Parkinson's disease is one of the most common neurological disorders. Two signature neuropathological results of the disease are the absence of pigmented dopaminergic neurons in the dense part of the substantia nigra and the presence of Lewy bodies and Lewy neurites. More than 6 million people worldwide have been diagnosed with Parkinson's disease. Its incidence and prevalence increase with age, with an average age of about 60 years. The incidence of Parkinson's disease in men is 1.5 times higher in women, and this trend is likely to increase with age. In most populations, 3% to 5% of Parkinson's disease are associated with known Parkinson's disease genes, representing single-gene Parkinson's disease. Can you correctly identify the signs and symptoms of Parkinson's disease? This article will test everyone's understanding through 5 small questions, let's try it together.
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Question One
Which is the classic symptom in the early clinical diagnosis of Parkinson's disease?
A. Postural balance disorder
B. Motor tremor
C. Bradykinesia
D. Postural tremor
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【Answers and analysis】
Answer: C. Parkinson's disease has four hallmark signs. To make a clinical diagnosis, patients must present with two of these three symptoms: resting tremor, muscle rigidity, and bradykinesia. The fourth hallmark sign — postural balance disorder — usually occurs late in the course of illness, at least after 8 years. In order to confirm the diagnosis, the patient must meet these core features and respond to dopaminergic therapy.
Many patients with Parkinson's disease also experience some degree of postural and/or motor tremor, although resting tremor is typical of the disease.
Question two
What symptoms may precede clinical diagnosis?
A. Decreased sense of smell
B. Aphasia
C. Voice becomes lower
D. Abnormal sweating
Answer: A. Non-motor symptoms or prodromal/pre-exercise symptoms may appear 10 years before the onset of motor symptoms. These symptoms include olfactory loss, loss of smell, depression, constipation, REM sleep behavior disorder, visual changes, anxiety, and other autonomic disorders. Olfactory tests may reveal hyposonmia, which precedes motor symptoms by years, thus providing evidence of the onset of Parkinson's disease. However, loss of smell is not specific and can also occur in Alzheimer's disease.
When parkinson's disease presents with motor symptoms, they are usually asymmetrical. The most common initial sign is resting tremor of the upper extremities. As the disease progresses, patients develop bradykinesia, stiffness, and gait difficulties. The axial posture becomes more curved and the stride length becomes shorter. Postural balance disorder is also a feature of Parkinson's disease, but it develops later in the course of the disease.
Decreased voice and sweating with other thermoregulatory abnormalities are typical symptoms of Parkinson's disease. Aphasia is not a typical symptom of the disease and can be absolutely ruled out during the diagnostic process.
Question three
Which tests may be helpful in confirming the diagnosis of Parkinson's disease?
A. CT
B. Dopamine transporter SPECT
C. MRI
D. Ultrasound
Answer: B. Parkinson's disease is a clinical diagnosis based primarily on motor features (although non-motor symptoms should not be overlooked). While measurements of CSF α-synuclear protein aggregates have so far provided encouraging preliminary results, this situation cannot rely on laboratory biomarkers. The dopamine transporter single photon emission CT (SPECT) improves diagnostic accuracy. Findings of MRI and CT are often of no value in diagnosing Parkinson's disease, and ultrasound is not sensitive or specific enough for the diagnosis of Parkinson's disease and atypical Parkinson's disease.
Question four
According to the new diagnostic criteria for Parkinson's disease, which symptoms can exclude Parkinson's disease from the differential diagnosis?
A. Cortical sensory loss
B. Early bulbar dysfunction
C. Isolated extensor plantar reaction
D. Repeated falls due to balance disorder within 1 year of onset
Answer: A. The Movement Disorders Association recently released new diagnostic criteria for Parkinson's disease. According to these guidelines, cortical sensory loss is one of nine absolute exclusion criteria. Early bulbar dysfunction and repeated falls (caused by impaired balance) within 1 year of onset are red flags for the diagnosis of Parkinson's disease. For patients diagnosed with the disease, red flags are not allowed. However, if there is a red flag, the patient may be diagnosed with clinically possible Parkinson's disease as long as the supporting criteria are balanced; if two red flags are present, at least two supporting criteria are required.
Question five
Which symptoms help distinguish between Parkinson's disease and atypical Parkinson's disease?
A. Vertical gaze at supranuclear paralysis
B. Heterogeneous phenomena
C. Tremor is not aggravated during exercise
D. Polymyoclonus minor
Answer: C. Early in the course of the disease, differentiating between Parkinson's disease and atypical Parkinson's disease (i.e., multisystem atrophy, progressive supranuclear palsy, cortical basal ganglia) can be a diagnostic challenge, and the rate of diagnostic errors between Parkinson's disease and primary tremor is high. Resting tremor does occur in idiopathic tremor, but it amplifies during exercise — a sign not found in Parkinson's disease.
Vertically gazed supranuclear palsy is a common symptom of progressive supranuclear palsy, but does not occur in Parkinson's disease. The phenomenon of allotments is one of the most common features of cortical basal ganglia degeneration. In multisystem atrophy, tremor is usually convulsive rather than stationary, accompanied by small polymyoclonus.
医脉通编译自：Rajesh Pahwa. Fast Five Quiz: Signs and Symptoms of Parkinson's Disease - Medscape - Jan 13, 2022.