Parkinson病の運動症状と精神症状

抄録

Parkinson's disease has conventionally been considered as a movement disorder resulting from selective loss of dopaminergic neurons in the midbrain. In the past two decades, however, it is becoming recognized that non–motor symptoms such as constipation, orthostatic hypotension, and psychiatric symptoms develop concomitantly with or even precede the onset of motor symptoms. Braak hypothesis, which suggested that the initial manifestations of Parkinson's disease pathology develop in the medulla oblongata, and subsequently extend to the midbrain and further to the cerebral cortex, prompted neurologists to pay more attention to the non–motor symptoms and the extra–nigral lesions, i.e., involvement of the non–dopaminergic systems.

In this review, I start the discussion with the motor symptoms of Parkinson's disease, as current diagnosis of Parkinson's disease is still based on their presence. The second part of the review is focused on the neuropsychiatric symptoms of Parkinson's disease, which are, among the other non–motor symptoms, the most important factors determining hospitalization or nursing home placement.