Moretti Rita, Torre Paola, Vilotti Cristina, Antonello Rodolfo M, Pizzolato Gilberto
University of Trieste, Clinical Neurology, Department of Internal Medicine and Clinical Neurology, Ospedale di Cattinara, Strada di Fiume, 447 34149 Trieste, Italy.
Expert Opin Pharmacother. 2007 Apr;8(6):817-29. doi: 10.1517/14656566.8.6.817.
Patients suffering from Parkinson's disease dementia (PDD) have a movement disorder, but it can be difficult to determine whether the functional impairment, which is critical in making the assessment of whether a patient has achieved the threshold for a diagnosis of dementia, is due to the dementia or the underlying Parkinson's disease. Although the cognitive impairment found in nondemented patients with Parkinson's disease is very dysexecutive in nature, the DSM IV (Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association IV) diagnosis of PDD has memory impairment as the defining characteristic of PDD. Severe deficits in cortical, cholinergic, excitatory, neuromodulatory input mean that memory impairment is not always due to encoding and retrieval strategy deficits, but it may also be amnesic without being related to concomitant Alzheimer's disease pathology. Patients with PDD have a high mortality, especially when they develop hallucinations and/or are admitted to nursing homes. Of interest is the reduction in mortality that was more marked in the subgroup with visual hallucinations at baseline. The increased mortality in PD may be due to autonomic failure, evidenced by the reductions in heart rate variability in these patients. This reduction is greater in patients with hallucinations. Rivastigmine is a dual inhibitor of brain acetyl- and butyrylcholinesterases that has been evaluated in the symptomatic treatment of patients with mild-to-moderate dementia associated with idiopathic Parkinson's disease. Although there is a need for more studies using pragmatic measures, such as time to residential care facility and both patient and carer quality of life assessments, rivastigmine appears to improve cognition and activities of daily living in patients with PDD, resulting in a clinically meaningful benefit in a large number of cases.
患有帕金森病痴呆（PDD）的患者存在运动障碍，但很难确定在评估患者是否达到痴呆诊断阈值时起关键作用的功能损害是由痴呆还是潜在的帕金森病引起的。尽管在无痴呆的帕金森病患者中发现的认知障碍本质上是执行功能严重受损，但美国精神病学协会《精神疾病诊断与统计手册》第四版（DSM-IV）对PDD的诊断以记忆障碍作为PDD的定义特征。皮质、胆碱能、兴奋性、神经调节输入的严重缺陷意味着记忆障碍并不总是由于编码和检索策略缺陷，也可能是失忆性的，且与同时存在的阿尔茨海默病病理无关。PDD患者的死亡率很高，尤其是当他们出现幻觉和/或入住养老院时。有趣的是，在基线时有视觉幻觉的亚组中死亡率降低更为明显。帕金森病患者死亡率增加可能是由于自主神经功能衰竭，这些患者心率变异性降低证明了这一点。幻觉患者的这种降低更为明显。利伐斯的明是一种脑乙酰胆碱酯酶和丁酰胆碱酯酶双重抑制剂，已在伴有特发性帕金森病的轻至中度痴呆患者的症状性治疗中进行了评估。尽管需要更多使用务实措施的研究，如入住护理机构的时间以及患者和照顾者生活质量评估，但利伐斯的明似乎能改善PDD患者的认知和日常生活活动能力，在大量病例中产生具有临床意义的益处。
