重新审视Rem睡眠行为障碍与帕金森病之间的关系——它们是一回事吗?

R. Beran
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摘要

本文就RBD与PD的关系及其病理生理学进行综述。大多数RBD患者在14年内发展为PD。帕金森病的病理生理学是一种在黑质纹状体通路中伴有多巴胺变性的α-突触核蛋白病。RBD的病理学尚不清楚。异常表明RBD和PD是不同的,吸烟就是明证。RBD和PD与葡糖脑苷酶基因突变(GBA基因)有关,表明具有GBA基因突变的RDB可预测PD。与对照组相比,PD和RBD在壳核、腹侧纹状体和苍白球中较低,但在黑质或丘脑底没有。VMAT2可能对PD中RBD的病理生理学没有贡献。RBD和PD的治疗方法不同。与无RBD的PD相比,有RBD的帕金森病患者有更多的抑郁。与对照组相比,只有患有RBD的PD的抑郁情绪在统计学上显著增加,而认知能力则无显著降低。与健康对照组相比,患有和不患有RBD的PD患者的配体结合减少,这表明尾状核和壳核内的VMAT2没有差异。研究表明,有RBD和无RBD的PD在胆碱能水平、去甲肾上腺素和葡萄糖代谢方面存在差异。RBD与PD是多系统的,影响多巴胺能通路以外的区域。RBD的治疗不会影响PD神经退行性变。研究人员继续寻找神经保护干预措施。PD和RBD之间存在关系,但不是绝对的。帕金森病黑质纹状体变性与RBD无关。病理生理学差异可以解释为什么RBD的治疗不会改变其自然史。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Relationship between Rem Sleep Behaviour Disorder and Parkinson’s Disease Revisited – Are They One and the Same?
This paper reviews the relationship between RBD and PD and the pathophysiology. Most RBD patients develop PD within 14 years. PD pathophysiology is α-synucleinopathy with dopamine degeneration in nigrostriatal pathways. RBD pathology is poorly understood. Anomalies suggest RBD and PD are different, evidenced by smoking. RBD and PD are associated with glucocerebrosidase gene mutations (GBA gene), suggesting RDB with GBA gene mutation predicts PD. PET imaging, assessing vesicular monoamine transporter 2 (VMAT2), indexing nigrostriatal dopamine innervation, is lower in PD and RBD, in the putamen, ventral striatum and globus pallidus but not substantia nigra or subthalamus, compared with controls. VMAT2 may not contribute to pathophysiology of RBD in PD. Treatments for RBD and PD differ. PD with RBD had more depression, compared to PD without RBD. Only PD with RBD had statistically significant increased depression, compared with controls, and non-significant lowered cognition. PD patients, with and without RBD, had decreased ligand binding, compared to healthy controls, indicating no difference in VMAT2 within the caudate and putamen. Research showed differences in cholinergic levels, noradrenaline and glucose metabolism for PD with and without RBD. RBD with PD, is multi-systematic, affecting regions beyond dopaminergic pathways. Treatment of RBD does not affects PD neurodegeneration. Researchers continue to search for neuro-protective intervention. There is a relationship between PD and RBD but it is not absolute. PD nigrostriatal degeneration is independent of RBD. Pathophysiological differences may explain why treatment of RBD does not alter its natural history.
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