Parkinson's disease
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- 作者：Alison Yarnall ; Neil Archibald ; David Burn
- 关键词：basal ganglia ; bradykinesia ; dementia ; dopamine ; dyskinesia ; extrapyramidal ; non-motor symptoms ; Parkinson's disease ; tremor
- 刊名：Medicine
- 出版年：2012
- 出版时间：October, 2012
- 年：2012
- 卷：40
- 期：10
- 页码：529-535
- 全文大小：393 K
文摘
Parkinson's disease (PD) is the second most common neurodegenerative condition affecting patients in the UK after Alzheimer's disease. It is broadly classified as a ¡®movement disorder¡¯ with a variety of clinical features, including bradykinesia, rigidity and tremor. Traditionally, focus has fallen on the treatment of ¡®motor¡¯ complications, such as tremor and mobility problems, although these features are only a small part of the clinical phenotype. In reality, PD is better defined as a multisystem neurodegenerative disorder causing a large number of motor and non-motor complications, and both aspects will be covered in this update. Although dopamine deficiency is the hallmark of the disease, other neurotransmitters involved in both motor and non-motor features of PD include acetylcholine, serotonin and noradrenaline. Diagnosis remains largely clinical and there are many potential pitfalls for the unwary clinician. Successful treatment relies heavily on a multidisciplinary approach with introduction of pharmacological therapy in a gradual, incremental and monitored setting. In the absence of definite disease-modifying agents, therapy remains symptomatic and complications increase as time progresses. Many of the most disabling complications are non-motor, and management of advanced PD is both complex and challenging. One of the most devastating non-motor consequences of PD is the development of Parkinson's disease dementia, which develops in up to 80 % of subjects over time. The search for disease-modifying agents to both delay the onset of PD and reduce the burden of cognitive impairment is therefore of paramount importance.