Sexual dimorphism in Parkinson’s disease: differences in clinical manifestations, quality of life and psychosocial functioning between males and females
Identifieur interne : 002222 ( Ncbi/Merge ); précédent : 002221; suivant : 002223Sexual dimorphism in Parkinson’s disease: differences in clinical manifestations, quality of life and psychosocial functioning between males and females
Auteurs : Farzaneh Farhadi ; Kia Vosoughi ; Gholam Ali Shahidi [Iran] ; Ahmad Delbari [Suède, Iran] ; Johan Lökk [Suède] ; Seyed-Mohammad Fereshtehnejad [Suède, Canada, Iran]Source :
- Neuropsychiatric Disease and Treatment [ 1176-6328 ] ; 2017.
Abstract
Sex-related differences in clinical manifestations and consequences of Parkinson’s disease (PD) have been poorly explored. Better understanding of sexual dimorphism in neurologic diseases such as PD has been announced as a research priority. The aim of our study was to determine independent sex differences in clinical manifestations and subtypes, psychosocial functioning, quality of life (QoL) and its domains between male and female individuals with PD.
A comprehensive list of demographics, motor symptoms and subtypes, nonmotor features, health-related quality of life (HRQoL), psychosocial functioning and general aspects of daily life was assessed in 157 individuals (108 males and 49 females) with idiopathic PD. In order to control for potential confounding variables, we applied Orthogonal Partial Least Squares – Discriminant Analysis (OPLS-DA) to explore the strength of each feature to discriminate male and female patients with PD.
While no sex difference was found in the total Unified Parkinson’s Disease Rating Scale (UPDRS) score and cumulative daily dose of levodopa, females had significantly more severe anxiety (mean difference =2.2 [95% confidence interval, CI: 0.5–4.0],
Our study provides a comprehensive understanding of sexual dimorphism in PD. Anxiety, depression, specific domains of HRQoL (mobility, emotional well-being, social support and bodily discomfort) and psychosocial functioning were significantly worse in female individuals with PD. Sexual dimorphism in PD highlights the features that are more likely to be affected in each sex and should be specifically targeted when managing male and female individuals with PD.
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DOI: 10.2147/NDT.S124984
PubMed: 28203083
PubMed Central: 5295791
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Medicine, Karolinska University Hospital, Stockholm, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Department of Geriatric Medicine, Karolinska University Hospital, Stockholm</wicri:regionArea><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation></author><author><name sortKey="Fereshtehnejad, Seyed Mohammad" sort="Fereshtehnejad, Seyed Mohammad" uniqKey="Fereshtehnejad S" first="Seyed-Mohammad" last="Fereshtehnejad">Seyed-Mohammad Fereshtehnejad</name><affiliation wicri:level="3"><nlm:aff id="af3-ndt-13-329">Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden</nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm</wicri:regionArea><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation><affiliation wicri:level="4"><nlm:aff id="af6-ndt-13-329">Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Neurology and Neurosurgery, McGill University, Montreal, QC</wicri:regionArea><orgName type="university">Université McGill</orgName><placeName><settlement type="city">Montréal</settlement><region type="state">Québec</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="af7-ndt-13-329">Firoozgar Clinical Research Development Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran</nlm:aff><country xml:lang="fr">Iran</country><wicri:regionArea>Firoozgar Clinical Research Development Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran</wicri:regionArea><wicri:noRegion>Tehran</wicri:noRegion></affiliation></author></analytic><series><title level="j">Neuropsychiatric Disease and Treatment</title><idno type="ISSN">1176-6328</idno><idno type="eISSN">1178-2021</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>Sex-related differences in clinical manifestations and consequences of Parkinson’s disease (PD) have been poorly explored. Better understanding of sexual dimorphism in neurologic diseases such as PD has been announced as a research priority. The aim of our study was to determine independent sex differences in clinical manifestations and subtypes, psychosocial functioning, quality of life (QoL) and its domains between male and female individuals with PD.