Department of Neurology, University of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany,
J Neurol. 2013 Dec;260(12):3077-85. doi: 10.1007/s00415-013-7125-6. Epub 2013 Oct 2.
The detection of Parkinson's disease (PD) at stages earlier than current diagnostic criteria allow for may increase the efficacy of disease-modifying therapies. Here we studied the relationship between retrospectively reported prodromal non-motor and motor features of PD, their pre-diagnostic presentation to physicians, and the extrapolated potential of an earlier diagnosis of PD considering early diagnostic markers detected at presence. One hundred and fifteen PD patients (41 women; age 63.2 ± 8.6 years) underwent a structured face-to-face interview on 22 prediagnostic symptoms. Present olfactory function, motor symptoms, and substantia nigra hyperechogenicity (SN-h) were assessed using standardized tools. Most frequently self-perceived symptoms in the early and very early prediagnostic phase (>2, >7 years prior to diagnosis) were hyposmia (23, 10 %), musculoskeletal pain (21, 9 %), and depression/anxiety (14, 11 %). In the late prediagnostic phase (≤ 2 years) mild motor signs, especially asymmetric bradykinesia and rest tremor, increasingly dominated the self-perception. In the prediagnostic phase, 99 % of patients consulted a physician because of motor symptoms but only 36 % with non-motor symptoms, mostly pain (20 %), depression/anxiety (9 %), constipation, bladder urgency, insomnia, REM sleep behaviour disorder, sexual dysfunction, and malignant melanoma (each, <6 %). Assuming the potential detectability of present hyposmia, asymmetric motor slowing and SN-h, a triad highly specific for PD, as early as 5 years prior to diagnosis, up to 84 (73 %) patients could have been identified in the prediagnostic phase using their or their physicians' awareness of early symptoms. We conclude that educating the general population and physicians on the importance of distinct prodromal features and applying symptom-specific diagnostic programs can improve the early detection of PD.
帕金森病（PD）在目前的诊断标准之前的阶段的检测可能会增加疾病修饰疗法的疗效。在这里，我们研究了回顾性报告的 PD 前驱期非运动和运动特征与其向医生呈现的关系，以及考虑到存在的早期诊断标志物而提前诊断 PD 的潜在可能性。115 名 PD 患者（41 名女性；年龄 63.2 ± 8.6 岁）接受了 22 项前驱症状的结构化面对面访谈。使用标准化工具评估当前的嗅觉功能、运动症状和黑质高回声（SN-h）。在早期和极早期前驱期（>2 年、>7 年前诊断）自我感知最常见的症状是嗅觉减退（23，10%）、肌肉骨骼疼痛（21，9%）和抑郁/焦虑（14，11%）。在晚期前驱期（≤2 年），轻度运动迹象，特别是不对称性运动迟缓，越来越主导了自我感知。在前驱期，99%的患者因运动症状而咨询医生，但只有 36%的患者因非运动症状，主要是疼痛（20%）、抑郁/焦虑（9%）、便秘、尿急、失眠、快速眼动睡眠行为障碍、性功能障碍和恶性黑色素瘤（各占<6%）。假设当前嗅觉减退、不对称性运动迟缓和 SN-h 的潜在可检测性，作为 PD 的高度特异性三联征，早在诊断前 5 年，就可以通过患者或其医生对早期症状的认识，在前驱期识别出多达 84 名（73%）患者。我们得出结论，通过向普通人群和医生宣传特定前驱期特征的重要性，并应用症状特异性诊断程序，可以提高 PD 的早期发现。
