Goldman Jennifer G, Postuma Ron
aSection of Parkinson Disease and Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA bDepartment of Neurology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
Curr Opin Neurol. 2014 Aug;27(4):434-41. doi: 10.1097/WCO.0000000000000112.
This review highlights recent advances in premotor and nonmotor features in Parkinson's disease, focusing on these issues in the context of prodromal and early-stage Parkinson's disease.
Although Parkinson's disease patients experience a wide range of nonmotor symptoms throughout the disease course, studies demonstrate that nonmotor features are not solely a late manifestation. Indeed, disturbances of smell, sleep, mood, and gastrointestinal function may herald Parkinson's disease or related synucleinopathies and precede these neurodegenerative conditions by 5 or more years. In addition, other nonmotor symptoms such as cognitive impairment are now recognized in incident or de-novo Parkinson's disease cohorts. Many of these nonmotor features reflect disturbances in nondopaminergic systems and early involvement of peripheral and central nervous systems, including olfactory, enteric, and brainstem neurons as in Braak's proposed pathological staging of Parkinson's disease. Current research focuses on identifying potential biomarkers that may detect persons at risk for Parkinson's disease and permit early intervention with neuroprotective or disease-modifying therapeutics.
Recent studies provide new insights into the frequency, pathophysiology, and importance of nonmotor features in Parkinson's disease as well as the recognition that these nonmotor symptoms occur in premotor, early, and later phases of Parkinson's disease.
本综述重点介绍帕金森病运动前和非运动特征的最新进展，着重探讨前驱期和早期帕金森病背景下的这些问题。
尽管帕金森病患者在整个病程中会经历多种非运动症状，但研究表明，非运动特征并非仅仅是晚期表现。事实上，嗅觉、睡眠、情绪和胃肠功能障碍可能预示着帕金森病或相关突触核蛋白病，并在这些神经退行性疾病出现前5年或更久就已出现。此外，现在在初发或新发帕金森病队列中也认识到了其他非运动症状，如认知障碍。这些非运动特征中的许多反映了非多巴胺能系统的紊乱以及外周和中枢神经系统的早期受累，包括如Braak提出的帕金森病病理分期中所涉及的嗅觉、肠道和脑干神经元。当前的研究重点是识别潜在的生物标志物，这些标志物可能检测出有患帕金森病风险的人，并允许早期使用神经保护或疾病修饰疗法进行干预。
最近的研究为帕金森病非运动特征的发生频率、病理生理学和重要性提供了新的见解，同时也认识到这些非运动症状出现在帕金森病的运动前、早期和晚期阶段。
