Болезнь Паркинсона. Фокус на ранние стадии

В обзоре представлены современные данные об особенностях развития нейродегенеративного процесса на ранних стадиях болезни Паркинсона (БП), рассмотрена гипотеза о наличии body-first и brain-first подтипов дебюта заболевания. К наиболее ранним проявлениям болезни относятся такие симптомы, как парасомнии, запоры, гипосмия, тревожно-депрессивное расстройство, дневная сонливость, изменение цветовосприятия, когнитивная дисфункция, легкие моторные проявления. Диагноз БП может быть поставлен при возникновении характерных двигательных проявлений: гипокинезии, тремора покоя, мышечной ригидности. В качестве подтверждающих методик используются ультразвуковое исследование черной субстанции, магнитно-резонансная томография в режиме SWI, а также методы функциональной нейровизуализации. Подход к лечению ранних стадий БП носит возраст-зависимый характер. Пациентам старше 70 лет рекомендуют начинать терапию с препаратов леводопы, более молодым пациентам – сагонистов дофаминовых рецепторов (АДР), амантадинов, ингибиторов МАО-В. Разбираются механизмы действия АДР, возможности их влияния на моторные и немоторные симптомы БП. Особое место уделено пирибедилу, у которого за счет двойного механизма действия отмечают положительный эффект в отношении когнитивных функций, депрессии, апатии, а также минимальный эффект в отношении дневной сонливости.

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