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Early morning off in patients with Parkinson's disease:a Chinese nationwide study and a 7-question screening scale

Translational Neurodegeneration 2020年第3期9卷 370-382页

作者： Chao Han Wei Mao Jing An Lifei Jiao Piu Chan on behalf of the China Early Morning Off(EMO)Study Group National Clinical Research Center for Geriatric Disorders Xuanwu Hospital of Capital Medical UniversityBeijingChina Department of Neurobiology Neurology and GeriatricsXuanwu Hospital of Capital Medical University45 Changchun RoadBeijing 100053China Beijing Institute of Geriatrics Xuanwu Hospital of Capital Medical University45 Changchun RoadBeijing 100053China Clinical Center for Parkinson's Disease Xuanwu Hospital of Capital Medical University45 Changchun RoadBejjing 100053China Key Laboratories for Neurodegenerative Diseases of the Ministry of Education Xuanwu Hospital of Capital Medical University45 Changchun RoadBeijing 100053China Bejjing Key Laboratory for Parkinson's Disease Xuanwu Hospital of Capital Medical University45 Changchun RoadBeijing 100053China Parkinson Disease Center of Beiing Institute for Brain Disorders Xuanwu Hospital of Capital Medical University45 Changchun RoadBeijing 100053China Advanced Innovative Center for Human Brain Protection Xuanwu Hospital of Capital Medical University45 Changchun RoadBejing 100053China Medical department Lundbeck(Bejjing)Pharmaceutical Co.ItdBeijingChina 不详

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

关键词： Parkinson's disease Early morning off Motor symptoms Non-motor symptoms screening scale

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