帕金森病患者用药后的病情改善低于预期:左旋多巴反应的盲法评估

IF 2.1 4区 医学 Q3 CLINICAL NEUROLOGY Parkinson's Disease Pub Date : 2024-02-21 DOI:10.1155/2024/2649578
Mette Niemann Johansen, Anna Handberg, Mohamed El Haddouchi, Josefine Grundtvig, Steen Rusborg Jensen, Lisette Salvesen, Annemette Løkkegaard
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引用次数: 0

摘要

背景。最新的运动障碍协会(MDS)诊断标准要求,帕金森病(Parkinson's disease,PD)患者必须对药物治疗有良好且持续的反应,才能被诊断为帕金森病。研究目的本研究旨在评估由运动障碍专家确诊的一组疑似帕金森病患者对左旋多巴的反应。方法在暂停使用多巴胺能药物 6 次半后,进行急性左旋多巴挑战试验(LDCT)。统一帕金森病评分量表的运动部分在关机状态和 LDCT(开机)后进行。良好效果的定义是改善了 30%。采用视频协议确保了标准化的运动检查,并对UPDRS-III关机和开机状态进行了盲测。此外,还纳入了一组年龄匹配的对照受试者(CS),但没有进行LDCT检查。所有参与者都接受了蒙特利尔认知评估(MoCA)和贝克抑郁量表(BDI)的评估。结果统计分析共纳入 37 名患者。21名患者的病情改善率低于30%,16名患者的病情改善率为30%。LDCT 显示,运动型 UPDRS 的总体平均改善率为 27.3%。在43.2%的患者中,LDCT显示的效果与患者自我感觉的医学评估之间存在差异。与CS相比,PD患者的MoCA评分明显更低,抑郁症状更多。结论。我们利用 LDCT 显示了左旋多巴的急性疗效,改善幅度约为 30%。虽然这为在 MDS 诊断标准中使用这一限制提供了支持,但在某些患者中,低于 30% 的急性效果应被视为可以接受。我们的研究凸显了药物对运动症状影响的客观测量与患者主观评价之间的差异。
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Improvement by Medication Less than Expected in Parkinson’s Disease: Blinded Evaluation of Levodopa Response
Background. The latest Movement Disorder Society (MDS) diagnostic criteria require a good and sustained response to medication to get a diagnosis of Parkinson’s disease, PD. Objective. The aim of this study was to evaluate levodopa response in a group of patients with probable PD, diagnosed by movement disorder specialists. Methods. An acute levodopa challenge test (LDCT) was performed after pausing the dopaminergic medication for 6 half-times. The motor part of the Unified Parkinson’s Disease Rating Scale was performed in the OFF-state and after LDCT (ON). A good effect was defined as >30% improvement. A video-protocol was used to secure standardized motor examination with blinded assessments of the UPDRS-III OFF and ON. An age-matched group of control subjects (CS) was included but did not go through LDCT. All participants were evaluated with Montreal Cognitive Assessment (MoCA) and Beck’s Depression Inventory (BDI). Results. In the statistical analysis, 37 patients were included. Twenty-one patients showed an improvement ≤30%, while 16 patients showed an improvement >30%. LDCT showed an overall mean improvement of 27.3% of motor UPDRS. In 43.2%, there was a discrepancy between the effect seen with the LDCT and the patients’ self-perceived medicine evaluation. Patients with PD had a significantly lower MoCA score and more depressive symptoms compared to CS. Conclusions. We showed an acute effect of levodopa using LDCT that was around 30% improvement. While it lends support to the use of this limit in the MDS diagnostic criteria, an acute effect of less than 30% should be considered acceptable in some patients. Our study highlights a discrepancy in the objective measure of medicine effect on motor symptoms and the patient’s subjective evaluation.
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来源期刊
Parkinson's Disease
Parkinson's Disease CLINICAL NEUROLOGY-
CiteScore
5.80
自引率
3.10%
发文量
0
审稿时长
18 weeks
期刊介绍: Parkinson’s Disease is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to the epidemiology, etiology, pathogenesis, genetics, cellular, molecular and neurophysiology, as well as the diagnosis and treatment of Parkinson’s disease.
期刊最新文献
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