Monoamine Oxidase-B Inhibitor Rasagiline Effects on Motor and Non-Motor Symptoms in Individuals with Parkinson’s Disease: A Systematic Review and Meta-Analysis

Objective: In the manuscript titled Monoamine Oxidase-B Inhibitor Rasagiline Effects on Motor and Non-Motor Symptoms in Individuals with Parkinsons Disease: A Systematic Review and Meta-Analysis, the objective was to conduct a systematic review with meta-analysis to investigate the effects that Rasagiline has on motor and non-motor symptoms in individuals with PD. Introduction: Rasagiline is a second-generation monoamine oxidase-B (MAO-B) inhibitor used both as monotherapy and adjunctive therapy for Parkinsons Disease (PD). Methods: A systematic literature search and meta-analysis were performed with randomized control trials that investigated the effects of Rasagiline on motor and non-motor symptoms in individuals with PD. The systematic search was conducted in PubMed, Cochrane, and EBSCO databases. Methodological quality was assessed using the Cochrane Grading Recommendations Assessment, Development and Evaluation approach. Results: Fourteen studies were included in our review. There were trivial to small and statistically significant improvements in motor symptoms for individuals with PD treated with Rasagiline compared to placebo. Non-motor symptoms showed no significant improvement with Rasagiline compared to placebo in five of six meta-analyses. Results were based on very low to moderate certainty of evidence. Conclusion: 1 mg/day Rasagiline significantly improved Parkinsonian motor symptoms in individuals with PD compared with placebo. For all outcomes, the 1 mg/day Rasagiline group was favored over the placebo group.

Liquid Subcutaneous Levodopa-Carbidopa ND0612 Effects on Motor Symptoms in Individuals with Parkinson’s Disease: A Systematic Review and Meta-Analysis

Objective: In the manuscript titled “Liquid subcutaneous Levodopa-Carbidopa ND0612 effects on motor symptoms in individuals with Parkinson’s Disease: A systematic review and meta-analysis”, the objective was to conduct a systematic review with meta-analysis to investigate the effects ND0612 24-hour dosing regimen has on motor symptoms in individuals with Parkinson’s Disease (PD). Introduction: ND0612 is a novel minimally invasive continuous subcutaneous delivery system of liquid Levodopa-Carbidopa being investigated for the treatment of PD in individuals experiencing motor symptoms. Methods: A systematic literature search was conducted in PubMed, Cochrane, and EBSCO databases to identify randomized controlled trials investigating the effects of ND0612 on motor symptoms in individuals with PD. Outcomes included the Unified Parkinson’s Disease Rating Scale (UPDRS) Part II and Part III scores. Methodological quality was assessed using the Cochrane Grading of Recommendations Assessment, Development, and Evaluation approach. Meta-analysis was performed using a random effects model with the DerSimonian and Laird method to estimate the effects of the ND0612 24-hour dosing regimen on UPDRS Part II and Part III scores. Results: Three studies were included in our review. There were statistically significant reductions in UPDRS Part II scores (mean difference (MD) −3.299;95% confidence interval (CI) −3.438, −3.159) and in UPDRS Part III scores (MD −12.695;95% CI −24.428, −0.962) in the ND0612 24-hour dosing regimen. Results were based on very low certainty of evidence. Conclusion: Based on very low certainty evidence, the ND0612 24-hour dosing regimen is effective at improving motor symptoms in individuals with PD. Our findings suggest that ND0612 is more effective at improving UPDRS Part II and Part III scores in individuals with PD than other pharmacological and non-pharmacological treatments, warranting further study.

