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Title 超高齢社会における高齢Parkinson病診療 〜現状と課題〜
Subtitle Editorial (論説)
Authors 高橋一司**
Authors (kana)
Organization **東京都立神経病院脳神経内科
Journal 神経治療学
Volume 39
Number 2
Page 51-57
Year/Month 2022 /
Article 報告
Publisher 日本神経治療学会
Abstract 「はじめに」Parkinson病(Parkinson disease:PD)は, Alzheimer病に次いで頻度の高い神経変性疾患であり, 運動障害をきたす変性疾患では最も多い. 有病率は100〜300/10万人とされ, 全国の患者数は概ね20万人程度と推定されている. PDの発症年齢は50〜65歳に多いが, 通常, 高齢になるほど発病率が増加するとされる. 本邦では高齢化率(65歳以上人口が総人口に占める割合)が28.4%となり(令和2年版高齢社会白書, 2019年10月1日), 未曾有の超高齢社会を迎え, 高齢PD患者の急激な増加が予測される. 「パーキンソン病診療ガイドライン2018」第III編のQ&A2-3「PDの予後に影響を与える因子は何か」では, 運動機能や日常生活障害の悪化, あるいは死亡率上昇に共通する因子として, 高齢発症, 長い罹病期間, 診断時の高度運動障害, 早期からの認知機能障害との記載がある. 高齢PD患者は, 治療が長期化し高齢になった患者と, 高齢発症の患者の両者を含む.
Practice 臨床医学：内科系
Keywords Parkinson disease, eldely patient, very late onset parkinsonism, super-aging society, clinical management

English

Title Clinical management of eldely patients with Parkinson disease in a super-aging society : current status and issues
Subtitle Editorial
Authors Kazushi TAKAHASHI
Authors (kana)
Organization Department of Neurology, Tokyo Metropolitan Neurological Hospital
Journal Neurological Therapeutics
Volume 39
Number 2
Page 51-57
Year/Month 2022 /
Article Report
Publisher Japanese Society of Neurological Therapeutics
Abstract In spite of the large number of elderly patients with Parkinson disease (PD) in Japan, there have been insufficient studies to provide useful information for their clinical management. In recent years, various researches clarifying the characteristics of elderly PD patients have been gradually accumulated, but there have been very few studies on "very" old-onset PD. The term "elderly PD" includes both patients who have been on treatment for a long time and have become elderly, and those who have developed PD at old age. Characteristics of old-onset PD patients include severe motor and non-motor symptoms from the onset, rapid symptom progression and a short life expectancy, high risk of developing axial symptoms, hallucinations and dementia, while the lower risk of developing motor complications (wearing off and dyskinesia) and impulse control disorders. Neuropathological findings include a high incidence of Alzheimer's pathology as well as Lewy bodies. In terms of clinical feature, rigid-akinetic phenotype is significantly more common. In addition, pharmacokinetic changes specific to the elderly are also important. The number of elderly PD patients is expected to increase rapidly in Japan, which is facing an unprecedented super-aging society. As a frontier for elderly PD patients, it is necessary to take the lead in establishing research results and evidence that contribute to the clinical management of elderly PD patients.
