帕金森病认知功能障碍研究进展

<正>目前认为,帕金森病(PD)是一种较为常见、复杂多层次的神经系统功能紊乱疾病,是以早期黑质致密部多巴胺能神经元丢失为核心的神经退行性疾病~〔1〕。PD的症状具有异质性,并伴具有临床显著性的非运动症状。PD非运动症状包括嗅觉减退、认知功能障碍、精神症状、睡眠障碍、自主神经功能紊乱、疼痛、疲劳等。其中认知功能障碍是一种常见的非运动症状,从程度上可分为轻度认知功能障碍(MCI)和痴呆。PD-MCI常见     

帕金森病相关性流涎研究进展

<正>帕金森病(PD)是一种中老年人常见的能引起运动症状和非运动症状的神经退行性疾病。近年人们从侧重运动症状的研究逐步转向非运动症状的研究,非运动症状已成为PD研究的新热点。PD的非运动症状包括自主神经系统症状、精神症状、睡眠障碍、胃肠道系统症状(吞咽障碍、流涎等)及不宁腿综合征等。流涎作为PD病人常见的非运动症状,给病人的社交、生活带来了不同程度的影响。本研究将对PD相关性     

帕金森病相关性睡眠障碍的研究进展

帕金森病(Parkinson disease,PD)是一种常见的神经系统变性疾病,临床表现可分为运动症状与非运动症状两大类。其中,PD非运动症状在病程早期极易被误诊、漏诊,如有些PD相关性睡眠障碍甚至是患者先驱症状。进一步研究PD相关性睡眠障碍的发病机制有助于预防性延缓PD疾病进展。基于此,本文主要综述PD相关性睡眠障碍的临床分类、可能的发病机制及治疗方案等,为PD治疗提供新的治疗思路。     

帕金森病患者非运动症状的主要表现及其治疗的研究进展

帕金森病(PD)是以运动强直、运动迟缓、震颤和非运动症状(NMS,如睡眠障碍、抑郁、便秘、疼痛等)的神经退行性疾病。研究表明,NMS将会伴随PD整个病程,影响患者的生活质量。本文主要综述了PD患者NMS的主要表现及治疗,为PD患者NMS的临床诊治提供参考。     

抗阻力运动对老年帕金森睡眠障碍病人睡眠质量及情绪状态的影响

正PD是老年人常见的神经系统退行性疾病,其临床表现包括运动症状和非运动症状。运动症状以静止性震颤、运动迟缓为主,非运动症状包括睡眠障碍、嗅觉障碍、焦虑抑郁情绪障碍。其中,非运动症状常出现较早,睡眠障碍往往可作为PD的首发症状出现[1]。研究表明,存在睡眠障碍症状的PD病人高达60%～98%[2],睡眠质量降低会极大地影响病人的情     

帕金森病与昼夜节律异常

机体的许多生理活动包括内分泌、代谢、免疫等均受昼夜节律的调控。昼夜节律异常与多种疾病有关,如肿瘤、 肥胖、糖尿病及情感障碍等, 其中也包括神经退行性疾病。帕金森病(PD) 是第二常见的神经退行性疾病,仅次于阿 尔茨海默病,其典型临床表现包括静止性震颤、肌强直、运动迟缓和姿势步态异常,同时也伴随许多非运动症状。昼 夜节律异常是其最常见的非运动症状之一,可发生于运动症状出现之前,亦可伴随整个病程,给患者及照料者的生 活质量造成了沉重的负担。文章将对PD 昼夜节律异常表现、生物学标志物变化及现有干预措施进行简要介绍。     

帕金森病执行功能障碍的研究进展

正帕金森病(Parkinsons disease,PD)是一种常见的神经系统变性疾病,以黑质致密部的多巴胺能神经元变性为特征,临床表现为运动迟缓、静止性震颤、肌强直、姿势步态障碍等。另外,PD常常伴随有非运动症状,包括认知功能障碍、嗅觉减退甚至丧失、情感及精神障碍、睡眠及自主神经受累等。PD认知功能障碍包括PD轻度认知功能障碍(mild     

帕金森病非运动症状的临床研究

目的 探讨PD患者非运动症状的临床表现及其发生率.方法 随机收集未经治疗的PD患者48例,在口服美多巴治疗前及治疗后6个月分别进行PD统一评定量表运动部分、非运动症状筛查量表、抑郁量表、认知功能量表、匹兹堡睡眠质量指数、便秘问卷测定.结果 主要的非运动症状发生率便秘94%、睡眠障碍63%、抑郁33%、认知功能障碍25%.治疗前各量表评分:PD评定量表(运动检查)33.93±19.82,非运动症状筛查量表异常率100%,抑郁量表5.18±4.45,蒙特利尔认知评估量表26.54±3.85,匹兹堡睡眠质量指数6.83±5.10,便秘45例;治疗6个月后各量表评分:PD评定量表(运动检查)11.14±9.43,非运动症状筛查量表异常率仍为100%,抑郁量表5.18±4.31,蒙特利尔认知评估量表26.65±3.64,匹兹堡睡眠质量指数6.97±4.81,便秘45例.在运动症状出现之前即有便秘8例、睡眠障碍6例,认知功能障碍均发生在Hoehn-Yahr分期Ⅲ期以上患者.结论 PD非运动症状表现多样,部分症状发生率较高,也可是其主要症状,也可先于运动症状出现.认知功能障碍发生于PD晚期.抗帕金森病治疗只能改善PD患者运动症状,不能改善非运动症状.     

