Molloy S A, Rowan E N, O'Brien J T, McKeith I G, Wesnes K, Burn D J
Institute of Ageing and Health, Wolfson Research Centre, Newcastle General Hospital, Newcastle upon Tyne, UK.
J Neurol Neurosurg Psychiatry. 2006 Dec;77(12):1323-8. doi: 10.1136/jnnp.2006.098079. Epub 2006 Sep 4.
Levodopa (L-dopa) is the gold standard treatment for Parkinson's disease, but a lack of clear efficacy combined with a perceived liability to neuropsychiatric side effects has limited L-dopa use in patients with parkinsonism and dementia. Therefore, the effect of L-dopa on the cognitive profile of dementia with Lewy bodies (DLB) and Parkinson's disease with dementia (PDD) is unclear.
To ascertain the acute and long-term effects of L-dopa on aspects of attention and cognition in patients with DLB and PDD, and to compare these with the effects in Parkinson's disease.
Baseline cognitive and motor function was assessed off L-dopa in patients with Parkinson's disease (n = 22), PDD (n = 27) and DLB (n = 11) using standard "bedside" measures and a computerised programme detecting reaction times and accuracy. All patients then underwent an acute L-dopa challenge with subsequent subjective and objective analysis of alertness, verbal recall, reaction times and accuracy. The same parameters were measured after 3 months on L-dopa to assess the prolonged effect.
Acute L-dopa challenge considerably improved motor function and subjective alertness in all patients without compromising either reaction times or accuracy, but increased fluctuations were noted in both groups with dementia. Neuropsychiatric scores improved in patients with Parkinson's disease both with and without dementia on L-dopa at 3 months. Although patients with Parkinson's disease also had better mean global cognitive function at this time, mean verbal attention and memory deteriorated, and patients with PDD had slower reaction times in some tests. No patient had a marked deterioration over this time. Patients with DLB did not experience any adverse cognitive or neuropsychiatric effects after 3 months of L-dopa treatment.
The use of L-dopa in patients with parkinsonism with dementia does not adversely affect cognitive function.
左旋多巴（L-多巴）是帕金森病的金标准治疗药物，但疗效不明确以及被认为存在神经精神副作用风险，限制了其在帕金森综合征合并痴呆患者中的应用。因此，L-多巴对路易体痴呆（DLB）和帕金森病痴呆（PDD）认知状况的影响尚不清楚。
确定L-多巴对DLB和PDD患者注意力和认知方面的急性和长期影响，并将其与帕金森病患者的影响进行比较。
使用标准的“床边”测量方法和检测反应时间及准确性的计算机程序，对帕金森病患者（n = 22）、PDD患者（n = 27）和DLB患者（n = 11）在停用L-多巴的情况下进行基线认知和运动功能评估。然后所有患者接受一次急性L-多巴激发试验，随后对警觉性、言语回忆、反应时间和准确性进行主观和客观分析。在服用L-多巴3个月后测量相同参数，以评估长期效果。
急性L-多巴激发试验在不影响反应时间或准确性的情况下，显著改善了所有患者的运动功能和主观警觉性，但两组痴呆患者的波动增加。服用L-多巴3个月后，帕金森病伴或不伴痴呆的患者神经精神评分均有所改善。尽管此时帕金森病患者的平均整体认知功能也较好，但平均言语注意力和记忆力下降，PDD患者在某些测试中的反应时间较慢。在此期间没有患者出现明显恶化。L-多巴治疗3个月后，DLB患者未出现任何不良认知或神经精神影响。
在帕金森综合征合并痴呆的患者中使用L-多巴不会对认知功能产生不利影响。
