Department of Neurology, Oregon Health and Science University, Portland, OR, USA.
Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.
Parkinsonism Relat Disord. 2019 Jun;63:20-30. doi: 10.1016/j.parkreldis.2019.02.017. Epub 2019 Feb 14.
Mobility deficits, including gait disturbance, balance impairments and falls, are common features of Parkinson's disease (PD) that negatively impact quality of life. Mobility deficits respond poorly to dopaminergic medications, indicating a role for additional neurotransmitters. Due to the critical role of cortical input to gait and balance, acetylcholine-an essential neurotransmitter system for attention-has become an area of interest for mobility. This review aimed to identify the role of cholinergic function on gait, balance, and falls in PD using three techniques; pharmacological, imaging, and electrophysiological. Studies supported the role of the cholinergic system for mobility in PD, with the most promising evidence indicating a role in falls. Imaging studies demonstrated involvement of anterior cholinergic (basal forebrain) systems in gait, and posterior (brainstem) systems in balance. However, this review identified a small number of studies which used varying protocols, making comparisons difficult. Further studies are warranted, measuring comprehensive gait and balance characteristics as well as gold standard falls detection to further quantify the relationship between ACh and mobility in PD.
运动障碍，包括步态障碍、平衡障碍和跌倒，是帕金森病（PD）的常见特征，会对生活质量产生负面影响。运动障碍对多巴胺能药物反应不佳，表明存在其他神经递质的作用。由于皮质输入对步态和平衡至关重要，乙酰胆碱——注意力的必需神经递质系统——已成为运动的一个研究领域。本综述旨在使用三种技术（药理学、影像学和电生理学）确定胆碱能功能对 PD 中步态、平衡和跌倒的作用。研究支持胆碱能系统对 PD 中运动的作用，最有前途的证据表明其在跌倒中起作用。影像学研究表明，前胆碱能（基底前脑）系统参与步态，后（脑干）系统参与平衡。然而，本综述发现了少数使用不同方案的研究，使得比较变得困难。需要进一步的研究，测量全面的步态和平衡特征以及黄金标准的跌倒检测，以进一步量化 ACh 与 PD 中运动的关系。
