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The Trajectory of Motor Deterioration to Death in Parkinson's Disease.
Frontiers in Neurology ( IF 3.4 ) Pub Date : 2021-08-18 , DOI: 10.3389/fneur.2021.670567
Sabrina Poonja 1 , Janis Miyasaki 1 , Xilai Fu 2 , Richard Camicioli 1 , Tina Sang 3 , Yan Yuan 2 , Fang Ba 1
Affiliation  

Background: Motor progression varies even among those with a single diagnosis such as Parkinson's disease (PD) and little is known about the trajectory of motor signs prior to death. Understanding deterioration patterns may help clinicians counsel patients and proactively plan interdisciplinary care, including palliative care. The objective of this study was to examine and describe Unified Parkinson's Disease Rating Scale motor score (UPDRS-III) trajectories at the end of life in PD. Methods: A retrospective chart review was performed for deceased PD patients who attended the Parkinson and Movement Disorders Program at the University of Alberta for at least 5 years between 1999 and 2018. UPDRS-III scores were recorded for all visits. Trajectory patterns were visualized with Loess curves stratified by sex and age at diagnosis. Piecewise linear models were used to individually model the UPDRS-III scores, and the trajectories obtained were clustered based on their features. Results: Among the 202 charts reviewed, 84 meeting inclusion criteria were analyzed. The UPDRS-III increased over time regardless of sex and age. Distinct trajectory variations present in PD (e.g., Consistent Deterioration, Stability-Deterioration, Improvement-Deterioration, Deterioration-Improvement-Deterioration) were identified. Twenty-five percent of the patients were classified as Undetermined/Irregular trajectories. In addition, regardless of trajectory type, many patients experienced a steep increase in UPDRS-III approaching death. Those with disease diagnosis after age 65 years had a shorter survival time, compared to PD patients with a younger age of onset. Conclusion: Our study identified dominant types of motor trajectory in PD that can help clinicians understand their patients' course of illness. This information can help counsel patients regarding the variability in motor deterioration and should alert physicians to recognize a terminal decline. Age of disease onset was correlated with survival time.

中文翻译:

帕金森病运动恶化至死亡的轨迹。

背景:即使在具有单一诊断(例如帕金森病 (PD))的患者中,运动进展也各不相同,并且对死亡前运动症状的轨迹知之甚少。了解恶化模式可能有助于临床医生为患者提供咨询并主动规划跨学科护理,包括姑息治疗。本研究的目的是检查和描述帕金森病患者生命末期的统一帕金森病评定量表运动评分 (UPDRS-III) 轨迹。方法:对 1999 年至 2018 年间参加阿尔伯塔大学帕金森和运动障碍项目至少 5 年的已故 PD 患者进行回顾性图表审查。记录所有访问的 UPDRS-III 评分。使用按诊断时的性别和年龄分层的 Loess 曲线可视化轨迹模式。使用分段线性模型对 UPDRS-III 分数进行单独建模,并根据其特征对获得的轨迹进行聚类。结果:在审查的 202 个图表中,分析了 84 个符合纳入标准的图表。无论性别和年龄如何,UPDRS-III 都会随着时间的推移而增加。确定了 PD 中存在的不同轨迹变化(例如,持续恶化、稳定性-恶化、改进-恶化、恶化-改善-恶化)。25% 的患者被归类为未确定/不规则的轨迹。此外,无论轨迹类型如何,许多患者在接近死亡时经历了 UPDRS-III 的急剧增加。与起病年龄较小的 PD 患者相比,65 岁后确诊的患者生存时间较短。结论:我们的研究确定了 PD 运动轨迹的主要类型,可以帮助临床医生了解患者的病程。该信息可以帮助患者就运动退化的可变性提供咨询,并应提醒医生识别终末衰退。发病年龄与生存时间相关。
更新日期:2021-08-18
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