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缓解帕金森病的压力:对症治疗、疾病修饰还是两者兼而有之?

Alleviating Stress in Parkinson's Disease: Symptomatic Treatment, Disease Modification, or Both?

机构信息

Neurology Department, Donders Institute for Brain, Cognition and Behaviour, Centre of Expertise for Parkinson and Movement Disorders, Radboud University Medical Centre, Nijmegen, The Netherlands.

出版信息

J Parkinsons Dis. 2024;14(s1):S147-S158. doi: 10.3233/JPD-230211.


DOI:10.3233/JPD-230211
PMID:38363618
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11380242/
Abstract

Psychological stress, a state of mental strain caused by mentally or physically threatening situations, plays a significant role in Parkinson's disease (PD). Motor symptoms worsen during acute stress and common non-motor symptoms in PD, such as anxiety and depression, are linked to chronic stress. Although evidence in humans is lacking, animal models of PD suggest that chronic stress can accelerate dopaminergic cell death. This suggests that stress-reducing interventions have not only symptomatic, but perhaps also disease-modifying effects. Our objective was to identify the most promising strategies for stress-reduction in PD and to analyze their potential value for disease-modification. An unstructured literature search was performed, primarily focusing on papers published between 2020-2023. Several large clinical trials have tested the efficacy of aerobic exercise and mindfulness-based interventions on PD symptoms. The evidence is promising, but not definitive yet: some exercise trials found a reduction in stress-related symptoms, whereas others did not or did not report it. In the majority of trials, biological measures of stress and of disease progression are missing. Furthermore, follow-up periods were generally too short to measure disease-modifying effects. Hence, mechanisms underlying the intervention effects remain largely unclear. These effects may consist of attenuating progressive neurodegeneration (measured with MRI-markers of substantia nigra integrity or cortical thickness), or a strengthening of compensatory cerebral mechanisms (measured with functional neuroimaging), or both. Lifestyle interventions are effective for alleviating stress-related symptoms in PD. They hold potential for exerting disease-modifying effects, but new evidence in humans is necessary to fulfill that promise.

摘要

心理压力是一种由精神或身体上的威胁情况引起的精神紧张状态,在帕金森病(PD)中起着重要作用。在急性压力下,运动症状会恶化,而 PD 常见的非运动症状,如焦虑和抑郁,与慢性压力有关。尽管人类缺乏证据,但 PD 的动物模型表明,慢性压力会加速多巴胺能细胞死亡。这表明减轻压力的干预措施不仅具有症状缓解作用,而且可能具有疾病修饰作用。我们的目标是确定 PD 中最有前途的减压策略,并分析它们对疾病修饰的潜在价值。进行了一次非结构化的文献检索,主要集中在 2020-2023 年期间发表的论文上。几项大型临床试验已经测试了有氧运动和基于正念的干预措施对 PD 症状的疗效。证据是有希望的,但还不是定论:一些运动试验发现与压力相关的症状有所减轻,而其他试验则没有或没有报告。在大多数试验中,缺乏生物应激和疾病进展的测量。此外,随访期通常太短,无法测量疾病修饰效应。因此,干预效果的机制在很大程度上仍不清楚。这些效果可能包括减轻进行性神经退行性变(通过测量黑质完整性或皮质厚度的 MRI 标志物来衡量),或增强代偿性大脑机制(通过功能神经影像学来衡量),或两者兼而有之。生活方式干预措施可有效缓解 PD 患者的压力相关症状。它们有可能发挥疾病修饰作用,但需要新的人类证据来实现这一承诺。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab8b/11380242/7723e2431ad6/jpd-14-jpd230211-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab8b/11380242/7723e2431ad6/jpd-14-jpd230211-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab8b/11380242/7723e2431ad6/jpd-14-jpd230211-g001.jpg

相似文献

[1]
Alleviating Stress in Parkinson's Disease: Symptomatic Treatment, Disease Modification, or Both?

J Parkinsons Dis. 2024

[2]
Study protocol for the MIND-PD study: a randomized controlled trial to investigate clinical and biological effects of mindfulness-based cognitive therapy in people with Parkinson's disease.

BMC Neurol. 2024-6-25

[3]
Stress and Mindfulness in Parkinson's Disease: Clinical Effects and Potential Underlying Mechanisms.

Mov Disord. 2021-1

[4]
The effects of yoga versus stretching and resistance training exercises on psychological distress for people with mild-to-moderate Parkinson's disease: study prxotocol for a randomized controlled trial.

Trials. 2017-11-2

[5]
A randomized controlled trial on the effects and acceptability of individual mindfulness techniques - meditation and yoga - on anxiety and depression in people with Parkinson's disease: a study protocol.

BMC Complement Med Ther. 2023-7-17

[6]
A mixed methods evaluation of a Mindfulness-Based Stress Reduction course for people with Parkinson's disease.

Complement Ther Clin Pract. 2017-10-25

[7]
Disease modification in Parkinson's disease.

Drugs Aging. 2011-8-1

[8]
Current Perspectives on Aerobic Exercise in People with Parkinson's Disease.

Neurotherapeutics. 2020-10

[9]
Stress and mindfulness in Parkinson's disease - a survey in 5000 patients.

NPJ Parkinsons Dis. 2021-1-18

[10]
Prediction of depression and anxiety via patient-assessed tremor severity, not physician-reported motor symptom severity, in patients with Parkinson's disease or essential tremor who have undergone deep brain stimulation.

J Neurosurg. 2018-2-23

引用本文的文献

[1]
Psychological stress associated with prognostic uncertainties in recently diagnosed Parkinson's disease patients: A qualitative study.

PLoS One. 2025-3-11

[2]
Study protocol for the MIND-PD study: a randomized controlled trial to investigate clinical and biological effects of mindfulness-based cognitive therapy in people with Parkinson's disease.

BMC Neurol. 2024-6-25

[3]
Predictors of stress resilience in Parkinson's disease and associations with symptom progression.

NPJ Parkinsons Dis. 2024-4-11

本文引用的文献

[1]
Effectiveness of stress management interventions to change cortisol levels: a systematic review and meta-analysis.

Psychoneuroendocrinology. 2024-1

[2]
How should we be using biomarkers in trials of disease modification in Parkinson's disease?

Brain. 2023-12-1

[3]
Assessment of heterogeneity among participants in the Parkinson's Progression Markers Initiative cohort using α-synuclein seed amplification: a cross-sectional study.

Lancet Neurol. 2023-5

[4]
Monitoring Substantia Nigra Degeneration Using Free Water Imaging across Prodromal and Clinical Parkinson's Disease.

Mov Disord. 2023-5

[5]
Two-year clinical progression in focal and diffuse subtypes of Parkinson's disease.

NPJ Parkinsons Dis. 2023-2-17

[6]
Efficacy of non-pharmacological interventions for depression in individuals with Parkinson's disease: A systematic review and network meta-analysis.

Front Aging Neurosci. 2022-11-10

[7]
Effectiveness of Acupuncture for Anxiety Among Patients With Parkinson Disease: A Randomized Clinical Trial.

JAMA Netw Open. 2022-9-1

[8]
Neurofilament light as a biomarker for motor decline in Parkinson's disease.

Front Neurosci. 2022-9-1

[9]
Inhibition of Neuroinflammation May Mediate the Disease-Modifying Effects of Exercise: Implications for Parkinson's Disease.

J Parkinsons Dis. 2022

[10]
The Disease Modification Conundrum in Parkinson's Disease: Failures and Hopes.

Front Aging Neurosci. 2022-2-28

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