Chaudhuri K Ray, Healy Daniel G, Schapira Anthony H V
Movement Disorders Unit, Kings College Hospital, Guy's King's and St Thomas' School of Medicine, London, UK.
Lancet Neurol. 2006 Mar;5(3):235-45. doi: 10.1016/S1474-4422(06)70373-8.
The clinical diagnosis of Parkinson's disease rests on the identification of the characteristics related to dopamine deficiency that are a consequence of degeneration of the substantia nigra pars compacta. However, non-dopaminergic and non-motor symptoms are sometimes present before diagnosis and almost inevitably emerge with disease progression. Indeed, non-motor symptoms dominate the clinical picture of advanced Parkinson's disease and contribute to severe disability, impaired quality of life, and shortened life expectancy. By contrast with the dopaminergic symptoms of the disease, for which treatment is available, non-motor symptoms are often poorly recognised and inadequately treated. However, attention is now being focused on the recognition and quantitation of non-motor symptoms, which will form the basis of improved treatments. Some non-motor symptoms, including depression, constipation, pain, genitourinary problems, and sleep disorders, can be improved with available treatments. Other non-motor symptoms can be more refractory and need the introduction of novel non-dopaminergic drugs. Inevitably, the development of treatments that can slow or prevent the progression of Parkinson's disease and its multicentric neurodegeneration provides the best hope of curing non-motor symptoms.
帕金森病的临床诊断依赖于对与多巴胺缺乏相关特征的识别，这些特征是黑质致密部变性的结果。然而，非多巴胺能和非运动症状有时在诊断前就已出现，并且几乎不可避免地会随着疾病进展而出现。事实上，非运动症状在晚期帕金森病的临床表现中占主导地位，并导致严重残疾、生活质量受损和预期寿命缩短。与该疾病可治疗的多巴胺能症状相比，非运动症状往往未得到充分认识和治疗。然而，现在注意力正集中在非运动症状的识别和量化上，这将成为改进治疗的基础。一些非运动症状，包括抑郁、便秘、疼痛、泌尿生殖系统问题和睡眠障碍，可用现有治疗方法改善。其他非运动症状可能更难治疗，需要引入新型非多巴胺能药物。不可避免的是，能够减缓或预防帕金森病及其多中心神经变性进展的治疗方法的开发，为治愈非运动症状提供了最大希望。
