Hayes Michael, Puhl Peter, Hagenah Johann, Russo Robert
Department of Neurology Concord Hospital Sydney Australia.
Department of Neurology Westküstenklinikum Heide Germany.
Mov Disord Clin Pract. 2016 Nov 1;4(3):397-402. doi: 10.1002/mdc3.12450. eCollection 2017 May-Jun.
The addition of a simple nonmotor symptom (NMS) screen and transcranial sonography (TCS) to standard clinical assessment may improve the diagnostic accuracy of Parkinson's disease (PD).
Sixty-nine subjects (23 established PD group, 23 healthy controls, and 23 possible PD) were enrolled. All completed 3 "yes-no" NMS questions (score, 0-3) and had a transcranial ultrasound assessing nigral hyperechogenicity (score, 0-1). A combined PD risk score of 0 to 4 was obtained for each subject. A PD risk score of ≥2 was used as the diagnostic cutoff for PD.
In the established PD group, there was an average of 2 NMSs per person or a group total of 46 of 69 possible NMSs, but only 4 of 69 NMSs in the healthy control group. Of the technically satisfactory TCS, 16 of 20 (80%) of the established PD group and 2 of 16 (12.5%) of the healthy control group were TCS positive. Using ≥2 NMSs alone as the cutoff identified 17 of 23 (74%) of the established PD and 100% of the healthy controls. The PD risk score of ≥2 identified 21 of 23 (91%) of the established PD as PD and 22 of 23 (96%) of the healthy control group as non-PD. In the possible PD group, the PD risk score identified 9 of 18 (50%) of those with a clinical diagnosis of PD and 4 of 5 (80%) of non-PD.
The combination of a brief NMS screen and TCS discriminated well between normal healthy controls and established PD. A positive TCS and one NMS, or a negative TCS with two NMSs, indicated a likely diagnosis of PD.
在标准临床评估中加入简单的非运动症状（NMS）筛查和经颅超声检查（TCS）可能会提高帕金森病（PD）的诊断准确性。
招募了69名受试者（23名确诊的PD组、23名健康对照者和23名可能患有PD者）。所有人都完成了3个“是或否”的NMS问题（得分0 - 3分），并进行了经颅超声检查以评估黑质高回声（得分0 - 1分）。为每个受试者获得了0至4的综合PD风险评分。将≥2的PD风险评分用作PD的诊断临界值。
在确诊的PD组中，每人平均有2种NMS，或在69种可能的NMS中该组共有46种，但健康对照组中69种NMS中只有4种。在技术上令人满意的TCS检查中，确诊的PD组20例中有16例（80%）TCS呈阳性，健康对照组16例中有2例（12.5%）TCS呈阳性。仅使用≥2种NMS作为临界值可识别出确诊的PD组23例中的17例（74%）和所有健康对照者。≥2的PD风险评分可将确诊的PD组23例中的21例（91%）诊断为PD，将健康对照组23例中的22例（96%）诊断为非PD。在可能患有PD的组中，PD风险评分可识别出临床诊断为PD的18例中的9例（50%）和非PD的5例中的4例（80%）。
简短的NMS筛查和TCS的组合能够很好地区分正常健康对照者和确诊的PD患者。TCS阳性且有1种NMS，或TCS阴性且有2种NMS，提示可能诊断为PD。