帕金森病非运动症状评估量表的研究进展

［摘要］　帕金森病(PD)是最常见的神经系统退行性疾病之一,其发病率呈上升趋势。PD的临床表现包括四大运动症状以及非运动症状。PD的非运动症状可伴随或早于运动症状出现,并严重影响患者的生活质量。因此,对PD非运动症状的有效评估有助于患者非运动症状的早期识别及严重程度评估,对改善患者生活质量具有重要意义。量表是PD非运动症状的主要评估手段,该文就目前临床常用的非运动症状评估量表作一综述。     

脑深部电刺激治疗帕金森病的研究进展

<正>帕金森病(PD)是一种与年龄有关的神经系统退行性疾病，其症状主要包括运动症状(如：动作迟缓、震颤、强直和不平衡)和非运动症状(如：认知障碍、精神障碍、睡眠障碍及疼痛和感觉障碍),严重影响患者的生活质量。流行病学调查显示我国65岁以上人群患病率为1.7%^[1]。随着我国人口老龄化，PD患者的数量预计到2030年将达到500万人，几乎占到全球PD患病人数的一半^[2]。     

帕金森病非运动症状的临床分析

目的通过对帕金森病患者非运动症状发生率进行分析,探讨非运动症状的临床特征。方法采用"帕金森病非运动症状筛查量表"对146例帕金森病患者的非运动症状发生率进行排序,并结合临床类型、Hoehn-Yahr分期等因素对非运动症状进行分析。结果帕金森病非运动症状的总发生率为98.6%,其中便秘的发生率最高为82.9%,其次为睡眠障碍(66.4%)、小便障碍(63.7%)、记忆困难(57.5%)、性生活障碍(50.7%)等。非运动症状发生率随Hoehn-Yahr分期的增加而增加,差异有统计学意义(P0.01)。结论自主神经功能障碍是帕金森病最常见的非运动症状。Hoehn-Yahr分期与非运动症状发生率明显相关。     

2011年第1期英文目录

睡眠行为异常（RBD）的特征是快速眼动（REM）睡眠期骨骼肌弛缓现象消失,并出现突出的运动行为,导致睡眠中断和自身或床伴的伤害。RBD与神经系统变性病有密切关联。RBD的症状常在神经系统变性病的其他症状数年之前出现,被认为可能是神经系统变性病发展过程中的某个阶段。对原发性RBD的纵向研究能充分了解其自然病程,将能增加对神经系统变性病的机制、诊断及治疗的认识。     

帕金森病痴呆危险因素的研究进展

原发性帕金森病（Parkinson's disease,PD）是一种好发于中老年人的常见中枢神经系统变性疾病。痴呆是PD患者的一种常见非运动症状,表现为痴呆的患者被称为帕金森病痴呆（PD dementia,PDD）。PDD严重影响了PD患者的社会功能及生活质量,对PD患者的预后造成不良影响。目前的研究发现,PDD危险因素包括人口学特征、生活习惯、运动症状、非运动症状、生物学标志物、基因、影像学类标志等各种因素,本文旨在对这些因素的相关研究结果进行综述。     

Les symptômes non-moteurs de la maladie de Parkinson de la physiopathologie au diagnostic précoce

Parkinson's disease is the second most common neurodegenerative disease after Alzheimer's disease. The pathophysiology of Parkinson's disease is complex and imperfectly known. Primum movens is abnormal intra-neuronal accumulation of the protein α-synuclein, leading to metabolic disturbances and neurodegeneration. This abnormal accumulation of α-synuclein is also found in dementia with Lewy bodies and multiple system atrophy, which together with Parkinson's disease form the group of α-synucleinopathies. Well known by its motor signs (bradykinesia, rest tremor, cogwheel rigidity and gait disturbance), Parkinson's disease is above all a systemic disease composed of a myriad of non-motor symptoms (constipation, sense of smell disorders, rapid eye movement sleep behaviour disorders, genitourinary disorders…). These non-motor symptoms caused by accumulation and migration of α-synuclein deposits from the gut and the olfactory bulb to the central nervous system may precede motor signs by ten years and therefore be of interest for early diagnosis. Furthermore, non-motor symptoms have a poorer impact on quality of life than motor signs themselves. Therefore, understanding, recognition and management of non-motor symptoms are crucial in management of parkinsonian patient. In this paper, we offer an update on the main non-motor symptoms of Parkinson's disease, from their pathophysiology to their screening, ending with their management.     