</p></sec><sec><title>Patients and methods</title><p>A comprehensive list of demographics, motor symptoms and subtypes, nonmotor features, health-related quality of life (HRQoL), psychosocial functioning and general aspects of daily life was assessed in 157 individuals (108 males and 49 females) with idiopathic PD. In order to control for potential confounding variables, we applied Orthogonal Partial Least Squares – Discriminant Analysis (OPLS-DA) to explore the strength of each feature to discriminate male and female patients with PD.</p></sec><sec><title>Results</title><p>While no sex difference was found in the total Unified Parkinson’s Disease Rating Scale (UPDRS) score and cumulative daily dose of levodopa, females had significantly more severe anxiety (mean difference =2.2 [95% confidence interval, CI: 0.5–4.0], <italic>P</italic>=0.011), worse nutritional status (23.8 [standard deviation, SD =4.2] vs 25.8 [SD =2.6], <italic>P</italic>=0.003) and poorer QoL (28.3 [SD =15.7] vs 17.9 [SD =14.2], <italic>P</italic><0.001). Based on multivariate discriminant analysis, emotional well-being, bodily discomfort, social support, mobility and communication domains of HRQoL, together with anxiety, depression and psychosocial functioning, were the strongest features with more severe/worse status in females after adjustment for potential statistical confounders.</p></sec><sec><title>Conclusion</title><p>Our study provides a comprehensive understanding of sexual dimorphism in PD. Anxiety, depression, specific domains of HRQoL (mobility, emotional well-being, social support and bodily discomfort) and psychosocial functioning were significantly worse in female individuals with PD. Sexual dimorphism in PD highlights the features that are more likely to be affected in each sex and should be specifically targeted when managing male and female individuals with PD.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Langston, Jw" uniqKey="Langston J">JW Langston</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Elbaz, A" uniqKey="Elbaz A">A Elbaz</name></author><author><name sortKey="Bower, Jh" uniqKey="Bower J">JH Bower</name></author><author><name sortKey="Maraganore, Dm" uniqKey="Maraganore D">DM Maraganore</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pavon, Jm" uniqKey="Pavon J">JM Pavon</name></author><author><name sortKey="Whitson, He" uniqKey="Whitson H">HE Whitson</name></author><author><name sortKey="Okun, Ms" uniqKey="Okun M">MS Okun</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stuendl, A" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Neuropsychiatr Dis Treat</journal-id><journal-id journal-id-type="iso-abbrev">Neuropsychiatr Dis Treat</journal-id><journal-id journal-id-type="publisher-id">Neuropsychiatric Disease and Treatment</journal-id><journal-title-group><journal-title>Neuropsychiatric Disease and Treatment</journal-title></journal-title-group><issn pub-type="ppub">1176-6328</issn><issn pub-type="epub">1178-2021</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28203083</article-id><article-id pub-id-type="pmc">5295791</article-id><article-id pub-id-type="doi">10.2147/NDT.S124984</article-id><article-id pub-id-type="publisher-id">ndt-13-329</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Research</subject></subj-group></article-categories><title-group><article-title>Sexual dimorphism in Parkinson’s disease: differences in clinical manifestations, quality of life and psychosocial functioning between males and females</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Farhadi</surname><given-names>Farzaneh</given-names></name><xref ref-type="aff" rid="af1-ndt-13-329">1</xref></contrib><contrib contrib-type="author"><name><surname>Vosoughi</surname><given-names>Kia</given-names></name><xref ref-type="aff" rid="af1-ndt-13-329">1</xref></contrib><contrib contrib-type="author"><name><surname>Shahidi</surname><given-names>Gholam Ali</given-names></name><xref ref-type="aff" rid="af2-ndt-13-329">2</xref></contrib><contrib contrib-type="author"><name><surname>Delbari</surname><given-names>Ahmad</given-names></name><xref ref-type="aff" rid="af3-ndt-13-329">3</xref><xref ref-type="aff" rid="af4-ndt-13-329">4</xref></contrib><contrib contrib-type="author"><name><surname>Lökk</surname><given-names>Johan</given-names></name><xref ref-type="aff" rid="af3-ndt-13-329">3</xref><xref ref-type="aff" rid="af5-ndt-13-329">5</xref></contrib><contrib contrib-type="author"><name><surname>Fereshtehnejad</surname><given-names>Seyed-Mohammad</given-names></name><xref ref-type="aff" rid="af3-ndt-13-329">3</xref><xref ref-type="aff" rid="af6-ndt-13-329">6</xref><xref ref-type="aff" rid="af7-ndt-13-329">7</xref><xref ref-type="corresp" rid="c1-ndt-13-329"></xref></contrib></contrib-group><aff id="af1-ndt-13-329"><label>1</label>Medical Student Research Committee</aff><aff id="af2-ndt-13-329"><label>2</label>Movement Disorders Clinic, Department of Neurology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran</aff><aff