Sharpe Gabriella, Macerollo Antonella, Fabbri Margherita, Tripoliti Elina
School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia.
Department of Neurology, The Walton Center for Neurology and Neurosurgery, Liverpool, United Kingdom.
Front Neurol. 2020 Sep 25;11:576569. doi: 10.3389/fneur.2020.576569. eCollection 2020.
Parkinson's disease (PD) is now known to be a multisystemic heterogeneous neurodegenerative disease, including a wide spectrum of both motor and non-motor symptoms. PD patients' management must encompass a multidisciplinary approach to effectively address its complex nature. There are still challenges in terms of treating axial (gait, balance, posture, speech, and swallowing) and cognitive symptoms that typically arise with disease progression becoming poorly responsive to dopaminergic or surgical treatments. The objectives of the study are to further establish the presentation of axial and cognitive symptoms in early PD [Hoehn and Yahr (H&Y) scale ≤ 2] and to discuss the evidence for non-pharmacological approaches in early PD. Mild and subtle changes in the investigated domains can be present even in early PD. Over the last 15 years, a few randomized clinical trials have been focused on these areas. Due to the low number of studies and the heterogeneity of the results, no definitive recommendations are possible. However, positive results have been obtained, with effective treatments being high-intensity treadmill and cueing for gait disturbances, high-intensity voice treatment, video-assisted swallowing therapy for dysphagia, and warm-up exercises and Wii Fit training for cognition. Considering the association of motor, speech, and cognitive function, future trials should focus on multidisciplinary approaches to combined non-pharmacological management. We highlight the need for a more unified approach in managing these "orphan" symptoms, from the very beginning of the disease. The concept "the sooner the better" should be applied to multidisciplinary non-pharmacological management in PD.
帕金森病（PD）现在被认为是一种多系统异质性神经退行性疾病，包括广泛的运动和非运动症状。PD患者的管理必须采用多学科方法，以有效应对其复杂的性质。在治疗轴性症状（步态、平衡、姿势、言语和吞咽）和认知症状方面仍然存在挑战，这些症状通常随着疾病进展而出现，对多巴胺能治疗或手术治疗反应不佳。本研究的目的是进一步明确早期PD[霍恩和亚尔（H&Y）分级≤2]中轴性和认知症状的表现，并讨论早期PD非药物治疗方法的证据。即使在早期PD中，所研究领域也可能存在轻微和细微的变化。在过去15年中，一些随机临床试验一直聚焦于这些领域。由于研究数量较少且结果存在异质性，无法给出明确的建议。然而，已经取得了积极的成果，有效的治疗方法包括针对步态障碍的高强度跑步机训练和提示、高强度语音治疗、针对吞咽困难的视频辅助吞咽治疗，以及针对认知的热身运动和Wii Fit训练。考虑到运动、言语和认知功能之间的关联，未来的试验应侧重于多学科联合非药物管理方法。我们强调从疾病一开始就需要一种更统一的方法来管理这些“孤儿”症状。“越早越好”的理念应应用于PD的多学科非药物管理。
