Parkinson病

抄録

Parkinson's disease (PD) is a progressive disorder of the nervous system that affects motor, neuropsychiatric, sleep, autonomic, and sensory functions. Motor symptoms of PD may include tremor, bradykinesia, muscle rigidity, postural instability, and speech and swallowing disturbances. Neuropsychiatric symptoms include depression, apathy, anxiety, cognitive impairment, hallucinations, and delusions. Sleep problems include insomnia, REM sleep behavioral disorder, excessive daytime sleepiness and sudden onset of sleep. Main autonomic symptoms include constipation, urinary dysfunction, orthostatic hypotension, sexual dysfunction, drenching sweat. Anosmia and sensory symptoms also are frequent complications of PD. Diagnosis of PD is determined by detecting these symptoms. The essential criterion is parkinsonism, which is defined as bradykinesia, in combination with at least 1 of rest tremor or rigidity. In addition, diagnosis of clinically established PD requires absence of absolute exclusion criteria, at least two supportive criteria, and no red flags. Exclusion criteria includes cerebellar abnormalities, downward vertical supranuclear gaze palsy, frontotemporal dementia, parkinsonism restricted to the lower limbs, treatment with dopamine receptor blocker, etc. Drugs, deep brain stimulation (DBS), and rehabilitation are measures to manage PD. Levodopa and dopamine agonists are the cardinal drugs to treat motor symptoms. Levodopa tended to induce motor complications such as wearing off and dyskinesia if used in the larger amount of more than 400 mg/day to PD patients with younger onset. Dopamine agonists induce motor complication less frequently than levodopa, but may include hallucinations, daytime sleepiness and impulse control disorders such as hypersexuality, gambling, and eating. Apomorphine is used for quick relief. DBS is a surgical procedure to treat motor symptoms of PD. Nowadays, increasing evidences support that physical activity improve motor and non-motor symptoms of PD. Global Parkinson's disease survey steering committee concluded in 2002 that “satisfaction with the explanation of the condition at diagnosis” and “current feelings of optimism” have a significant impact on health-related quality of life of PD patients.