Clinical Characteristics Of Patients With Parkinson's Disease

Objective: To investigate the clinical features of motor symptoms and non-motor symptoms in PD.Further deepening the comprehensive understanding of clinicians on PD.So as to guide early diagnosis of PD and provide clinical basis for establishment of long-term treatment.Methods: 102 patients with PD were enrolled in the outpatient department of Neurology,Guizhou Provincial People's Hospital,from June 2015 to December 2016.Clinical data were registered by a specially trained neurological physician.Comparing the clinical features among PD patients with different course,H-Y staging,clinical subtypes and the onset type.Analysing the correlation between motor symptoms,non-motor symptoms and gender,age,course of disease,H-Y stage,LEDD,clinical subtypes and onset type.Exploring the occurrence and development of motor symptoms,non-motor symptoms and motor complications.Results:(1)Among 102 cases PD patients,the incidence of male patients was higher(56.86%),and the ratio of male and female was 1.31:1.The age was 62.01±14.75 years old,course was 3.52±3.81 years,age of onset was 58.48±14.81 years,H-Y staging was 2.29±1.09 period.(2)Initial symptom appeared on the right side in 50.00% patients.Tremor was the initial symptom in 65.69%patients..During the course of the disease,the incidence of tremor was 79.41%,and the motion retardation was 67.65%,and the stiffness of the body was about 57.84%.Freezing was found in 36.2 % and falls in 12.4 %.(3)Levodopa(LD)was choosed in80.39% of patients.The mean duration of LD treatment was 1.55±1.99 years,mean LEDD was 250±143.98 mg.MAO-B inhibitors and COMT inhibitors were rarely introduced in patients.Patients who were not treated account for 1.96%.(4)Motor complications occurred in 20.59%,symptom fluctuations in15.69%,dyskinesia in5.88%.Concurrent symptoms and dyskinesias was 0.98%.LEDD is an independent risk factor for symptom fluctuations(P=0.02).(5)The total incidence rate of NMSwas 100%,which ranked in the top 5 of the non-motor symptoms was constipation(73.53%),depression(67.65%),anxiety(61.76%),a decline in interest(52.94%),concentration(51.96%),insomnia(51.96%).PD patients with non-motor symptoms ranging from 2 to 24,with an average of 10.02±4.49.(6)H-Y stage,course of disease,clinical subtypes were positively correlated with the number of NMS,and the correlation coefficients were r=0.713,r=0.446,F=3.41(P=0.037<0.05).The longer course,the higher H-Y stage,the more NMS number occurred.Compared with the patients with tremor and mixed type,the number of patients with NMS was more severe.(7)Multiple regression analysis showed that H-Y stage,course had different effect on NMS score,the regression coefficient was 0.835,0.748.Conclusion:(1)Motor symptoms of PD patients was severe.The NMS of PD are prevalent in patients,which runs through the whole course of the disease.There are various forms of NMS,and constipation,depression and anxiety are the most common.(2)PD patients have taken single levodopa compound preparation,and a few patients were not treated with any medicine yet.Therefore,the standard treatment for newly diagnosed patients needs further improvement.(3)Attention should be paid to patients with limb dysfunction or stiffness as the first symptom,and those patients who with olfactory disorders,sleep disorders,constipation,urinary dysfunction(urgency ? nocturia),orthostatic hypotension.Close follow-up these patients who are likely to gradually develop the core symptoms of PD.These symptoms are thought to be an early symptom of PD.(4)LEDD is an independent risk factor for symptom fluctuations,The greater dose,the greater the risk of symptom fluctuations.(5)The longer course,the higher H-Y stage,the more NMS number occurred.Compared with the patients with tremor and mixed type,the number of patients with NMS was more severe.(6)H-Y stage,course had different effects on the number of NMS.(7)It is necessary to comprehensively consider the patient's motor symptoms,non-motor symptoms,motor complications and personal situation in the formulation of drug therapy for PD patients.Objective: To analyze the clinical features in 60 sporadic PD patients and 1 familial PD pedigrees retrospectly and discuss the relationship with DJ-1 gene mutation.Methods: We summarized patient's clinical features after completing relevant inspection,and detected the DJ-1 gene mutation through combining the polymerase chain reaction(PCR)technique with DNA sequencing for PD patients Results: Among 60 sporadic PD patients,there were 32 cases of male,28 cases of female,and the male/female ratio was1.14:1.The age was 57.51±16.24 years old,course was 3.16±3.39 years,age of onset was 54.33±16.17 years,H-Y staging was 1.90±0.93 period.Initial symptom appeared on the right side in 48.33% patients.Tremor was the initial symptom in 65.00% patients.During the course of the disease,the incidence of tremor was 78.33%,and the motion retardation was 61.67%,and the stiffness of the body was about 51.67%.Freezing was found in 1.67% and falls in 3.33 %.10 patients had symptoms of fluctuations and dyskinesia in 3 patients.A total of 4patients in the families,3 female patients(2 deaths),and 1 male patients.Tremor was the initial symptom in all 4 patients.Initial symptom appeared on the right side in 3cases,and 1 cases on both sides.All 4 cases had static tremor,and slow movement symptoms,abnormal posture and gait in 3 cases.Symptom fluctuation in 2 cases,and dystonia in 1 cases in the later stage of the disease.We didn't detect mutation in 2-7exon of DJ-1 gene in 60 sporadic PD patients and 2 patients,2 unaffected family members in one PD families.Conclusion: Sporadic patients were consistent with the occurrence and development of general PD.The PD families accord with the autosomal recessive inheritance.Female case is more than male slightly,Female patients are more frequent than males,and symptoms of advanced symptoms are common in the later stage of PD.The 60 sporadic PD patients and 2 family PD patients may not be caused by gene mutation in exon 2-7 of DJ-1gene.