Maetzler Walter, Liepelt Inga, Berg Daniela
Center of Neurology, Department of Neurodegeneration and Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.
Lancet Neurol. 2009 Dec;8(12):1158-71. doi: 10.1016/S1474-4422(09)70291-1.
Neuromodulatory or even neuroprotective therapy could soon be available for Parkinson's disease (PD), raising the question of how we should define and measure disease progression. Reported evidence suggests that several symptoms worsen with disease duration. Bradykinesia, rigidity, and activities of daily living deteriorate faster at the beginning of the disease, and this deterioration is paralleled by a decline in functional presynaptic dopaminergic activity, as shown by imaging techniques. Cognitive, speech, sleep, and gait difficulties might progress linearly in proportion to disease duration. Reduced variability in heart rate, orthostatic dysfunction, and visual hallucinations start to develop at mid-stage disease and are more common in late stages than earlier stages. In this Review, we summarise our current understanding of the progression of PD-associated symptoms and markers and conclude that an effective measurement of progression of PD must adapt to the different stages of the disease. In addition to routine clinical rating scales, new quantitative assessments of motor and non-motor symptoms, which should be more broadly available, reasonably priced, and easy-to-use, are needed.
神经调节甚至神经保护疗法可能很快就可用于治疗帕金森病（PD），这就引发了一个问题：我们应该如何定义和衡量疾病进展。报告的证据表明，几种症状会随着疾病持续时间的延长而恶化。运动迟缓、僵硬和日常生活活动能力在疾病初期恶化得更快，成像技术显示，这种恶化与功能性突触前多巴胺能活性的下降同时出现。认知、言语、睡眠和步态困难可能与疾病持续时间成比例地线性进展。心率变异性降低、体位性功能障碍和视幻觉在疾病中期开始出现，且在晚期比早期更常见。在本综述中，我们总结了目前对PD相关症状和标志物进展的理解，并得出结论，有效的PD进展测量必须适应疾病的不同阶段。除了常规临床评分量表外，还需要对运动和非运动症状进行新的定量评估，这些评估应该更广泛可得、价格合理且易于使用。
