Larsen J P, Dupont E, Tandberg E
Department of Neurology, Central Hospital of Rogaland, Stavanger, Norway.
Acta Neurol Scand. 1994 Apr;89(4):242-51. doi: 10.1111/j.1600-0404.1994.tb01674.x.
The objective of this paper is to evaluate the accuracy of conventional diagnostic criteria for Parkinson's disease and give an overview of alternative causes to parkinsonian syndromes. We also propose a new approach to the clinical diagnosis of Parkinson's disease, which may improve the diagnostic accuracy. The available information on autopsy findings in patients clinically diagnosed as Parkinson's disease shows that 20 to 30% of these patients do not have the typical neuropathological features with Lewy bodies and cell loss in the substantia nigra. The use of selected additional clinical criteria improves the diagnostic accuracy, however, at the cost of rejecting a rather large group of patients with idiopathic disease verified by autopsy. Based on this fact and a review of the literature on parkinsonian syndromes that may be confused with idiopathic Parkinson's disease, we propose criteria for diagnostic subgroups of the disease classified at different levels of confidence. The suggested diagnostic subgroups are clinical definite, probable and possible Parkinson's disease with a decreasing level of specificity and an increasing level of sensitivity in the different patient categories. The clinical features given special importance in this classification includes presence of resting tremor, asymmetrical disease, response to dopamine agonism and presence of atypical clinical features like dementia and clinical autonomic failure at onset and pyramidal or cerebellar signs at examination. In addition, a history indicating possible etiology for another parkinsonian syndrome will exclude the diagnosis.
本文的目的是评估帕金森病传统诊断标准的准确性，并概述帕金森综合征的其他病因。我们还提出了一种帕金森病临床诊断的新方法，这可能会提高诊断准确性。关于临床诊断为帕金森病患者尸检结果的现有信息表明，这些患者中有20%至30%没有黑质中存在路易小体和细胞丢失的典型神经病理学特征。使用选定的附加临床标准可提高诊断准确性，然而，代价是拒绝了相当一大批经尸检证实为特发性疾病的患者。基于这一事实以及对可能与特发性帕金森病混淆的帕金森综合征文献的综述，我们提出了该疾病在不同置信水平分类的诊断亚组标准。建议的诊断亚组为临床确诊、可能和疑似帕金森病，在不同患者类别中特异性水平降低，敏感性水平升高。在此分类中特别重视的临床特征包括静止性震颤的存在、疾病的不对称性、对多巴胺激动剂的反应以及非典型临床特征的存在，如发病时的痴呆和临床自主神经功能衰竭以及检查时的锥体束或小脑体征。此外，表明可能是另一种帕金森综合征病因的病史将排除该诊断。