id="af3-ndt-13-329"><label>3</label>Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden</aff><aff id="af4-ndt-13-329"><label>4</label>Iranian Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, Iran</aff><aff id="af5-ndt-13-329"><label>5</label>Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden</aff><aff id="af6-ndt-13-329"><label>6</label>Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada</aff><aff id="af7-ndt-13-329"><label>7</label>Firoozgar Clinical Research Development Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran</aff><author-notes><corresp id="c1-ndt-13-329">Correspondence: Seyed-Mohammad Fereshtehnejad, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Novum Fifth Floor, 14186 Stockholm, Sweden, Tel +46 8 5858 9397, Fax +46 8 5858 5470, Email <email>sm.fereshtehnejad@ki.se</email></corresp></author-notes><pub-date pub-type="collection"><year>2017</year></pub-date><pub-date pub-type="epub"><day>01</day><month>2</month><year>2017</year></pub-date><volume>13</volume><fpage>329</fpage><lpage>338</lpage><permissions><copyright-statement>© 2017 Farhadi et al. This work is published and licensed by Dove Medical Press Limited</copyright-statement><copyright-year>2017</copyright-year><license><license-p>The full terms of this license are available at <ext-link ext-link-type="uri" xlink:href="https://www.dovepress.com/terms.php">https://www.dovepress.com/terms.php</ext-link> and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p></license></permissions><abstract><sec><title>Introduction</title><p>Sex-related differences in clinical manifestations and consequences of Parkinson’s disease (PD) have been poorly explored. Better understanding of sexual dimorphism in neurologic diseases such as PD has been announced as a research priority. The aim of our study was to determine independent sex differences in clinical manifestations and subtypes, psychosocial functioning, quality of life (QoL) and its domains between male and female individuals with PD.</p></sec><sec><title>Patients and methods</title><p>A comprehensive list of demographics, motor symptoms and subtypes, nonmotor features, health-related quality of life (HRQoL), psychosocial functioning and general aspects of daily life was assessed in 157 individuals (108 males and 49 females) with idiopathic PD. In order to control for potential confounding variables, we applied Orthogonal Partial Least Squares – Discriminant Analysis (OPLS-DA) to explore the strength of each feature to discriminate male and female patients with PD.</p></sec><sec><title>Results</title><p>While no sex difference was found in the total Unified Parkinson’s Disease Rating Scale (UPDRS) score and cumulative daily dose of levodopa, females had significantly more severe anxiety (mean difference =2.2 [95% confidence interval, CI: 0.5–4.0], <italic>P</italic>=0.011), worse nutritional status (23.8 [standard deviation, SD =4.2] vs 25.8 [SD =2.6], <italic>P</italic>=0.003) and poorer QoL (28.3 [SD =15.7] vs 17.9 [SD =14.2], <italic>P</italic><0.001). Based on multivariate discriminant analysis, emotional well-being, bodily discomfort, social support, mobility and communication domains of HRQoL, together with anxiety, depression and psychosocial functioning, were the strongest features with more severe/worse status in females after adjustment for potential statistical confounders.</p></sec><sec><title>Conclusion</title><p>Our study provides a comprehensive understanding of sexual dimorphism in PD. Anxiety, depression, specific domains of HRQoL (mobility, emotional well-being, social support and bodily discomfort) and psychosocial functioning were significantly worse in female individuals with PD. Sexual dimorphism in PD highlights the features that are more likely to be affected in each sex and should be specifically targeted when managing male and female individuals with PD.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>Parkinson’s disease</kwd><kwd>sexual dimorphism</kwd><kwd>male</kwd><kwd>female</kwd><kwd>quality of life</kwd><kwd>psychosocial functioning</kwd></kwd-group></article-meta></front><floats-group><fig id="f1-ndt-13-329" position="float"><label>Figure 1</label><caption><p>Score scatter plot to show the performance of the OPLS model to separate male and female PD patients.</p><p><bold>Note:</bold> The separation of the two classes of observations are shown in the horizontal (<italic>t</italic>1) direction, while the vertical (<italic>t</italic>2) direction expresses within-class variability.</p><p><bold>Abbreviations:</bold> OPLS, Orthogonal Partial Least Squares; PD, Parkinson’s disease; <italic>t</italic>1, score of each participant from the main discriminant component in the <italic>X</italic>-block (horizontal axis); <italic>t</italic>2, score of each participant from the <italic>Y</italic>-orthogonal component (vertical axis).