诊断
目前，帕金森病尚无特定诊断检查。由接受过神经系统疾病培训的医生（称为神经科医生）进行诊断。帕金森病的诊断基于您的病史、症状回顾以及神经系统和体格检查进行。
医护团队可能会建议进行一种特异性单光子发射计算机断层成像术（SPECT）扫描，称作多巴胺转运蛋白（DAT）扫描。虽然该检查可能协助支持对帕金森病的怀疑，但最终仍需根据症状和神经系统检查结果得出准确诊断。大部分患者无需接受 DAT 扫描。
医护团队可能会安排实验室检查（例如血液检查）来排除可能引起您症状的其他状况。
也有可能借助影像学检查（例如 MRI、脑部超声检查以及 PET 扫描）来排除其他疾病。影像学检查对诊断帕金森病帮助不大。
除了此类检查，医疗护理团队成员还可能给您开具治疗帕金森病的药物卡比多巴-左旋多巴复方制剂（Rytary、Sinemet 等）。您必须服用足够剂量才能受益，因为低剂量服用一两天无法得到可靠疗效。这种药物带来的明显改善往往可以确认对帕金森病的诊断。
诊断帕金森病有时需要花费一段时间。医疗护理专业人员可能会建议您定期前往接受过运动障碍诊疗培训的神经科医生处复诊，评估您的状况和症状在一段时间内的变化，并诊断帕金森病。
不过，可能即将推出一项新的检测。研究人员正在研究一项可以在症状开始前就发现帕金森病的检查。该检测称为 α-突触核蛋白种子扩增测定。在 2023 年的一项研究中，研究人员检测了 1000 多人的脊髓液，寻找 α-突触核蛋白团块。α-突触核蛋白出现在路易体内。它会形成身体无法分解的团块。团块扩散并损伤脑细胞。
α-突触核蛋白团块是帕金森病的标志性体征。该检测准确识别出帕金森病患者的概率为 87.7%。该检测也能非常灵敏地检测出存在帕金森病风险的人群。
这次 α-突触核蛋白种子扩增测定是迄今为止规模最大的一项研究。部分科研人员表示，这项研究可能给帕金森病的诊断、研究和治疗试验带来颠覆性的改变。但还需要进行更大规模的研究。研究人员希望将来可以使用血样而不是脊髓液进行检测。
治疗
帕金森病尚无法治愈，但用药有助于控制症状，并且通常效果显著。在一些更严重的情况下，医生可能会建议施行手术。
医疗护理团队还可能建议您改变生活方式，尤其是坚持有氧运动。在某些情况下，注重平衡和伸展的物理疗法很重要。言语语言病理科医生可以帮助您改善说话问题。
Medicines
Medicines may help improve problems with walking, movement and tremor. The medicines work by increasing or substituting for dopamine in the brain.
People with Parkinson's disease have low levels of brain dopamine. But dopamine can't be given directly because it can't enter the brain.
Your symptoms may improve significantly after you start treatment. The benefits may lessen over time, but usually medicines still control symptoms well.
Medicines you may be prescribed include:
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Carbidopa-levodopa (Rytary, Sinemet, others). Levodopa is the most effective Parkinson's disease medicine. It is a natural chemical that passes into the brain and becomes dopamine. Levodopa is combined with carbidopa to help levodopa reach the brain and to prevent or lessens side effects such as nausea.
Side effects may include nausea and lightheadedness when you stand, called orthostatic hypotension. Higher doses of levodopa may cause involuntary movements, known as dyskinesia. If this happens, your dose may need to be lessened or adjusted.
The benefit from levodopa may lessen over time. It also may wax and wane. This is called wearing off.
Carbidopa-levodopa usually is best taken on an empty stomach if you have advanced Parkinson's disease. Follow your healthcare team's advice on the best time to take it.
- Inhaled levodopa (Inbrija). This medicine helps manage symptoms when oral medicines suddenly stop working during the day.
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Carbidopa-levodopa infusion (Duopa). This medicine is given through a feeding tube in a gel form and goes directly into the small intestine.
