Parkinson Hastalarında Motor Dışı Semptomların ve Yaşam Kalitesinin Klinik İlişkileri: Motor ve Non-Motor Özelliklerin Analizi

Öz

Amaç: Non-motor semptomlar (NMS) Parkinson hastalığı (PH) hastalarını önemli ölçüde etkiler, ancak hastalığın ilerlemesi ve yaşam kalitesi ile ilişkilerinin daha fazla araştırılması gerekir. PH hastalarında NMS yükü, motor semptomlar, hastalık süresi ve yaşam kalitesi arasındaki ilişkileri değerlendirmek. Yöntemler: Bu kesitsel çalışmaya 141 PH hastası dahil edilmiştir. NMS, NMS Ölçeği kullanılarak değerlendirilmiştir. Motor semptomlar Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) ve Hoehn-Yahr (H&Y) evrelemesi kullanılarak değerlendirildi. Yaşam kalitesi Parkinson Hastalığı Anketi-39 (PDQ-39) kullanılarak ölçülmüştür. Hastalık süresi üç gruba ayrılmıştır: <4 yıl, 5-8 yıl ve >9 yıl. İstatistiksel analizler korelasyon katsayılarını, çok değişkenli lojistik regresyonu ve doğrusal regresyon modellerini içermektedir. Bulgular: NMS yükü yaşam kalitesi (r=0.507, p<0.001) ve motor semptomlar (r=0.504, p<0.001) ile güçlü korelasyon gösterdi. Tek değişkenli analizde yaş (p<0.001), hastalık süresi 5-8 yıl (p<0.001) veya 9< yıl (p<0.001), UPDRS-III (p<0.001), LEDD (p<0.001) ve H&Y >3 (p<0.001) anlamlı bulunmuştur. Çok değişkenli aşamada, yaş (p<0.001), hastalık süresi 9< yıl (p=0.015) ve UPDRS-III (p=0.004) istatistiksel olarak anlamlı kalmıştır. UPDRS-III'teki her bir birimlik artış PDQ-39'u 1,91 puan ve NMS toplam skorundaki her bir puanlık artış PDQ-39'u 3,35 puan artırmıştır (her biri için p<0,001). Sonuç NMS, PH hastalarında yaşam kalitesini önemli ölçüde etkiler ve hastalık süresi ile birlikte yükü artar. Motor semptom şiddeti ve NMS, hastalığın ilerlemesi ve yaşam kalitesinin bağımsız belirleyicileridir.

Anahtar Kelimeler

• Parkinson Hastalığı
• Non-Motor Semptomlar
• Yaşam Kalitesi
• Hastalığın İlerlemesi
• Hareket Bozuklukları

Clinical Correlates of Non-Motor Symptoms and Quality of Life in Parkinson's Disease Patients: Analysis of Motor and Non-Motor Features

Öz

Aim: Non-motor symptoms (NMS) significantly impact Parkinson's disease (PD) patients, yet their relationship with disease progression and quality of life requires further investigation. To evaluate the associations between NMS burden, motor symptoms, disease duration, and quality of life in PD patients. Methods: This cross-sectional study included 141 PD patients. NMS were assessed using the NMS Scale. Motor symptoms were evaluated using Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) and Hoehn-Yahr (H&Y) staging. Quality of life was measured using Parkinson's Disease Questionnaire-39 (PDQ-39). Disease duration was categorized into three groups: <4 years, 5-8 years, and >9 years. Statistical analyses included correlation coefficients, multivariate logistic regression, and linear regression models. Results: NMS burden strongly correlated with quality of life (r=0.507, p<0.001) and motor symptoms (r=0.504, p<0.001). Age (p<0.001), disease duration 5-8 years (p<0.001) or 9< years (p<0.001), UPDRS-III (p<0.001), LEDD (p<0.001) and H&Y >3 (p<0.001) were significant in the univariate analysis. In the multivariate stage, age (p<0.001), disease duration 9< years (p=0.015) and UPDRS-III (p=0.004) remained statistically significant. Each one-unit increase in UPDRS-III increased PDQ-39 by 1.91 points and each one-point increase in NMS total score increased PDQ-39 by 3.35 points (p<0.001 for each). Conclusion: NMS significantly impact quality of life in PD patients, with burden increasing alongside disease duration. Motor symptom severity and NMS represent independent determinants of disease progression and quality of life.

