Risk Factors Of Dyskinesias In Parkinson’s Disease

ObjectiveParkinson’sdisease（PD）isaprogressiveneurodegenerative disease,characterized by the progressive degeneration of dopaminergic neurons in the midbrain.Up to now,Levodopa（L-dopa）,which is precursor levodopa,is still recognized as the most widely used and effective medication for Parkinson’s disease（PD）,but long period therapy is often associated with the development of dyskinesia,which brought not only challenges for neurologists,but also impaired daily living and poor life quality of PD patients.The annual prevalence increases with age,PD has become the second most common neurodegenerative disease in the elderly.While the benefts of levodopa are indisputable,its contribution to long-term complications and the question of when to initiate therapy remain the topic of controversy.After 5 years of levodopa treatment,the prevalence of dyskinesia is about 40-50%,rising to 90%after 10 years of above.However,the reporting prevalence of dyskinesia in China is very low.A recent domestic report shwed that the prevelence of dyskinesia after 5years of levodopa treatment was only 20%,significantly lower than that abroad.The analysis results of the risk factors of levodopa-induced dyskinesia in current clinical studies are different.,which included age of onset,,duration of disease and treatment,severity of disease,duration and dose of levodopa treatment,and body weight。Many factors are interrelated,such as the duration and severity of the disease,duration and dose of levodopa treatmen.So it’s difficult to distinguish which of these factors are independent risk factors for the development of dyskinesia.Therefore,whether the main cause of the occurrence of dyskinesia is related to the progress of the disease itself or its treatment,whether levodopa therapy should be delayed,the dose of levodopa should be limited,or dopamine receptor agonists should be used early are still controversial and very difficult clinical issues.In this study,we evaluated the development of dyskinesia in 86 PD patients on LD therapy who were admitted to our clinic and investigated the risk factors that could have a role in the appearance of these problems.Therefore,we can try to avoid the risk factors intervention to prevent and reduce the occurrence of dyskinesia.MethodsWe assessed the following variables:general information（age at onset of Parkinson’s disease,gender,weight）;living habit（tea,smoke）;duration（duration of Parkinson’s disease,duration of levodopa treatment）;medicine（levodopa monodoses,daily levodopa doses,other antiparkinsonian drugs）;Hoehn and Yahr stages;UPDRS（III）scores.We used the mAIMS to assist in the assessment of dyskinesias.Statistical analysis was performed with SPSS 23.0,the specific prevalence rates of dyskinesia was estimated.The independent sample t test and Chi-square analysis were employed for comparing group means and categorical data,respectively.Univariate logistic regression analysis was used to analyze the influencing factors of dysplasia.Variables with statistical significance were screened for multivariate logistic analysis of its independent risk factors.All p values were2-sided and values<0.05 were considered statistically significant.ResultsFor the subgroups with and without dyskinesias,there were significant difference in gender,the age of onset,duration of levodopa treatment,the daily equivalent dose of levodopa,Hoehn and Yahr stages and UPDRS（III）scores.Univariate logistic regression analysis revealed four significant factors for dysplasia:the earlier age of onset（OR=1.005,P=0.004）,the longer duration of disease（OR=3.421,P<0.05）,the larger daily equivalent dose of levodopa（OR=1.997,P=0.037）,and the higher H&Y stage（OR=2.529,P=0.031）.In addition to gender,duration of levodopa treatment,weight and UPDRSⅢscore,other results were consistent with t test,mann-whitney U test or ^{X 2} test.Factors without statistical significance in univariate logistic regression analysis were screened out,and multivariate logistic regression analysis was performed for the remaining factors.The independent risk factors associated with the occurrence of dyslinesias were age of onset（OR value=2.932,P=0.001）and daily equivalent dose of levodopa（OR value=1.287,P=0.003）.Conclusions1.The prevalence of dyskinesia in Parkinson’s disease is low（26.7%）,which is different from foreign reports.2.The age of onset and daily equivalent dose of levodopa are independent risk factors for the occurrence of dyskinesias.The age of onset is less than 60 years old,and the daily equivalent dose of levodopa greater than 400mg is more likely to cause dyskinesias.3.The prevalence of dyskinesia significantly increased in the middle and late stages of PD and the disease duration greater than 5 years.