Value of combined midbrain sonography, olfactory and motor function assessment in the differential diagnosis of early Parkinson's disease
| Autor: | Sabine Kleinschmidt, Lara Kaulitz, Uwe Walter, Robert Heilmann, Jacqueline Höppner, Knut Busse, Irene Gemende, Reiner Benecke, Mazen Abu-Mugheisib, Christian Wunderlich, Alexander Wolters |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Pathology Parkinson's disease Ultrasonography Doppler Transcranial Comorbidity Gastroenterology Cohort Studies Diagnosis Differential Olfaction Disorders Hyposmia Internal medicine medicine Humans Age of Onset Aged Retrospective Studies Movement Disorders Essential tremor Parkinsonism Parkinson Disease Retrospective cohort study Middle Aged medicine.disease Transcranial Doppler Substantia Nigra Psychiatry and Mental health Cohort Female Surgery Neurology (clinical) Differential diagnosis medicine.symptom Psychology Algorithms |
| Zdroj: | Journal of Neurology, Neurosurgery & Psychiatry. 83:441-447 |
| ISSN: | 1468-330X 0022-3050 |
| Popis: | Objective Characteristic features of Parkinson9s disease (PD) are asymmetric parkinsonian motor signs, hyposmia and substantia nigra (SN) hyperechogenicity on transcranial ultrasound. However, each of these features has limited diagnostic value as they may be present, albeit less frequently, in other parkinsonian disorders. Here, the diagnostic sensitivity and specificity of combined assessment of these three features are evaluated. Methods 632 patients with parkinsonism (PD, vascular parkinsonism, atypical parkinsonian syndromes, essential tremor and major depressive disorder with motor slowing) were assessed on the Unified Parkinson9s disease Rating Scale for motor asymmetry (right–left score difference ≥2), the 12 item Sniffin9 Sticks test (SS-12) and transcranial ultrasound. The derivation (validation) cohort consisted of 517 (115) subjects (193 (35) women; age 65.4±9.6 (62.3±10.3) years) of whom 385 (68) had PD and 132 (47) non-PD parkinsonism; another 21 (6) subjects were not included due to missing transcranial insonability. Of the validation cohort, all patients had a disease duration ≤2 years and observers were blind to diagnoses. Results The optimum cut-off values for discrimination of PD were SS-12 score 2 (SN hyperechogenicity). Sensitivity, specificity and positive predictive values for the diagnosis of PD were as follows, for the derivation cohort: motor asymmetry 88%, 54% and 85%; hyposmia 75%, 70% and 88%; SN hyperechogenicity 90%, 63% and 88%; two features present 96%, 72% and 91%; three features present 57%, 94% and 97%; and for the validation cohort: two features present 91%, 77% and 85%; three features present 49%, 98% and 97%. Conclusion The combined assessment of motor asymmetry, hyposmia and SN hyperechogenicity improves diagnostic specificity and allows early diagnosis of PD. |
| Databáze: | OpenAIRE |
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