Kada se pojavljuju simptomi oštećenja autonomnog nervnog sistema kod obolelih od Parkinsonove bolesti?
Sažetak
Uvod/Cilj. Poremećaji autonomnog nervnog sistema javljaju se kod gotovo svih obolelih od Parkinsonove bolesti (PB) u nekom stadijumu njihove bolesti. Cilj našeg istraživanja bio je da se utvrde pojava i tip autonomnih poremećaja, kao i faktori koji utiču na njihovu pojavu ispitivanjem potencijalne povezanosti sa demografskim varijablama vezanim za kliničku prezentaciju i simptome bolesti u grupi bolesnika sa PB. Metode. Ispitivali smo obolele od PB koji su lečeni u Klinici za neurologiju u Beogradu u dvogodišnjem periodu, podeljene u tri grupe: 25 de novo bolesnika, 25 obolelih koji su lečeni i nisu imali nikakve komplikacije vezane za dugotrajnu primenu levodope i 22 bolesnika na levodopi kod kojih su se pojavile motorne komplikacije izazvane levodopom. Istovremeno je analizirano 35 zdravih (kontrolnih) ispitanika, uparenih prema uzrastu i polu. Rezultati. Disfunkcija autonomnog nervnog sistema definisana je prema Ewing-ovim dijagnostičkim kriterijumima. Testovi, pokazatelji ispada simpatičkog i parasimpatičkog nervnog sistema, bili su statistički značajno različiti kod obolelih od PB u poredjenju sa kontrolom, što je sugerisalo poremećaj oba sistema. Kada su izdvojene pojedine grupe obolelih, međutim, pokazano je da disfunkcija oba sistema postoji kod dve grupe lečenih od PB, dok je kod de novo, nelečenih bolesnika, uočen samo poremećaj simpatičkog nervnog sistema. Zbog toga je kompletna autonomna neuropatija dijagnostikovana samo kod lečenih od PB, dok su de novo oboleli definisani kao oboleli sa izolovanom simpatičkom disfunkcijom. Osobe sa kompletnom autonomnom neuropatijom razlikovale su se od osoba bez autonomne neuropatije po višem kumulativnom i motornom unifikovanom skoru za Parkinsonovu bolest (p < 0,01), skoru aktivnosti svakodnevnog života (p < 0,05), Schwab-England skali (p < 0,001) i procenjenoj težini bolesti prema Hoehn-Yahr-u. Bolesnici se nisu razlikovali prema drugim kliničkodemografskim karakteristikama (pol, uzrast u vreme postavljanja dijagnoze, aktuelnom uzrastu, trajanju bolesti, zahvaćenoj strani, bolu i „freezing-u“), ali su imali statistički značajno niži mini mentalni skor (MMS), kao i skor na Hamiltonovoj skali depresivnosti i anksioznosti (p < 0,05). Zaključak. Rezultati ove studije potvrđuju visoku prevalenciju poremećaja autonomnog nervnog sistema u ranoj fazi bolesti kod obolelih od Parkinsonove bolesti, sa predominantnom disfunkcijom simpatikusa. Bolesnici kod kojih se razvila kompletna autonomna neuropatija (simpatička i parasimpatička) imali su izraženu funkcionalnu slabost, teže kliničke simptome, uz prisustvo anksioznosti i depresije.
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