Parkinson's Clinic of Eastern Toronto and Movement Disorders Center, Toronto, Ontario, Canada.
J Neurol Sci. 2012 Dec 15;323(1-2):113-6. doi: 10.1016/j.jns.2012.08.029. Epub 2012 Sep 16.
Young onset Parkinson's disease patients, typically aged 21 to between 40 and 55, have symptomatology similar to regular onset patients. Despite this, we suspect that physicians take longer to diagnose young onset patients since Parkinson's disease is ruled out due to the younger age. The history prior to diagnosis of 14 young onset patients (within 21 to 45 years of age) was compared with an equivalent number of regular onset patients matched by gender, tremor presence, and Hoehn and Yahr stage. Indeed, a longer period of time was taken to diagnose younger patients with an average of additional 15 months (p<0.001). This trend of older patients being diagnosed sooner was present in the regular onset group analyzed in isolation, but not so for the younger group. The lack of age-dependent variation in time required for diagnosis suggests that Parkinson's disease is not considered at all in the diagnosis for an extended period, accounting for the large difference in prevalence of young onset group to the regular onset group. We also observed a significantly higher number of neurologist visits (p=0.002) and clinical investigations (p<0.001) prior to diagnosis of young-onset patients. Due to the impact of delayed diagnoses on young onset patients and clinical resources, we propose that Parkinson's disease be more actively considered in differential diagnoses of younger patients presenting associated symptoms.
早发型帕金森病患者通常年龄在 21 岁至 40 至 55 岁之间，其症状与普通发病患者相似。尽管如此，我们怀疑医生诊断早发型患者需要更长的时间，因为由于年龄较小，帕金森病被排除在外。将 14 名早发型患者（21 至 45 岁）的诊断前病史与性别、震颤存在和 Hoehn 和 Yahr 分期相匹配的相同数量的普通发病患者进行比较。实际上，诊断年轻患者所需的时间要长一些，平均多 15 个月（p<0.001）。这种老年患者更早被诊断出的趋势在单独分析的普通发病组中存在，但在年轻组中并非如此。诊断所需时间与年龄无关的趋势表明，在很长一段时间内，帕金森病根本没有被考虑用于诊断，这解释了早发型组与普通发病组之间患病率差异如此之大的原因。我们还观察到，在诊断出早发型患者之前，神经科医生就诊次数（p=0.002）和临床检查次数（p<0.001）明显增加。由于延迟诊断对早发型患者和临床资源的影响，我们建议在出现相关症状的年轻患者的鉴别诊断中更积极地考虑帕金森病。
