Background:Early morning off(EMO)is a common feature of Parkinson's disease(PD).This study aimed to characterize its clinical features and develop a convenient and pragmatic self-assessment instrument in a Chinese...Background:Early morning off(EMO)is a common feature of Parkinson's disease(PD).This study aimed to characterize its clinical features and develop a convenient and pragmatic self-assessment instrument in a Chinese nationwide population.Methods:This study was conducted on 942 PD patients admitted to 55 clinic centers for movement disorders between June 2018 and May 2019 in China.Stepwise logistic regression analyses were performed to determine potential risk factors and the most predictive symptoms of EMO,as well as whether EMO was an independent risk factor of functional dependency in daily life.Based on this,a 7-question scale was derived for EMO screening.Diagnostic accuracy of this scale was assessed from the area under the receiver operative characteristic curve(AUROC)and its 95%confidence intervals(CIs).We further calculated sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)for the optimal cutoff point.Results:EMO occurred in 49.2%of PD patients across all disease stages.We identified 7 symptoms most predictive of EMO,including bradykinesia or rigidity,excessive sweating or salivation,ificulty in turning on or getting out of bed,muscle cramp,fatigue or sleepiness,frozen state or freezing gait,and tremor.The resulting 7-item scale was confirmed to be of good discrimination with a relatively large AUROC of 0.83,a relatively high sensitivity of 75.7%,specificity of 77.5%,PPV of 76.5%,and NPV of 76.7%.Nonideal nighttime sleep,long PD duration,advanced H&Y stages,posture instability gait difficulty-dominant or mixed subtypes,and high levodopa dose were independently associated with increased risk of EMO.EMO patients were at 87%higher(OR=1.87,95%C:1.07-3.32)risk of experiencing functional dependency in daily living compared with their counterparts.Conclusions:We demonstrated that EMO is a common feature for PD patients across all disease stages and put forward an EMO-specific screening card of sufficient accuracy and brevity.Meanwhile,we have thrown some light upon potential determinants and negative health effects of EMO.Our findings may exert great impact on improving the awareness,recognition and management of EMO in PD patients.展开更多
目的评估交感神经皮肤反应(sympathetic skin response,SSR)和PD自主神经症状量表(the scale for outcomes in PD for autonomic symptoms,SCOPA-AUT)对帕金森病(Parkinson disease,PD)患者自主神经功能损害的诊断价值及自主神经功能障...目的评估交感神经皮肤反应(sympathetic skin response,SSR)和PD自主神经症状量表(the scale for outcomes in PD for autonomic symptoms,SCOPA-AUT)对帕金森病(Parkinson disease,PD)患者自主神经功能损害的诊断价值及自主神经功能障碍影响因素。方法应用SSR、SCOPA-AUT和统一帕金森病评分量表(unified Par-kinson disease rating scale,UPDRS)对50例PD患者进行评估;应用SSR及SCOPA-AUT量表对33例对照组进行评估。结果PD组四肢SSR的潜伏期及波幅与对照组相比差异有显著统计学意义(P<0.01或0.05)。SCOPA-AUT总分(23.54±12.48)、消化系统症状(8.00±3.77)及泌尿系统症状评分(6.28±3.51)均高于对照组,差异有统计学意义(P<0.01)。SCOPA-AUT总分与UPDRS评分、H&Y分级、Schwab和England日常生活得分显著相关,差异有统计学意义(P<0.01或0.05),与病程、年龄无明显的相关性(P(0.05)。结论PD患者自主神经功能障碍随着病情进展而加重,PD患者SCOPA-AUT评分与上、下肢SSR波幅呈负相关,SSR和SCOPA-AUT可作为评价PD患者自主神经功能障碍的客观量化临床指标。展开更多
基金This study was supported by grants from the National Key R&D Program of China(No.2018YFC1312001,2017YFC0840105)Advanced Innovative Center for Human Brain Protection,Beijing Municipal Science&Technology Commission(No.Z161100000216140,Z171100000117013)National Science and Technology Major Project(2017ZX09304018).
文摘Background:Early morning off(EMO)is a common feature of Parkinson's disease(PD).This study aimed to characterize its clinical features and develop a convenient and pragmatic self-assessment instrument in a Chinese nationwide population.Methods:This study was conducted on 942 PD patients admitted to 55 clinic centers for movement disorders between June 2018 and May 2019 in China.Stepwise logistic regression analyses were performed to determine potential risk factors and the most predictive symptoms of EMO,as well as whether EMO was an independent risk factor of functional dependency in daily life.Based on this,a 7-question scale was derived for EMO screening.Diagnostic accuracy of this scale was assessed from the area under the receiver operative characteristic curve(AUROC)and its 95%confidence intervals(CIs).We further calculated sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)for the optimal cutoff point.Results:EMO occurred in 49.2%of PD patients across all disease stages.We identified 7 symptoms most predictive of EMO,including bradykinesia or rigidity,excessive sweating or salivation,ificulty in turning on or getting out of bed,muscle cramp,fatigue or sleepiness,frozen state or freezing gait,and tremor.The resulting 7-item scale was confirmed to be of good discrimination with a relatively large AUROC of 0.83,a relatively high sensitivity of 75.7%,specificity of 77.5%,PPV of 76.5%,and NPV of 76.7%.Nonideal nighttime sleep,long PD duration,advanced H&Y stages,posture instability gait difficulty-dominant or mixed subtypes,and high levodopa dose were independently associated with increased risk of EMO.EMO patients were at 87%higher(OR=1.87,95%C:1.07-3.32)risk of experiencing functional dependency in daily living compared with their counterparts.Conclusions:We demonstrated that EMO is a common feature for PD patients across all disease stages and put forward an EMO-specific screening card of sufficient accuracy and brevity.Meanwhile,we have thrown some light upon potential determinants and negative health effects of EMO.Our findings may exert great impact on improving the awareness,recognition and management of EMO in PD patients.