The tube is placed during a minor surgery. There are some risks of having the tube. The tube may fall out or cause an infection at the infusion site.
Carbidopa-levodopa infusion is for patients with advanced Parkinson's who still respond to the medicine but need a more constant level of levodopa. It helps control motor difficulties and other symptoms such as anxiety and depression.
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Dopamine agonists. Unlike levodopa, dopamine agonists don't change into dopamine. Instead, they mimic dopamine effects in the brain.
They aren't as effective as levodopa in treating symptoms. But they last longer and may be used with levodopa to improve how well it works.
Dopamine agonists include:
- Pramipexole (Mirapex ER).
- Rotigotine (Neupro), given as a patch.
- Apomorphine (Apokyn), a short-acting dopamine agonist shot for quick relief.
Side effects of dopamine agonists may include lightheadedness, nausea, hallucinations and sleepiness. The medicine also may cause involuntary movements and compulsive behaviors, such as hypersexuality, gambling, and eating.
If you're taking these medicines and behaving in ways that aren't typical for you, talk with your healthcare team.
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Monoamine oxidase B (MAO B) inhibitors. These medicines include:
- Selegiline (Zelapar).
- Rasagiline (Azilect).
- Safinamide (Xadago).
MAO B inhibitors help block an enzyme called monoamine oxidase B (MAO B) that breaks down brain dopamine. When selegiline is given with levodopa, it may keep levodopa from wearing off.
Side effects of MAO B inhibitors may include headaches, nausea, insomnia and confusion.
MAO B inhibitors also may cause hallucinations. When added to carbidopa-levodopa, these medicines increase the risk of hallucinations.
MAO B inhibitors usually are not used along with most antidepressants or some pain medicines because serious but rare reactions may happen. Ask your healthcare professional before taking any other medicines with an MAO B inhibitor.
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Catechol O-methyltransferase, also called COMT, inhibitors. These help levodopa therapy last longer by blocking an enzyme that breaks down dopamine. They include:
- Entacapone (Comtan).
- Opicapone (Ongentys).
- Tolcapone (Tasmar). This medicine is rarely prescribed because of its risk of serious liver damage and liver failure.
Side effects of COMT inhibitors may include increased risk of involuntary movements. Side effects also may include diarrhea, nausea or vomiting.
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Anticholinergics. These medicines were used for many years. They aren't used as often now because of their modest benefits and risk of side effects. They may be helpful in controlling severe tremor for some people with Parkinson's disease. They include:
- Benztropine.
- Trihexyphenidyl.
Side effects of anticholinergics may include memory loss, urinary problems, confusion, blurred vision, dry mouth and constipation.
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Amantadine (Gocovri). This medicine may be taken alone for short-term relief of mild, early-stage Parkinson's disease symptoms. It's mainly used with carbidopa-levodopa during advanced Parkinson's disease to help control involuntary muscle movements.
Side effects of amantadine may include mottled skin, thinking and memory problems, ankle swelling, hallucinations, and agitation.
- Adenosine receptor antagonists (A2A receptor antagonists). One of these medicines is istradefylline (Nourianz). These help prevent the wearing off of dopamine and allow more dopamine to be released. Researchers also are looking into whether these medicines may help treat other Parkinson's disease symptoms.
- Pimavanserin (Nuplazid). This medicine treats hallucinations and delusions that can occur with Parkinson's disease.
