Department of Neurology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive-2RCP, Iowa City, Iowa, 52242, USA.
Neurology Service, Veterans Affairs Medical Center, Iowa City, Iowa, USA.
Neurotherapeutics. 2020 Oct;17(4):1495-1510. doi: 10.1007/s13311-020-00963-x. Epub 2020 Nov 17.
Cognitive dysfunction is common in Parkinson's disease (PD) and predicts poor clinical outcomes. It is associated primarily with pathologic involvement of basal forebrain cholinergic and prefrontal dopaminergic systems. Impairments in executive functions, attention, and visuospatial abilities are its hallmark features with eventual involvement of memory and other domains. Subtle symptoms in the premotor and early phases of PD progress to mild cognitive impairment (MCI) which may be present at the time of diagnosis. Eventually, a large majority of PD patients develop dementia with advancing age and longer disease duration, which is usually accompanied by immobility, hallucinations/psychosis, and dysautonomia. Dopaminergic medications and deep brain stimulation help motor dysfunction, but may have potential cognitive side effects. Central acetylcholinesterase inhibitors, and possibly memantine, provide modest and temporary symptomatic relief for dementia, although there is no evidence-based treatment for MCI. There is no proven disease-modifying treatment for cognitive impairment in PD. The symptomatic and disease-modifying role of physical exercise, cognitive training, and neuromodulation on cognitive impairment in PD is under investigation. Multidisciplinary approaches to cognitive impairment with effective treatment of comorbidities, proper rehabilitation, and maintenance of good support systems in addition to pharmaceutical treatment may improve the quality of life of the patients and caregivers.
认知功能障碍在帕金森病(PD)中很常见,并且预测着不良的临床结局。它主要与基底前脑胆碱能和前额叶多巴胺能系统的病理性参与有关。执行功能、注意力和视空间能力的损伤是其标志性特征,最终会涉及到记忆和其他领域。在 PD 的运动前期和早期,轻微的症状会进展为轻度认知障碍(MCI),可能在诊断时就已经存在。最终,随着年龄的增长和疾病持续时间的延长,大多数 PD 患者会发展为痴呆症,通常伴有运动不能、幻觉/精神病和自主神经功能障碍。多巴胺能药物和深部脑刺激有助于改善运动功能,但可能存在潜在的认知副作用。中枢乙酰胆碱酯酶抑制剂,可能还有美金刚,为痴呆症提供适度和暂时的症状缓解,但对于 MCI 尚无基于证据的治疗方法。目前尚无针对 PD 认知障碍的经证实的疾病修饰治疗方法。运动、认知训练和神经调节对 PD 认知障碍的症状和疾病修饰作用正在研究中。多学科方法治疗认知障碍,有效治疗合并症、适当康复以及维持良好的支持系统,除了药物治疗外,还可能提高患者和照护者的生活质量。
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