2020年 · 第100卷第27期

Parkinson's disease (PD) is a common neurodegenerative disease in middle-aged and elderly people. Its clinical features include motor symptoms such as bradylosis, tremor, myotonia and non-motor symptoms (NMS). Common NMS mainly include: neuropsychiatric symptoms (depression, anxiety, psychiatric symptoms, cognitive impairment/dementia, apathy, impulse control and related disorders), autonomic dysfunction (postural hypotension, constipation, salivation, urinary dysfunction, sexual dysfunction, drug-related gastrointestinal discomfort, hyperhidrosis, etc.), sleep-wake disorders (insomnia or sleep fragmentation, excessive daytime sleepiness and sleep episodes, sleep behavior disorders during rapid eye movement), pain, fatigue, olfactory and visual disorders, etc.^[1]。 NMS involves a wide range, with large individual differences, and its symptoms may overlap with PD itself or other comorbid symptoms, which lacks specificity, resulting in difficulties for clinicians to diagnose and treat it.

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There are a variety of motor and non-motor symptoms in Parkinson's disease, among which non-motor symptoms have a more serious impact on the quality of life of patients with Parkinson's disease. Improve the non-motor symptoms of Parkinson's disease and help improve the quality of life of patients. Previous studies on non-motor symptoms of Parkinson's disease were mostly single-center and small-sample studies, and the types of non-motor symptoms involved were relatively limited, which could not fully reflect the impact of non-motor symptoms on the quality of life of patients with Parkinson's disease. To this end, the study focused on the impact of non-motor symptoms on the quality of life of patients with Parkinson's disease by analyzing the COPPADIS-2015 study cohort. The cohort was a 5-year multicenter, integrated observational follow-up cohort study nationwide in Spain. A total of 898 follow-up samples were included, and dementia patients were excluded using the Mini-Mental Status Examination Scale (MMSE), and quality of life assessment was performed using the Quality of Life Questionnaire for Parkinson's Patients (PDQ-39), the Subjective Scale for Global Quality of Life (PQ-10) and the EUROHIS-QOL 8 scale, and the motor symptoms of Parkinson's disease were assessed using the modified Hoehn-Yahr staging and the third and fourth parts of the Unified Parkinson's Disease Rating Scale (UPDRS). Nonmotor symptoms of Parkinson's disease were assessed using the Parkinson's Disease Nonmotor Symptom Scale (NMSS), Frozen Gait Questionnaire (FOGQ), Parkinson's Disease Sleep Scale (PDSS), VAS Pain Rating Scale, VAF Fatigue Rating Scale, Beck Depression Scale-Ⅱ (BDI-Ⅱ), Neuropsychiatric Scale (NPI), and Parkinson's Disease Impulse Control Disorder Scale. The study found that patients with PD [n =692, (62.6 ± 8.9) years old, male proportion 60.3%] had better quality of life than healthy controls [n =206, (61.0 ± 8.3) years old, male proportion 49.5%] worse [PDQ-39: (17.1 ± 13.5) score versus (4.4 ± 6.3) score (P<0.0001）； PQ-10: (7.3 ± 1.6) points to (8.1 ± 1.2) points (P<0.0001）； EUROHIS-QOL8: (3.8 ± 0.6) points to (4.2 ± 0.5) points (P<0.0001）]。 In addition, PDQ-39 was significantly correlated with NMSS score, BDI-Ⅱ score and FOGQ score. PQ-10 was significantly associated with mood and gait disorders.

Parkinson's disease is a common neurodegenerative disease that exhibits significant clinical heterogeneity. LRRK2 is the most common pathogenic gene in Parkinson's disease. Patients with LRRK2 pathogenic mutations have similar clinical manifestations to those with sporadic Parkinson's disease. The LRRK2 risk variants (G2385R, R1628P, and S1647T) are associated with an increased risk of developing Parkinson's disease in Asian populations. Previous studies have shown that LRRK2 mutations lead to rapid progression of motor symptoms in patients with Parkinson's disease, but the changing characteristics of non-motor symptoms have not been evaluated. To assess the progressive characteristics of motor and non-motor symptoms in carriers and non-carriers of the specific LRRK2 risk variant in Asian patients with Parkinson's disease, the study conducted a 4-year prospective study. A total of 202 patients with Parkinson's disease (including 133 carriers of the LRRK2 variant and 69 non-carriers) were included in the study for a 4-year follow-up study. Modified Hoehn-Yahr staging, Unified Parkinson's Disease Rating Scale (UPDRS) Part III, Parkinson's Disease Non-motor Symptom Scale, Parkinson's Disease Quality of Life Questionnaire (PDQ-39) were used for assessment. Longitudinal analysis revealed faster progression of Hoehn-Yahr staging in carriers of the LRRK2 risk variant than in non-carriers after 4 years (0.65 for carriers of the risk variant; 0.06 for non-carriers;P =0.041）。 Although the gait and posture scores of UPDRS in carriers of the LRRK2 risk variant were both higher than those in non-carriers, the differences were not statistically significant. Furthermore, unlike carriers of the LRRK2 risk variant, non-carriers showed transient improvement in non-motor symptoms at Visit 2.