Gupta Harsh V, Mehta Shyamal H, Zhang Nan, Hentz Joseph G, Shill Holly A, Driver-Dunckley Erika, Sabbagh Marwan N, Belden Christine M, Dugger Brittany N, Beach Thomas G, Serrano Geidy E, Sue Lucia I, Davis Kathryn, Adler Charles H
Department of Neurology Mayo Clinic Scottsdale AZ USA.
Department of Biostatistics Mayo Clinic Scottsdale AZ USA.
Mov Disord Clin Pract. 2018 Feb 22;5(2):165-170. doi: 10.1002/mdc3.12589. eCollection 2018 Mar-Apr.
Clinical diagnostic criteria for PD rely on rest tremor, bradykinesia, and rigidity. These features are non-specific and neuropathological confirmation remains the gold standard for diagnosis. This study presents data on clinical certainty ratings in autopsy-proven PD.
Subjects were assessed annually by a movement disorders specialist and assigned to a clinical certainty group for PD based on multiple clinical features before autopsy. The three groups considered for analysis are as follows: Group I 0-49% certainty, Group II 50-89% certainty, and Group III 90-100% certainty. All subjects were autopsied and had a standardized neuropathological assessment.
275 subjects were assigned a PD certainty at their last visit before death. Group I had 80 subjects, Group II 56 subjects, and Group III 139 subjects. The clinical features recorded in Group I, II, and III, were as follows: rest tremor, bradykinesia, rigidity, postural instability, asymmetric onset, persistent asymmetry, current response to dopaminergic treatment, motor fluctuations, and dyskinesia. Rigidity, postural instability, asymmetric onset, current response to dopaminergic treatment, motor fluctuation, and dyskinesia were more likely to be present in the group which was rated with higher certainty. The final diagnosis of PD was confirmed by neuropathological assessment in 85% of the patients in Group III as compared to 30% in Group II and 5% in Group I.
High certainty (90-100%) had strong positive predictive value (85%) for autopsy-proven PD as compared to either lower certainty groups (0-49% and 50-89%) which had lower predictive value (5% and 30% respectively).
帕金森病（PD）的临床诊断标准依赖于静止性震颤、运动迟缓及肌强直。这些特征并非特异性的，而神经病理学确诊仍是诊断的金标准。本研究展示了经尸检证实的PD患者临床确定性评级的数据。
由运动障碍专科医生每年对受试者进行评估，并在尸检前根据多种临床特征将其归入PD临床确定性组。分析时考虑的三组如下：I组，确定性为0 - 49%；II组，确定性为50 - 89%；III组，确定性为90 - 100%。所有受试者均接受尸检并进行标准化神经病理学评估。
275名受试者在死亡前最后一次就诊时被评定为PD确定性。I组有80名受试者，II组有56名受试者，III组有139名受试者。I组、II组和III组记录的临床特征如下：静止性震颤、运动迟缓、肌强直、姿势不稳、起病不对称、持续不对称、当前对多巴胺能治疗的反应、运动波动及异动症。肌强直、姿势不稳、起病不对称、当前对多巴胺能治疗的反应、运动波动及异动症在确定性评级较高的组中更易出现。经神经病理学评估，III组85% 的患者最终确诊为PD，而II组为30%，I组为5%。
与确定性较低的组（0 - 49%和50 - 89%，其预测值分别为5%和30%）相比，高确定性（90 - 100%）对经尸检证实的PD具有较强的阳性预测价值（85%）。
