Biundo Roberta, Fiorenzato Eleonora, Antonini Angelo
Parkinson's Disease and Movement Disorders Unit, San Camillo Hospital IRCCS, Venice-Lido, Italy.
Parkinson's Disease and Movement Disorders Unit, San Camillo Hospital IRCCS, Venice-Lido, Italy; University of Padua, Padua, Italy.
Int Rev Neurobiol. 2017;133:389-415. doi: 10.1016/bs.irn.2017.05.031. Epub 2017 Jul 13.
Parkinson's disease (PD) is a common neurodegenerative disorder, characterized by motor and nonmotor symptoms (NMS). Several subsequent studies substantiate the great functional burden related to NMS, their progression, and negative effect on quality of life in PD. Additional evidence indicates interesting relationships between striatal dopaminergic function and NMS. The basal ganglia are implicated in the modulation and integration of sensory information and pain, bladder function is under control of both inhibitory (D1) and facilitatory (D2) dopaminergic inputs, finally reduced dopaminergic activity in the mesocortical and mesolimbic pathways is involved in the development of several NMS including mood, motivational, and cognitive alterations. Some NMS fluctuate in response to dopaminergic treatment and are relieved by dopamine replacement therapy, other are insensitive to current therapeutic strategies. The relation among the overall disease complications, perhaps the most important for PD patients and family members' well-being and functionality is dementia that affects most PD patients over the course of disease. Specific pharmacological treatment is lacking, and alternative approaches have been implemented to improve everyday functionality and quality of life. The state of the art suggests that cognitive rehabilitation in PD is possible and may either increase performance or preserve cognitive level over the time. However, it is also evident that cognitive abnormalities in PD are heterogeneous and we still do not have biomarkers to detect early patients at risk for dementia. Cognitive dysfunction is one the most prevalent NMS and is a clinically and functionally important disease milestone. Given the available clinical and imaging evidence it is possible to use cognition to model NMS progression and design nonpharmacological interventions. In this chapter we will address the use of cognitive rehabilitation and noninvasive brain stimulation techniques to modulate cognitive performance and rescue connectivity in affected brain circuitry.
帕金森病（PD）是一种常见的神经退行性疾病，以运动症状和非运动症状（NMS）为特征。随后的多项研究证实了与NMS相关的巨大功能负担、其进展以及对PD患者生活质量的负面影响。更多证据表明纹状体多巴胺能功能与NMS之间存在有趣的关系。基底神经节参与感觉信息和疼痛的调节与整合，膀胱功能受抑制性（D1）和促进性（D2）多巴胺能输入的控制，最后，中皮质和中边缘通路中多巴胺能活性降低与包括情绪、动机和认知改变在内的多种NMS的发生有关。一些NMS会随着多巴胺能治疗而波动，并可通过多巴胺替代疗法得到缓解，另一些则对当前的治疗策略不敏感。在所有疾病并发症中，对PD患者及其家庭成员的幸福感和功能可能最为重要的是痴呆症，它会影响大多数PD患者的病程。目前缺乏特异性药物治疗，因此已采用替代方法来改善日常功能和生活质量。目前的研究表明，PD患者的认知康复是可行的，并且可能随着时间的推移提高表现或维持认知水平。然而，同样明显的是，PD患者的认知异常具有异质性，我们仍然没有生物标志物来检测早期有痴呆风险的患者。认知功能障碍是最常见的NMS之一，是一个在临床和功能上都很重要的疾病里程碑。鉴于现有的临床和影像学证据，可以利用认知来模拟NMS的进展并设计非药物干预措施。在本章中，我们将探讨使用认知康复和非侵入性脑刺激技术来调节认知表现并挽救受影响脑回路中的连接性。