Non-Motor Symptoms in Parkinson’s Disease Patients—An Observational Study

Background: Parkinson’s disease (PD) remains a challenge for neurologists, particularly in its advanced stages when non-motor symptoms become a burden for the patient. While motor symptoms may be satisfactorily controlled with levodopa therapy or continuous levodopa/carbidopa intestinal gel (LCIG) administration, autonomic, sleep and mental disorders are hard to treat. During the last years, researchers have shifted their interest more to non-motor symptoms, PD being now considered a complex multiorgan impairment. Objective: The aim of this study was to describe non-motor symptoms in 40 Romanian patients diagnosed with PD, under conventional and LCIG administration treatment. Methods: A cross-sectional observational study was conducted, consisting of two groups of 20 patients each: the first group comprised PD patients who received conventional Levodopa treatment, while the second group was formed of patients receiving LCIG therapy. Various data concerning patient’s age, gender, duration of illness, comorbidities, motor and non-motor symptoms were recorded. The data were processed in SPSS v.20. Results: Subjects under continuous LCIG administration, although showing amelioration of motor symptoms, complained more frequently of constipation, mental, and sleeping disorders (statistically significant). Regarding anosmia, orthostatic hypotension, hypersalivation, urinary incontinence and restless legs syndrome, no statistical significant difference was observed between the two groups (p > 0.05). Conclusion: Nowadays, more research is conducted on non-motor symptoms in PD patients, as therapeutic measures try to limit these burdens, in order to improve patient’s quality of life.

Progression of motor symptoms in Parkinson’s disease

Parkinson＇s disease （PD） is a chronic progressive neurodegenerative disease that is clinically manifested by a triad of cardinal motor symptoms - rigidity, bradykinesia and tremor - due to loss of dopaminergic neurons. The motor symptoms of PD become progressively worse as the disease advances. PD is also a heterogeneous disease since rigidity and bradykinesia are the major complaints in some patients whereas tremor is predominant in others. In recent years, many studies have investigated the progression of the hallmark symptoms over time, and the cardinal motor symptoms have dif- ferent rates of progression, with the disease usually progressing faster in patients with rigidity and bradykinesia than in those with predominant tremor. The current treatment regime of dopamine-replacement therapy improves motor symptoms and alleviates disability. Increasing the dosage of dopaminergic medication is commonly used to combat the worsening symptoms. However, the drug-induced involuntary body movements and motor complications can significantly contribute to overall disability. Further, none of the currently-available therapies can slow or halt the disease progression. Significant research efforts have been directed towards developing neuroprotective or disease-modifying agents that are intended to slow the progression. In this article, the most recent clinical studies investigating disease progression and current progress on the development of disease-modifying drug trials are reviewed.

Glutamatergic Neurons in the Caudal Zona Incerta Regulate Parkinsonian Motor Symptoms in Mice

Parkinson’s disease(PD)is the second most common and fastest-growing neurodegenerative disorder.In recent years,it has been recognized that neurotransmitters other than dopamine and neuronal systems outside the basal ganglia are also related to PD pathogenesis.However,little is known about whether and how the caudal zona incerta(ZIc)regulates parkinsonian motor symptoms.Here,we showed that specific glutamatergic but not GABAergic ZIc^(VgluT2) neurons regulated these symptoms.ZIc^(VgluT2) neuronal activation induced time-locked parkinsonian motor symptoms.In mouse models of PD,the ZIc^(VgluT2) neurons were hyperactive and inhibition of their activity ameliorated the motor deficits.ZIc^(VgluT2) neurons monosynaptically projected to the substantia nigra pars reticulata.Incerta-nigral circuit activation induced parkinsonian motor symptoms.Together,our findings provide a direct link between the ZIc,its glutamatergic neurons,and parkinsonian motor symptoms for the first time,help to better understand the mechanisms of PD,and supply a new important potential therapeutic target for PD.

