Department of Neurology, Emory University School of Medicine, Atlanta, GA.
Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA.
Eur J Neurol. 2017 Oct;24(10):1244-1254. doi: 10.1111/ene.13376. Epub 2017 Jul 31.
Psychotic symptoms are common, disabling non-motor features of Parkinson's disease (PD). Despite noted heterogeneity in clinical features, natural history and therapy response, current dogma posits that psychosis generally progresses in a stereotypic manner through a cascade of events that begins with minor hallucinations and evolves to severe hallucinations and delusions. Further, the occurrence of psychotic symptoms is believed to indicate a poor prognosis. Here we propose a classification scheme that outlines the pathogenesis of psychosis as it relates to dysfunction of several neurotransmitter systems. We hypothesize that several subtypes exist, and that PD psychosis is not consistently indicative of a progressive cascade and poor prognosis. The literature was reviewed from 1990 to 2017. An overview of the features of PD psychosis is followed by a review of data indicating the existence of neurotransmitter-related subtypes of psychosis. We found that ample evidence exists to demonstrate the presence of multiple subtypes of PD psychosis, which are traced to dysfunction of the following neurotransmitter systems: dopamine, serotonin and acetylcholine. Dysfunction of each of these systems is recognizable through their clinical features and correlates, and the varied long-term prognoses. Identifying which neurotransmitter system is dysfunctional may help to develop targeted therapies. PD psychosis has various subtypes that differ in clinical features, underlying pathology and pathophysiology, treatment response and prognosis. A novel classification scheme is presented that describes the clinical subtypes with different outcomes, which could lead to the development of targeted therapies. Future research should focus on testing the viability of this classification.
精神病症状是常见的，也是帕金森病（PD）的非运动性致残特征。尽管临床特征、自然病史和治疗反应存在明显异质性，但目前的定论认为，精神病通常通过一系列事件以刻板的方式进展，这些事件始于轻微的幻觉，发展为严重的幻觉和妄想。此外，精神病症状的发生被认为预示着预后不良。在这里，我们提出了一个分类方案，概述了与几种神经递质系统功能障碍相关的精神病发病机制。我们假设存在几种亚型，并且 PD 精神病并不总是表明存在进行性级联和不良预后。对 1990 年至 2017 年的文献进行了回顾。概述了 PD 精神病的特征，随后回顾了表明存在与神经递质相关的精神病亚型的数据。我们发现，有充分的证据表明 PD 精神病存在多种亚型，这些亚型可追溯到以下神经递质系统的功能障碍：多巴胺、血清素和乙酰胆碱。这些系统的每个系统的功能障碍都可以通过其临床特征和相关性以及不同的长期预后来识别。确定哪个神经递质系统功能障碍可能有助于开发靶向治疗。PD 精神病有多种亚型，在临床特征、潜在病理和病理生理学、治疗反应和预后方面存在差异。提出了一种新的分类方案，描述了具有不同结局的临床亚型，这可能导致靶向治疗的发展。未来的研究应侧重于测试这种分类的可行性。
