Skjærbæk Casper, Knudsen Karoline, Horsager Jacob, Borghammer Per
Department of Nuclear Medicine & PET, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, J220, 8200 Aarhus N, Denmark.
J Clin Med. 2021 Jan 31;10(3):493. doi: 10.3390/jcm10030493.
Parkinson's disease (PD) is the second most common neurodegenerative disease. Patients show deposits of pathological, aggregated α-synuclein not only in the brain but throughout almost the entire length of the digestive tract. This gives rise to non-motor symptoms particularly within the gastrointestinal tract and patients experience a wide range of frequent and burdensome symptoms such as dysphagia, bloating, and constipation. Recent evidence suggests that progressive accumulation of gastrointestinal pathology is underway several years before a clinical diagnosis of PD. Notably, constipation has been shown to increase the risk of developing PD and in contrast, truncal vagotomy seems to decrease the risk of PD. Animal models have demonstrated gut-to-brain spreading of pathological α-synuclein and it is currently being intensely studied whether PD begins in the gut of some patients. Gastrointestinal symptoms in PD have been investigated by the use of several different questionnaires. However, there is limited correspondence between subjective gastrointestinal symptoms and objective dysfunction along the gastrointestinal tract, and often the magnitude of dysfunction is underestimated by the use of questionnaires. Therefore, objective measures are important tools to clarify the degree of dysfunction in future studies of PD. Here, we summarize the types and prevalence of subjective gastrointestinal symptoms and objective dysfunction in PD. The potential importance of the gastrointestinal tract in the etiopathogenesis of PD is briefly discussed.
帕金森病(PD)是第二常见的神经退行性疾病。患者不仅在大脑中出现病理性聚集的α-突触核蛋白沉积,几乎在整个消化道中也有沉积。这会引发非运动症状,尤其是在胃肠道内,患者会经历多种频繁且令人困扰的症状,如吞咽困难、腹胀和便秘。最近的证据表明,在临床诊断帕金森病的数年前,胃肠道病理就已在逐渐累积。值得注意的是,便秘已被证明会增加患帕金森病的风险,相反,迷走神经干切断术似乎会降低患帕金森病的风险。动物模型已经证明病理性α-突触核蛋白可从肠道传播至大脑,目前正在深入研究帕金森病是否在某些患者的肠道中起始。帕金森病的胃肠道症状已通过多种不同问卷进行调查。然而,主观胃肠道症状与胃肠道客观功能障碍之间的对应关系有限,而且使用问卷往往会低估功能障碍的程度。因此,客观测量是未来帕金森病研究中明确功能障碍程度的重要工具。在此,我们总结了帕金森病主观胃肠道症状和客观功能障碍的类型及患病率。并简要讨论了胃肠道在帕金森病病因发病机制中的潜在重要性。
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