Mechanisms of motor symptom improvement by long-term Tai Chi training in Parkinson’s disease patients

Background:Tai Chi has been shown to improve motor symptoms in Parkinson’s disease(PD),but its long-term effects and the related mechanisms remain to be elucidated.In this study,we investigated the effects of long-term Tai Chi training on motor symptoms in PD and the underlying mechanisms.Methods:Ninety-five early-stage PD patients were enrolled and randomly divided into Tai Chi(n=32),brisk walk-ing(n=31)and no-exercise(n=32)groups.At baseline,6 months and 12 months during one-year intervention,all participants underwent motor symptom evaluation by Berg balance scale(BBS),Unified PD rating-scale(UPDRS),Timed Up and Go test(TUG)and 3D gait analysis,functional magnetic resonance imaging(fMRI),plasma cytokine and metabolomics analysis,and blood Huntingtin interaction protein 2(HIP2)mRNA level analysis.Longitudinal self-changes were calculated using repeated measures ANOVA.GEE(generalized estimating equations)was used to assess factors associated with the longitudinal data of rating scales.Switch rates were used for fMRI analysis.False discovery rate correction was used for multiple correction.Results:Participants in the Tai Chi group had better performance in BBS,UPDRS,TUG and step width.Besides,Tai Chi was advantageous over brisk walking in improving BBS and step width.The improved BBS was correlated with enhanced visual network function and downregulation of interleukin-1β.The improvements in UPDRS were asso-ciated with enhanced default mode network function,decreased L-malic acid and 3-phosphoglyceric acid,and increased adenosine and HIP2 mRNA levels.In addition,arginine biosynthesis,urea cycle,tricarboxylic acid cycle and beta oxidation of very-long-chain fatty acids were also improved by Tai Chi training.Conclusions:Long-term Tai Chi training improves motor function,especially gait and balance,in PD.The underlying mechanisms may include enhanced brain network function,reduced inflammation,improved amino acid metabolism,energy metabolism and neurotransmitter metabolism,and decreased vulnerability to dopaminergic degeneration.Trial registration This study has been registered at Chinese Clinical Trial Registry(Registration number:ChiCTR2000036036;Registration date:August 22,2020).

Study of an integrated non-motor symptoms questionnaire for Parkinson＇s disease

Background Although the validity of non-motor symptoms screening questionnaire （NMSQuest） for Parkinson＇s disease has been verified in several recent researches, the specificity of the questionnaire is still in doubt. This study aimed to compare the non-motor symptoms （NMS） in Parkinson＇s disease （PD） with a medically ill control group. Methods In this study, the first comprehensive clinic-based NMS screening questionnaire for PD developed by the Parkinson＇s Disease Non-Motor Group （PDNMG） was used. Data from 90 PD patients and 270 sex-and age-matched control subjects, including stroke （n=90）, heart disease （n=-90） and diabetes （n=-90） were analyzed. Results Compared with control group, NMS was more common in PD; on an average, most PD patients reported more than 12 non-motor items. There was a correlation of total NMS score in PD patients with Hoehn ＆ Yahr Staging, but not with age, sex distribution, disease duration, or age at disease onset. Additionally, depression, constipation and impaired olfaction which occurred prior to the motor symptoms of PD were reported in this study. Conclusions NMS are more common in PD patients. There are some NMS that occurred at the preclinical stage of PD and might predict the onset of motor symptoms of PD patients.

Effects of a Cocktail Supplement of Ginkgo Biloba and Acai Extract on Cognitive Symptoms of Parkinson’s Disease

Parkinson’s Disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms, including cognitive impairment. Current treatments often involve synthetic drugs with significant side effects and potential for dependency. This study investigates the effects of a natural supplement combination of Ginkgo Biloba and Acai Extract on cognitive symptoms in a 77-year-old male with PD. The participant underwent a three-month supplementation regimen, with cognitive function assessed using the Montreal Cognitive Assessment (MoCA) test before and after the intervention. The results indicated an improvement in cognitive scores, suggesting that the combination of Ginkgo Biloba and Acai Extract may offer a promising alternative or adjunct to conventional PD treatments. This study highlights the potential of natural supplements in managing PD symptoms and calls for further research with larger sample sizes to confirm these findings. Human data was performed in accordance with the Declaration of Helsinki by the Roxbury District IRB Board (IRB Number: IRB00011767).

