Bahar SAY, Yasemin ÜNAL, Zerrin Özaydın AKSUN, Rezzak YILMAZ, Muhittin Cenk AKBOSTANCI

Parkinson Hastalığında Prodromal Dönem Non-Motor Semptomların Hastalık Klinik Progresyonu Üzerine Etkisi

Amaç: Parkinson hastalığı (PH) prodromal dönemi için birçok non-motor semptom tanımlanmıştır. Non-motor semptomlar PH riskini belirlemede yardımcı olabilir. Bu çalışmanın amacı prodromal dönemde non-motor semptom varlığının PH’nin klinik progresyonuna etkisini araştırmaktır. Gereç ve Yöntem: Çalışma için Parkinson hastalarında hastalık tanısından önceki dönemde non-motor semptom varlığını sorguladık ve iki grup oluşturuldu. En az bir prodromal non-motor semptom varlığı bildirenler Grup 1, non-motor semptom varlığı olmayanlar ise Grup 2 olarak sınıflandırıldı. Her bir hasta için PH olabilirlik oranı, likelihood ratios (LRs), Uluslararası Hareket Bozuklukları komitesi önerisine göre hesaplandı ve hastalık progresyonu ile korelasyonu değerlendirildi. Klinik progresyon Birleşik PH Değerlendirme Ölçeği, bölüm 3 toplam puanı hastalık süresine bölünerek hesaplandı. Hastalık klinik progresyonu ve bunu etkileyen faktörler jeneralize lineer model ile analiz edildi. Bulgular: Grup 1’de 48 hasta (24 erkek, 24 kadın), Grup 2’de 46 hasta (32 erkek, 14 kadın) vardı. Her iki grup demografik veriler ve hastalık özellikleri açısından benzerdi. Grup 1’de depresyon ve kabızlık (her bir semptom için oran ve sayı %37,5, n=18) yaygındı. Grup 1’in klinik progresyon oranı Grup 2’den anlamlı olarak yüksekti (p=0,037). Grup 1’de hastalık progresyon oranı ile nonmotor semptomlara ait LRs arasında anlamlı korelasyon yoktu (rs=0,10, p=0,49). Bununla birlikte sadece hastalık tanı yaşının, klinik progresyonu etkileyen anlamlı bir faktör olduğu saptandı (p=0,69). Sonuç: PH’de, prodromal dönemde non-motor semptom varlığının hastalık progresyonu üzerine etkisi görünmemektedir. Bu durum non-motor semptomların patogenezindeki dopaminerjik olmayan, ekstra nigrostriatal yolak varlığı nedeniyle de olabilir.

The Impact of Prodromal Stage Non-Motor Symptoms on Clinical Progression in Parkinson’s Disease

Objectives: Several non-motor symptoms (NMSs) were described in the prodromal Parkinson’s disease (PD). The aim of this study is to investigate the impact of the presence of prodromal NMSs on clinical progression of PD. Materials and Methods: We questioned the presence of NMSs in the prediagnostic stage in patients with PD. Group 1 reported at least one prodromal NMS and Group 2 reported no prodromal NMSs. As recommended by the Movement Disorder Society Task Force, the total likelihood ratios (LRs) of NMSs were calculated and correlated with disease progression. Clinical progression was determined by dividing the Unified Parkinson’s Disease Rating Scale Part III total score by the duration of the disease. Generalized linear model (GzLM) was used to determine associations between clinical progression rate and the predictor variables. Results: Group 1 had 48 patients (24 male, 24 female), and Group 2 had 46 patients (32 male, 14 female). Both groups were similar in terms of demographic and disease characteristics. Depression and constipation (for each symptom, 18 patients and 37.5%) were common in Group 1. The rate of clinical progression was higher in Group 1 than in Group 2 (p=0.037). There was no significant correlation between clinical progression rate and LRs of NMSs in Group 1 (rs=0.10, p=0.49). However, age of the diagnosis was the only significant factor associated with the clinical progression (p=0.69). Conclusion: Prodromal NMSs do not seem to impact the rate of disease progression, which may be explained by the non-dopaminergic and extra nigro-striatal pathway that cause NMSs.

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