</p></caption><graphic xlink:href="ndt-13-329Fig1"></graphic></fig><fig id="f2-ndt-13-329" position="float"><label>Figure 2</label><caption><p>Loading plots of the OPLS model to separate male and female PD patients showing the importance of each feature for this discrimination.</p><p><bold>Abbreviations:</bold> OPLS, Orthogonal Partial Least Squares; PD, Parkinson’s disease; <italic>p</italic>1, loading value; PDQ, PD questionnaire; SCOPA, Scales for Outcomes in Parkinson’s Disease; CV, cardiovascular; FOSS, freezing–speech–swallowing; UPDRS, Unified Parkinson’s Disease Rating Scale; ADL, activities of daily living; PIGD, postural instability–gait difficulty; MNA, Mini-Nutritional Assessment.</p></caption><graphic xlink:href="ndt-13-329Fig2"></graphic></fig><fig id="f3-ndt-13-329" position="float"><label>Figure 3</label><caption><p>Loadings scatter plot <italic>p</italic>1 vs <italic>p</italic>2 to show the performance each feature/characteristic of the OPLS model to separate male and female PD patients.</p><p><bold>Notes:</bold> The horizontal axis displays the <italic>X</italic>-loadings <italic>p</italic> and the <italic>Y</italic>-loadings <italic>q</italic> of the predictive component. The vertical axis displays the <italic>X</italic>-loadings <italic>p</italic>(o) and the <italic>Y</italic>-loadings <italic>s</italic>(o) for the <italic>Y</italic>-orthogonal component. <italic>X</italic>-variables situated in the vicinity of the dummy <italic>Y</italic>-variables have the highest discriminatory power between the classes.</p><p><bold>Abbreviations:</bold> OPLS, Orthogonal Partial Least Squares; PD, Parkinson’s disease; PDQ, PD questionnaire; SCOPA, Scales for Outcomes in Parkinson’s Disease; ADL, activities of daily living; CV, cardiovascular; FOSS, freezing–speech–swallowing; UPDRS, Unified Parkinson’s Disease Rating Scale; PIGD, postural instability–gait difficulty; MNA, Mini-Nutritional Assessment.</p></caption><graphic xlink:href="ndt-13-329Fig3"></graphic></fig><table-wrap id="t1-ndt-13-329" position="float"><label>Table 1</label><caption><p>Comparison of demographic characteristics, disease severity scales, psychiatric features, nutritional status and QoL scores between males and females with PD</p></caption><table frame="hsides" rules="groups"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Characteristics</th><th valign="top" align="left" rowspan="1" colspan="1">Male (n=108)</th><th valign="top" align="left" rowspan="1" colspan="1">Female (n=49)</th><th valign="top" align="left" rowspan="1" colspan="1"><italic>P</italic>-value</th></tr></thead><tbody><tr><td valign="top" align="left" rowspan="1" colspan="1"><bold>Demography and general information</bold></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Age (year), mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Current</td><td valign="top" align="left" rowspan="1" colspan="1">61.4 (11.2)</td><td valign="top" align="left" rowspan="1" colspan="1">60.5 (13.6)</td><td valign="top" align="left" rowspan="1" colspan="1">0.685</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> PD onset</td><td valign="top" align="left" rowspan="1" colspan="1">55.2 (11.6)</td><td valign="top" align="left" rowspan="1" colspan="1">53.4 (12.4)</td><td valign="top" align="left" rowspan="1" colspan="1">0.384</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Duration of disease (year), mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">6.1 (4.9)</td><td valign="top" align="left" rowspan="1" colspan="1">8.2 (5.7)</td><td valign="top" align="left" rowspan="1" colspan="1"><bold>0.023</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Level of education, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"><bold>0.015</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Illiterate</td><td valign="top" align="left" rowspan="1" colspan="1">7 (6.5)</td><td valign="top" align="left" rowspan="1" colspan="1">10 (21.3)</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Primary and/or secondary</td><td valign="top" align="left" rowspan="1" colspan="1">26 (24.1)</td><td valign="top" align="left" rowspan="1" colspan="1">11 (23.4)</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> High school/diploma</td><td valign="top" align="left" rowspan="1" colspan="1">28 (25.9)</td><td valign="top" align="left" rowspan="1" colspan="1">15 (31.9)</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> College and/or university</td><td valign="top" align="left" rowspan="1" colspan="1">47 (43.5)</td><td valign="top" align="left" rowspan="1" colspan="1">11 (23.4)</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Smoking, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1">15 (13.9)</td><td