Parkinsonism & related disorders最新文献

Background: Orthostatic hypotension (OH) is a frequent autonomic feature of Parkinson's disease (PD), yet its long-term clinical consequences remain insufficiently characterized, particularly regarding falls and major vascular events.

Methods: Adults aged ≥50 years with PD who had a 2018 hospitalization or outpatient visit and received antiparkinsonian medication were included; the first encounter served as the index. Patients with vascular events in the prior 12 months were excluded. Five-year risks were assessed using inverse probability of treatment weighting (IPTW) and propensity score matching (PSM). Logistic regression estimated ORs, negative binomial models assessed fall counts, and OH pharmacotherapy effects were evaluated.

Results: Among 111,368 patients with PD who met the inclusion criteria, 2598 had OH. OH was independently associated with higher 5-year fall risk (adjusted OR 1.35, 95 % CI 1.21-1.51) and more cumulative falls (IRR 1.22, 95 % CI 1.20-1.24). These associations persisted in PSM analyses. In contrast, OH was not associated with major vascular events (adjusted OR 0.99, 95 % CI 0.86-1.14). Traditional cardiovascular risk factors, including hypertension, dyslipidemia, and diabetes, were strongly associated with vascular outcomes. Among patients with OH, pharmacotherapy was associated with higher fall risk (adjusted OR 1.34, 95 % CI 1.10-1.64) but not with vascular events. Findings were consistent across sensitivity analyses.

Conclusions: In this national PD cohort, both OH and its pharmacotherapy increased long-term fall risk but showed no association with major vascular events. These findings indicate distinct outcome profiles of OH, underscoring the need for focused fall-prevention and further evaluation of vascular safety.

Background: Isolated rapid eye movement sleep behavior disorder (iRBD) is a prodromal stage of α-synucleinopathy such as Parkinson's disease (PD). Brain cholinergic alterations have been reported in these diseases, but direct comparisons of terminal density between iRBD and clinically manifest PD have not yet been performed.

Objectives: To assess brain cholinergic terminal density in iRBD using positron emission tomography (PET) with [¹⁸F]-fluoroethoxybenzovesamicol (FEOBV), and to compare findings with both healthy controls and patients with PD.

Methods: Forty-six participants (16 with polysomnography-confirmed iRBD, 12 with PD, and 18 controls) underwent high-resolution PET neuroimaging with FEOBV. Voxel-wise analyses and effect size mapping were conducted to compare the groups, using standardized uptake value ratios (SUVRs). Correlations were performed between whole-cortex SUVR and clinical measures.

Results: Compared to controls, both the iRBD and PD groups exhibited significant cortical cholinergic denervation of similar magnitudes (11-12 %). Effect size mapping revealed very large losses (Cohen's ds < -1.5) in the posterior cortex in both patient groups, predominantly occipital-parietal in iRBD and occipital-temporal in PD. In iRBD, lower cortical uptake was associated with poorer performance on executive and visuospatial tests. Moreover, in iRBD but not in PD, there was a trend toward higher FEOBV uptake in subcortical areas, including brainstem regions.

Conclusions: Cholinergic denervation in iRBD is comparable in extent to that in PD, with subtle topographic distinctions, and correlates with cognitive deficits.