Neuronal injury in the motor cortex after chronic stroke and lower limb motor impairment: a voxelbased lesion symptom mapping study

Many studies have examined motor impairments using voxel-based lesion symptom mapping, but few are reported regarding the corresponding relationship between cerebral cortex injury and lower limb motor impairment analyzed using this technique. This study correlated neuro- nal injury in the cerebral cortex of 16 patients with chronic stroke based on a voxel-based lesion symptom mapping analysis. Neuronal injury in the corona radiata, caudate nucleus and putamen of patients with chronic stroke could predict walking speed. The behavioral measure scores were consistent with motor deficits expected after damage to the cortical motor system due to stroke. These findings suggest that voxel-based lesion symptom mapping may provide a more accurate prognosis of motor recovery from chronic stroke according to neuronal injury in cerebral motor cortex.

Non-motor signs and symptoms in Parkinson’s disease

Motor symptoms are cardinal clinical features of Parkinson’s disease (PD). Progress in drug therapy and rehabilitation has been presenting beneficial effect for motor symptoms. However, non-motor symptoms and signs in PD have been accumulated growing attentions and its amelioration may also give beneficial effect for PD patients’ and their care givers’ quality of life. In this mini-review, I overviewed non-motor symptoms and signs in PD.

脑源性神经营养因子介导帕金森病的运动防治:作用与机制

背景:运动干预作为经济有效的非物理疗法,可有效上调脑源性神经营养因子表达进而防治帕金森病发生发展,但目前关于靶向脑源性神经营养因子的运动治疗策略在延缓帕金森病发生发展的潜在作用机制尚不明晰。目的:以脑源性神经营养因子和帕金森病的关系为切入点,分析帕金森病病理状态下运动对脑源性神经营养因子表达的特异性调控作用及机制,梳理脑源性神经营养因子介导下不同运动方式对帕金森病的改善效果,并阐明靶向脑源性神经营养因子的运动治疗策略在防治帕金森病的潜在作用机制,旨在为运动防治帕金森病提供新的理论依据。方法:以“帕金森病,脑源性神经营养因子,神经保护,多巴胺,神经元异常凋亡,神经炎症反应,突触可塑性,运动”等为中文检索词;以“Parkinson’s disease,BDNF,Neuroprotection,neuroinflammation,synaptic plasticity”等为英文检索词,分别检索中国知网、万方数据库、PubMed和Web of Science数据库,搜寻各数据库建库至2024年2月发表的所有研究文献,根据纳排标准共获得核心相关文献98篇。结果与结论:①在帕金森病理背景下,运动可通过促进肌因子鸢尾素大量分泌,并降低色氨酸-犬尿氨酸代谢途径紊乱特异性调控脑源性神经营养因子表达。②有氧运动,尤其是特殊有氧运动(动物:旋转杆步行/人类:北欧健走)以及多模式运动可显著上调脑源性神经营养因子表达,进而改善帕金森病的运动症状,此外脑源性神经营养因子还介导身心运动(太极拳)对帕金森病患者认知障碍和睡眠障碍等非运动症状的有效调节。③运动诱导的高表达脑源性神经营养因子可能通过上调抗炎因子白细胞介素10、神经生长因子β和转化生长因子β表达,下调促炎因子肿瘤坏死因子α及白细胞介素1β表达,并抑制核转录因子κB信号通路表达降低小胶质细胞活性减轻神经炎症反应;增加酪氨酸羟化酶活性以促进多巴胺合成释放,并通过下调基质金属蛋白酶3及糖原合成酶激酶3β表达抑制α-突触核蛋白在丝氨酸129位点的磷酸化修饰,以防止神经异常凋亡;诱导突触效能的长时程增强发生,促进突触后致密区蛋白95及突触素大量表达以改善突触可塑性,发挥神经保护作。④鉴于脑源性神经营养因子在帕金森病发病进程及治疗中发挥重要作用,靶向脑源性神经营养因子的运动治疗策略将有助于推动帕金森病疾病“运动+药物”精准医疗的发展。但由于目前研究采用的运动处方较为单一,且研究焦点主要围绕运动症状而缺乏对非运动症状的考察,因此亟待学者采用更加统一和系统的运动处方,围绕非有氧运动类型对同一批帕金森病患者进行长期纵向跟踪研究,以此完善帕金森病运动防治领域研究的不足。

