia, Palermo, Italy

[40] Univ Roma Tor Vergata, Rome, Italy

[41] Osped Vaio, Fidenza, Italy

[42] Univ Bologna, Dipartimento Sci Neurol, Bologna, Italy

[43] PO Guzzardi, Vittoria, Italy

[44] Osped Cattinara, Trieste, Italy

[45] Univ Integrata Verona, Azienda Osped, Verona, Italy

[46] Osped Casa Sollievo Sofferenza, San Giovanni Rotondo, Italy

[47] Ist Nazl Neurol Carlo Besta, Milan, Italy

[48] Ist Clin Citta Brescia, Brescia, Italy

[49] Osped G Iazzolino, Vibo Valentia, Italy

[50] Ist Sci San Giuseppe, Oggebbio, Italy

来源：

JOURNAL OF NEUROLOGY | 2012年 / 259卷 / 12期

关键词：

Parkinson's disease; Non-motor symptoms; Mortality; Cognition; Quality of life; Motor progression; FRONTAL ASSESSMENT BATTERY; MINI-MENTAL-STATE; MULTICENTER; QUESTIONNAIRE; DEMENTIA; SAMPLE; PRIAMO; SCALE; FAB;

D O I：

10.1007/s00415-012-6557-8

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Non-motor symptoms are gaining relevance in Parkinson's disease (PD) management but little is known about their progression and contribution to deterioration of quality of life. We followed prospectively 707 PD patients (62 % males) for 2 years. We assessed non-motor symptoms referred to 12 different domains, each including 1-10 specific symptoms, as well as motor state (UPDRS), general cognition, and life quality. Hoehn & Yahr (H&Y) stage was used to categorize patient status (I-II mild; III moderate; IV-V severe). We found that individual non-motor symptoms had variable evolution over the 2-year follow-up with sleep, gastrointestinal, attention/memory and skin disturbances (hyperhidrosis and seborrhea) becoming more prevalent and psychiatric, cardiovascular, and respiratory disorders becoming less prevalent. Development of symptoms in the cardiovascular, apathy, urinary, psychiatric, and fatigue domains was associated with significant life-quality worsening (p < 0.0045, alpha with Bonferroni correction). During the observation period, 123 patients (17 %) worsened clinically while 584 were rated as stable. There was a fivefold greater increase in UPDRS motor score in worse compared with stable patients over 24 months (p < 0.0001 vs. baseline both in stable and worse group). The total number of reported non-motor symptoms increased over 24 months in patients with motor worsening compared to stable ones (p < 0.001). Thirty-nine patients died (3.4 % of patients evaluable at baseline) with mean age at death of 74 years. Deceased patients were older, had significantly higher H&Y stage and motor score, and reported a greater number of non-motor symptoms at baseline. In conclusion, overall non-motor symptom progression does not follow motor deterioration, is symptom-specific, and only development of specific domains negatively impacts quality of life. These results have consequences for drug studies targeting non-motor features.

引用

页码：2621 / 2631

页数：11

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