Watanabe Hirohisa, Hara Kazuhiro, Ito Mizuki, Katsuno Masahisa, Sobue Gen
Nagoya University, Brain and Mind Research Center.
Brain Nerve. 2018 Feb;70(2):139-146. doi: 10.11477/mf.1416200966.
The International Parkinson and Movement Disorder Society offered standard diagnostic criteria for Parkinson's disease (PD) in 2015. These diagnostic criteria provided systematization of the diagnostic process and detailed explanations of parkinsonism, absolute exclusion criteria, red flags, and supportive criteria. The presence of parkinsonism was a core feature of the criteria. Clear instructions for defining the motor features were described. With regard to the novel aspects, non-motor manifestations (hyposmia, autonomic dysfunction, psychiatric dysfunction, and sleep dysfunction) and ancillary diagnostic tests (olfactory test, cardiac MIBG scintigraphy, and presynaptic dopaminergic imaging) were incorporated. Absolute exclusion criteria comprised 9 features that have the potential to exclude PD with greater than 97% sensitivity. The presence of dementia during the early stage of the illness was not classified as an exclusion criterion. The 10 red flags that indicate another cause of parkinsonism but can also be observed in pathologically proven PD were listed. Red flags were counterbalanced by supportive criteria to allow diagnosis of PD. These 4 supportive criteria were highly specific for a diagnosis of PD. With regard to the level of certainty, clinically established PD and clinically probable PD were described. In this review, we summarize the main points of the MDS-PD criteria and discuss the utility and limitations.
国际帕金森病和运动障碍协会于2015年提出了帕金森病(PD)的标准诊断标准。这些诊断标准使诊断过程系统化,并对帕金森综合征、绝对排除标准、警示信号和支持标准进行了详细解释。帕金森综合征的存在是该标准的核心特征。文中描述了定义运动特征的明确说明。在新的方面,纳入了非运动表现(嗅觉减退、自主神经功能障碍、精神功能障碍和睡眠功能障碍)以及辅助诊断测试(嗅觉测试、心脏间碘苄胍闪烁显像和突触前多巴胺能成像)。绝对排除标准包括9个特征,这些特征排除PD的敏感性大于97%。疾病早期出现痴呆未被列为排除标准。列出了10个警示信号,这些信号表明存在帕金森综合征的其他病因,但在病理证实的PD中也可能出现。支持标准对警示信号起到了平衡作用,从而允许对PD进行诊断。这4条支持标准对PD诊断具有高度特异性。在确定性水平方面,描述了临床确诊的PD和临床可能的PD。在本综述中,我们总结了MDS-PD标准的要点,并讨论了其效用和局限性。