背景:非运动症状(NMS)是帕金森病(PD)患者生活质量的重要且普遍存在的决定因素。然而,他们治疗的有力证据基础仍然是一个未满足的主要需求。
目的:提供关于药理学进展的最新综述,非药理学,以及PD中NMS的基于运动的干预措施,涵盖自MDS工作队建议发布以来的时期。
方法:我们进行了文献检索以确定药理学,非药理学,以及对PD中NMS的基于运动的干预措施。由于最近有关于该主题的评论,我们只纳入了2017年1月1日至2021年12月1日的研究,并将我们的搜索限于随机和非随机(包括开放标签)临床试验。
结果:我们讨论了基于2017年以来可用数据管理NMS的新策略,例如使用屈昔多巴治疗直立性低血压。失眠的几种多巴胺能治疗选择,以及一系列针对认知和神经精神症状的非药物和基于运动的干预措施,疼痛,失眠和过度嗜睡。
结论:最近的证据表明,有针对性的非药物治疗,以及其他一些NMS管理方案可能对生活质量有显著的有益影响,需要在PD的治疗途径中加以考虑.
BACKGROUND: Non-motor symptoms (NMS) are an important and ubiquitous determinant of quality of life in Parkinson\'s disease (PD). However, robust evidence for their treatment is still a major unmet need.
OBJECTIVE: This study aimed to provide an updated review on advances in pharmacological, nonpharmacological, and exercise-based interventions for NMS in PD, covering the period since the publication of the MDS Task Force Recommendations.
METHODS: We performed a literature search to identify pharmacological, non-pharmacological, and exercise-based interventions for NMS in PD. As there are recent reviews on the subject, we have only included studies from the 1st of January 2017 to the 1st of December 2021 and limited our search to randomised and non-randomised (including open-label) clinical trials.
RESULTS: We discuss new strategies to manage NMS based on data that have become available since 2017, for instance, on the treatment of orthostatic hypotension with droxidopa, several dopaminergic treatment options for insomnia, and a range of non-pharmacological and exercise-based interventions for cognitive and neuropsychiatric symptoms, pain, and insomnia and excessive sleepiness.
CONCLUSIONS: Recent evidence suggests that targeted non-pharmacological treatments, as well as some other NMS management options, may have a significant beneficial effect on the quality of life and need to be considered in the pathways of treatment of PD.