Anahtar Kelimeler

• Parkinson
• Non-Motor Symptoms
• Quality of Life
• Disease Progression
• Movement Disorders

Destekleyen Kurum

no

Etik Beyan

Ethical approval was obtained from the Adana City Training and Research Hospital Ethics Committee and the study was conducted by the principles of the Declaration of Helsinki (05/12/24, no:250). Informed consent forms were obtained from all patients and control subjects.

Teşekkür

no

Kaynakça

1. 1.Bloem BR, Okun MS, Klein C. Parkinson's disease. Lancet. 2021 Jun 12;397(10291):2284-2303. https://doi.org/10.1016/S0140-6736(21)00218-X
2. 2.Jellinger KA. Neuropathobiology of non-motor symptoms in Parkinson's disease. Neural Transm (Vienna). 2015 Oct;122(10):1429-40. https://doi.org/10.1007/s00702-015-1405-5
3. 3.Güzelad Ö, Özkan A, Parlak H, et al. Protective mechanism of Syringic acid in an experimental model of Parkinson’s disease. Metabolic Brain Disease, 2021;36(5), 1003–14. https://doi.org/10.1007/s11011-021-00704-9
4. 4.Postuma RB, Aarsland D, Barone P, et al. Identifying prodromal Parkinson's disease: pre-motor disorders in Parkinson's disease. Mov Disord. 2012; 27:617-26. https://doi.org/10.1002/mds.24996
5. 5.Stern MB, Lang A, Poewe W. Toward a redefinition of Parkinson's disease. Mov Disord. 2012; 27:54-60. https://doi.org/10.1002/mds.24051
6. 6.Berg D, Postuma RB, Adler CH, et al. MDS research criteria for prodromal Parkinson's disease. Mov Disord. 2015;30: 1600-11. https://doi.org/10.1002/mds.26431
7. 7.Poewe W, Seppi K, Tanner CM, et al. Parkinson's disease. Nat Rev Dis Primers. 2017;3:17013. https://doi.org/10.1038/nrdp.2017.13
8. 8.Martinez-Martin P, Rodriguez-Blazquez C, Paz S, Paz S, et al. Parkinson's symptoms and health related quality of life as predictors of costs: a longitudinal observational study with linear mixed model analysis. PLoS One. 2015;10: e0145310. https://doi.org/10.1371/journal.pone.0145310

9. 9.Chaudhuri KR, Martinez-Martin P, Schapira AH et al. International multicentre pilot study of the first comprehensive self completed nonmotor symptoms questionnaire for Parkinson's disease: the NMSQuest study. Mov Disord 2006;21:916-23. https://doi.org/10.1002/mds.20844
10. 10.Balaban H. Scales used in the evaluation of Parkinson's disease. Türkiye Klinikleri Nöroloji 2003;1:231-6.
11. 11.Siderowf A, McDermott M, Kieburtz K, et al. Test-retest reliability of the unified Parkinson's disease rating scale in patients with early Parkinson's disease: results from a multicenter clinical trial. Mov Disord 2002; 17:758-63. https://doi.org/10.1002/mds.10011
12. 12.Kayapınar T. Parkinson hastalığı yaşam kalitesi anketi (PDQ-39) güvenilirlik ve geçerlilik çalışması (Yüksek Lisans Tezi). T.C. Haliç Üniversitesi Sağlık Bilimleri Enstitüsü, İstanbul,2018.
13. 13.Chaudhuri KR, Healy DG, Schapira AHV. Non-motor symptoms of Parkinson's disease: diagnosis and management. Lancet Neurology. 2006 Mar;5(3):235-45. https://doi.org/10.1016/S1474-4422(06)70373-8
14. 14.Marinus J, Zhu K, Marras C, et al. Risk factors for non-motor symptoms in Parkinson's disease. Lancet Neurology. 2018 Jun;17(6):559-68. https://doi.org/10.1016/S1474-4422(18)30127-3
15. 15.Cankaya S, Altınayar S. Evaluation of non-motor findings in Parkinson's patients using the NMSQ questionnaire. 2020;1;47-55.
16. 16.Pekel NB. The effect of diabetes mellitus on non-motor symptoms in Parkinson's disease. Acta Medica Alanya. 2019;3:293-9. https://doi.org/10.30565/medalanya.569168