Parkinson病の非運動症状の治療

抄録

Nonmotor symptoms (NMS) have increasingly been recognized as an important part of Parkinson disease (PD). Although NMS are very common across all stages of PD, NMS are frequently undeclared from the patients, often under–recognized by the clinicians and remain untreated. The burden of NMS can define a patient's health–related quality of life. The management of NMS has been recognized as an important area of unmet needs in PD. There is a broad spectrum of NMS in PD, which include neuro–psychiatric disturbance (hallucination, delirium, delusion, impulse control disorders, cognitive dysfunction, dementia), autonomic dysfunction (orthostatic hypotension, constipation, urinary dysfunction, sexual dysfunction, hyperhydrosis), sleep disturbance (insomnia, excessive daytime sleepiness, sudden onset of sleep, REM sleep behavior disorders, restless legs syndrome), mood disorders (depression, anxiety, apathy), fatigue and sensory disturbance (pain, smell loss). Although the importance of a dopaminergic contribution to NMS in PD has been highlighted, the NMS of PD include a multitude of clinical systems derived from complex multi–neurotransmitter dysfunction involving not just the dopaminergic pathways but also noradrenergic, serotonergic and cholinergic pathways in the brain. In addition to the evolution of NMS as an intrinsic part of the disease, treatment used in PD can trigger, worsen, or even be the primary cause of symptoms. The symptoms and treatments of NMS in PD are often multiple and complex. The 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. By using the current evidence in the medical literature, evidence–based medicine helps to provide the best possible care to patients. Although there has been a number of placebo–controlled randomized trials of treatments of PD–related NMS and the evidence base for treating a range of NMS in PD has grown substantially in recent years, many nonmotor areas still lack an adequate evidence base of high–quality studies.