Deeb Wissam, Nozile-Firth Kamilia, Okun Michael S
Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States.
Center for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida College of Medicine, Gainesville, FL, United States.
Handb Clin Neurol. 2019;167:257-277. doi: 10.1016/B978-0-12-804766-8.00014-5.
Parkinson's disease (PD) is a complex neuropsychiatric disorder that manifests with a variety of motor and nonmotor symptoms. Its incidence increases with age. It is important for clinicians to be able to distinguish symptoms of aging and other comorbidities from those of PD. The diagnosis of PD has traditionally been rendered using strict criteria that mainly rely on the cardinal motor symptoms of rest tremor, rigidity, and bradykinesia. However, newer diagnostic criteria proposed by the Movement Disorders Society for diagnosis of PD collectively reflect a greater appreciation for the nonmotor symptoms. The treatment of PD remains symptomatic and the most noticeable improvements have been documented in the motor symptoms. Levodopa remains the gold standard for therapy, however there are now many other potential medical and surgical treatment strategies. Nonmotor symptoms have been shown to affect quality of life more than the motor symptoms. There is ongoing research into symptomatic and disease modifying treatments. Given the multisystem involvement in PD, an interdisciplinary patient-centered approach is recommended by most experts. This chapter addresses first the diagnostic approach and the many geriatric considerations. This is followed by a review of the nonmotor symptoms. Finally, a summary of current treatment strategies in PD is presented along with potential treatment complications.
帕金森病（PD）是一种复杂的神经精神疾病，表现为多种运动和非运动症状。其发病率随年龄增长而增加。对于临床医生来说，能够区分衰老症状和其他合并症与帕金森病症状非常重要。传统上，帕金森病的诊断主要依据严格的标准，这些标准主要依赖静止性震颤、强直和运动迟缓等主要运动症状。然而，运动障碍协会提出的帕金森病新诊断标准总体上反映了对非运动症状的更多认识。帕金森病的治疗仍然是对症治疗，最显著的改善记录在运动症状方面。左旋多巴仍然是治疗的金标准，然而现在有许多其他潜在的药物和手术治疗策略。已表明非运动症状比运动症状对生活质量的影响更大。目前正在对对症治疗和疾病修饰治疗进行研究。鉴于帕金森病涉及多系统，大多数专家建议采用以患者为中心的跨学科方法。本章首先讨论诊断方法以及许多老年医学方面的考虑因素。随后回顾非运动症状。最后，总结帕金森病当前的治疗策略以及潜在的治疗并发症。
