Clinical Study On The Patterns Of Motor Symptoms And Seasonal Differences Of Non-motor Symptoms In Patients With Parkinson’s Disease

Objective We aimed to validate and explore the simplified Chinese version of the MDS-UPDRS motor part(MDS-UPDRS-Ⅲ),which could identify the patterns of motor symptoms in patients with Parkinson’s disease(PD),and then we evaluated their relation with other PD clinical features.Subjects and methods The MDS-UPDRS-Ⅲ was tested on 350 patients with PD who were admitted to the Wuhan Tongji hospital from November 2017 to September 2019.Besides,a series of scales included the revised Hoehn-Yahr(H&Y)staging scale,PD non-motor symptoms scale(NMSS)and Mini-Mental State Examination(MMSE)were also used to assess disease stage,overall non-motor symptoms and cognitive function respectively.Confirmatory factor analysis(CFA)and secondary exploratory factor analysis(EFA)were applied to determine if the factor structure of the original English version could be confirmed in the simplified Chinese version.Spearman correlation analysis and multiple linear regression analysis were performed between the obtained motor factors and other PD clinical features.Results(1)The data analysis could be performed on 332 patients with PD included 191 men and 141 women.The H&Y grades in patients were distributed in various stages and 317 cases were in the early or middle stage,which accounted for 92.5%.(2)CFA was performed on the simplified Chinese version of the MDS-UPDRS-Ⅲ.The Comparative Fit Index(CFI)after the model modification was 0.903,which reflected the good fit of the model of the English one.Seven motor factors were extracted and named from the EFA:central axis symptoms,rest tremor,rigidity,bradykinesia(right upper extremity),bradykinesia(left upper extremity),postural tremor or action tremor,bradykinesia(both lower extremities).(3)The central axis symptoms factor was related to urinary symptoms,cardiovascular symptoms,the duration of disease and sleep or fatigue by the analysis of multiple linear regression models.Rigidity factor was related to perception/hallucinations.Bradykinesia(right upper extremity)factor was associated with attention/memory,while Bradykinesia factor(both lower limbs)was associated with mood/cognition and sleep/fatigue.Other factors had no relations with demographic and non-motor symptoms.Conclusion The factor structure of the original English version is confirmed in the simplified Chinese one,which identifies the patterns of motor symptoms in PD.The evaluation of the relationship between motor factors and other PD clinical features may help to elucidate the common pathophysiological mechanisms and provides an objective base for further research on subtypes in PD.Objective To investigate the changes of postural stability and analyze the related factors in early-stage Parkinson’s disease(PD)patients.Subjects and methods Thirty untreated early-stage patients with PD admitted to the Wuhan Tongji hospital and twenty healthy controls were recruited from February to June in 2019.The measurements of the postural sway based on the inertial accelerometer were completed.Jerk and root mean square acceleration(RMS)were selected as parameters for measuring the posture sway,which were measured in the antero-posterior(AP)direction,medio-lateral(ML)/left-right direction and the total vector direction respectively.In different visual status,the postural sway parameters were compared to find the differences between untreated PD and healthy controls.Besides,the parameters were also compared between the untreated and the treated patients.Results(1)Both in the eyes open(EO)and eyes closed(EC)status,parameters(Jerk(AP),Jerk,Jerk(ML),RMS(AP),RMS)in untreated PD group were higher than those in control group(P<0.05).There were no significant differences in the increase rate or deterioration rate in the sway parameters between the PD group and the control group from EO to EC status(P>0.05).(2)In the EC status,parameters(Jerk(AP),Jerk,RMS(AP),RMS)both in PD group and in control group were higher than those in the EO status(P<0.05).(3)There were no significant differences in the sway parameters between untreated and treated patients in EO status(P>0.05).It was same as the parameters in EC status,except the increase of RMS(ML)in treated patients(P=0.047).Conclusion Postural instability also exists in early-stage Parkinson’s patients,with worsening in eyes closed status.Initial treatment of levodopa has no significant effect on it.Objective To identify what effect seasonal variation may have on clinical symptoms in patients with Parkinson’s disease(PD).Subjects and methods We assessed the clinical symptoms by a series of rating scales on474 patients with PD admitted to the Wuhan Tongji hospital from September 2016 to September 2019.The modified H&Y grading scale,Unified Parkinson’s Disease Rating Scale-part III and part IV(MDS-UPDRS-III,MDS-UPDRS-IV)were applied to evaluate the disease stage,motor function and motor complications respectively.PD Sleep Scale(PDSS),Epworth Sleepiness Scale(ESS),Hamilton Depression Scale(HAMD-17),Hamilton Anxiety Scale(HAMA),PD-Autonomic questionnaire(SCOPA-AUT)and Mini-Mental State Examination(MMSE)were used to assess sleep disorders,mood disturbances,autonomic dysfunction and cognitive function respectively.Patients were divided into two groups—winter & spring group and summer & autumn group on the basis of their assessment date,and we compared differences in clinical features between the two groups.Results(1)The data analysis could be performed on 474 patients included 309 cases in winter & spring group and 165 cases in summer & autumn group.There were no significant differences between the two groups in gender composition,age,duration of disease,H&Y stage,MDS-UPDRS-Ⅲ total score,the occurrence of motor complications(motor fluctuation or dyskinesia)and levodopa equivalent dose(P> 0.05).(2)There was a seasonal difference in PDSS total scores(p=0.036),with the lower scores(119.5±23.2)in winter & spring group and the higher(114.4±25.6)in summer & autumn group.Seasonal difference was also observed in the total scores of SCOPA-AUT(P=0.049),with the higher scores(28.7±4.8)in winter & spring group and the lower(27.8±4.3)in summer & autumn group.There were no differences between the two groups in total scores of ESS,HAMD-17,HAMA,and MMSE.(3)The items analysis of PDSS found the seasonal differences in item1(total sleep quality),item 2(sleep maintenance),and item 8(nocturia)(P<0.05).There was no difference in item7(night hallucinations)between the two groups.Seasonal differences were also observed in domain 2(urinary symptoms),domain 3(cardiovascular symptoms)and domain 7(sexual dysfunction)in the analysis of SCOPA-AUT domains(P<0.05).Conclusion Non-motor symptoms in PD fluctuate with the season,with worsening of symptoms in the winter and spring compared to the summer and autumn.The research on seasonal fluctuation of PD is an extension of the research on circadian rhythm system of PD,which can provide ideas for comprehensive treatment of PD.