帕金森病

最后审阅: 2 十一月 2022
最后更新: 24 三月 2022

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
更多 关键诊断因素

其他诊断因素

  • 面具脸
  • 发音过弱
  • 运动过弱型构音障碍
  • 写字过小症
  • 前屈姿势
  • 拖曳小碎步步态
  • 共轭凝视障碍
  • 乏力
  • 便秘
  • 抑郁
  • 焦虑
  • 痴呆
  • 神经安定剂或止吐剂暴露
  • 非典型帕金森综合征的特征
其他诊断因素

危险因素

  • 年龄增长
  • 青年发病的家族性 PD 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
更多 危险因素

诊断性检查

首要检查

  • 多巴胺能药物试验
更多 首要检查

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)
  • 嗅觉检查
  • 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)
更多 需考虑的检查

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

持续性治疗

轻度帕金森综合征

中度帕金森综合征

晚期帕金森综合征

撰稿人

作者

Delaram Safarpour, MD, MSCE

Assistant Professor of Neurology

Department of Neurology

School of Medicine

Oregon Health & Science University

Portland

OR

利益声明

DS has received honoraria for participation in advisory boards for Boston Scientific (the manufacturer of Deep Brain Stimulation device) and Abbvie (the manufacturer of Duopa). She has received consultation fees from Abbott (the manufacturer of Deep Brain Stimulation device). DS has received an institutional grant and has received an honorarium for lectures from Parkinson Study Group.

Marian L. Dale, MD, MCR

Assistant Professor of Neurology

Department of Neurology

Oregon Health & Science University

Staff Neurologist

Portland VA Medical Center

Portland

OR

利益声明

MLD has received consulting honoraria from Synergic Medical Technologies and UCB, and has received grant funding from the NIH and the Collins Medical Trust.

Lauren S. Talman, MD

Assistant Professor of Neurology

Department of Neurology

School of Medicine

Oregon Health & Science University

Portland

OR

利益声明

LST declares that she has no competing interests.

鸣谢

Dr Delaram Safarpour, Dr Marian L. Dale, and Dr Lauren S. Talman would like to gratefully acknowledge Dr Avram Fraint, 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. AF, 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

    • 多巴胺能类药物治疗早期帕金森病的运动症状
    • 帕金森病非运动症状治疗方法更新
    更多 指南
  • 患者教育信息

    帕金森病:如何定义?

    帕金森病:哪些治疗有效?

    更多 患者教育信息
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