重复经颅磁刺激联合恩他卡朋双多巴治疗帕金森病运动及非运动症状的疗效:一项随机对照试验

背景帕金森病(PD)是常见的运动障碍性疾病之一,多见于中老年人,随着人口老龄化的不断加剧,发病率越来越高,给患者家庭乃至社会均带来沉重的负担。目的探讨重复经颅磁刺激联合恩他卡朋双多巴对帕金森病患者运动及非运动症状的疗效。方法本研究为随机、双盲设计。选取2022年8月—2024年5月在南京鼓楼医院集团宿迁医院就诊的帕金森病患者共110例。采用随机数字表法分为对照组32例、恩他卡朋双多巴组40例和观察组38例。对照组患者接受多巴丝肼治疗(0.5片/次,3次/d)和假性刺激,恩他卡朋双多巴组患者接受恩他卡朋双多巴治疗(1片/次,3次/d)和假性刺激,观察组患者接受恩他卡朋双多巴(1片/次,3次/d)联合重复经颅磁刺激治疗(40个序列/d,1次/d,5次/周),共治疗4周。分别在治疗前及治疗后采用帕金森病评定量表第三部分(UPDRSⅢ)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、帕金森病睡眠量表(PDSS)、简易精神状态量表(MMSE)、自主神经症状量表(SCOPA-AUT)、日常生活能力量表(ADL)评估患者的运动及非运动症状的改善情况。结果对照组患者治疗后UPDRSⅢ评分低于组内治疗前,ADL评分高于组内治疗前(P<0.05);恩他卡朋双多巴组、观察组患者治疗后UPDRSⅢ、HAMD、HAMA、SCOPA-AUT评分低于组内治疗前,MMSE、PDSS、ADL评分高于组内治疗前(P<0.05)。恩他卡朋双多巴组与观察组患者治疗后UPDRSⅢ、HAMD、HAMA、SCOPA-AUT评分低于对照组,PDSS、MMSE、ADL评分高于对照组(P<0.05)。观察组患者治疗后UPDRSⅢ、HAMD、HAMA、SCOPA-AUT评分低于恩他卡朋双多巴组,PDSS、MMSE、ADL评分高于恩他卡朋双多巴组(P<0.05)。治疗后三组患者不良反应总发生率比较,差异无统计学意义(P>0.05)。结论帕金森病患者予以重复经颅磁刺激联合恩他卡朋双多巴治疗,可以明显改善其运动及非运动症状,且其疗效优于单一药物治疗。

帕金森病神经突触损伤及中药干预研究进展

帕金森病(PD)是一种常见的神经退行性疾病,临床表现主要分为运动症状和非运动症状。运动症状是PD的终末核心特征之一,与黑质致密部多巴胺能神经元丢失直接相关。而PD运动症状出现之前往往会表现出嗅觉障碍、视觉障碍、睡眠障碍、抑郁、认知障碍等非运动症状,严重影响患者的生活质量。这些症状的产生与大脑特定部位神经突触损伤及功能变化有关,围绕PD突触损伤进行早期诊断和干预是防止PD进行性加重的重要环节。传统中医药在治疗神经退行性疾病方面具有丰富的理论知识和临床经验,中药是常用手段,且其对突触保护凸显出独特的作用。本文综述了神经突触损伤在PD相关症状发生发展过程中扮演的角色,突触损伤的机制和中药对突触损伤的干预作用及潜在机制,以期为神经退行性疾病的有效防治提供新的思路。

