帕金森病早期失眠的临床进展

Clinical Advances in Early Insomnia Associated with Parkinson’s Disease

摘要: 帕金森病(PD)是一种以运动障碍为主要特征的慢性神经退行性疾病，其早期常伴有失眠这一非运动症状，显著影响患者生活质量并可能加速认知衰退。本文综述了帕金森病早期失眠的临床医学进展，包括其流行病学特点、临床表现与评估方法、发生机制及治疗进展。研究显示，帕金森病早期失眠的发病机制复杂，涉及神经递质失衡、运动症状直接干扰及药物相关睡眠障碍等多方面因素。临床评估包括主观评估和客观评估，如多导睡眠图和体动记录仪等。治疗方面，传统药物治疗存在依赖性和副作用，而新型药物如褪黑素受体激动剂及非药物治疗(如认知行为治疗、运动康复和光照治疗)显示出较好的应用前景。通过成功与失败的案例分析，强调了综合治疗及个体化治疗方案的重要性。未来研究需进一步明确发病机制，开发更有效的治疗方法，并建立标准化的评估体系，以提升帕金森病早期失眠的治疗效果和患者生活质量。

Abstract: Parkinson’s disease (PD) is a chronic neurodegenerative disorder primarily characterized by motor dysfunction. Insomnia, a non-motor symptom, often accompanies PD in its early stages, significantly affecting patients’ quality of life and potentially accelerating cognitive decline. This review summarizes the clinical progress in early insomnia associated with Parkinson’s disease, covering its epidemiological characteristics, clinical manifestations and assessment methods, pathogenesis, and therapeutic advancements. The pathogenesis of early insomnia in PD is complex, involving multiple factors such as neurotransmitter imbalances, direct motor symptom interference, and drug-induced sleep disorder. Clinical assessment includes both subjective and objective methods, such as polysomnography and actigraphy. In terms of treatment, traditional pharmacological therapies are associated with dependency and side effects, while novel drugs like melatonin receptor agonists and non-pharmacological treatments (including cognitive-behavioral therapy, exercise rehabilitation, and light therapy) show promising prospects. Case analyses of both successful and unsuccessful treatments highlight the importance of comprehensive and individualized therapeutic approaches. Future research needs to further clarify the pathogenesis, develop more effective treatment methods, and establish standardized assessment systems to improve the therapeutic outcomes and quality of life for patients with early insomnia in Parkinson’s disease.