Parkinson's Disease and Diabetes Mellitus: Synergistic Effects on Pathophysiology and GI Motility.
Parkinson's Disease and Diabetes Mellitus: Synergistic Effects on Pathophysiology and GI Motility.
复制标题
帕金森病和糖尿病：对病理生理学和胃肠道运动的协同作用。
DOI：
10.1007/s11894-023-00868-7
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发表时间：
2023
影响因子：
--
通讯作者：
Sharma,Amol
中科院分区：
文献类型：
--
作者：
Yan,Yun;Shimoga,Dhanush;Sharma,Amol
综述的目的帕金森病和糖尿病影响越来越多的全球老龄化人口。这两种疾病广泛影响胃肠道（GI）运动，具有相似和不同的临床症状。尽管如此，帕金森病和糖尿病的GI症状造成了显著的发病率和生活质量的损害。他们的病理生理学是知之甚少，因此，有效的治疗方案是缺乏的。最近的发现帕金森氏病患者有口咽吞咽困难和便秘。他们也有轻度或不存在与胃排空延迟相关的上消化道症状，这在70%的患者中普遍存在。帕金森病患者胃排空延迟导致药物吸收不稳定和运动症状波动。一半的糖尿病患者有上消化道症状，这与胃排空和岛叶皮层大脑活动的变化有关。大多数糖尿病患者也有便秘。糖尿病患者患帕金森病的风险增加，抗糖尿病药物与降低患帕金森病的风险有关。高血压与晚期糖化终产物形成和α-突触核蛋白聚集加速有关。GLP-1受体激动剂也被证明在改善帕金森病合并糖尿病患者的运动症状和认知方面有效。这两种情况都具有传播神经退行性变化的协同病理生理学。糖尿病和帕金森病患者的胃肠道症状缺乏治疗选择。抗糖尿病治疗可改善帕金森病的运动症状，但其对胃肠道症状的影响尚不清楚。
Purpose of ReviewParkinson’s disease and diabetes affect an increasing proportion of the aging global population. Both conditions extensively affect gastrointestinal (GI) motility with similar and differing clinical symptoms. Nonetheless, GI symptoms in Parkinson’s disease and diabetes pose significant morbidity and impairment of quality of life. Their pathophysiology is poorly understood, and therefore, effective treatment options are lacking.Recent FindingsParkinson’s disease patients have oropharyngeal dysphagia and constipation. They also have mild or absent upper GI symptoms associated with delayed gastric emptying, which is prevalent in 70% of patients. Delayed gastric emptying in Parkinson’s disease leads to erratic medication absorption and fluctuating motor symptoms. Half of diabetics have upper GI symptoms, which correlate to gastric emptying and changes in brain activity of the insular cortex. The majority of diabetics also have constipation. Diabetics have an increased risk for developing Parkinson’s disease and anti-diabetic medications are associated with risk reduction of developing Parkinson’s disease. Hyperglycemia is associated with advanced glycated end products formation and acceleration of α-synuclein aggregation. GLP-1 receptor agonists have also demonstrated efficacy in improving motor symptoms and cognition in Parkinson’s disease patients with diabetes.SummaryParkinson’s disease and diabetes are pan-enteric disorders with significant GI symptoms and impairment of gut motility. Both conditions have synergistic pathophysiologies that propagate neurodegenerative changes. Treatment options for GI symptoms in diabetic and Parkinson’s disease patients are lacking. Anti-diabetic treatment improves motor symptoms in Parkinson’s disease, however, its effect on GI symptoms is unclear.