Department of Neurology, Christians-Albrechts University, Arnold-Heller-Str. 3, Haus 41, Kiel, 24105, Germany.
Department of Neurodegeneration, Hertie-Institute of Clinical Brain Research, Tuebingen, Germany.
CNS Drugs. 2017 Jul;31(7):551-570. doi: 10.1007/s40263-017-0450-z.
Apart from the typical motor symptoms, Parkinson's disease is characterized by a wide range of different non-motor symptoms, which are highly prevalent in all stages of the disease and have an incisive influence on quality of life. Moreover, their treatment continues to be challenging. In this review, we critically summarize the evidence for the impact of dopaminergic therapies on non-motor symptoms in Parkinson's disease. We performed a PubMed search to identify relevant clinical studies that investigated the response of non-motor symptoms to dopaminergic therapy. In the domain of neuropsychiatric disturbances, there is increasing evidence that dopamine agonists can ameliorate depression or anxiety. Other neuropsychiatric symptoms such as psychosis or impulse control disorders can also be worsened or even be induced by dopaminergic agents. For the treatment of sleep disturbances, it is essential to identify different subtypes of sleep pathologies. While there is for example profound evidence for the effectiveness of dopaminergic medication for the treatment of restless legs syndrome and sleep fragmentation, evidence for an improvement of rapid eye movement sleep behavior disorder is lacking. With regard to the broad spectrum of autonomic disturbances, response to dopaminergic treatment seems to differ largely, with on the one hand, some evidence for an improvement of sexual function or sweating with dopaminergic treatment, while on the other hand, constipation can be worsened. Finally, the analysis of sensory deficits reveals that some forms of pain, in particular fluctuation-dependent dystonic pain, can be well addressed by adapting the dopaminergic therapy, while no effect has been seen so far for hyposmia or visual deficits. Moreover, the occurrence of non-motor fluctuations is gaining increased attention, as they can be specifically addressed by a more continuous dopaminergic intake. Taken together, there is evidence of a good response of some (but not all) non-motor symptoms to dopaminergic therapy, which must be individually adapted to the special spectrum of symptoms.
除了典型的运动症状外，帕金森病还表现出广泛的不同非运动症状，这些症状在疾病的所有阶段都高度普遍存在，并对生活质量产生深远影响。此外，它们的治疗仍然具有挑战性。在这篇综述中，我们批判性地总结了多巴胺能治疗对帕金森病非运动症状影响的证据。我们进行了 PubMed 检索，以确定研究多巴胺能治疗对非运动症状反应的相关临床研究。在神经精神障碍领域，越来越多的证据表明多巴胺激动剂可以改善抑郁或焦虑。其他神经精神症状，如精神病或冲动控制障碍，也可能因多巴胺能药物而恶化，甚至诱发。对于睡眠障碍的治疗，必须识别不同类型的睡眠病理学。虽然例如有确凿的证据表明多巴胺能药物对治疗不安腿综合征和睡眠片段化非常有效，但缺乏对快速眼动睡眠行为障碍改善的证据。关于广泛的自主神经障碍，对多巴胺能治疗的反应似乎差异很大，一方面，有一些证据表明多巴胺能治疗可以改善性功能或出汗，而另一方面，便秘可能会恶化。最后，对感觉缺陷的分析表明，一些形式的疼痛，特别是与波动相关的张力障碍性疼痛，可以通过调整多巴胺能治疗来很好地解决，而嗅觉丧失或视力缺陷目前还没有效果。此外，非运动波动的发生越来越受到关注，因为它们可以通过更持续的多巴胺摄入来专门解决。总的来说，有证据表明一些（但不是全部）非运动症状对多巴胺能治疗有良好的反应，必须根据特殊的症状谱进行个体化调整。
