超高齢期のパーキンソン病

Parkinson's Disease in the Oldest-Old

高齢化に伴い，高齢期患者を中心にパーキンソン病（PD）患者が激増している。超高齢者PDは早期から高度の運動症状を呈し，臨床像が典型例と異なり，診断は必ずしも容易ではなく，L-ドパ治療効果も不十分なことが多い。現在使用される多くのPD治療薬のエビデンスは超高齢者を除外したエントリー基準で実施された臨床試験に基づいており，今後は超高齢者PDへの治療エビデンスの構築が必要である。

Abstract

The prevalence of Parkinson's disease (PD) has increased globally, especially in older age groups. Older age at onset is associated with more severe motor and nonmotor symptoms at diagnosis and more rapid and severe progression. Because majority of older people have multiple comorbidities, patients with PD may be misdiagnosed. Limited response to L-dopa medication in the older patients has been indicated. The risk of motor complications decreases with increasing age, while the risk of axial complications, hallucinations, and dementia increases. Evidence for many of the currently used PD medications is based on clinical trials with the criteria that exclude older patients, and it will be necessary to establish evidence of medication for PD in older patients.