Chaudhuri K Ray, Schapira Anthony H V
National Parkinson Foundation Centre of Excellence, King's College Hospital and University Hospital Lewisham, London, UK.
Lancet Neurol. 2009 May;8(5):464-74. doi: 10.1016/S1474-4422(09)70068-7.
Several studies, including work from the Parkinson's disease (PD) non-motor group and others, have established that the non-motor symptoms of PD are common, occur across all stages of PD, are under-reported, and are a key determinant of quality of life. Research suggests that the non-motor symptoms of the disease are frequently unrecognised by clinicians and remain untreated. Even when identified, there is a common perception that many of these symptoms are untreatable. The role of dopaminergic drugs in treating the various non-motor problems of PD, although clinically recognised, has received little attention. In this Review, we investigate the dopaminergic basis of the range of non-motor symptoms that occur in PD such as depression, apathy, sleep disorders (including rapid-eye movement sleep behaviour disorder), and erectile dysfunction. We discuss the evidence that these symptoms are treatable, at least in part, with various dopaminergic strategies and, where relevant, we also refer to the use of deep-brain stimulation of appropriate targets in the brain. This Review provides a comprehensive overview of the management of this challenging aspect of PD.
包括帕金森病(PD)非运动症状研究小组及其他机构的多项研究已经证实,PD的非运动症状很常见,在PD的各个阶段都会出现,报告不足,并且是生活质量的关键决定因素。研究表明,该疾病的非运动症状常常未被临床医生识别且未得到治疗。即使被识别出来,人们普遍认为这些症状中的许多是无法治疗的。多巴胺能药物在治疗PD的各种非运动问题中的作用,尽管在临床上已得到认可,但却很少受到关注。在本综述中,我们研究了PD中出现的一系列非运动症状(如抑郁、冷漠、睡眠障碍(包括快速眼动睡眠行为障碍)和勃起功能障碍)的多巴胺能基础。我们讨论了这些症状至少部分可通过各种多巴胺能策略进行治疗的证据,并且在相关情况下,我们还提及了对大脑中适当靶点进行深部脑刺激的应用。本综述全面概述了PD这一具有挑战性的方面的管理。