Guillard A, Fénelon G, Mahieux F
Clinique Neurologique, Hôpital Tenon, Paris.
Rev Neurol (Paris). 1991;147(5):337-55.
No clear general view has emerged from the many recent studies devoted to cognitive disorders in Parkinson's disease. Disparity of the populations and methods, as well as interference from motor disorders and possible psychiatric disorders account for the variability of epidemiological data. Subtle cognitive disorders can be found in most patients at the very beginning of the disease. Recent memory is disturbed in free recall tests, but recognition capacities are preserved. Individualization of visuospatial disorders is discussed. Alteration of conceptual capacities is the predominant disorder. Clinically obvious cognitive disorders appear only in some patients after several years of neurological disease. Some risk factors are agreed upon. The bradyphrenia concept is debated, and the term dementia is not accepted by all authors. The major cognitive alterations in Parkinson's disease differ from those observed in Alzheimer dementia, but the latter is more frequent in parkinsonian patients than in the general population. Patients with Parkinson's disease are also exposed to the risk of transient psychotic episodes. Where parkinsonian cognitive pathology is concerned, modern imaging methods are of no help to clinicians. The anatomical and biochemical changes observed in these patients are reviewed, and their responsibility in the genesis of cognitive disorders is discussed: lesions of brainstem nuclei and alterations in their cortical projections on one side, Alzheimer type dementia lesions and Lewys' bodies on the other side. The diverse and inconstant cognitive disorders of patients with Parkinson's disease cannot be explained by lesions of one single structure; they probably result from variable combinations of multiple known or unknown neuronal and biochemical changes.
近期众多针对帕金森病认知障碍的研究尚未形成清晰的总体观点。研究人群和方法的差异，以及运动障碍和可能存在的精神障碍的干扰，导致了流行病学数据的变异性。在疾病最初阶段，大多数患者即可发现轻微的认知障碍。自由回忆测试中近期记忆受到干扰，但识别能力得以保留。文中讨论了视觉空间障碍的个体化情况。概念能力的改变是主要的障碍。临床上明显的认知障碍仅在部分患者出现神经系统疾病数年之后才会显现。一些风险因素已得到认可。关于思维迟缓的概念存在争议，并非所有作者都接受“痴呆”这一术语。帕金森病的主要认知改变与阿尔茨海默病性痴呆中观察到的情况不同，但帕金森病患者中后者的发生率高于一般人群。帕金森病患者还面临短暂性精神病发作的风险。就帕金森病认知病理学而言，现代成像方法对临床医生并无帮助。文中回顾了这些患者观察到的解剖学和生化变化，并讨论了它们在认知障碍发生过程中的作用：一方面是脑干核团的病变及其皮质投射的改变，另一方面是阿尔茨海默型痴呆病变和路易小体。帕金森病患者多样且不恒定的认知障碍无法用单一结构的病变来解释；它们可能是多种已知或未知的神经元和生化变化的不同组合所致。
