Kostić Vladimir S, Tomić Aleksandra, Ječmenica-Lukić Milica
Institute of Neurology CCS School of Medicine University of Belgrade Belgrade Serbia.
Mov Disord Clin Pract. 2016 Mar 11;3(4):323-330. doi: 10.1002/mdc3.12343. eCollection 2016 Jul-Aug.
Fatigue is 1 of the most common and most disabling symptoms among patients with Parkinson's disease (PD) and has a significant impact on their quality of life. Yet the pathophysiology of fatigue is poorly understood, while its treatment is "limited to an empirical approach based on plausible hypotheses."
PubMed was searched for articles with the key words "Parkinson's disease" or "parkinsonism" and "fatigue" that were published by or before August 2015. The analysis of articles, which were selected on subjective grounds, was used to review the current knowledge of pathophysiology and treatment outcomes in studies focused on fatigue in PD.
Clinical and experimental findings support the view that fatigue is a primary manifestation of PD. The main hypothesized pathophysiological mechanisms include abnormal basal ganglia (BG)-cortical mechanisms, particularly frontal loops, and an imbalance between neurotransmitters (e.g., dopamine [DA] and serotonin), along with an altered hypothalamus-pituitary-adrenal axis, neuroinflammation, cardiac sympathetic denervation, etc. Pragmatic treatment of fatigue in patients with PD includes various pharmacological (dopaminergic and psychostimulant drugs, antidepressants) and nonpharmacological strategies, although current knowledge suffers from insufficient evidence to support the use of any drug or nondrug therapy.
疲劳是帕金森病（PD）患者中最常见且最致残的症状之一，对其生活质量有重大影响。然而，疲劳的病理生理学知之甚少，其治疗“仅限于基于似是而非假设的经验性方法”。
在PubMed上检索截至2015年8月或之前发表的关键词为“帕金森病”或“帕金森综合征”以及“疲劳”的文章。对基于主观标准选择的文章进行分析，以回顾聚焦于PD疲劳的研究中病理生理学和治疗结果的现有知识。
临床和实验结果支持疲劳是PD的主要表现这一观点。主要的病理生理机制假说包括基底神经节（BG）-皮质机制异常，尤其是额叶环路，以及神经递质（如多巴胺[DA]和5-羟色胺）失衡，同时伴有下丘脑-垂体-肾上腺轴改变、神经炎症、心脏交感神经去神经支配等。PD患者疲劳的实用治疗包括各种药物治疗（多巴胺能和精神兴奋药物、抗抑郁药）和非药物策略，尽管目前的知识缺乏足够证据支持使用任何药物或非药物疗法。