平肝熄风汤辅助治疗对帕金森伴抑郁患者非运动症状、睡眠质量和抑郁症状的影响

目的探讨平肝熄风汤辅助治疗对帕金森伴抑郁患者非运动症状、睡眠质量和抑郁症状的影响。方法选取2021年1月至2022年1月在本院确诊的98例帕金森伴抑郁患者,采用随机数字表法将其分为平肝熄风组和对照组,每组49例。对照组患者采用多巴丝肼、普拉克索片和曲唑酮治疗,平肝熄风组在对照组的基础上采用平肝熄风汤辅助治疗。两组均持续治疗24周。分别于治疗前后,比较两组的非运动症状、睡眠质量和抑郁症状。结果治疗后平肝熄风组NMSS评分中除认知方面评分,其他方面评分均低于对照组(P<0.05)。平肝熄风组治疗后第10、12、24周PSQI和HAMD评分均低于对照组(P<0.05)。平肝熄风组不良反应发生率为12.24%,对照组为24.49%,组间差异无统计学意义(P>0.05)。结论平肝熄风汤辅助治疗对帕金森伴抑郁患者非运动症状、睡眠质量和抑郁症状都有较好的改善效果。

普拉克索联合多巴丝肼治疗帕金森病患者的效果

目的:观察普拉克索联合多巴丝肼治疗帕金森病患者的效果。方法:选取2021年3月至2023年3月该院收治的86例帕金森病患者进行前瞻性研究,按随机数字表法将其分为研究组和对照组各43例,对照组予以多巴丝肼治疗,研究组在对照组基础上联合普拉克索治疗,比较两组临床疗效,治疗前后Hoehn-Yahr分级、非运动症状控制[非运动症状评价量表(NMSS)]评分、血清miR-124和miR-137水平、认知功能[蒙特利尔认知量表(MOCA)]评分和生命质量[帕金森患者生活质量问卷(PDQ-39)]评分,以及不良反应发生率。结果:研究组治疗总有效率为95.35%(41/43),高于对照组的81.40%(35/43),差异有统计学意义(P<0.05);治疗后,研究组Hoehn-Yahr分级优于对照组,差异有统计学意义(P<0.05);研究组病情严重程度、发生频率等NMSS评分均低于对照组,差异有统计学意义(P<0.05);研究组血清miR-124水平高于对照组,血清miR-137水平低于对照组,差异均有统计学意义(P<0.05);研究组MOCA评分高于对照组,PDQ-39评分低于对照组,差异均有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:普拉克索联合多巴丝肼治疗帕金森病患者可提高治疗总有效率、血清miR-124水平和MOCA评分,降低血清miR-137水平、NMSS评分和PDQ-39评分,改善Hoehn-Yahr分级,效果优于单纯多巴丝肼治疗。

广西地区幽门螺杆菌感染与帕金森病患者运动症状严重程度相关性研究

分析广西地区幽门螺杆菌感染与帕金森病患者运动症状严重程度的相关性。将广西科技大学第一附属医院2022年1月—2023年12月收治的70例帕金森病患者纳入试验组,将广西科技大学第一附属医院同期的70例健康人员纳入参照组。对组间人员基本资料进行收集,实施碳-14尿素呼气试验,进行UPDRS PartⅢ评分,研究幽门螺杆菌感染与帕金森病患者血清维生素B12、帕金森病评定量表评分之间的相关性。结果显示,试验组的碳-14尿素呼气试验中幽门螺杆菌阳性率高于参照组(P<0.05);试验组和参照组的血清维生素B12水平比较,无统计学差异(P>0.05);试验组中幽门螺杆菌阳性组和阴性组的血清维生素B12水平比较,无统计学差异(P>0.05);幽门螺杆菌阳性组的UPDRS PartⅢ评分高于阴性组,组间数据差异具有统计学意义(P<0.05)。研究发现,感染幽门螺杆菌易加重帕金森病患者的运动症状,两者之间关系密切,值得探讨。

