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当帕金森病患者开始出现幻觉时。

When a Parkinson's disease patient starts to hallucinate.

作者信息

Poewe Werner

机构信息

Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.

出版信息

Pract Neurol. 2008 Aug;8(4):238-41. doi: 10.1136/jnnp.2008.152579.

Abstract

Visual hallucinations are a typical feature of Lewy body parkinsonism and occur in some 40% of patients with Parkinson's disease. Age and cognitive decline are the most important intrinsic risk factors, but hallucinosis is often triggered by comorbid conditions such as infection and dehydration. The single most important trigger, however, is exposure to CNS drugs, in particular antiparkinsonian agents. While hallucinosis and psychosis can be triggered by amantadine and anticholinergics, they are more commonly experienced after changes in dopaminergic medication. Dopamine agonists have greater potential to induce hallucinosis compared with L-dopa. Attempting to reduce antiparkinsonian drugs is an important part in the management of these patients, but atypical neuroleptics like clozapine or quetiapine are frequently necessary. Visual hallucinations in Parkinson's disease patients with dementia can also be improved by treatment with the cholinesterase inhibitor rivastigmine.

摘要

视幻觉是路易体帕金森病的典型特征,约40%的帕金森病患者会出现视幻觉。年龄和认知功能减退是最重要的内在危险因素,但幻觉症常由感染和脱水等合并症引发。然而,最重要的单一触发因素是接触中枢神经系统药物,尤其是抗帕金森病药物。虽然金刚烷胺和抗胆碱能药物可引发幻觉症和精神病,但在多巴胺能药物发生变化后更常出现这些症状。与左旋多巴相比,多巴胺激动剂诱发幻觉症的可能性更大。减少抗帕金森病药物的使用是这些患者管理的重要组成部分,但通常需要使用氯氮平或喹硫平之类的非典型抗精神病药物。患有痴呆症的帕金森病患者的视幻觉也可通过使用胆碱酯酶抑制剂卡巴拉汀进行治疗得到改善。

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