Nonmotor Symptom Changes and Their Association With Falls Among Parkinson's Disease Patients Undergoing Deep Brain Stimulation: A 1-Year Cohort Study

IF 4.8 1区医学 Q1 NEUROSCIENCES

CNS Neuroscience & Therapeutics Pub Date : 2025-02-28 DOI:10.1111/cns.70310

Ying Gao, Hui You, Jue Wang, Mengsi Yao, Dianyou Li, Bomin Sun, Linbin Wang, Xian Qiu

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引用次数: 0

Abstract

Objectives

Fall severely affects the quality of life of Parkinson's disease (PD) patients. Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective treatment for PD motor symptoms (MS), but DBS increased the risk of falls in some studies and has mixed effects on nonmotor symptoms (NMS). However, the link between NMS and falls, and how DBS influences this relationship, remain unclear. This study investigated changes in NMS and falls before and after STN-DBS, and the longitudinal association between NMS and falls.

Methods

The study included 136 PD patients undergoing STN-DBS between April 2020 and February 2022. Data were collected preoperatively, at 6 months, and at 12 months postoperatively. Assessments included MS via the Unified Parkinson's Disease Rating Scale-III (UPDRS-III) and NMS via the Nonmotor Symptoms Scale (NMSS). We used the Friedman and chi-square tests to assess changes in NMS and falls. Specific circumstances of falls were assessed through structured interviews. Generalized estimating equations (GEE) were used to explore the longitudinal associations between NMS and fall occurrence, as well as the interaction effects between MS and NMS on fall occurrence.

Results

Significant improvements (p < 0.01) were observed in all NMSS domains except gastrointestinal, with no change in fall occurrence. However, there were significant changes in both the locations where falls occurred and whether freezing of gait was present among falling patients (p < 0.01). GEE analysis revealed significant associations between falls and mood/cognition (p = 0.044), gastrointestinal (p = 0.027), and urinary symptoms (p = 0.007), as well as interactions between motor and these NMS domains (p < 0.05).

Conclusions

NMS, particularly mood/cognition, gastrointestinal, and urinary symptoms, and their interactions with MS, are associated with falls, underscoring the need for targeted fall prevention strategies.

Abstract Image

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目的跌倒严重影响帕金森病（PD）患者的生活质量。眼下核（STN）深部脑刺激（DBS）是治疗帕金森病运动症状（MS）的有效方法，但在一些研究中，DBS会增加跌倒的风险，而且对非运动症状（NMS）的影响也不尽相同。然而，NMS与跌倒之间的联系以及DBS如何影响这种关系仍不清楚。本研究调查了 STN-DBS 治疗前后 NMS 和跌倒的变化，以及 NMS 和跌倒之间的纵向联系。方法该研究纳入了 2020 年 4 月至 2022 年 2 月间接受 STN-DBS 治疗的 136 名帕金森病患者。数据收集时间为术前、术后 6 个月和术后 12 个月。评估包括通过统一帕金森病评分量表-III（UPDRS-III）进行的MS评估和通过非运动症状量表（NMSS）进行的NMS评估。我们使用弗里德曼检验和卡方检验来评估 NMS 和跌倒的变化。跌倒的具体情况通过结构化访谈进行评估。我们使用广义估计方程 (GEE) 来探讨 NMS 与跌倒发生率之间的纵向关系，以及 MS 和 NMS 对跌倒发生率的交互影响。结果除胃肠道外，所有 NMSS 领域均有显著改善（p < 0.01），跌倒发生率无变化。然而，跌倒发生的地点和跌倒患者是否出现步态冻结均有显著变化（p < 0.01）。GEE 分析显示，跌倒与情绪/认知（p = 0.044）、胃肠道（p = 0.027）和泌尿系统症状（p = 0.007）之间存在明显关联，运动症状与这些 NMS 领域之间也存在交互作用（p < 0.05）。结论 NMS，尤其是情绪/认知、胃肠道和泌尿系统症状，以及它们与多发性硬化症的相互作用与跌倒有关，强调了有针对性的跌倒预防策略的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.