Titova Nataliya, Qamar Mubasher A, Chaudhuri K Ray
Federal State Budgetary Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Healthcare of the Russian Federation, Moscow, Russia.
National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, United Kingdom; Maurice Wohl Clinical Neuroscience Institute, Kings College, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, United Kingdom.
Int Rev Neurobiol. 2017;132:33-54. doi: 10.1016/bs.irn.2017.02.016. Epub 2017 Apr 4.
Nonmotor symptoms (NMS) of Parkinson's disease (PD) were recognized by the great James Parkinson himself who mentioned symptoms such as sleep dysfunction, delirium, dementia, and dysautonomia, in his seminal 1817 essay, "An Essay on the Shaking Palsy" (Parkinson, 1817). In spite of the key impact of PD NMS on quality of life, there was little holistic research and awareness till the validation and use of comprehensive tools such as the NMS questionnaire, scale, and the revised version of the unified PD rating scale. Research studies using these tools highlighted the key impact of the burden of NMS on quality of life of PD patients and the need for NMS to be routinely assessed in clinic. We now define PD as a motor and nonmotor disorder, and the natural history includes a long prodromal phase of PD dominated by a range of NMS. The prodromal phase is the subject of much research particularly in relation to neuroprotection and identifying subjects at risk. Use of NMS tools has also validated burden grading of NMS with cutoff values, which can be used as outcome measure in clinical trials. Finally, the complex multineurotransmitter dysfunction that is seen in PD has been shown to manifest clinically as nonmotor subtypes. Recognition of such subtypes is likely to lead to the emergence of personalized and precision medicine in PD.
帕金森病（PD）的非运动症状（NMS）最早由伟大的詹姆斯·帕金森本人发现，他在1817年具有开创性的论文《震颤麻痹论》（帕金森，1817年）中提到了睡眠功能障碍、谵妄、痴呆和自主神经功能障碍等症状。尽管帕金森病非运动症状对生活质量有关键影响，但在诸如非运动症状问卷、量表以及统一帕金森病评定量表修订版等综合工具得到验证和使用之前，几乎没有全面的研究和认识。使用这些工具的研究突出了非运动症状负担对帕金森病患者生活质量的关键影响，以及在临床中对非运动症状进行常规评估的必要性。我们现在将帕金森病定义为一种运动和非运动障碍，其自然病史包括一个以一系列非运动症状为主的漫长前驱期。前驱期是许多研究的主题，特别是在神经保护和识别高危人群方面。非运动症状工具的使用也通过临界值验证了非运动症状的负担分级，这可作为临床试验的结果指标。最后，帕金森病中所见的复杂多神经递质功能障碍已被证明在临床上表现为非运动亚型。认识到这些亚型可能会推动帕金森病个性化和精准医学的出现。
