德国神经病学会关于帕金森病患者认知障碍和情感障碍的诊断和治疗指南：诊断程序和非药物干预的新重点。
German Society of Neurology guidelines for the diagnosis and treatment of cognitive impairment and affective disorders in people with Parkinson's disease: new spotlights on diagnostic procedures and non-pharmacological interventions.
机构信息
Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Department of Neurology, School of Medicine and Health Science, Carl Von Ossietzky University of Oldenburg, Oldenburg, Germany.
出版信息
J Neurol. 2024 Nov;271(11):7330-7357. doi: 10.1007/s00415-024-12503-0. Epub 2024 Aug 9.
BACKGROUND AND OBJECTIVE
Cognitive impairment and dementia as well as affective disorders are common and debilitating syndromes that develop in people with Parkinson's disease (PwPD). The authors summarized recommendations for the 2023 updated German guidelines on "Parkinson's disease" from the German Neurological Society (DGN), focusing on the diagnosis and treatment of these disorders.
METHODS
The recommendations were based on literature reviews, other relevant guidelines, and expert opinions.
RESULTS
Measurements to assess cognitive and affective states were reviewed for psychometric properties, use in routine clinical practice, and availability in German. To improve mild cognitive impairment, cognitive training and physical aerobic training are recommended. To treat Parkinson's disease (PD)-related dementia, cognitive stimulation (as a non-pharmacological intervention) and acetylcholinesterase inhibitors (AChEIs, i.e., rivastigmine) are recommended. Cognitive behavioral therapy is recommended to treat depression, anxiety, and fear of progression. Physical interventions are recommended to treat depression, fatigue, and apathy. Optimized dopaminergic treatment is the first-line pharmacological strategy recommended to manage depression, apathy, anhedonia, fatigue, and mood swings. Major depression can be additionally treated using venlafaxine or desipramine, while moderate depression can be treated pharmacologically according to its clinical phenotype (psychomotor retardation or agitation) and comorbidities (e.g., sleep disturbances, pain). Venlafaxine and nortriptyline can be used to treat anhedonia, while citalopram can be used for anxiety.
CONCLUSIONS
In addition to the updated pharmacological treatment options, new insights into recommendations for standardized diagnostics and non-pharmacological interventions were provided for the German health care system. However, more studies are needed to explore the full potential of non-pharmacological interventions to treat and prevent cognitive impairment and affective disorders.
背景与目的
认知障碍和痴呆以及情感障碍是常见且使人衰弱的综合征，可在帕金森病（PD）患者中发展。作者总结了德国神经病学学会（DGN）关于“帕金森病”的 2023 年更新德国指南的建议，重点是这些疾病的诊断和治疗。
方法
这些建议基于文献综述、其他相关指南和专家意见。
结果
为了评估认知和情感状态，对评估认知和情感状态的测量方法进行了综述，包括其心理测量学特性、在常规临床实践中的应用以及在德语中的可用性。为了改善轻度认知障碍，建议进行认知训练和身体有氧训练。为了治疗帕金森病（PD）相关痴呆，建议进行认知刺激（作为一种非药物干预）和乙酰胆碱酯酶抑制剂（AChEIs，即加兰他敏）。建议采用认知行为疗法治疗抑郁、焦虑和对进展的恐惧。建议采用身体干预治疗抑郁、疲劳和淡漠。优化多巴胺能治疗是推荐的一线药物治疗策略，用于治疗抑郁、淡漠、快感缺失、疲劳和情绪波动。可以使用文拉法辛或去甲替林治疗重度抑郁症，而根据其临床表型（运动迟缓和激越）和合并症（例如睡眠障碍、疼痛），可以对中度抑郁症进行药物治疗。可以使用文拉法辛和去甲替林治疗快感缺失，而可以使用西酞普兰治疗焦虑。
结论
除了更新的药物治疗选择外，还为德国医疗保健系统提供了关于标准化诊断和非药物干预建议的新见解。然而，需要更多的研究来探索非药物干预治疗和预防认知障碍和情感障碍的全部潜力。
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