McKinnon Jonathan H, Demaerschalk Bart M, Caviness John N, Wellik Kay E, Adler Charles H, Wingerchuk Dean M
Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA.
Neurologist. 2007 Nov;13(6):382-5. doi: 10.1097/NRL.0b013e31815a351a.
: Akinetic-rigid syndromes are a heterogeneous group of diseases with overlapping clinical manifestations. A recent American Academy of Neurology practice parameter indicated that olfactory testing was "probably useful" for differentiating idiopathic Parkinson disease (IPD) from other diseases with features of parkinsonism.
: To determine the diagnostic accuracy of olfactory testing for differentiating IPD from other parkinsonian disorders.
: The objective was addressed using a structured, evidence-based, critically appraised topic format. This format includes development of a clinical scenario, focused and answerable clinical question, search strategy, evidence appraisal, reporting and interpretation of results, commentary, and bottom line conclusions. Participants included neurology consultants and residents, clinical epidemiologists, a medical librarian, and neurologists with expertise in movement disorders.
: Two studies evaluated the diagnostic accuracy of olfactory testing within a broad spectrum of parkinsonian syndromes. Each study examined different test methods [University of Pennsylvania Smell Identification Test; "Sniffin' Sticks"] and both were compromised by several potential biases in sampling and outcome evaluation. The University of Pennsylvania Smell Identification Test is moderately sensitive (77%; likelihood ratio 0.27) and specific (85%; likelihood ratio 4.9) for differentiation of IPD from non-IPD syndromes, but less specific (62%; likelihood ratio 2.0) for distinguishing IPD from multiple system atrophy.
: The diagnostic accuracy of olfactory testing for differentiating IPD from other disorders is insufficient to justify its routine clinical use but available evidence is derived from small samples and studies of questionable validity. Recommendations for future research of olfactory testing for diagnosis and disease predication are discussed.
运动不能-强直综合征是一组临床表现重叠的异质性疾病。美国神经病学学会最近的一项实践参数表明，嗅觉测试对于区分特发性帕金森病（IPD）与其他具有帕金森综合征特征的疾病“可能有用”。
确定嗅觉测试在区分IPD与其他帕金森病性障碍方面的诊断准确性。
采用结构化、基于证据、严格评估的主题形式来解决该目标。这种形式包括临床情景的制定、聚焦且可回答的临床问题、检索策略、证据评估、结果报告与解读、评论以及最终结论。参与者包括神经科会诊医生和住院医师、临床流行病学家、医学图书馆员以及在运动障碍方面具有专业知识的神经科医生。
两项研究评估了嗅觉测试在广泛帕金森综合征范围内的诊断准确性。每项研究都检查了不同的测试方法[宾夕法尼亚大学嗅觉识别测试；“嗅觉棒”]，并且两者都受到抽样和结果评估中几个潜在偏倚的影响。宾夕法尼亚大学嗅觉识别测试在区分IPD与非IPD综合征方面具有中等敏感性（77%；似然比0.27）和特异性（85%；似然比4.9），但在区分IPD与多系统萎缩方面特异性较低（62%；似然比2.0）。
嗅觉测试在区分IPD与其他疾病方面的诊断准确性不足以证明其在临床常规使用的合理性，但现有证据来自小样本且有效性存疑的研究。讨论了嗅觉测试用于诊断和疾病预测未来研究的建议。
