Klingelhoefer Lisa, Jitkritsadakul Onanong, Bhidayasiri Roongroj
Technical University Dresden, Dresden, Germany.
Chulalongkorn Center of Excellence for Parkinson's Disease & Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Int Rev Neurobiol. 2017;133:347-387. doi: 10.1016/bs.irn.2017.04.004. Epub 2017 May 31.
The comprehensive evaluation of nonmotor symptoms (NMS) in Parkinson's disease (PD) starts with the awareness of physicians, patients, and caregivers on their nature, clinical presentation, and effect on patient's daily activities and quality of life. This awareness can be better achieved if the symptoms can be visualized, measured, and monitored. As NMS are largely subjective in nature, a majority of them cannot be visualized (unlike tremor, which is easily seen), making their identification and quantification difficult. While symptoms are nonmotor, it does not mean that they are not measurable, as many NMS are integral to motor symptoms of Parkinson's, yet often neglected. In this review, we attempt to provide the most up-to-date and comprehensive literature review on the objective measurement and monitoring of NMS in PD. The aim is to make it clinically relevant by approaching NMS by domains as identified in the NMS Questionnaire. A section on the assessment of nonmotor fluctuations is also included, providing prospects for future objective monitoring. With the advances of technology, it is likely that many NMS will have objective outcomes, thus making these symptoms easily measurable and hopefully lead to future clinical trials that incorporate nonmotor outcomes. Nevertheless, it still requires a physician's judgment to determine which method, scales, objective measures, or monitoring devices or a combination of these is most appropriate to the individual patient in order to answer a particular clinical question.
帕金森病(PD)非运动症状(NMS)的综合评估始于医生、患者及其照料者对这些症状的本质、临床表现以及对患者日常活动和生活质量影响的认识。如果这些症状能够被可视化、测量和监测,那么这种认识就能更好地达成。由于NMS在很大程度上具有主观性,它们中的大多数无法像震颤那样容易被观察到,这使得对其进行识别和量化变得困难。虽然这些症状是非运动性的,但这并不意味着它们无法测量,因为许多NMS是帕金森病运动症状的组成部分,却常常被忽视。在本综述中,我们试图提供关于PD中NMS客观测量和监测的最新且全面的文献综述。目的是通过按照NMS问卷中确定的领域来探讨NMS,使其具有临床相关性。还包括了一个关于非运动波动评估的章节,为未来的客观监测提供前景。随着技术的进步,许多NMS可能会有客观的评估结果,从而使这些症状易于测量,并有望促成纳入非运动结果的未来临床试验。然而,仍需要医生进行判断,以确定哪种方法、量表、客观测量手段或监测设备,或者这些的某种组合,最适合个体患者,以便回答特定的临床问题。