Department of Neurology, Concord Hospital, Sydney, NSW.
Med J Aust. 2010 Feb 1;192(3):144-9. doi: 10.5694/j.1326-5377.2010.tb03453.x.
Parkinson disease (PD) is a multisystem neurodegenerative disorder that affects about 1% of the population over the age of 55 years and has mean age of onset of about 60 years. The Braak hypothesis proposes that the earliest pathological evidence of PD is found in the enteric nervous system, medulla and olfactory bulb, and only subsequently progresses (over years) to the substantia nigra and cortex. Non-motor symptoms, such as constipation, hyposmia and sleep disorders, may precede typical motor features of PD by several years. No treatment has been convincingly shown to slow PD progression (ie, a neuroprotective drug remains elusive). Symptomatic benefit from dopaminergic therapy is usually maintained throughout the course of the disease. The decision as to whether to commence treatment with either levodopa or a dopamine agonist needs to be individually tailored, but long-term outcomes appear to be equivalent. Advanced PD is complicated by the loss of non-dopaminergic neurones, resulting in symptoms that are largely unresponsive to dopaminergic therapy. Treatment with apomorphine, Duodopa or deep-brain stimulation surgery may be beneficial for selected patients with advanced PD. Non-motor symptoms, such as mood disorders, cognitive impairment, autonomic dysfunction and sleep disorders, are responsible for significant morbidity. Management often requires a multidisciplinary approach.
帕金森病（PD）是一种多系统神经退行性疾病，影响 55 岁以上人群的 1%左右，发病平均年龄约为 60 岁。Braak 假说提出，PD 的最早病理证据存在于肠神经系统、髓质和嗅球中，仅随后（经过数年）进展到黑质和皮质。非运动症状，如便秘、嗅觉障碍和睡眠障碍，可能在 PD 的典型运动特征出现前几年就已经出现。没有治疗方法被证实可以减缓 PD 的进展（即，神经保护药物仍然难以捉摸）。多巴胺能治疗的症状缓解通常在整个疾病过程中都能维持。是否开始使用左旋多巴或多巴胺激动剂治疗的决定需要个体化定制，但长期结果似乎是等效的。晚期 PD 由于非多巴胺能神经元的丧失而变得复杂，导致症状对多巴胺能治疗反应不佳。对于晚期 PD 的某些患者，使用阿扑吗啡、Duodopa 或深部脑刺激手术可能是有益的。非运动症状，如情绪障碍、认知障碍、自主功能障碍和睡眠障碍，会导致显著的发病率。管理通常需要多学科方法。