外科手术
脑深部刺激
脑深部刺激
进行脑深部刺激时要在大脑深处植入电极。电极传递的刺激量由放置在胸部皮肤下类似起搏器的装置控制。一根穿过皮肤的导线将装置与电极相连接。
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脑深部刺激。在进行脑深部刺激（DBS）的过程中，外科医生会将电极植入大脑的特定部位。电极与植入胸部锁骨附近的脉冲发生器连接。发生器向脑部发送电脉冲，可减轻帕金森病的症状。
医疗护理团队可能会根据需要调整设置，以治疗您的状况。手术存在风险，包括感染、卒中或脑出血。有些人在使用 DBS 系统时会遇到问题，或者由于刺激而出现并发症。医疗护理团队成员可能需要调整或更换系统的某些部件。
脑深部刺激最常用于患有晚期帕金森病且左旋多巴的疗效不稳定的患者。DBS 可以稳定药物波动、减少或停止不自主运动（运动障碍）、减少震颤、缓解僵硬并改善运动表现。
DBS 可以有效控制对左旋多巴的不稳定反应，也能有效控制无法通过药物调整改善的运动障碍。
然而，除震颤外，DBS 对左旋多巴治疗无效的问题没有帮助。即使左旋多巴对震颤的治疗效果不佳，DBS 也可能对震颤有控制作用。
虽然 DBS 可能持续改善帕金森病的症状，但是并不能阻止帕金森病的发展。
Deep brain stimulation
Deep brain stimulation, also called DBS, involves putting electrodes within the brain. The electrodes are connected to a pacemaker-like device that is inserted under the skin on the chest. The electrodes are connected to a generator placed in the chest near the collarbone. The generator sends electrical pulses to the brain and may reduce Parkinson's disease symptoms.
You may need follow-up appointments to adjust the settings for best results. Some people experience problems with the DBS system or have complications due to stimulation. A member of your healthcare team may need to adjust or replace some parts of the system.
DBS can be very helpful for improving severe tremor and controlling involuntary muscle movements, called dyskinesia. It is effective for controlling changing responses to levodopa or for controlling dyskinesia that doesn't improve with medicine changes.
Deep brain stimulation is most effective for people who respond to levodopa therapy. Although DBS may have long-term benefits for helping with symptoms, it does not keep Parkinson's disease from getting worse. Researchers are looking into ways to improve how well DBS works.
Side effects of deep brain stimulation may include:
- Bleeding in the brain.
- Injury or death of tissue.
- Infection.
- Skin breakage.
- Muscle twitches.
- Depression.
- Speech or vision problems.
先进的治疗方法
MRI 引导聚焦超声波（MRgFUS）是一种微创治疗方法，已经帮助一些帕金森病患者成功管理震颤。通过 MRI 将超声引导至大脑内震颤开始的部位。超声波的温度非常高，可烧灼引起震颤的部位。
临床试验