Practice Clinical internal medicine
Keywords Parkinson disease, eldely patient, very late onset parkinsonism, super-aging society, clinical management
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参考文献

  • 1) Wirdefeldt K, Adami HO, Cole P et al: Epidemiology and etiology of Parkinson's disease: A review of the evidence. Eur J Epidemiol 26(Suppl): S1-S58, 2011
    pubmed
  • 2) Poewe W, Seppi K, Tanner CM et al: Parkinson disease. Nat Rev Dis Primers 3: 1-21, 2017
  • 3) 日本神経学会監修「パーキンソン病診療ガイドライン」作成委員会編集: 第III編パーキンソン病診療に関するQ&A. パーキンソン病診療ガイドライン2018. 医学書院, 東京都, 2018, p132-281
  • 4) Driver JA, Logroscino G, Gaziano JM et al: Incidence and remaining lifetime risk of Parkinson disease in advanced age. Neurology 72: 432-438, 2009
    pubmed
  • 5) Yamawaki M, Kusumi M, Kowa H et al: Changes in prevalence and incidence of Parkinson's disease in Japan during a quarter of a century. Neuroepidemiology 32 : 263-269, 2009
    pubmed
残りの39件を表示する
  • 6) Hely MA, Morris JGL, Reid WGJ et al: Age at onset: the major determinant of outcome in Parkinson's disease. Acta Neurol Scand 92: 455-463, 1995
  • 7) Diamond SG, Markham CH, Hoehn MM et al: Effect of age at onset on progression and mortality in parkinson's disease. Neurology 39: 1187-1190, 1989
    pubmed
  • 8) Ferguson LW, Rajput AH, Rajput A: Early-onset vs. Late-onset Parkinson's disease: A Clinical-pathological Study. Can J Neurol Sci 43: 113-119, 2015
    pubmed
  • 9) Jankovic J, Carter J, Gauthier S et al: Variable expression of Parkinson's disease: a base-line analysis of the DATATOP cohort. The Parkinson Study Group. Neurology 40: 1529-1534, 1990
  • 10) Birkmayer W, Riederer P, Youdim MBH: Distinction between benign and malignant type of parkinson's disease. Clin Neurol Neurosurg 81: 158-164, 1979
  • 11) Goetz CG, Tanner CM, Stebbins GT et al: Risk factors for progression in parkinson's disease. Neurology 38: 1841-1844, 1988
    pubmed
  • 12) Marttila RJ, Rinne UK: Disability and Progression in Parkinson's Disease. Acta Neurol Scand 56: 159-169, 1977
    pubmed
  • 13) Rajput AH, Rajput EF: Octogenarian parkinsonism -Clinicopathological observations. Parkinsonism Relat Disord 37: 50-57, 2017
    pubmed
  • 14) Kim R, Shin JH, Park S et al: Longitudinal evolution of non-motor symptoms according to age at onset in early Parkinson's disease. J Neurol Sci 418: 117157, 2020
    pubmed
  • 15) Prange S, Danaila T, Laurencin C et al: Age and time course of long-term motor and nonmotor complications in Parkinson disease. Neurology 92: e148-e160, 2019
    pubmed
  • 16) Kostic V, Przedborski S, Flaster E et al: Early development of levodopa-induced dyskinesias and response fluctuations in young-onset parkinson's disease. Neurology 41: 2202-2205, 1991
  • 17) Pagano G, Ferrara N, Brooks DJ et al: Age at onset and Parkinson disease phenotype. Neurology 86: 1400-1407, 2016
    pubmed
  • 18) Zhou MZ, Gan J, Wei YR et al: The association between non-motor symptoms in Parkinson's disease and age at onset. Clin Neurol Neurosurg 115: 2103-2107, 2013
    pubmed
  • 19) Park HR, Youn J, Cho JW et al: Characteristic Motor and Nonmotor Symptoms Related to Quality of Life in Drug-Naive Patients with Late-Onset Parkinson Disease. Neurodegener Dis 18: 19-25, 2018
  • 20) Chung SJ, Yoo HS, Lee YH et al: Heterogeneous Patterns of Striatal Dopamine Loss in Patients with Young- versus Old-Onset Parkinson's Disease: Impact on Clinical Features. J Mov Disord 12: 113-119, 2019
    pubmed
  • 21) Ming CS, De Andrade LAF, Amaro E et al: Higher nigrostriatal dopamine neuron loss in early than late onset Parkinson's disease? -A [99mTc]-TRODAT-1 SPECT study. Mov Disord 22: 863-866, 2007
  • 22) Antonini A, Moresco RM, Gobbo C et al: Striatal dopaminergic denervation in early and late onset Parkinson's disease assessed by PET and the tracer [11C]FECIT: Preliminary findings in one patient with autosomal recessive parkinsonism (Park2). Neurol Sci 23 Suppl 2: S51-S52, 2002
