Lien C T, Mutch W J
Department of Medicine for the Elderly, Dundee Healthcare NHS Trust, Royal Victoria Hospital.
Scott Med J. 1997 Oct;42(5):147-50. doi: 10.1177/003693309704200511.
Parkinson's disease is characterised by a variable combination of tremor, rigidity, bradykinesia and impaired righting reflexes. The cumulative life-time risk is one in 40. Levodopa remains the single most effective treatment in older patients, and the minimum dose to achieve maximum functional benefit should be employed. When fluctuations occur, controlled release preparations and selegiline can improve function. Oral dopamine agonists have a role but the combined side effect profile with levodopa should be monitored. COMT inhibitors have recently become available. Subcutaneous apomorphine can be helpful when "on-off" phenomena are marked. The concept of neuroprotection continues to be debated. Surgery is an option for fitter older people but neurotransplantation remains essentially a research tool.
帕金森病的特征是震颤、僵硬、运动迟缓及翻正反射受损等多种症状的不同组合。终生累计风险为1/40。左旋多巴仍是老年患者最有效的单一治疗药物，应采用能实现最大功能效益的最小剂量。出现症状波动时，控释制剂和司来吉兰可改善功能。口服多巴胺激动剂有一定作用，但应监测其与左旋多巴联合使用时的副作用。儿茶酚-O-甲基转移酶（COMT）抑制剂最近已投入使用。当“开-关”现象明显时，皮下注射阿扑吗啡可能会有帮助。神经保护的概念仍在争论中。手术是身体状况较好的老年人的一种选择，但神经移植基本上仍是一种研究工具。
