帕金森病非运动症状刘卫国ppt课件.ppt

Autonomic dysfunction Sleep disturbances Mood disorders Cognitive dysfunction Psychosis in Parkinsons disease Sleep disturbances Difficulty falling asleep or fragmentation of nocturnal sleep Restless leg syndrome or periodic limb movements in sleep Rapid eye movement (REM) sleep behavior disorder Daytime sleepiness Excessive daytime sleepiness (EDS) levodopa monotherapy dopamine agonists Sudden sleep episodes (sleep attacks) dopaminergic therapy Sleep disturbances PD-ascending reticular activating system (dorsal raphe and locus coeruleus) Drugs Drowsiness--dopamine agonists, amantadine and anticholinergics EDS and sleep attacks--Levodopa and all dopamine agonists Awakening effect--selegiline (amphetamine-like effects) Feeling sleepy--not to drive Sleep disturbances Diagnoses--sleep, apnea or restless leg syndrome, urinary tract infection detrusor hyperactivity or prostatism Excluded--sleep hygiene: regular bedtime, regular meals, and appropriate bedroom environment Selegiline-morning Sedative-during the day(X) Tricyclic antidepressants-evening(X) Modification dopaminergic therapy Modafinil(莫达非尼) Treatment of Sleep disturbances Sustained anti-parkinsonian effects: Sustained subcutaneous apomorphine infusion, Subthalamic nucleus stimulation. Transdermal rotigotine(罗替戈汀 ) Atypical neuroleptics (such as quetiapine or clozapine) or sedatives Parasomnias clonazepam or additional dopaminergic therapy Treatment of Sleep disturbances Autonomic dysfunction Sleep disturbances Mood disorders Cognitive dysfunction Psychosis in Parkinsons disease Depression 40% Majority of cases----minor depression 4 to 6%----major depression (DSM-IV criteria) Serotonin is mainly involved Anxiety disorders 20 to 40% Generalized anxiety disorders Agoraphobia (广场恐怖) Panic disorder(惊恐障碍) Social phobia(社交恐怖症) Mood disorders Psychosocial support, counseling, and psychothera