Kelberman Michael A, Vazey Elena M
Department of Biology, University of Massachusetts, Amherst, MA, USA.
Curr Pharmacol Rep. 2016 Dec;2(6):253-261. doi: 10.1007/s40495-016-0071-0. Epub 2016 Sep 28.
Non-motor symptoms in patients with Parkinson's Disease (PD) are better predictors of quality of life changes, caregiver burden, and mortality than motor symptoms. Levodopa has limited, and sometimes detrimental, effects on these symptoms. In this review we discuss recent evidence on pharmacological treatments for non-motor symptoms.
Breakthroughs have been made in the treatment of psychosis and sleep dysfunction. Pimavanserin has become the first FDA approved drug for PD psychosis. There is also new research supporting cholinesterase inhibitors for sleep disorders in PD. Other studies, including several novel treatments, have shown mixed results for apathy, depression, and fatigue.
Further research is needed to develop treatments for non-motor symptoms in PD. Preclinical and postmortem studies indicate that non-motor symptoms in PD may arise from pathology in non-dopamine systems. Although sometimes used off-label, therapies that target such systems have been under-utilized in treating non-motor symptoms and warrant further clinical investigation.
帕金森病（PD）患者的非运动症状比运动症状更能预测生活质量变化、照料者负担和死亡率。左旋多巴对这些症状的作用有限，有时甚至有害。在本综述中，我们讨论了非运动症状药物治疗的最新证据。
在精神病和睡眠功能障碍的治疗方面取得了突破。匹莫范色林已成为首个获美国食品药品监督管理局（FDA）批准用于治疗PD精神病的药物。也有新的研究支持胆碱酯酶抑制剂用于治疗PD睡眠障碍。其他研究，包括几种新疗法，在治疗淡漠、抑郁和疲劳方面结果不一。
需要进一步研究以开发治疗PD非运动症状的方法。临床前和尸检研究表明，PD的非运动症状可能源于非多巴胺系统的病理改变。尽管有时会超适应症使用，但针对此类系统的疗法在治疗非运动症状方面未得到充分利用，值得进一步进行临床研究。