valign="top" align="left" rowspan="1" colspan="1">2 (4.1)</td><td valign="top" align="left" rowspan="1" colspan="1">0.095</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Comorbidities, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Depression</td><td valign="top" align="left" rowspan="1" colspan="1">18 (16.8)</td><td valign="top" align="left" rowspan="1" colspan="1">19 (40.4)</td><td valign="top" align="left" rowspan="1" colspan="1"><bold>0.002</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Hypertension</td><td valign="top" align="left" rowspan="1" colspan="1">16 (15.0)</td><td valign="top" align="left" rowspan="1" colspan="1">12 (25.0)</td><td valign="top" align="left" rowspan="1" colspan="1">0.133</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> IHD</td><td valign="top" align="left" rowspan="1" colspan="1">19 (17.8)</td><td valign="top" align="left" rowspan="1" colspan="1">5 (10.9)</td><td valign="top" align="left" rowspan="1" colspan="1">0.283</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Diabetes</td><td valign="top" align="left" rowspan="1" colspan="1">10 (9.3)</td><td valign="top" align="left" rowspan="1" colspan="1">10 (21.7)</td><td valign="top" align="left" rowspan="1" colspan="1"><bold>0.037</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Stroke/TIA</td><td valign="top" align="left" rowspan="1" colspan="1">1 (0.9)</td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="left" rowspan="1" colspan="1">1</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Osteoporosis</td><td valign="top" align="left" rowspan="1" colspan="1">8 (7.5)</td><td valign="top" align="left" rowspan="1" colspan="1">11 (23.9)</td><td valign="top" align="left" rowspan="1" colspan="1"><bold>0.005</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Total (comorbidity burden), mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">0.5 (1.0)</td><td valign="top" align="left" rowspan="1" colspan="1">0.8 (1.0)</td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"><bold>Motor severity and medications</bold></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">UPDRS score, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Part II – ADL</td><td valign="top" align="left" rowspan="1" colspan="1">11.4 (7.4)</td><td valign="top" align="left" rowspan="1" colspan="1">12.3 (7.4)</td><td valign="top" align="left" rowspan="1" colspan="1">0.471</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Part III – motor</td><td valign="top" align="left" rowspan="1" colspan="1">15.0 (9.0)</td><td valign="top" align="left" rowspan="1" colspan="1">16.8 (9.4)</td><td valign="top" align="left" rowspan="1" colspan="1">0.251</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Part IV – complications</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Dyskinesia</td><td valign="top" align="left" rowspan="1" colspan="1">0.9 (1.5)</td><td valign="top" align="left" rowspan="1" colspan="1">0.9 (1.9)</td><td valign="top" align="left" rowspan="1" colspan="1">0.961</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Wearing off</td><td valign="top" align="left" rowspan="1" colspan="1">1.7 (1.3)</td><td valign="top" align="left" rowspan="1" colspan="1">1.6 (1.3)</td><td valign="top" align="left" rowspan="1" colspan="1">0.698</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Total</td><td valign="top" align="left" rowspan="1" colspan="1">31.2 (17.6)</td><td valign="top" align="left" rowspan="1" colspan="1">34.6 (19.3)</td><td valign="top" align="left" rowspan="1" colspan="1">0.322</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">H&Y stage, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">1.9 (0.9)</td><td valign="top" align="left" rowspan="1" colspan="1">2.2 (0.9)</td><td valign="top" align="left" rowspan="1" colspan="1"><bold>0.035</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Schwab and England ADL score (%), mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">82.2 (17.2)</td><td valign="top" align="left" rowspan="1" colspan="1">76.7 (19.3)</td><td valign="top" align="left" rowspan="1" colspan="1">0.076</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Motor impairment score A,<xref ref-type="table-fn" rid="tfn1-ndt-13-329">a</xref> mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">11.2 (6.3)</td><td valign="top" align="left" rowspan="1" colspan="1">12.1 (6.4)</td><td valign="top" align="left" rowspan="1" colspan="1">0.387</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Motor impairment score B,<xref ref-type="table-fn" rid="tfn2-ndt-13-329">b</xref> mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">3.7 (3.5)</td><td valign="top" align="left" rowspan="1" colspan="1">4.7 (3.7)</td><td valign="top" align="left" rowspan="1" colspan="1">0.132</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Medications</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Levodopa