课件：帕金森病非运动症状.ppt

后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用 资料仅供参考，实际情况实际分析 * KEY POINTS: Both serotonin (5-HT) and norepinephrine (NE) are neurotransmitters that have ascending tracts to the cerebral cortex and limbic area, as well as descending tracts to the spinal cord1 The cell bodies for these tracts originate in major nuclei of the midbrain. For the central nervous system, the 5-HT cell bodies are located in the raphe nuclei and the largest cluster of NE cells are located in the locus coeruleus1 Each of these midbrain nuclei has ascending tracts, which project to brain regions thought to be involved in depressive symptoms, as well as ascending and descending tracts involved in pain suppression Decreased neurotransmission of 5-HT and NE is believed to be associated with depression2 5-HT- and NE-secreting neurons project upward from their respective nuclei in the brainstem, directly stimulating many areas of the brain Brain areas stimulated include the prefrontal cortex, which is involved in executive functions, and the limbic system which include anatomical structures involved in behavior, motivation, and emotion, such as the hippocampus, anterior cingulate cortex, hypothalamus, and amygdala REFERENCES: Mega MS, Cummings JL, Salloway S, Malloy P. The limbic system: An anatomic, phylogenetic, and clinical perspective. J Neuropsychiatry Clin Neurosci 1997;9:315-330. Hales RE, Yudofsky SC. Mood disorders. In: Textbook of Clinical Psychiatry. 4th ed. Arlington: American Psychiatric Publishing; 2003:479-486. 提示可能有其他递质或激素参与 抗胆碱能制剂 单胺氧化酶—B抑制剂 金刚烷胺 DA受体激动剂 三环类抗抑郁剂 可能和伏隔核、中脑边缘环路功能失调有关。 精神症状在减量或停用后减轻至消失。 在PD早期即出现。 主要与脑干睡眠调节中枢变性、皮质-丘脑环路功能失调有关。 60% -98%患者存在夜间睡眠障碍，其中25% 程度较重。 睡眠障碍和疾病严重程度、日常生活能力、运动评分、 L-dopa剂量和运动迟缓-僵直评分显著相关。 对排除其他神经疾病的特发性RBD患者随访7年，60%的患者最终发展为PD。 RBD可出现在运动症状期前，是运动症状产生的预测因子。 影像学证实单独RBD 症状的PD 患者的双侧纹状体DA摄入明显减少。 与睡眠相关的核团，如蓝斑、黑质、脑桥被盖核的神经细胞变性坏死，影响睡眠-觉醒周期的调节。 PD药物的影响：DA受体激动剂。 ，中华医学会神经病学分会运 动障碍及帕金森病学组 最近10多年，无论是对PD发病机制的认识还是