Neurodegenerative disease and obesity: what is the role of weight loss and bariatric interventions?

Neurodegenerative diseases are amongst the leading causes of worldwide disability, morbidity and decreased quality of life. They are increasingly associated with the concomitant worldwide epidemic of obesity. Although the prevalence of both AD and PD continue to rise, the available treatment strategies to combat these conditions remain ineffective against an increase in global neurodegenerative risk factors. There is now epidemiological and mechanistic evidence associating obesity and its related disorders of impaired glucose homeostasis, type 2 diabetes mellitus and metabolic syndrome with both AD and PD. Here we describe the clinical and molecular relationship between obesity and neurodegenerative disease. Secondly we outline the protective role of weight loss, metabolic and caloric modifying interventions in the context of AD and PD. We conclude that the application of caloric restriction through dietary changes, bariatric (metabolic) surgery and gut hormone therapy may offer novel therapeutic strategies against neurodegenerative disorders. Investigating the protective mechanisms of weight loss, metabolic and caloric modifying interventions can increase our understanding of these major public health diseases and their management.     

Gender differences in motor and non-motor symptoms in early Parkinson disease

Gender differences in motor and non-motor symptoms in Parkinson disease (PD) are still controversial. This study aimed to investigate gender differences in clinical characteristics in patients with early PD.This study included 415 PD patients (201 men and 214 women) with modified Hoehn-Yahr stage 1 to 3 and a disease duration of ≤5 years. Demographic information was obtained by interviews, and motor and non-motor PD symptoms were evaluated with appropriate scales.Women with PD had a shorter duration of formal education than men with PD. No significant differences were found in other demographic variables. Women with PD had significantly lower scores in Unified Parkinson Disease Rating Scale part III and postural tremor compared to men with PD, which was significant after controlling for formal education. No significant gender-related differences were found in scores related to other motor symptoms. Concerning non-motor symptoms, men with PD had higher scores of sexual function on the Non-Motor Symptoms Scale, which means sexual dysfunction was more severe or occurred more frequently in men with PD. Women with PD had significantly higher scores of sleep disturbance in the Pittsburgh Sleep Quality Index, which was not significant after adjustment for multiple comparison.The present study suggests that women with PD had milder motor symptoms compared to men with PD, and gender differences in sexual function can be observed as non-motor symptoms.     

Cardiovascular consequences of sleep-related breathing disorders

Sleep-related breathing disorders (SRBDs) represent a spectrum of abnormalities that range from simple snoring to upper airway resistance syndrome to sleep apnea. The clinical presentation may include obesity, snoring, neuropsychological dysfunction, and daytime hypersomnolence and tiredness. The acute hemodynamic alterations of obstructive sleep apnea include systemic and pulmonary hypertension, increased right and left ventricular afterload, and increased cardiac output. Earlier reports attributed the coexistence of SRBDs with cardiovascular diseases to the shared risk factors such as age, sex, and obesity. However, recent epidemiologic data confirm an independent association between SRBDs and the different manifestations of cardiovascular diseases. Possible mechanisms may include a combination of intermittent hypoxia and hypercapnia, repeated arousals, sustained increase in sympathetic tone, reduced baroreflex sensitivity, increased platelet aggregation, and elevated plasma fibrinogen and homocysteine levels. The strength of the association, its pathogenesis, and the impact of treatment of SRBDs on the health outcome of patients with cardiovascular diseases are issues to be addressed in future studies.     

Neuronal histaminergic system in aging and age-related neurodegenerative disorders

The neuronal histaminergic system is involved in many physiological functions and is severely affected in age-related neurodegenerative diseases such as Parkinson's disease (PD) and Alzheimer's disease (AD). The properties of the neuronal histaminergic system in experimental animals and the alterations observed in postmortem brain material of PD or AD patients are reviewed. The production of neuronal histamine shows diurnal fluctuations in control subjects who had no neuropsychiatric disorders, while this fluctuation was strongly altered in patients with neurodegenerative diseases, including PD and AD. In addition, different alterations shown as expression levels of histidine decarboxylase (the key enzyme for histamine production), histamine-methyltransferase (the histamine deactivating enzyme), and histamine receptors (H_1–4R) were found in various neurodegenerative disorders. Discrepancies between results from animal models and postmortem human brain material studies have made clear that the validation of animal models is absolutely necessary and that studies on patients and human postmortem material are essential to understand the changes of neuronal histaminergic system occurring in neuropsychiatric disorders.     

帕金森病冻结步态的研究进展

冻结步态（FOG）是帕金森病（PD）最常见的步态异常，多出现在疾病中晚期，可导致PD患者跌倒，造成伤害。FOG的病因尚不清楚，临床显示FOG与PD患者的焦虑、抑郁、认知障碍等非运动症状有关。目前药物治疗效果欠佳，康复治疗有一定的效果。早期识别并干预FOG，可以降低致残率和改善预后。本文将从FOG的发病机制、评估方法、与非运动症状的关系以及治疗方面的研究进展进行综述。