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帕金森病淡漠的治疗及其对潜在病理生理学的意义

Treatment of Apathy in Parkinson's Disease and Implications for Underlying Pathophysiology.

作者信息

Maher Senan, Donlon Eoghan, Mullane Gerard, Walsh Richard, Lynch Tim, Fearon Conor

机构信息

Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland.

Academic Unit of Neurology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland.

出版信息

J Clin Med. 2024 Apr 11;13(8):2216. doi: 10.3390/jcm13082216.

Abstract

Apathy is a prevalent and highly debilitating non-motor symptom of Parkinson's disease (PD) that is often overlooked in clinical practice due to its subtle nature. This review aims to provide a comprehensive overview of the current evidence for the treatment of apathy in PD, highlighting recent advancements and emerging therapeutic avenues. In this review, we analyse a diverse array of treatment strategies for apathy in PD, including pharmacological interventions, non-pharmacological approaches, and emerging neuromodulation techniques. We evaluate the efficacy, safety, and limitations of established pharmacotherapies, such as dopaminergic agents, antidepressants, and cognitive enhancers. Additionally, we examine the promising role of non-pharmacological interventions, encompassing psychotherapies and behavioural interventions, in ameliorating apathetic symptoms. Furthermore, this review explores the effects of neuromodulation techniques on apathy, including the modulation of apathy via deep brain stimulation and emerging data on the potential influence of transcranial magnetic stimulation (TMS) on apathy in PD. Ultimately, a deeper understanding of effective treatment strategies for apathy has the potential to significantly improve the quality of life and overall well-being of individuals living with PD.

摘要

冷漠是帕金森病(PD)一种普遍且极具致残性的非运动症状,因其性质隐匿,在临床实践中常被忽视。本综述旨在全面概述当前PD中冷漠治疗的证据,突出近期进展和新兴治疗途径。在本综述中,我们分析了PD中冷漠的多种治疗策略,包括药物干预、非药物方法和新兴的神经调节技术。我们评估了既定药物疗法(如多巴胺能药物、抗抑郁药和认知增强剂)的疗效、安全性和局限性。此外,我们研究了非药物干预(包括心理治疗和行为干预)在改善冷漠症状方面的潜在作用。此外,本综述探讨了神经调节技术对冷漠的影响,包括通过深部脑刺激调节冷漠以及关于经颅磁刺激(TMS)对PD中冷漠潜在影响的最新数据。最终,深入了解冷漠的有效治疗策略有可能显著提高PD患者的生活质量和整体幸福感。

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