dose (mg), mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Cumulative daily dose (mg)</td><td valign="top" align="left" rowspan="1" colspan="1">869.0 (468.0)</td><td valign="top" align="left" rowspan="1" colspan="1">855.4 (406.3)</td><td valign="top" align="left" rowspan="1" colspan="1">0.866</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Weight-adjusted daily dose (mg/kg)</td><td valign="top" align="left" rowspan="1" colspan="1">12.1 (6.8)</td><td valign="top" align="left" rowspan="1" colspan="1">13.6 (8.1)</td><td valign="top" align="left" rowspan="1" colspan="1">0.231</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Dopamine agonists, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1">58 (54.7)</td><td valign="top" align="left" rowspan="1" colspan="1">25 (56.8)</td><td valign="top" align="left" rowspan="1" colspan="1">0.814</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Amantadine, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1">48 (45.7)</td><td valign="top" align="left" rowspan="1" colspan="1">22 (46.8)</td><td valign="top" align="left" rowspan="1" colspan="1">0.900</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Selegiline, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1">10 (9.5)</td><td valign="top" align="left" rowspan="1" colspan="1">8 (18.6)</td><td valign="top" align="left" rowspan="1" colspan="1">0.125</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Antidepressants, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1">18 (16.7)</td><td valign="top" align="left" rowspan="1" colspan="1">12 (24.5)</td><td valign="top" align="left" rowspan="1" colspan="1">0.248</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Antihypertensive, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1">1 (0.9)</td><td valign="top" align="left" rowspan="1" colspan="1">0</td><td valign="top" align="left" rowspan="1" colspan="1">1</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Progression rate,<xref ref-type="table-fn" rid="tfn3-ndt-13-329">c</xref> mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">7.2 (5.7)</td><td valign="top" align="left" rowspan="1" colspan="1">6.2 (4.9)</td><td valign="top" align="left" rowspan="1" colspan="1">0.368</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"><bold>Motor subtypes</bold></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Tremor – % of UPDRS – Part III, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">15.6 (13.7)</td><td valign="top" align="left" rowspan="1" colspan="1">13.3 (13.6)</td><td valign="top" align="left" rowspan="1" colspan="1">0.344</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Rigidity – % of UPDRS – Part III, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">10.5 (7.3)</td><td valign="top" align="left" rowspan="1" colspan="1">9.5 (6.9)</td><td valign="top" align="left" rowspan="1" colspan="1">0.392</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Bradykinesia – % of UPDRS – Part III, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">40.3 (17.2)</td><td valign="top" align="left" rowspan="1" colspan="1">43.4 (17.5)</td><td valign="top" align="left" rowspan="1" colspan="1">0.317</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Gait – % of UPDRS – Part III, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">16.4 (12.1)</td><td valign="top" align="left" rowspan="1" colspan="1">20.2 (12.2)</td><td valign="top" align="left" rowspan="1" colspan="1">0.071</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Freezing, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">0.4 (0.8)</td><td valign="top" align="left" rowspan="1" colspan="1">0.8 (1.0)</td><td valign="top" align="left" rowspan="1" colspan="1"><bold>0.027</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Falls, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">0.6 (1.1)</td><td valign="top" align="left" rowspan="1" colspan="1">0.9 (1.0)</td><td valign="top" align="left" rowspan="1" colspan="1">0.216</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Axial/limb ratio, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">0.9 (0.8)</td><td valign="top" align="left" rowspan="1" colspan="1">0.9 (0.5)</td><td valign="top" align="left" rowspan="1" colspan="1">0.738</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Asymmetry Index, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">0.2 (0.2)</td><td valign="top" align="left" rowspan="1" colspan="1">0.1 (0.2)</td><td valign="top" align="left" rowspan="1" colspan="1">0.160</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">PIGD score, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">2.1 (2.3)</td><td valign="top" align="left" rowspan="1" colspan="1">2.9 (2.5)</td><td