Risk Factors For Dyskinesia In Patients With Parkinson’s Disease

Objective:This study aimed to explore the risk factors for dyskinesia in patients with Parkinson’s disease(PD).Methods:Thirty-eight patients with dyskinesia who were admitted to the Parkinson’s clinic of the Department of Neurology of the First Hospital of Jilin University from January2019 to September 2022,were included in this study.Of the 38,20 patients were excluded due to insufficient follow-up,lack of medical history data or inability to complete the scale,and the case group ultimately included 18 patients.During the study period,there were 614 idiopathic PD patients without dyskinesia,and 61(10%)of them were selected as the control group.twenty-two patients were excluded for the same reasons listed above,and 39 patients eventually formed the control group.Demographic data and clinical characteristics were collected,and the occurrence of PD motor symptoms,non-motor symptoms,and dyskinesia were evaluated using the MDS-UPDRS.Patients in the two groups were further examined for iron deposition in the brain with 3.0T magnetic resonance quantitative magnetic sensitivity imaging.We used IBM-SPSS(version 25.0)for statistical analysis and binary logistic regression analysis to identify the independent risk factors for dyskinesia in patients with Parkinson’s disease.we also used the receiver operating characteristic curve to evaluate the diagnostic value of QSM value difference for dyskinesia.P<0.05 was considered statistically significant.Results:(1)In terms of demographic data,the proportion of female patients in the PD-LID(+)was higher than that of the PD-LID(-)group,and the difference was statistically significant(P=0.02);(2)In terms of clinical data,compared with the PD-LID(-)group,the PD-LID(+)group had lower systolic and diastolic blood pressure(systolic blood pressure: P<0.01;diastolic blood pressure: P<0.01),earlier PD onset age(P<0.01),longer PD course(P<0.01),higher total LEDD(P<0.01),higher LEDD(P=0.02)and higher DA LED(P<0.01).In terms of scale score,compared with the PD-LID(-)group,the PD-LID(+)group had a higher score of MDS-UPDRS part IV(P<0.01).Regarding the PD onset side,the proportion of left onset was higher in the PD-LID(+)group(P=0.02).Regarding MDS-UPDRS phenotypes,MT type accounted for more in the PD-LID(+)group(P=0.02);(3)In terms of iron deposition in different nuclei in the brain,compared with the PD-LID(-)group,the QSM values of patients in the PD-LID(+)group were higher in the right dentate nucleus(P<0.01),bilateral dentate nucleus(P=0.01),left substantia nigra pars reticulata(P=0.02),right substantia nigra pars reticulata(P<0.01)the bilateral substantia nigra pars reticulata(P<0.01),right substantia nigra compacta(P=0.09),left substantia nigra(P=0.04),right substantia nigra(P<0.01),bilateral substantia nigra(P<0.01),left globus pallidus(P<0.01),right globus pallidus(P<0.01),bilateral globus pallidus(P<0.01),bilateral putamen(P=0.01),left caudate nucleus(P<0.01),right caudate nucleus(P<0.01),bilateral caudate nucleus(P<0.01),new striatum(P<0.01),lenticular nucleus(P<0.01),and the striatum(P<0.01);(4)The binary logistic regression analysis found that the higher the MDS-UPDRS part IV score,the greater the risk of LID(OR=1.52,P=0.016);the higher the QSM value of the right pallidus,the greater the risk of LID(OR=1.04E+60,P=0.029);and the higher the QSM value of the left caudate nucleus,the greater the risk of LID(OR=4.26E+60,P=0.034);(5)The area under the curve of the RGP’s QSM value to diagnose PD-LID(+)was 0.789(P<0.05),its cut off value was 95.6 ppb,sensitivity was 55.6%,and specificity was 97.3%.The area under the curve of the LCN’s QSM value to diagnose PD-LID(+)was 0.895(P<0.05),the cut off value was 41.05 ppb,with a sensitivity of88.9%,and a specificity of 82.1%.The area under the curve for the occurrence of PD-LID(+)was 0.926(P<0.05)based on the QSM value of RGP combined with LCN,with a sensitivity of 94.4% and a specificity of 97.3%.Conclusion:(1)Among the patients with dyskinesia in this research center,there were more women,more patients with lower blood pressure,earlier PD onset age,more patients with left onset,longer PD course,higher equivalent dose of levodopa,more patients with the MT type,and higher MDS-UPDRS Part IV scores.(2)Part IV of the MDS-UPDRS,the QSM value of the right globus pallidus,and the QSM value of the left caudate nucleus were independent risk factors for dyskinesia.(3)The QSM value of the RGP greater than 95.6 ppb or the QSM value of the LCN greater than 41.05 ppb,has diagnostic value for dyskinesia(the area under the curve was 0.789 and 0.895 respectively),and the diagnostic efficiency of the two indicators combined(the area under the curve is 0.926),is higher than that of the independent indicators,suggesting that increased iron deposition in the right pallidum and the left caudate nucleus may be involved in the occurrence of dyskinesia.