Department of Neurology, McGill University, Montreal General Hospital, Montreal, Quebec, Canada.
Mov Disord. 2012 Apr 15;27(5):617-26. doi: 10.1002/mds.24996.
Increasing recognition that Parkinson's disease (PD) may start outside of the substantia nigra has led to a rapidly expanding effort to define prodromal stages of PD, before motor signs permit classical diagnosis. Many of these efforts center around the identification of clinical non-motor symptoms and signs of disease. There is now direct evidence that olfaction, rapid eye movement (REM) sleep behavior disorder (RBD), constipation, and depression can be present in prodromal PD. In addition, there is suggestive evidence that visual changes, other autonomic symptoms, and subtle cognitive changes may also be present at prodromal stages. A critical issue in utility of these prodromal markers will be assessment of sensitivity, specificity, and positive and negative predictive values. Although these have yet to be fully defined, olfactory deficits, some visual changes, and autonomic symptoms occur in the majority of PD patients at diagnosis, suggesting good potential sensitivity. However, with the exception of RBD and perhaps some specific autonomic measures, specificity, and positive predictive value of these markers may be insufficient to be used alone as identifiers of prodromal disease. The evidence for the utility of olfaction, RBD, autonomic markers, visual changes, mood disorders, and cognitive loss as markers of prodromal PD and the potential sensitivity and specificity of these markers are summarized.
越来越多的人认识到帕金森病（PD）可能始于黑质之外，这导致了人们迅速努力定义 PD 的前驱阶段，即在运动迹象允许进行经典诊断之前。这些努力中的许多都集中在识别临床非运动症状和疾病迹象上。现在有直接证据表明，嗅觉、快速眼动（REM）睡眠行为障碍（RBD）、便秘和抑郁可能存在于前驱期 PD 中。此外，有提示性证据表明，视觉变化、其他自主症状和细微的认知变化也可能存在于前驱阶段。这些前驱性标志物的实用性的一个关键问题将是评估其敏感性、特异性以及阳性和阴性预测值。尽管这些尚未得到充分定义，但嗅觉缺陷、一些视觉变化和自主症状在大多数 PD 患者的诊断中都存在，这表明其具有很好的潜在敏感性。然而，除了 RBD 之外，也许还有一些特定的自主测量指标，这些标志物的特异性和阳性预测值可能不足以单独作为前驱疾病的标识。本文总结了嗅觉、RBD、自主标志物、视觉变化、情绪障碍和认知丧失作为前驱 PD 标志物的效用证据，以及这些标志物的潜在敏感性和特异性。