valign="top" align="left" rowspan="1" colspan="1">0.050</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">FOSS score, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">1.6 (1.7)</td><td valign="top" align="left" rowspan="1" colspan="1">2.0 (1.7)</td><td valign="top" align="left" rowspan="1" colspan="1">0.202</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"><bold>Nonmotor features</bold></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">UPDRS score, Part I – mental, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">1.9 (2.0)</td><td valign="top" align="left" rowspan="1" colspan="1">2.7 (3.1)</td><td valign="top" align="left" rowspan="1" colspan="1">0.098</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Cognitive impairment, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">0.3 (0.5)</td><td valign="top" align="left" rowspan="1" colspan="1">0.5 (0.9)</td><td valign="top" align="left" rowspan="1" colspan="1">0.244</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Hallucination, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">0.3 (0.7)</td><td valign="top" align="left" rowspan="1" colspan="1">0.3 (0.9)</td><td valign="top" align="left" rowspan="1" colspan="1">0.953</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Apathy, mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">0.6 (1.1)</td><td valign="top" align="left" rowspan="1" colspan="1">0.9 (1.2)</td><td valign="top" align="left" rowspan="1" colspan="1">0.255</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Sleep disturbances, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1">38 (35.2)</td><td valign="top" align="left" rowspan="1" colspan="1">20 (40.8)</td><td valign="top" align="left" rowspan="1" colspan="1">0.498</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Orthostasis, n (%)</td><td valign="top" align="left" rowspan="1" colspan="1">23 (21.3)</td><td valign="top" align="left" rowspan="1" colspan="1">5 (10.2)</td><td valign="top" align="left" rowspan="1" colspan="1">0.093</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Anxiety score (HADS), mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">5.9 (4.9)</td><td valign="top" align="left" rowspan="1" colspan="1">8.7 (5.1)</td><td valign="top" align="left" rowspan="1" colspan="1"><bold>0.002</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Depression score (HADS), mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">4.4 (4.2)</td><td valign="top" align="left" rowspan="1" colspan="1">6.6 (4.4)</td><td valign="top" align="left" rowspan="1" colspan="1"><bold>0.003</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Fatigue score (FSS), mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">4.3 (2.0)</td><td valign="top" align="left" rowspan="1" colspan="1">5.0 (1.6)</td><td valign="top" align="left" rowspan="1" colspan="1"><bold>0.012</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Nutritional status score (MNA), mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">25.8 (2.6)</td><td valign="top" align="left" rowspan="1" colspan="1">23.8 (4.2)</td><td valign="top" align="left" rowspan="1" colspan="1"><bold>0.003</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Psychosocial functioning score (SCOPA-PS, %), mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1">23.1 (23.1)</td><td valign="top" align="left" rowspan="1" colspan="1">32.1 (19.1)</td><td valign="top" align="left" rowspan="1" colspan="1"><bold>0.018</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">QoL (PDQ-39), mean (SD)</td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1"></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Mobility</td><td valign="top" align="left" rowspan="1" colspan="1">22.5 (24.0)</td><td valign="top" align="left" rowspan="1" colspan="1">40.8 (27.4)</td><td valign="top" align="left" rowspan="1" colspan="1"><<bold>0.001</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> ADL</td><td valign="top" align="left" rowspan="1" colspan="1">23.9 (23.9)</td><td valign="top" align="left" rowspan="1" colspan="1">32.0 (28.4)</td><td valign="top" align="left" rowspan="1" colspan="1">0.066</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Emotional well-being</td><td valign="top" align="left" rowspan="1" colspan="1">23.5 (21.7)</td><td valign="top" align="left" rowspan="1" colspan="1">39.4 (24.4)</td><td valign="top" align="left" rowspan="1" colspan="1"><<bold>0.001</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Stigma</td><td valign="top" align="left" rowspan="1" colspan="1">21.2 (25.1)</td><td valign="top" align="left" rowspan="1" colspan="1">23.5 (25.7)</td><td valign="top" align="left" rowspan="1" colspan="1">0.609</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Social support</td><td valign="top" align="left" rowspan="1" colspan="1">7.5 (15.9)</td><td valign="top" align="left" rowspan="1" colspan="1">20.1 (25.9)</td><td valign="top" align="left" rowspan="1" colspan="1"><<bold>0.001</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Cognition</td><td valign="top" align="left" rowspan="1" colspan="1">16.6 (20.0)</td><td valign="top" align="left" rowspan="1" colspan="1">20.7 (20.3)</td><td valign="top" align="left" rowspan="1" colspan="1">0.243</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Communication</td><td valign="top" align="left" rowspan="1" colspan="1">13.4 (18.4)</td><td valign="top" align="left" rowspan="1" colspan="1">18.9 (21.5)</td><td valign="top" align="left" rowspan="1" colspan="1">0.105</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> Bodily discomfort</td><td valign="top" align="left" rowspan="1" colspan="1">17.2 (20.1)</td><td valign="top" align="left" rowspan="1" colspan="1">33.0 (25.3)</td><td valign="top" align="left" rowspan="1" colspan="1"><<bold>0.001</bold></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"> PDSI</td><td valign="top" align="left" rowspan="1" colspan="1">17.9 (14.2)</td><td valign="top" align="left" rowspan="1" colspan="1">28.3 (15.7)</td><td valign="top" align="left" rowspan="1" colspan="1"><<bold>0.001</bold></td></tr></tbody></table><table-wrap-foot><fn><p><bold>Notes:</bold></p></fn><fn id="tfn1-ndt-13-329"><label>a</label><p>Score A is the sum of UPDRS – Part III items concerning facial expression, tremor, rigidity and bradykinesia, which are considered relatively <sc>l</sc>-dopa responsive.</p></fn><fn id="tfn2-ndt-13-329"><label>b</label><p>Score B is the sum of UPDRS – Part III items concerning speech and axial impairment (arising from chair, posture, postural stability and gait), which are considered relatively <sc>l</sc>-dopa nonresponsive.</p></fn><fn id="tfn3-ndt-13-329"><label>c</label><p>Calculated via diving current UPDRS score by duration of PD. Univariate comparisons have been performed using either independent samples <italic>t</italic>-test, chi-square test or Fisher’s exact test, wherever appropriate. Statistically significant <italic>P</italic>-values (<italic>P</italic><0.05) are presented in bold.</p></fn><fn id="tfn4-ndt-13-329"><p><bold>Abbreviations:</bold> QoL, quality of life; PD, Parkinson’s disease; SD, standard deviation; IHD, interstitial heart disease; TIA, transient ischemic attack; UPDRS, Unified Parkinson’s Disease Rating Scale; ADL, activities of daily living; H&Y, Hoehn and Yahr; PIGD, postural instability–gait difficulty; FOSS, freezing–speech–swallowing; HADS, Hospital Anxiety and Depression Scale; FSS, Fatigue Severity Scale; MNA, Mini-Nutritional Assessment; SCOPA-PS, Scales for Outcomes in Parkinson’s Disease – Psychosocial; PDQ-39, 39-item PD Questionnaire; PDSI, Parkinson’s Disease Summary Index.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>Canada</li><li>Iran</li><li>Suède</li></country><region><li>Québec</li><li>Svealand</li></region><settlement><li>Montréal</li><li>Stockholm</li></settlement><orgName><li>Université McGill</li></orgName></list><tree><noCountry><name sortKey="Farhadi, Farzaneh" sort="Farhadi, Farzaneh" uniqKey="Farhadi F" first="Farzaneh" last="Farhadi">Farzaneh Farhadi</name><name sortKey="Vosoughi, Kia" sort="Vosoughi, Kia" uniqKey="Vosoughi K" first="Kia" last="Vosoughi">Kia Vosoughi</name></noCountry><country name="Iran"><noRegion><name sortKey="Shahidi, Gholam Ali" sort="Shahidi, Gholam Ali" uniqKey="Shahidi G" first="Gholam Ali" last="Shahidi">Gholam Ali Shahidi</name></noRegion><name sortKey="Delbari, Ahmad" sort="Delbari, Ahmad" uniqKey="Delbari A" first="Ahmad" last="Delbari">Ahmad Delbari</name><name sortKey="Fereshtehnejad, Seyed Mohammad" sort="Fereshtehnejad, Seyed Mohammad" uniqKey="Fereshtehnejad S" first="Seyed-Mohammad" last="Fereshtehnejad">Seyed-Mohammad Fereshtehnejad</name></country><country name="Suède"><region name="Svealand"><name sortKey="Delbari, Ahmad" sort="Delbari, Ahmad" uniqKey="Delbari A" first="Ahmad" last="Delbari">Ahmad Delbari</name></region><name sortKey="Fereshtehnejad, Seyed Mohammad" sort="Fereshtehnejad, Seyed Mohammad" uniqKey="Fereshtehnejad S" first="Seyed-Mohammad" last="Fereshtehnejad">Seyed-Mohammad Fereshtehnejad</name><name sortKey="Lokk, Johan" sort="Lokk, Johan" uniqKey="Lokk J" first="Johan" last="Lökk">Johan Lökk</name><name sortKey="Lokk, Johan" sort="Lokk, Johan" uniqKey="Lokk J" first="Johan" last="Lökk">Johan Lökk</name></country><country name="Canada"><region name="Québec"><name sortKey="Fereshtehnejad, Seyed Mohammad" sort="Fereshtehnejad, Seyed Mohammad" uniqKey="Fereshtehnejad S" first="Seyed-Mohammad" last="Fereshtehnejad">Seyed-Mohammad Fereshtehnejad</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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