Emre Murat
Department of Neurology, Istanbul Faculty of Medicine, Istanbul, Turkey.
Lancet Neurol. 2003 Apr;2(4):229-37. doi: 10.1016/s1474-4422(03)00351-x.
Dementia affects about 40% of patients with Parkinson's disease; the incidence of dementia in these patients is up to six times that in healthy people. Clinically, the prototype of dementia in PD is a dysexecutive syndrome. Loss of cholinergic, dopaminergic, and noradrenergic innervation has been suggested to be the underlying neurochemical deficits. Nigral pathology alone is probably not sufficient for the development of dementia. Although there is some controversy with regard to the site and type of pathology involved, dementia is likely to be associated with the spread of pathology to other subcortical nuclei, the limbic system, and the cerebral cortex. On the basis of more recent studies, the main pathology seems to be Lewy-body-type degeneration with associated cellular and synaptic loss in cortical and limbic structures. Alzheimer's disease-type pathology is commonly associated with dementia but less predictive. Recent evidence from small studies suggests that cholinesterase inhibitors may be effective in the treatment of dementia associated with PD.
痴呆症影响约40%的帕金森病患者；这些患者的痴呆症发病率高达健康人的六倍。临床上，帕金森病痴呆症的典型表现是执行功能障碍综合征。胆碱能、多巴胺能和去甲肾上腺素能神经支配的丧失被认为是潜在的神经化学缺陷。仅黑质病变可能不足以导致痴呆症的发生。尽管在涉及的病理部位和类型方面存在一些争议，但痴呆症可能与病理扩散到其他皮质下核、边缘系统和大脑皮层有关。根据最近的研究，主要病理似乎是路易体样变性，并伴有皮质和边缘结构中的细胞和突触丧失。阿尔茨海默病样病理通常与痴呆症相关，但预测性较差。小型研究的最新证据表明，胆碱酯酶抑制剂可能有效治疗与帕金森病相关的痴呆症。
