Parkinson’s disease in Estonia: epidemiology, quality of life, clinical characteristics and pharmacotherapy
Kuupäev
2019-02-15
Autorid
Ajakirja pealkiri
Ajakirja ISSN
Köite pealkiri
Kirjastaja
Abstrakt
Parkinsoni tõbi on levinuim liikumishäiret põhjustav neurodegeneratiivne haigus, mida esineb vähemalt 1% üle 60 aastaste inimeste seas. Tartumaal on Parkinsoni tõve epidemioloogilisi näitajaid uuritud esmakordselt 20 aastat tagasi, mil levimus -ja haigestumuskordajad olid vastavalt 152/100 000 ja 17/100 000. Kirjanduse andmetel on Parkinsoni tõvega patsientidel ligi 1,5 korda suurem suremisrisk võrreldes üldpopulatsiooniga. Haiguse peamisteks avaldusteks on progresseeruv liigutuste aeglus ja kohmakus, lihasjäikus, värin ning tasakaalu -ja kõnnakuhäire. Lisaks kuuluvad kliinilisse pilti mittemotoorsed sümptomid: mälu-, meeleolu -ja unehäired, kõhukinnisus, uriinipidamatus, väsimus, valu jm. Efektiivseimaks ravimiks on levodopa, mille kõrvaltoimena võivad kasutajal tekkida motoorsed komplikatsioonid.
Käesoleva uurimistöö peamiseks eesmärgiks oli kirjeldada Parkinsoni tõve epidemioloogilisi näitajaid Tartumaal, samuti iseloomustada patsientide kliinilist profiili, sealhulgas uurida motoorsete komplikatsioonide ning mittemotoorsete sümptomite esinemissagedust ja neid soodustavaid tegureid. Uurimistöö üheks eesmärgiks oli ka analüüsida Parkinsoni tõvega patsientide elukvaliteeti ja seda mõjutavaid tegureid. Populatsiooni-põhine epidemioloogiline uuring Tartumaal näitas, et võrreldes 1990-ndate aastatega oli kasvanud Parkinsoni tõve esinemissagedus (olemasolevate juhtude esinemine), ent haigestumus (uute juhtude teke) püsis samal tasemel. Nüüdses uuringus oli proportsionaalselt rohkem kaugelearenenud raskusastmega patsiente. Surmatunnistustel oli Parkinsoni tõve diagnoos märgitud ligi pooltel surnud uuritavatel. Parkinsoni tõvega patsientidel ei esinenud haiguse varases staadiumis oluliselt erinevat suremisriski võrreldes samaealise üldpopulatsiooniga. Motoorseid ravikomplikatsioone esines umbes veerandil patsientidest. Kõige sagedasemad mittemotoorsed sümptomid olid kognitsioonihäire, öised unehäired, põiehäired ja väsimus. Elukvaliteedi peamisteks mõjutajateks olid depressioon, motoorsed (nt. riietumine, söömine jm.) ja mittemotoorsed (nt. uni, valu jm.) igapäevaelu aspektid, kusjuures objektiivselt hinnatud parkinsonistlike sümptomite raskusaste ei olnud patsiendi elukvaliteedi hinnangus määrav.
Parkinson’s disease is the most common neurodegenerative disease causing movement problems. Its prevalence is about 1% among people over 60 years. The first epidemiologic study on Parkinson’s disease that was conducted 20 years ago in the County of Tartu, found the prevalence and incidence estimates to be 152/100 000 and 17/100 000, respectively. Patients with Parkinson’s disease have a 1.5-folded higher risk of dying compared to the general population. Clinical cardinal manifestations of Parkinson’s disease include tremor, bradykinesia, rigidity and postural instability. In addition to the motor features, the clinical picture also involves the non-motor symptoms – cognitive and emotional disorders, sleep and urinary problems, fatigue, pain, etc. Levodopa is the most effective antiparkinsonian medication, however, its long-term use is related to the emergence of motor complications. The primary aim of the present thesis was to describe the epidemiologic characteristics of Parkinson’s disease in the County of Tartu. We also aimed at analysing the clinical profile of the patients, including the frequency and associative factors of motor complications and non-motor symptoms. An additional aim was to study the factors related to the health-related quality of life of the patients. The population-based epidemiologic study demonstrated increase in the prevalence of Parkinson’s disease, while the incidence has remained stable compared to the previous study. The proportion of patients with more severe stages of the disease has increased. Death certificates may underrepresent the real burden of this disease – out of all the deceased subjects with clinically diagnosed Parkinson’s disease, only about 50% had the disease noted on their death certificates. Mortality in patients with early Parkinson’s disease was not different compared to the general population. About a quarter of patients had some kind of motor complications. Cognitive impairment, fatigue, urinary and nighttime sleep problems were the most frequent non-motor symptoms. Depression, motor and non-motor experiences of daily living were the most important factors affecting the quality of life of the patients with Parkinson’s disease. Results of the motor assessments performed by neurologists might not correspond to the quality of life evaluated by the patients.
Parkinson’s disease is the most common neurodegenerative disease causing movement problems. Its prevalence is about 1% among people over 60 years. The first epidemiologic study on Parkinson’s disease that was conducted 20 years ago in the County of Tartu, found the prevalence and incidence estimates to be 152/100 000 and 17/100 000, respectively. Patients with Parkinson’s disease have a 1.5-folded higher risk of dying compared to the general population. Clinical cardinal manifestations of Parkinson’s disease include tremor, bradykinesia, rigidity and postural instability. In addition to the motor features, the clinical picture also involves the non-motor symptoms – cognitive and emotional disorders, sleep and urinary problems, fatigue, pain, etc. Levodopa is the most effective antiparkinsonian medication, however, its long-term use is related to the emergence of motor complications. The primary aim of the present thesis was to describe the epidemiologic characteristics of Parkinson’s disease in the County of Tartu. We also aimed at analysing the clinical profile of the patients, including the frequency and associative factors of motor complications and non-motor symptoms. An additional aim was to study the factors related to the health-related quality of life of the patients. The population-based epidemiologic study demonstrated increase in the prevalence of Parkinson’s disease, while the incidence has remained stable compared to the previous study. The proportion of patients with more severe stages of the disease has increased. Death certificates may underrepresent the real burden of this disease – out of all the deceased subjects with clinically diagnosed Parkinson’s disease, only about 50% had the disease noted on their death certificates. Mortality in patients with early Parkinson’s disease was not different compared to the general population. About a quarter of patients had some kind of motor complications. Cognitive impairment, fatigue, urinary and nighttime sleep problems were the most frequent non-motor symptoms. Depression, motor and non-motor experiences of daily living were the most important factors affecting the quality of life of the patients with Parkinson’s disease. Results of the motor assessments performed by neurologists might not correspond to the quality of life evaluated by the patients.
Kirjeldus
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Märksõnad
Parkinson disease, epidemiology, quality of life, pharmacotherapy, Estonia