目的:初步数据表明,帕金森病(PD)的步态异常可能与交感神经支配相关。没有进行运动学步态研究来证实这一观察。我们旨在将时空运动步态参数与心脏交感神经支配相关联,这是由PD中的心脏[11C]HEDPET确定的。
方法:回顾性数据库分析了27例心脏交感神经支配的PD患者。所有患者均接受时空运动学步态评估(药物“关闭”状态),心脏[11C]HED和多巴胺能大脑[11C]DTBZPET扫描。我们采用分层回归方法来检查心脏去神经支配程度之间的关联,多巴胺能黑质纹状体神经变性,和三个步态参数——速度,步长和节奏。
结果:更广泛的心脏神经支配与速度较慢相关(估计值:-1.034,95%CI[-1.65,-0.42],p=0.002),较短的步长(估计值:-0.818,95%CI[-1.43,-0.21],p=0.011)和较低的节奏(估计:-0.752,95%CI[-1.28,-0.23],p=0.007)单独解释30%(调整后R²:0.297),20%(调整后的R²:0.202)和23%(调整后的R²:0.227)的可变性,谨慎。这些关联仍然独立于纹状体多巴胺能损伤和混杂因素,如年龄,Hoehn和Yahr(HY)阶段,周围神经病变,认知,和自主神经症状。相比之下,纹状体多巴胺能神经支配与步长显著相关(估计值:0.883,95%CI[0.29,1.48],p=0.005),解释了约24%的变异性,但与HY分期有关。
结论:更严重的心脏去甲肾上腺素能神经支配与较低的步态速度有关,与纹状体多巴胺能神经支配和HY分期无关,影响步长和节奏。这些结果表明外周自主系统变性对PD步态功能障碍的独立贡献。
OBJECTIVE: Preliminary data suggest that gait abnormalities in Parkinson disease (PD) may be associated with sympathetic cardiac denervation. No kinematic gait studies were performed to confirm this observation. We aimed to correlate spatiotemporal kinematic gait parameters with cardiac sympathetic denervation as determined by cardiac [11C]HED PET in PD.
METHODS: Retrospective database analysis of 27 PD patients with cardiac sympathetic denervation. All patients underwent spatiotemporal kinematic gait assessment (medication \'off\' state), cardiac [11C]HED and dopaminergic brain [11C]DTBZ PET scans. We employed a hierarchical regression approach to examine associations between the extent of cardiac denervation, dopaminergic nigrostriatal neurodegeneration, and three gait parameters - velocity, step length and cadence.
RESULTS: More extensive cardiac denervation was associated with slower velocity (estimate: -1.034, 95% CI [-1.65, -0.42], p = 0.002), shorter step length (estimate: -0.818, 95% CI [-1.43, -0.21], p = 0.011) and lower cadence (estimate: -0.752, 95% CI [-1.28, -0.23], p = 0.007) explaining alone 30% (Adjusted-R²: 0.297), 20% (Adjusted-R²: 0.202) and 23% (Adjusted-R²: 0.227) of the variability, respecivetly. These associations remained independent of striatal dopaminergic impairment and confounding factors such as age, Hoehn and Yahr (HY) stages, peripheral neuropathy, cognition, and autonomic symptoms. In contrast, striatal dopaminergic denervation was significantly associated with step length (estimate: 0.883, 95% CI [0.29, 1.48], p = 0.005), explaining about 24% of the variability but was dependent of HY stage.
CONCLUSIONS: More severe cardiac noradrenergic denervation was associated with lower gait velocity, independent of striatal dopaminergic denervation and HY stage, impacting both step length and cadence. These results suggest independent contributions of the peripheral autonomic system degeneration on gait dynsfunction in PD.