Weerkamp N J, Tissingh G, Poels P J E, Zuidema S U, Munneke M, Koopmans R T C M, Bloem B R
Bronovo Hospital, Department of Neurology, The Hague, The Netherlands; Radboud University Nijmegen, Department of Neurology, Nijmegen Center for Evidence Based Practice, The Netherlands.
Bronovo Hospital, Department of Neurology, The Hague, The Netherlands.
Parkinsonism Relat Disord. 2014 Nov;20(11):1157-60. doi: 10.1016/j.parkreldis.2014.07.017. Epub 2014 Aug 28.
Management of Parkinson's disease (PD) and atypical parkinsonism in nursing homes depends on a timely and accurate diagnosis. However, little is known about the diagnostic accuracy of these parkinsonian syndromes in nursing homes. We examined this issue in a large group of Dutch nursing home residents.
Twelve large nursing home organizations in the Netherlands accounting for 100 nursing homes with a total population of 5480 residents participated. Residents with PD or atypical parkinsonism were identified according to their nursing home medical chart diagnosis. Additionally, local pharmacists provided a list of all residents using antiparkinson medication. We compared the admission diagnosis to a clinical diagnosis made in the study, based upon interview and detailed neurological examination by movement disorders experts. Diagnoses were based on accepted clinical criteria for PD and atypical parkinsonism.
In the total population of 5480 residents, 258 had previously been diagnosed with a form of parkinsonism according to their medical record. In 53 of these residents (20.5%) we changed or rejected the diagnosis. Specifically, we found no parkinsonism in 22 of these 53 residents (8.5% of all patients with suspected parkinsonism). In the remaining 31 residents (12%), we established a new diagnosis within the parkinsonian spectrum.
In a large population of Dutch nursing home residents, 20% of diagnoses within the parkinsonian spectrum were inaccurate. Almost 9% of residents had inadvertently received a diagnosis of parkinsonism. Better recognition of parkinsonism in nursing homes is important, because of the consequences for management and prognosis.
养老院中帕金森病（PD）和非典型帕金森综合征的管理依赖于及时准确的诊断。然而，对于这些帕金森综合征在养老院中的诊断准确性知之甚少。我们在一大群荷兰养老院居民中研究了这个问题。
荷兰的12个大型养老院机构参与了研究，这些机构共有100家养老院，居民总数为5480人。根据养老院病历诊断确定患有PD或非典型帕金森综合征的居民。此外，当地药剂师提供了所有使用抗帕金森药物居民的名单。我们将入院诊断与研究中基于运动障碍专家的访谈和详细神经学检查做出的临床诊断进行了比较。诊断基于公认的PD和非典型帕金森综合征临床标准。
在5480名居民的总体中，根据病历，有258人先前被诊断患有某种形式的帕金森综合征。在这些居民中，我们对53人（20.5%）的诊断进行了更改或否定。具体而言，在这53名居民中，我们发现有22人（占所有疑似帕金森综合征患者的8.5%）没有帕金森综合征。在其余31名居民（12%）中，我们在帕金森综合征范围内确定了新的诊断。
在一大群荷兰养老院居民中，帕金森综合征范围内20%的诊断不准确。近9%的居民被误诊断为帕金森综合征。鉴于对管理和预后的影响，更好地识别养老院中的帕金森综合征很重要。
