Lincoln County Hospital, Lincoln, LN2 5QY, UK.
J Neurol. 2013 Dec;260(12):2951-8. doi: 10.1007/s00415-013-6848-8. Epub 2013 Feb 3.
There is ample evidence from a large number of clinical and pathological studies of an early involvement of olfactory bulbs and cortex in the Lewy body pathology in idiopathic Parkinson's disease (iPD), the olfactory system being one of the first targets of degeneration in this condition. The olfactory dysfunction may be measurably present at the time of initial presentation and progresses in a proportion of patients as the disease advances. Patients with iPD have a more severe olfactory loss as compared to multisystem atrophy whereas the syndromes of corticobasal degeneration and progressive supranuclear palsy have no olfactory loss. A proportion of drug induced parkinsonism may have olfactory loss indicative of primary pathology of dopaminergic degeneration in these patients. Unlike single photon emission tomography, formal measurement of olfaction would provide a supportive role in diagnosing or excluding iPD depending on the duration of an individual patient's parkinsonian symptoms. Whilst olfaction may be only minimally impaired in early stages and may thus not help to differentiate from other syndromes, an intact olfaction in patients with parkinsonism of few years' duration would indicate a non-iPD pathology. Olfactory measurement is easy, cheap and now easily available in a number of tests, and olfactory assessment at different stages of parkinsonism should be used as a diagnostic aid for idiopathic PD and would enhance the diagnostic accuracy of iPD when used in conjunction with the UK Parkinson's disease society Brain Bank supportive criteria for diagnosis of idiopathic Parkinson's disease.
大量的临床和病理学研究充分表明，在特发性帕金森病（iPD）中，嗅球和皮质很早就涉及路易体病理学，嗅觉系统是这种疾病最早发生退行性变的靶器官之一。嗅觉功能障碍在疾病初始发作时可能已经可以测量到，并在疾病进展过程中在一部分患者中逐渐加重。与多系统萎缩相比，iPD 患者的嗅觉丧失更为严重，而皮质基底节变性和进行性核上性麻痹综合征则没有嗅觉丧失。一部分药物诱导的帕金森病可能存在嗅觉丧失，表明这些患者存在多巴胺能退行性变的原发性病理。与单光子发射计算机断层扫描不同，嗅觉的正式测量将根据个体帕金森病症状的持续时间，为诊断或排除 iPD 提供辅助作用。尽管嗅觉在早期阶段可能只有轻微受损，因此无法帮助与其他综合征区分，但几年病程的帕金森病患者嗅觉正常，则表明存在非 iPD 病理。嗅觉测量简单、廉价，现在有多种测试方法都可以进行，在帕金森病的不同阶段进行嗅觉评估应作为 iPD 的诊断辅助手段，与英国帕金森病学会脑库支持的 iPD 诊断标准一起使用时，将提高 iPD 的诊断准确性。
