Tremor-dominant ve bradikinezi-dominant Parkinson hastalarında progresyonda rolü olan faktörlerin karşılaştırılması; Preklinik dönemden geç evreye hastalıkta dönüm noktaları
Comparison of Factors Contributing to Disease Progression in Tremor-Dominant and Bradykinesia-Dominant Parkinson's Disease Patients: Key Turning Points from the Preclinical to the Late Stage
- Tez No: 874012
- Danışmanlar: PROF. DR. YEŞİM SÜCÜLLÜ KARADAĞ
- Tez Türü: Tıpta Uzmanlık
- Konular: Nöroloji, Neurology
- Anahtar Kelimeler: Belirtilmemiş.
- Yıl: 2024
- Dil: Türkçe
- Üniversite: Sağlık Bilimleri Üniversitesi
- Enstitü: Ankara Bilkent Şehir Hastanesi
- Ana Bilim Dalı: Nöroloji Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 108
Özet
Amaç: Parkinson hastalığında görülen motor ve non-motor semptomların, sosyoekonomik ve kültürel etkenlerin tremor semptomu dominant olan ve bradikinezi semptomu dominant olan iki farklı fenotipik hasta grubunda premotor evreden ileri evreye kadar gösterdiği farklılıkları incelemektir. Gereç ve Yöntem: Çalışmamızda 2019 yılı Mayıs ayından itibaren 2024 yılı Nisan ayına kadar Ankara Bilkent Şehir Hastanesi Nöroloji Hareket Bozuklukları polikliniklerine başvuran, 30-85 yaş aralığında, 2015 Uluslararası Hareket Bozuklukları Cemiyeti Kriterleri'ne göre Parkinson hastalığı tanısı olan 226 hasta dahil edilmiştir. Hastalar tanı aldıkları sırada daha belirgin olan motor semptomları temel alınarak bradikinezi dominant ve tremor dominant olarak iki gruba ayrılmıştır. Hastaların Parkinson tanısı aldıkları tarih, non-motor ve motor semptomlarının başlama tarihi, kullanmış oldukları medikal veya cihaz destekli tedaviler ve radyolojik görüntüleme bulguları hastane ve e-nabız veri sistemi üzerinden retrospektif incelenerek kaydedilmiştir. Medeni durum, eğitim durumu, meslek, gelir durumu, emeklilik tarihi ve duygusal birliktelikleri gibi sosyoekonomik ve kültürel özellikleri hastalar telefon ile aranarak veya poliklinik kontrollerine geldiklerinde bizzat görüşülerek elde edilmiştir. Verilerin istatistiksel analizinde IBM SPSS (Statistical Package for Social Sciences) versiyon 23 programı kullanılmıştır. Bütün testlerde anlamlılık düzeyi p
Özet (Çeviri)
Objective: The aim of this study is to investigate the differences in motor and non-motor symptoms observed in Parkinson's disease among two distinct phenotypic patient groups, one with dominant tremor symptoms and the other with dominant bradykinesia symptoms, in terms of socio-economic and cultural factors from the premotor stage to advanced stages. Material and Methods: A total of 226 patients diagnosed with Parkinson's disease according to the 2015 International Movement Disorder Society Criteria, aged between 30 and 85 years, who presented to the Neurology Movement Disorders outpatient clinics at Ankara Bilkent City Hospital from May 2019 to April 2024, were included in our study. Patients were divided into two groups based on the more prominent motor symptoms at the time of diagnosis: bradykinesia-dominant and tremor-dominant. Data regarding the date of Parkinson's diagnosis, onset date of non-motor and motor symptoms, medical or device-aided therapies used, and radiological findings were reviewed and obtained retrospectively from hospital and“e-nabız”data systems. Socioeconomic and cultural characteristics such as marital status, educational level, occupation, income status, retirement date, and emotional relationships were obtained by telephone interviews with patients or during outpatient clinic visits. IBM SPSS (Statistical Package for Social Sciences) version 23 software was used for statistical analysis. A significance level of p < 0.05 was considered for all tests. Results: The mean age of the patients was 63.7 years (range: 34–83 years), with 56.6% (n=128) being male and 43.4% (n=98) female. Among the patients, 56.6% (n=128) were bradykinesia-dominant and 43.4% (n=98) were tremor-dominant. In our study, 66% of our patients had a total education period of 8 years or less, while 33% had an education period of more than 8 years. The median education period for the bradykinesia-dominant patient group was 8 years, and it was 5 years for the tremor-dominant patient. When occupation groups were categorized as highly active, moderately active, and low active, no difference was observed in the distribution of occupations between bradykinesia-dominant and tremor-dominant patients (p=0.088). When the initial medical treatment choice after diagnosis was reviwed, levodopa preparation was found to be present in 53.1% of bradykinesia-dominant patients and 36.7% of tremor-dominant patients (p=0.014). There was no difference in the onset duration of postural instability between the two groups. When the onset time of dyskinesia was compared between the two groups, it was observed that dyskinesia appeared in the bradykinesia-dominant group a median of 5.1 years after diagnosis and in the tremor-dominant group a median of 7.1 years after diagnosis (p=0.044). Upper and lower gastrointestinal dysfunction appeared earlier in tremor-dominant patients, while urinary dysfunction and psychiatric symptoms appeared earlier in bradykinesia-dominant patients. Structural changes observed in MRI were found to be higher in bradykinesia-dominant patients compared to tremor-dominant patients. The most commonly observed structural findings were cortical atrophy (67.3%), cerebellar atrophy (55.8%), and paramagnetic substance accumulation (10.6%), respectively. Conclusion: Motor and non-motor symptoms in Parkinson's disease can manifest in different forms and severities in each patient. Therefore, the disease needs to be evaluated in a wide range clinically and pharmacologically. Factors influencing the progression and treatment choice of the disease were investigated in our study, and two different subtypes based on motor characteristics were compared in this regard. Dividing Parkinson's disease into subtypes based on clinicopathological characteristics will enable personalized therapies.
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