Weintraub Daniel, Mamikonyan Eugenia
Perelman School of Medicine (DW, EM), University of Pennsylvania, Philadelphia; Parkinson's Disease Research, Education and Clinical Center (PADRECC) (DW), Philadelphia Veterans Affairs Medical Center, Philadelphia.
Perelman School of Medicine (DW, EM), University of Pennsylvania, Philadelphia.
Am J Geriatr Psychiatry. 2019 Sep;27(9):998-1018. doi: 10.1016/j.jagp.2019.03.002. Epub 2019 Mar 9.
Affective disorders, cognitive decline, and psychosis have long been recognized as common in Parkinson disease (PD), and other psychiatric disorders include impulse control disorders, anxiety symptoms, disorders of sleep and wakefulness, and apathy. Psychiatric aspects of PD are associated with numerous adverse outcomes, yet in spite of this and their frequent occurrence, there is incomplete understanding of epidemiology, presentation, risk factors, neural substrate, and management strategies. Psychiatric features are typically multimorbid, and there is great intra- and interindividual variability in presentation. The hallmark neuropathophysiological changes that occur in PD, plus the association between exposure to dopaminergic medications and certain psychiatric disorders, suggest a neurobiological basis for many psychiatric symptoms, although psychological factors are involved as well. There is evidence that psychiatric disorders in PD are still under-recognized and undertreated and although psychotropic medication use is common, controlled studies demonstrating efficacy and tolerability are largely lacking. Future research on neuropsychiatric complications in PD should be oriented toward determining modifiable correlates or risk factors and establishing efficacious and well-tolerated treatment strategies.
情感障碍、认知衰退和精神病长期以来一直被认为在帕金森病（PD）中很常见，其他精神障碍包括冲动控制障碍、焦虑症状、睡眠和觉醒障碍以及冷漠。PD的精神方面与许多不良后果相关，然而，尽管如此且其频繁发生，但对其流行病学、表现、危险因素、神经基质和管理策略仍缺乏全面了解。精神特征通常是多种疾病并存，并且在表现上个体内和个体间存在很大差异。PD中发生的标志性神经病理生理变化，加上接触多巴胺能药物与某些精神障碍之间的关联，表明许多精神症状存在神经生物学基础，尽管心理因素也有涉及。有证据表明，PD中的精神障碍仍未得到充分认识和治疗，尽管精神药物的使用很普遍，但缺乏证明其疗效和耐受性的对照研究。未来关于PD神经精神并发症的研究应致力于确定可改变的相关因素或危险因素，并建立有效且耐受性良好的治疗策略。
