Takahashi Kazushi
Department of Neurology, Tokyo Metropolitan Neurological Hospital.
Rinsho Shinkeigaku. 2013;53(11):974-6. doi: 10.5692/clinicalneurol.53.974.
Non-motor symptoms are common in patients with newly diagnosed Parkinson's disease (PD), and some even predate the emergence of the classic motor features. The premotor phase of PD is characterized by several important non-motor features, including constipation, olfactory dysfunction, REM sleep behavior disorder (RBD), depression, etc. The basis of this prodromal stage is that the pathological process related to Lewy bodies, may start outside of the substantia nigra. We investigated 469 Japanese PD patients in our multicenter study, using the Japanese version of the RBD screening questionnaire. Probable RBD was detected in 146 patients (31%) and the RBD symptoms of 53 patients preceded the onset of PD motor symptoms. With the probable exception of RBD, non-motor clinical markers can be sensitive for an impending diagnosis of PD, but these features are common and non-specific. The combination of non-motor clinical markers and more specific markers (e.g., imaging or genetic markers) may achieve sufficient utility in PD diagnosis and prediction in future. Being able to diagnose that a patient has PD at an earlier time point than is currently possible, would be allowed to introduce potential disease-modifying therapies at a time when it could have fundamental and long-lasting effects.
非运动症状在新诊断的帕金森病（PD）患者中很常见，有些甚至早于经典运动特征的出现。PD的运动前期以几种重要的非运动特征为特征，包括便秘、嗅觉功能障碍、快速眼动睡眠行为障碍（RBD）、抑郁等。这个前驱期的基础是，与路易小体相关的病理过程可能在黑质之外开始。在我们的多中心研究中，我们使用日语版的RBD筛查问卷对469名日本PD患者进行了调查。146名患者（31%）检测到可能的RBD，其中53名患者的RBD症状先于PD运动症状出现。除了可能的RBD外，非运动临床标志物对即将到来的PD诊断可能敏感，但这些特征常见且不具特异性。非运动临床标志物与更具特异性的标志物（如影像学或基因标志物）的结合可能在未来的PD诊断和预测中发挥足够的作用。能够在比目前更早的时间点诊断出患者患有PD，将能够在可能产生根本和长期影响的时候引入潜在的疾病修饰疗法。
