Hely Mariese A, Reid Wayne G J, Adena Michael A, Halliday Glenda M, Morris John G L
Department of Neurology, Westmead Hospital, Westmead, New South Wales, Australia.
Mov Disord. 2008 Apr 30;23(6):837-44. doi: 10.1002/mds.21956.
After 20 years follow-up of newly diagnosed patients with Parkinson's disease (PD), 100 of 136 (74%) have died. The mortality rate fell in the first 3 years of treatment, then rose compared to the general population, the standardized mortality ratio from 15 to 20 years reaching 3.1. Drug induced dyskinesia and end of dose failure were experienced by most patients, but the main current problems relate to the non-levodopa responsive features of the disease. Dementia is present in 83% of 20-year survivors. Dementia correlates with increasing age and probably reflects an interplay of multiple pathologies. Seventeen people with dementia had postmortems. Eight had diffuse Lewy bodies as the only cause of dementia, while others had mixed neuropathology. Only one person lives independently and 48% are in nursing homes. Excessive daytime sleepiness is noted in 70%, falls have occurred in 87%, freezing in 81%, fractures in 35%, symptomatic postural hypotension in 48%, urinary incontinence in 71%, moderate dysarthria in 81%, choking in 48%, and hallucinations in 74%. The challenge is to understand the cellular mechanisms underlying the diverse features of advanced PD that go far beyond a lack of dopamine.
对新诊断的帕金森病（PD）患者进行20年随访后，136例中有100例（74%）死亡。死亡率在治疗的前3年下降，随后与普通人群相比上升，15至20年的标准化死亡率达到3.1。大多数患者经历过药物性运动障碍和剂末失效，但目前的主要问题与该疾病对左旋多巴无反应的特征有关。20年存活者中83%存在痴呆。痴呆与年龄增长相关，可能反映了多种病理过程的相互作用。17例痴呆患者进行了尸检。8例仅有弥漫性路易体作为痴呆的唯一病因，其他患者存在混合性神经病理学改变。只有1人独立生活，48%的患者住在养老院。70%的患者存在日间过度嗜睡，87%的患者发生过跌倒，81%的患者出现冻结现象，35%的患者发生骨折，48%的患者出现症状性体位性低血压，71%的患者出现尿失禁，81%的患者存在中度构音障碍，48%的患者出现呛噎，74%的患者出现幻觉。挑战在于了解晚期帕金森病多种特征背后的细胞机制，这些特征远远超出了多巴胺缺乏的范畴。
