Longitudinal Mediation Modelling To Activities Of Daily Living In Patients With Parkinson’s Disease

Objective:Parkinson’s disease is a common neurological degenerative condition whose prevalence is rising as the aging process speeds up.It has a significant negative impact on elderly patients’ ability to carry out daily activities,lowers their quality of life,and places a significant burden on their families and society.Rapid eye movement sleep behavior disorder is a neurodegenerative disease’s early sign and warning symptom.The earliest and most prevalent non-motor sign of Parkinson’s disease is autonomic nerve dysfunction.The goal of this study was to examine the long-term mediating influence of autonomic dysfunction on rapid eye movement sleep behavior disorder and everyday functioning in Parkinson’s disease patients and see whether this effect was changing over time.Methods:In the study,410 subjects from the Parkinson’s Disease Progression Markers Program(PPMI)database were recruited for six follow-up visits.Rapid eye movement sleep behavioral disorder screening question(RBDSQ),Scales for Outcomes in Parkinson’s disease-Autonomic(SCOPA-AUT),movement disorder society-sponsored revision of the unified Parkinson’s disease rating scale part two(UDPRS Ⅱ),evaluated rapid eye movement sleep behavior disorder,autonomic nervous dysfunction,and daily living ability.With rapid eye movement sleep behavior disorder as the independent variable,autonomic nervous dysfunction as the mediating variable and daily living ability as the dependent variable,the latent growth curve mediation model,the latent change score mediation model and the Bayesian dynamic mediation model were respectively constructed for longitudinal analysis.Results:Correlation analysis showed that there was a positive correlation between rapid eye movement sleep behavior disorder,autonomic nervous dysfunction and daily living ability at six follow-up visits(P<0.01).The latent growth curve mediation model showed that the total effect of the intercept of rapid eye movement sleep disorder → the intercept of daily living ability was significant(β=0.427,95%CI: 0.310～0.534),the indirect effect of the intercept of rapid eye movement sleep disorder → the intercept of autonomic nervous dysfunction → the intercept of daily living ability was significant(β=0.231,95%CI: 0.158～0.324),the direct effect of the intercept of rapid eye movement sleep disorder → the intercept of daily living ability score was significant(β=0.196,95%CI: 0.045～0.331).The indirect effect of slope of rapid eye movement sleep disorder → slope of autonomic dysfunction → slope of daily living ability was significant(β=0.272,95%CI: 0.112～0.509),the total effect of slope of rapid eye movement sleep disorder → slope of daily living ability was not significant(β=0.030,95%CI:-0.189～0.270),the direct effect(β=-0.242,95%CI:-0.515～0.016)on the slope of rapid eye movement sleep disorder → the slope of daily living ability was not significant.Results from the latent change score mediation model showed a significant total effect from baseline Rapid eye movement sleep disorder to changes in ability to perform daily living from V06 to V12(β=0.342,95%CI: 0.027～0.703),the indirect effect of baseline rapid eye movement sleep disorder affected the change in ability of daily living from V06 to V12 through changes in autonomic dysfunction from baseline to V06 the indirect effect was significant(β=1.591,95%CI: 0.913～3.032),baseline rapid eye movement sleep disorder had a significant direct effect on daily living ability from V06 to V12(β=-1.249,95%CI:-2.703～-0.609).The results of Bayesian dynamic mediation model showed that the 95%CI of the mediating effect of autonomic dysfunction was 0.033-0.093,0.062-0.130,0.099-0.178 when the follow-up time from baseline to V12 was mapped to the interval [0,1],and the time was0.25,0.50,and 0.75,respectively.The confidence interval did not include 0,and the mediating effect of autonomic nervous dysfunction was significant at all time points.With the passage of time,the indirect effects of autonomic dysfunction show an increasing trend.Conclusions:This study found that the longitudinal mediation effect of autonomic dysfunction in PD patients was significant between rapid eye movement sleep behavior disorder and daily living ability.The symptoms of rapid eye movement sleep behavior disorder affected patients’ daily living ability by aggravating the symptoms of autonomic dysfunction.In addition,with the increase of the course of the disease,the mediation effect of autonomic dysfunction shows a rising trend.Therefore,for patients with Parkinson’s disease,effective prevention and intervention of rapid eye movement sleep behavior disorder in the early stage is helpful to reduce the occurrence of symptoms related to autonomic dysfunction,and is helpful to improve patients’ daily living ability and improve their quality of life.