加味三味汤治疗帕金森病非运动症状临床疗效

目的:探讨加味三味汤治疗帕金森病患者的非运动症状方面的临床疗效,以期获得更好的治疗效果及临床经验。方法:选取符合标准的50例帕金森病患者,随机分为对照组与实验组,每组各25例,对照组予以多巴丝肼片治疗;实验组在此基础上加用加味三味汤治疗,治疗一疗程后,比较两组患者的新版世界运动障碍学会帕金森病综合量表(MDS-UPDRS)中的日常生活非运动症状与运动症状量表中的震颤、动作迟缓、认知功能、焦虑、抑郁、饮水呛咳、夜尿、失眠、嗜睡、便秘、疲惫感、口角流涎十二项指标的综合评估。结果:在治疗前,两组患者所选取指标的综合评分没有统计学意义(P>0.05);治疗后,实验组患者的综合评分相较于对照组评分减少,有统计学意义(P<0.05)。并且两组患者的评分下降率也有统计学意义(P<0.01)。结论:加味三味汤可改善帕金森病患者的非运动症状,延缓病情进展。

帕金森病伴睡眠障碍的研究进展

帕金森病(PD)是一种与运动和非运动症状相关的大脑退行性疾病,与环境、遗传、神经系统老化等多种因素有关。近年的调查研究显示,中国PD平均患病年龄60岁,在65岁以上人群中,每10万人约1700名患者。睡眠障碍是PD的非运动症状之一,临床表现包括失眠、白天过度嗜睡、不宁腿综合征、快速眼动期睡眠行为障碍以及睡眠呼吸障碍等多种类型。由于存在个体差异,PD伴睡眠障碍疾病治疗过程中应在医生指导下选择最适合患者个体的药物。本文对PD睡眠障碍发病机制和常用药物治疗方案进行综述,希望能够为今后PD伴睡眠障碍的治疗提供新的思路。

从肝论治帕金森病非运动症状

基于肝的生理特点,从风、火、痰、瘀、虚五种病机证素对帕金森病非运动症状进行探讨。由于患者素体阴精不足,或阴血亏虚,阴虚不能制阳,阳亢化风;或肝郁克脾,脾运失司,痰湿内生;或肝气郁滞,阻碍血行;或痰瘀留滞经络而致病。阴精、肝血不足,筋脉失养为虚;痰浊、血瘀阻滞经络为实。治则以平肝滋阴、疏肝清热、理气化痰、活血养血为主,中药和针刺并用。肝风内扰,以平肝为主,兼以滋阴,选方镇肝熄风汤;肝火伤阴,以清热为主,兼以养阴,选方丹栀逍遥散;气滞痰阻,以理气为主,兼以化痰,选方柴胡加龙骨牡蛎汤;气滞血瘀,以理气为主,兼以活血,选方血府逐瘀汤;肝血亏虚,以补血为主,兼以柔肝,选方补肝汤。针刺辨病与辨证相结合,进行加减配穴。

帕金森病患者血清尿酸、同型半胱氨酸和胱抑素C水平与运动症状及认知功能的相关性

目的探讨帕金森病(Parkinson’s disease,PD)患者血清尿酸(uric acid,UA)、同型半胱氨酸(homocysteine,HCY)、胱抑素C(cystatin C,CysC)水平与PD患者的运动症状及认知功能的关系。方法选取2019年1月至2022年8月河北省人民医院收治PD患者200例。按照首发运动症状分为震颤(tremor-dominant,TD)组(n=104)和非震颤(non-tremor-dominant,NTD)组(n=96),依据蒙特利尔认知评估量表分为PD认知功能正常(cognitive normal in Parkinson’s disease,PD-CN)组(n=118)和PD认知功能障碍(cognitive impairment in Parkinson’s disease,PD-CI)组(n=82)。分别比较各组血清UA、HCY、CysC水平,采用多因素logistic回归分析PD患者TD和认知功能障碍的危险因素。结果与NTD组相比,TD组血清UA水平较高,Hcy、Cys C水平较低,差异均有统计学意义(P<0.05);多因素logistic回归分析结果显示,UA、HCY和Cys C是PD患者TD的独立危险因素。与PD-CI组相比,PD-CN组血清UA水平较高,HCY、Cys C水平较低,差异均有统计学意义(P<0.05);多因素logistic回归分析结果显示:UA、HCY和Cys C是PD患者认知功能障碍的独立危险因素(P<0.05)。结论PD患者血清UA、HCY、Cys C与运动症状和认知功能相关。