Role of cholinesterase inhibitors in Parkinson's disease and dementia with Lewy bodies
Role of cholinesterase inhibitors in Parkinson's disease and dementia with Lewy bodies
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DOI：
10.1177/0891988704267463
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发表时间：
2004-09-01
影响因子：
2.6
通讯作者：
McKeith, IG
中科院分区：
文献类型：
--
作者：
Aarsland, D;Mosimann, UP;McKeith, IG
本文综述了帕金森病和痴呆（PDD）和路易体痴呆（DLB）的胆碱能变化，其潜在的临床意义，以及胆碱酯酶抑制剂治疗PDD和DLB的现有证据。已报告了胆碱能核的显著神经元损失、新皮质、海马和选定丘脑核中胆碱能标记物减少以及受体变化。一项大型和2项小型安慰剂对照试验以及近20项开放标签研究表明，胆碱酯酶抑制剂对DLB和PDD患者的认知、精神症状和整体功能具有积极作用。大多数患者对治疗耐受良好，锥体外系运动功能无明显恶化。鉴于在使用抗精神病药物治疗期间严重敏感反应的高风险和脑血管事件的风险增加，鼓励更多的胆碱酯酶抑制剂临床试验以确定其在DLB和PDD中的确切作用。
This article reviews the cholinergic changes in Parkinson's disease and dementia (PDD) and dementia with Lewy bodies (DLB), their potential clinical implications, and the available evidence for cholinesterase inhibitors in the treatment of PDD and DLB. Marked neuronal loss of cholinergic nuclei, reduced cholinergic markers in the neocortex, hippocampus, and selected thalamic nuclei, and receptor changes have been reported. One large and 2 small placebo-controlled trials and nearly 20 open-label studies suggest that cholinesterase inhibitors have a positive effect on cognition, psychiatric symptoms, and global function in patients with DLB and PDD. The treatment is well tolerated in most patients without any apparent worsening of extrapyramidal motor features. Given the high risk of severe sensitivity reactions and increased risk of cerebrovascular incidents during treatment with neuroleptics, more clinical trials of cholinesterase inhibitors are encouraged to establish their precise role in DLB and PDD.