  • 23) Palermo G, Giannoni S, Frosini D et al: Dopamine Transporter, Age, and Motor Complications in Parkinson's Disease: A Clinical and Single-Photon Emission Computed Tomography Study. Mov Disord 35: 1028-1036, 2020
    pubmed
  • 24) De La Fuente-Fernandez RD, Lim AS, Sossi V et al: Age and severity of nigrostriatal damage at onset of Parkinson's disease. Synapse 47: 152-158, 2003
  • 25) Panzacchi A, Moresco RM, Garibotto V et al: A voxel-based PET study of dopamine transporters in Parkinson's disease: Relevance of age at onset. Neurobiol Dis 31: 102-109, 2008
    pubmed
  • 26) Hamada K, Hirayama M, Watanabe H et al: Onset age and severity of motor impairment are associated with reduction of myocardial 123I-MIBG uptake in Parkinson's disease. J Neurol Neurosurg Psychiatry 74: 423-426, 2003
    pubmed
  • 27) Suzuki M, Urashima M, Oka H et al: Cardiac sympathetic denervation in bradykinesia-dominant Parkinson's disease. Neuroreport 18: 1867-1870, 2007
    pubmed
  • 28) Saiki S, Hirose G, Sakai K et al: Cardiac 123I-MIBG scintigraphy can assess the disease severity and phenotype of PD. J Neurol Sci 220: 105-111, 2004
    pubmed
  • 29) Jellinger KA: Very old onset parkinsonism: A clinical-pathological study. Parkinsonism Relat Disord 57: 39-43, 2018
    pubmed
  • 30) Fabbri M, Kauppila LA, Ferreira JJ et al: Challenges and Perspectives in the Management of Late-Stage Parkinson's Disease. J Parkinsons Dis 10(s1): S75-S83, 2020
    pubmed
  • 31) 木下芳一:【高齢者消化管疾患の今日的課題】高齢者の胃酸関連疾患の時代変化. Geriatr Med 47: 561-565, 2009
  • 32) Evans MA, Triggs EJ, Cheung M et al: Gastric Emptying Rate in the Elderly: Implications for Drug Therapy. J Am Geriatr Soc 29: 201-205, 1981
    pubmed
  • 33) 永山 寛: 高齢パーキンソン病患者のlevodopa体内動態に関する加齢の影響 one-compartment open modelによる検討. 神経治療 16: 81-86, 1999
    Medical*Online
  • 34) Imai E, Horio M, Iseki K et al: Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient. Clin Exp Nephrol 11: 156-163, 2007
    pubmed
  • 35) Baba Y, Higuchi MA, Fukuyama K et al: Effect of chronic kidney disease on excessive daytime sleepiness in Parkinson disease. Eur J Neurol 18: 1299-1303, 2011
    pubmed
  • 36) 日本神経学会 監修「パーキンソン病診療ガイドライン」作成委員会編集: 第II編Evidence Based Medicineの手法を用いた推奨. パーキンソン病診療ガイドライン2018. 医学書院, 東京都, 2018, p96-129
  • 37) Romagnolo A, Fabbri M, Merola A et al: Beyond 35 years of Parkinson's disease: a comprehensive clinical and instrumental assessment. J Neurol 965: 1989-1997, 2018
  • 38) Klietz M, Greten S, Wegner F et al: Safety and Tolerability of Pharmacotherapies for Parkinson's Disease in Geriatric Patients. Drugs Aging 36: 511-530, 2019
    pubmed
  • 39) Fagerberg P, Klingelhoefer L, Bottai M et al: Lower energy intake among advanced vs. Early parkinson's disease patients and healthy controls in a clinical lunch setting: A cross-sectional study. Nutrients 12: 2109, 2020
  • 40) Maeda T, Shimo Y, Chiu SW et al: Clinical manifestations of nonmotor symptoms in 1021 Japanese Parkinson's disease patients from 35 medical centers. Parkinsonism Relat Disord 38: 54-60, 2017
    pubmed
  • 41) Watanabe H, Saiki H, Chiu SW et al: Real-World Nonmotor Changes in Patients with Parkinson's Disease and Motor Fluctuations: J-FIRST. Mov Disord Clin Pract 7: 431-439, 2020
    pubmed
  • 42) Yoritaka A, Shimo Y, Hatano T et al: Motor/Nonmotor Symptoms and Progression in Patients with Parkinson's Disease: Prevalence and Risks in a Longitudinal Study. Parkinsons Dis 2020: 2735361, 2020
  • 43) Ito H, Takayama T, Kondo H et al: Real-world safety and effectiveness of rotigotine in patients with Parkinson's disease: analysis of a post-marketing surveillance study in Japan. Int J Neurosci 2020 Aug 26; 1-11, 2020
  • 44) Rinaldi D, Bianchini E, Sforza M et al: The tolerability, safety and efficacy of safinamide in elderly Parkinson's disease patients: a retrospective study. Aging Clin Exp Res 2020 Jul 17; Online ahead of print, 2020
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