Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
Lancet. 2024 Jan 20;403(10423):305-324. doi: 10.1016/S0140-6736(23)01429-0.
Although dopamine replacement therapy remains a core component of Parkinson's disease treatment, the onset of motor fluctuations and dyskinetic movements might require a range of medical and surgical approaches from a multidisciplinary team, and important new approaches in the delivery of dopamine replacement are becoming available. The more challenging, wide range of non-motor symptoms can also have a major impact on the quality of life of a patient with Parkinson's disease, and requires careful multidisciplinary management using evidence-based knowledge, as well as appropriately tailored strategies according to the individual patient's needs. Disease-modifying therapies are urgently needed to prevent the development of the most disabling refractory symptoms, including gait and balance difficulties, cognitive impairment and dementia, and speech and swallowing impairments. In the third paper in this Series, we present the latest evidence supporting the optimal treatment of Parkinson's disease, and describe an expert approach to many aspects of treatment choice where an evidence base is insufficient.
尽管多巴胺替代疗法仍然是帕金森病治疗的核心组成部分，但运动波动和运动障碍的出现可能需要多学科团队提供一系列的医疗和手术方法，并且在提供多巴胺替代方面也出现了一些重要的新方法。更具挑战性的、广泛的非运动症状也会对帕金森病患者的生活质量产生重大影响，因此需要使用循证知识进行仔细的多学科管理，并根据患者个体的需求制定适当的策略。目前迫切需要进行疾病修饰治疗，以预防最具致残性的难治性症状的发展，包括步态和平衡困难、认知障碍和痴呆以及言语和吞咽障碍。在本系列的第三篇论文中，我们提出了支持帕金森病最佳治疗的最新证据，并描述了一种在证据基础不足的情况下，针对治疗选择的许多方面的专家方法。
