2018 年 35 巻 3 号 p. 272-276
Although Parkinson disease (PD) is generally considered a movement disorder, a majority of PD patients also suffer from non–motor symptoms (NMS) adding to the overall burden of parkinsonian motor symptoms. NMS in PD are numerous and include sleep disturbance (insomnia, excessive daytime sleepiness, sudden onset of sleep, REM sleep behaviour disorders, restless legs syndrome), mood disorders (depression, anxiety, apathy) and fatigue, neuro–psychiatric disturbance (hallucination, delirium, delusion, impulse control disorders, dopamine dysregulation syndrome, cognitive dysfunction, dementia), autonomic dysfunction (orthostatic hypotension, constipation, urinary dysfunction, sexual dysfunction, hyperhydrosis) and sensory disturbance (pain). Despite the high prevalence and associated disability of NMS in PD, many of the NMS may not have effective treatment options. One possible strategy for assisting clinicians in decision–making is the use of evidence–based medicine (EBM) treatment guideline, whose principles allow clinically meaningful conclusions to be drawn from clinical trials, and therefore the comparison of results from these different trials is simplified. The new Japanese “PD clinical guideline 2018” updates the previous PD treatment guideline 2011 and incorporates new data on efficacy, safety, and implications for clinical practice of treatments for NMS of PD published from January 2009 to February 2016. By using the current evidence in the medical literature, EBM helps to provide the best possible care to patients. There is a paucity of research concerning the diagnosis and treatment of NMS in PD. The NMS of PD are frequently missed or undeclared during routine consultations and well–performed large–scale RCTs for the treatment of the different NMS in PD are lacking. A large number of studies indicates that this is a continually changing field and that there is a need for constant updates.