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
- 抗精神病药或止吐药暴露
- 非典型帕金森综合征的特征
- 嗅觉减退/失嗅
- 睡眠障碍
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
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）
- 嗅觉检查
- 基因检测
- 神经心理测试
- 血清铜蓝蛋白
- 24 小时尿铜
- 使用碘-123 间碘苄胍 (meta-iodobenzylguanidine, MIBG) 进行心交感神经检查
- 脑病理学（尸检）
新兴检查
- 皮肤活组织检查
治疗流程
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
- ACR–ACNM–SNMMI 关于运动障碍的多巴胺转运蛋白（DaT）单光子发射型计算机断层显像（SPECT）性能的实践参数
- 欧洲神经病学学会/运动障碍学会欧洲分会——帕金森病治疗指南：Ⅰ. 侵入性疗法
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