探索 Mayo Clinic 的研究 测试新的治疗、干预与检查方法，旨在预防、检测、治疗或控制这种疾病。
生活方式与家庭疗法
您需要与医疗护理团队密切合作，找到一个能最大程度缓解症状，且副作用最小的帕金森病治疗计划。某些药物会使您的症状恶化，因此请与您的医护团队就您当前服用的任何药物进行讨论。
改变某些生活方式也可以帮助帕金森病患者更容易地生活。
健康饮食
尽管尚无证据表明食物或食物搭配有助于改善帕金森病，但有些食物可能有助于缓解某些帕金森病的症状。例如，食用高纤维食物和饮用足量液体通常有助于预防由帕金森病引起的便秘。
均衡饮食还提供可能对帕金森病患者有益的营养素，如 ω-3 脂肪酸。
运动
运动可能增加您的肌肉力量、柔韧性和平衡性。运动还可能改善您的健康状况，减少抑郁或焦虑。
医疗护理团队可能建议您与物理治疗师合作，以了解适合您的运动项目。您也可以尝试行走、游泳、园艺、跳舞、水中有氧运动或伸展运动等。
帕金森病可能扰乱平衡感，导致您难以用正常的步态行走。运动可能会改善您的平衡。以下建议也可能有帮助：
- 尽量不要走得太快。
- 行走时尽量让脚后跟先着地。
- 如果您注意到自己在拖着脚走路，请停下来检查您的姿势。最好站直。
- 行走时目视前方，而不是低头看。
避免跌倒
在疾病后期，您可能更容易跌倒。实际上，只是轻轻地推或撞一下，您就可能失去平衡。下面的建议可能有帮助：
- 走 U 形弯，而不要以脚为轴转动身体。
- 将体重均匀地分配在双脚上，不要倾斜。
- 避免行走时携带物品。
- 避免后退。
日常生活活动
日常生活（如穿衣、吃饭、浸浴和写字）对帕金森病患者来说可能很困难。职业治疗师可以向您展示减轻日常生活负担的技巧。
如果您存在言语障碍，言语治疗师或许能为您提供帮助。许多帕金森病患者都存在言语障碍，例如语速缓慢、声音虚弱、难以发出辅音、言语不清、说话低声、音调单调、毫无情绪，以及不合时宜的沉默。言语治疗师或许有助于解决这些问题。
替代医学
支持性疗法可以帮助缓解帕金森病的一些症状和并发症，例如疼痛、疲劳和抑郁。以下疗法与治疗结合使用时，可改善生活质量：
妥善处理与支持
慢性病患者的生活可能充满艰辛；有时感到气愤、抑郁或泄气都并不罕见。帕金森病会让人非常沮丧，因为行走、说话甚至吃饭都变得更加困难，并且需要消耗更长的时间。
抑郁症在帕金森病患者中较为常见。但是抗抑郁药物可能有助于缓解抑郁症状，因此如果您一直感到悲伤或绝望，请咨询医疗护理团队。
虽然朋友和家人可能是您最好的盟友，但是了解您所经历的事情的人可能特别有帮助。互助组并不一定适合所有人。但是，对于许多帕金森病患者及其家人来说，互助组可以作为获取有关帕金森病的实用信息的好资源。
此外，互助组可提供一个场所，让您找到经历过类似情况并且能够支持您的人。
尝试维持一些日常活动可能会有所帮助。目标是在帕金森病发作之前尽可能多做力所能及的事情。关注当下并尝试保持积极的态度。
要了解您所在社区的互助组，请咨询医疗护理团队、帕金森病社工或当地公共卫生护士。或者请联系帕金森病基金会或美国帕金森病协会。
您及家人也可能从与心理健康专业人员的交谈中受益，例如在与慢性疾病患者打交道方面接受过专业培训的心理医生或社工。
准备您的预约
您可能要先咨询医疗护理专业人员。然后，您可能会被转诊至在神经系统疾病诊疗领域训练有素的医生，也称为神经科医生。
由于通常有很多问题需要讨论，所以最好为就诊提前做好准备。以下信息可以帮助您做好约诊准备。
您可以做什么
- 写下您目前出现的所有症状，包括那些看起来与本次就诊无关的任何症状。
- 写下关键个人信息，包括任何主要压力或近期的生活变化。
- 列出您正在服用的所有药物、维生素和补充剂。
- 如果可能，请家人或朋友陪同就诊。有时可能难以记住就诊时提供给您的所有信息。陪同您的人可能记住您遗漏或遗忘的内容。
- 写下要在就诊时咨询的问题。
由于就诊时间有限，因此提前准备好问题清单有助于充分利用就诊时间。关于帕金森病，要向医生咨询的一些基本问题包括：
- 最有可能导致我出现症状的病因是什么？
- 还可能有其他病因吗？
- 我需要做哪些检查？这些检查需要特殊准备吗？
- 帕金森病通常会如何发展？
- 我最终是否需要长期护理？
- 有哪些治疗方法可供选择？您推荐哪种治疗？
- 治疗会有哪些类型的副作用？
- 如果治疗无效或不再有效，是否还有其他选择？
- 我还有其他健康状况。我怎样才能最好地同时管理这些状况？
- 有没有我可以带回家的手册或其他印刷材料？您推荐哪些网站？
除了您准备咨询医护团队的问题外，就诊期间您还可以随时提出其他问题。
医生可能做些什么
医疗护理团队可能会问您一些问题。准备好回答这些问题或许可以节省时间，可以更详细地讨论您关心的其他问题。可能向您询问：
- 何时开始出现症状？
- 症状是持续存在还是时有时无？
- 是否有任何因素似乎能令您的症状好转？
- 有没有什么情况似乎会加重您的症状？