帕金森病非运动症状治疗的研究进展——基于循证医学的评价
Update on treatments for nonmotor symptoms of Parkinson's disease-an evidence-based medicine review.
机构信息
Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Institute of Psychiatry, Psychology & Neuroscience at King's College and Parkinson Foundation International Centre of Excellence at King's College Hospital, Denmark Hill, London, United Kingdom.
出版信息
Mov Disord. 2019 Feb;34(2):180-198. doi: 10.1002/mds.27602. Epub 2019 Jan 17.
OBJECTIVE
To update evidence-based medicine recommendations for treating nonmotor symptoms in Parkinson's disease (PD).
BACKGROUND
The International Parkinson and Movement Disorder Society Evidence-Based Medicine Committee's recommendations for treatments of PD were first published in 2002, updated in 2011, and now updated again through December 31, 2016.
METHODS
Level I studies testing pharmacological, surgical, or nonpharmacological interventions for the treatment of nonmotor symptoms in PD were reviewed. Criteria for inclusion and quality scoring were as previously reported. The disorders covered were a range of neuropsychiatric symptoms, autonomic dysfunction, disorders of sleep and wakefulness, pain, fatigue, impaired olfaction, and ophthalmologic dysfunction. Clinical efficacy, implications for clinical practice, and safety conclusions are reported.
RESULTS
A total of 37 new studies qualified for review. There were no randomized controlled trials that met inclusion criteria for the treatment of anxiety disorders, rapid eye movement sleep behavior disorder, excessive sweating, impaired olfaction, or ophthalmologic dysfunction. We identified clinically useful or possibly useful interventions for the treatment of depression, apathy, impulse control and related disorders, dementia, psychosis, insomnia, daytime sleepiness, drooling, orthostatic hypotension, gastrointestinal dysfunction, urinary dysfunction, erectile dysfunction, fatigue, and pain. There were no clinically useful interventions identified to treat non-dementia-level cognitive impairment.
CONCLUSIONS
The evidence base for treating a range of nonmotor symptoms in PD has grown substantially in recent years. However, treatment options overall remain limited given the high prevalence and adverse impact of these disorders, so the development and testing of new treatments for nonmotor symptoms in PD remains a top priority. © 2019 International Parkinson and Movement Disorder Society.
目的
更新针对帕金森病（PD）非运动症状的循证医学推荐。
背景
国际帕金森病和运动障碍协会循证医学委员会针对 PD 的治疗建议于 2002 年首次发布，2011 年进行了更新，现在又更新至 2016 年 12 月 31 日。
方法
我们回顾了针对 PD 非运动症状的治疗进行药理学、手术或非药理学干预的 I 级研究。纳入标准和质量评分标准与之前报道的相同。涵盖的疾病包括一系列神经精神症状、自主神经功能障碍、睡眠和觉醒障碍、疼痛、疲劳、嗅觉障碍和眼科功能障碍。报告了临床疗效、对临床实践的影响以及安全性结论。
结果
共有 37 项新研究符合审查条件。没有随机对照试验符合治疗焦虑障碍、快速眼动睡眠行为障碍、过度出汗、嗅觉障碍或眼科功能障碍的纳入标准。我们确定了对治疗抑郁症、淡漠、冲动控制和相关障碍、痴呆、精神病、失眠、白天嗜睡、流涎、体位性低血压、胃肠道功能障碍、尿功能障碍、勃起功能障碍、疲劳和疼痛有用或可能有用的干预措施。针对非痴呆水平认知障碍，没有发现有用的干预措施。
结论
近年来，针对 PD 一系列非运动症状的治疗证据基础有了很大的增长。然而，鉴于这些疾病的高患病率和不良影响，总体治疗选择仍然有限，因此开发和测试 PD 非运动症状的新治疗方法仍然是当务之急。
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