小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 运动迟缓
- 静止性震颤
- 强直
- 姿势不稳
其他诊断因素
- 面具脸
- 发音过弱
- 运动减少性构音障碍
- 写字过小症
- 前屈姿势
- 拖曳小碎步步态
- 共轭凝视障碍
- 疲劳
- 便秘
- 抑郁症
- 焦虑
- 痴呆
- 神经安定剂或止吐剂暴露
- 非典型帕金森症的特征
危险因素
- 年龄增长
- 青年发病的家族性帕金森病史
- 编码葡萄糖脑苷脂酶的基因发生突变
- 接触 1-甲基-4-苯基-1,2,3,6-四氢吡啶 (MPTP)
- 长期暴露于金属
- 男性
- 其他遗传学危险因素
- 头部外伤
- 地理因素影响
- 毒素接触
- 职业
诊断性检查
首要检查
- 多巴胺能药物试验
需考虑的检查
- 颅脑 MRI 扫描
- 功能性神经成像（多巴胺转运蛋白成像，例如 FP-CIT 或 beta-CIT SPECT，或是氟多巴 PET）
- 嗅觉测试
- 基因检测
- 神经心理测试
- 血清铜蓝蛋白
- 24 小时尿铜
- 脑病理学（尸检）
新兴检查
- 基底节超声检查
- 使用碘-123 间碘苄胍 (meta-iodobenzylguanidine, MIBG) 进行心交感神经检查
治疗流程
轻度帕金森症
中度帕金森症
晚期帕金森症
撰稿人
作者
Avram Fraint, MD, MS
Department of Neurology
Division of Movement Disorders
Northwestern University Feinberg School of Medicine
Chicago
IL
利益声明
AF declares that he has no competing interests.
鸣谢
Dr Avram Fraint would like to gratefully acknowledge Dr Danny Bega, Dr Meredith Spindler, Dr Jayne R. Wilkinson, and Dr Andrew D. Siderowf, the previous contributors to this topic.
利益声明
DB served on the speaker's bureau for Teva Pharmaceuticals, and ACADIA Pharmaceutical, Inc; he has received consultancy fees from US WorldMeds and grant support from the Parkinson Foundation; he was on the board of directors for Rock Steady Boxing Windy City. MS, JRW, and ADS declare that they have no competing interests.
同行评议者
Graham A. Glass, MD
Assistant Clinical Professor
Department of Neurology
UCSF Medical Center
Parkinson's Disease Research
Education and Clinical Center
San Francisco
CA
利益声明
GAG declares that he has no competing interests.
Daniel Kremens, MD, JD
Assistant Professor of Neurology
Jefferson Medical College
Thomas Jefferson University
Philadelphia
PA
利益声明
DK declares that he has no competing interests.
Donald Grosset, BSc (Honours), MB, ChB, MD, FRCP
Consultant Neurologist / Honorary Senior Lecturer
Institute of Neurological Sciences
Southern General Hospital / University of Glasgow
Glasgow
UK
利益声明
DG is an author of a reference cited in this topic.
Patricia Dowsey Limousin, MD, PhD
Reader in Clinical Neurology
Honorary Consultant
Institute of Neurology
National Hospital for Neurology and Neurosurgery
London
UK
利益声明
PDL declares that she has no competing interests.
Nikolaus McFarland, MD, PhD
Assistant Professor
Department of Neurology
University of Florida College of Medicine
Gainesville
FL
利益声明
NM declares that he has no competing interests.
鉴别诊断
- 特发性震颤
- 进行性核上麻痹 (progressive supranuclear palsy, PSP)
- 多系统萎缩（MSA；MSA-A，过去称为 Shy-Drager 综合征；MSA-P，纹状体黑质变性；MSA-C，橄榄脑桥小脑萎缩）
更多 鉴别诊断指南
- 疑似神经系统疾病：识别和转诊
- 帕金森病非运动症状治疗方法的更新
更多 指南患者教育信息
Parkinson's disease: what is it?
Parkinson's disease: what treatments work?
更多 患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明