Sauerbier Anna, Jenner Peter, Todorova Antoniya, Chaudhuri K Ray
National Parkinson Foundation International Centre of Excellence, King's College London, London, UK; National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre and Dementia Unit at South London and Maudsley NHS Foundation Trust and The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK.
Institute of Pharmaceutical Science, King's College London, UK.
Parkinsonism Relat Disord. 2016 Jan;22 Suppl 1:S41-6. doi: 10.1016/j.parkreldis.2015.09.027. Epub 2015 Sep 11.
Non motor symptoms (NMS) represent a significant burden in Parkinson's disease (PD) with numerous studies highlighting the importance of NMS both in "pre-motor" phase of PD as well as throughout the course of disease. In part this has led the international Parkinson and Movement Disorder Society (IPMDS) task force to attempt a re-definition of PD incorporating NMS and not base the diagnosis solely on motor symptoms. While motor subtypes within PD have been recognized and researched, recent clinical and neurobiological research suggests the existence of discrete non motor subtypes in PD, particularly in untreated (drug naïve) and early PD patients. Several independent observers have reported specific "clusters of NMS dominant PD" using a data driven approach in early and untreated PD patients while others have reported on the burden of NMS in untreated PD and specific NMS dominant phenotypes in untreated or treated PD using observational case series based data. In this review we report on specific NMS dominant phenotypes of PD as described in the literature using clinical observational studies and address pathophysiological concepts. A proposal for several NMS subtypes are reported combining clinical reports with, where possible, evidence base supporting probable biomarkers.
非运动症状(NMS)在帕金森病(PD)中是一项重大负担,众多研究强调了非运动症状在PD“运动前期”以及疾病全过程中的重要性。部分原因导致国际帕金森和运动障碍协会(IPMDS)特别工作组试图重新定义PD,将非运动症状纳入其中,而不是仅基于运动症状进行诊断。虽然PD中的运动亚型已得到认可和研究,但最近的临床和神经生物学研究表明,PD中存在离散的非运动亚型,尤其是在未治疗(初治)和早期PD患者中。几位独立观察者在早期和未治疗的PD患者中采用数据驱动方法报告了特定的“非运动症状主导的PD集群”,而其他人则使用基于观察性病例系列的数据报告了未治疗PD中非运动症状的负担以及未治疗或治疗PD中特定的非运动症状主导表型。在本综述中,我们使用临床观察性研究报告了文献中描述的PD特定非运动症状主导表型,并探讨病理生理概念。报告了几种非运动症状亚型的提议,将临床报告与可能支持潜在生物标志物的证据基础相结合。
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