Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.
BMJ. 2022 Oct 24;379:e068718. doi: 10.1136/bmj-2021-068718.
Neuropsychiatric symptoms (NPSs) such as affective disorders, psychosis, behavioral changes, and cognitive impairment are common in Parkinson's disease (PD). However, NPSs remain under-recognized and under-treated, often leading to adverse outcomes. Their epidemiology, presentation, risk factors, neural substrate, and management strategies are incompletely understood. While psychological and psychosocial factors may contribute, hallmark PD neuropathophysiological changes, plus the associations between exposure to dopaminergic medications and occurrence of some symptoms, suggest a neurobiological basis for many NPSs. A range of psychotropic medications, psychotherapeutic techniques, stimulation therapies, and other non-pharmacological treatments have been studied, are used clinically, and are beneficial for managing NPSs in PD. Appropriate management of NPSs is critical for comprehensive PD care, from recognizing their presentations and timing throughout the disease course, to the incorporation of different therapeutic strategies (ie, pharmacological and non-pharmacological) that utilize a multidisciplinary approach.
神经精神症状（NPSs），如情感障碍、精神病、行为改变和认知障碍，在帕金森病（PD）中很常见。然而，NPSs 仍然未被充分认识和治疗，这往往会导致不良后果。其流行病学、表现、危险因素、神经基础和管理策略尚不完全清楚。虽然心理和社会心理因素可能起作用，但 PD 的神经病理学标志性变化，加上接触多巴胺能药物与某些症状发生之间的关联，表明许多 NPSs 具有神经生物学基础。一系列精神药物、心理治疗技术、刺激疗法和其他非药物治疗已被研究、用于临床，并有益于 PD 中 NPSs 的管理。NPSs 的适当管理对于全面的 PD 护理至关重要，从识别其在疾病过程中的表现和时间，到采用多学科方法整合不同的治疗策略（即，药物和非药物）。
