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Clinical characteristics of fatigued Parkinson’s patients and the response to dopaminergic treatment

Translational Neurodegeneration 2016年第1期5卷 75-81页

作者： Rao Fu Xiao-Guang Luo Yan Ren Zhi-Yi He Hong Lv Neurology Department Outpatient of Parkinson’s DiseaseFirst Affiliated Hospital of China Medical University155#Nanjing bei streetHeping DistrictShenyang 110001P R China

Background:Fatigue,which is commonly observed in Parkinson’s disease(PD),can greatly reduce quality of life and is difficult to *** here aimed to investigate the prevalence and characteristics of fatigue among PD patients and to explore an effective strategy to treat PD ***:This was an observational cross-sectional study conducted in northeastern *** examined fatigue in 222 PD patients from northeastern China using the Parkinson Fatigue Scale-16(PFS-16).The disease severity,depression,sleep and cognitive functioning were assessed with the Hoehn&Yahr staging(H-Y stage),Unified Parkinson’s Disease Rating Scale(UPDRS),Hamilton Depression Scale(HAMD),Parkinson’s Disease Sleep Scale(PDSS)and Montreal Cognitive Assessment(MoCA)by ***:The frequency of fatigue in PD patients was 59.46%.Fatigued patients had longer disease durations and greater disease severity than nonfatigued ***,fatigued PD patients scored significantly higher for all motor symptoms,except for tremor,and had more serious depressive symptoms and sleep disturbances than nonfatigued PD patients *** sleep disturbance severity was an independent factor for ***,43.04% of fatigued patients taking dopaminergic drugs had fatigue *** severity was identified as an independent factor for dopaminergic drug non-responsive ***:PD patients with severe sleep disturbances tend to suffer from *** improved fatigue only in PD patients with mild depression or no depression,implying that dopaminergic medication is required,but not sufficient,for fatigue suppression in PD patients with moderate or severe ***,restoring serotonergic neurotransmission as a combination therapy may offer a better strategy for the treatment of fatigue in these patients.

关键词： Parkinson’s disease Fatigue Sleep disorder Depression dopaminergic drugs

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Drug therapy for Parkinson's disease: An update

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World Journal of Pharmacology 2015年第1期4卷 117-143页

作者： Omar ME Abdel-Salam Department of Toxicology and Narcotics Medical DivisionNational Research Centre

Parkinson's disease(PD) is the most common neurodegenerative movement disorder, affecting about 1% of the population above the age of 65. PD is characterized by a selective degeneration of the dopaminergic neurons of the substantia nigra pars compacta. This results in a marked loss of striatal dopamine and the development of the characteristic features of the disease, i.e., bradykinesia, rest tremor, rigidity, gait abnormalities and postural instability. Other types of neurons/neurotransmitters are also involved in PD, including cholinergic, serotonergic, glutamatergic, adenosine, and GABAergic neurotransmission which might have relevance to the motor, non-motor, neuro-psychiatric and cognitive disturbances that occur in the course of the disease. The treatment of PD relies on replacement therapy with levodopa(L-dopa), the precursor of dopamine, in combination with a peripheral decarboxylase inhibitor(carbidopa or benserazide). The effect of L-dopa, however, declines over time together with the development of motor complications especially dyskinesia in a significant proportion of patients within 5 years of therapy. Other drugs include dopaminereceptor-agonists, catechol-O-methyltransferase inhibitors, monoamine oxidase type B(MAO-B) inhibitors, anticholinergics and adjuvant therapy with the antiviral drug and the N-methyl-D-aspartate glutamate receptor antagonist amantadine. Although, these medications can result in substantial improvements in parkinsonian symptoms, especially during the early stages of the disease, they are often not successful in advanced disease. Moreover, dopaminergic cell death continues over time, emphasizing the need for neuroprotective or neuroregenerative therapies. In recent years, research has focused on non-dopaminergic approach such as the use of A2 A receptor antagonists: istradefylline and preladenant or the calcium channel antagonist isradipine. Safinamide is a selective and reversible inhibitor of MAO-B, a glutamate receptor inhibi

关键词： Parkinson disease Levodopa dopaminergic drugs Neuroprotective agents Non-dopaminergic drugs Mitochondrial enhancers

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