鉴别诊断阿尔茨海默病张振馨—培训课件.pptVIP

Olfactory dysfunction (hyposmia) in neurodegenerative disease Olfactory dysfunction in a-synucleinopathies PD: in 80-100% of non-demented patients impaired (olfactory threshold discrimination/ identification) 50% anosmic, 35% severe hyposmia, 15% moderate hyposmia independent of the severity and duration of PD, early in the course of the clinical disease 哪些诊断 testing 有助于鉴别诊断 Diagnostic neurophysiology testing (1 Class III) Electro-oculography (square wave jerk) Impaired gaze holding: PSP/87.5%, MSA/64%, PD/15.3% Latency of horizontal saccades slower in CBDPD % errors on anti-saccade greater in PSPPDMSA SWjerk: PD18%, MSA7%, CBD20%, PSP60% 哪些诊断 testing有助于鉴别诊断 Diagnostic neurophysiology testing (1 Class III) Anal sphincter EMG Motor unit prolongation Cutoff20 for probable MSA: se62%, sp92% Cutoff20 for probable MSA: overlap PD MSA A blinded study: No sig. differences PD vs MSA 哪些诊断 testing 有助于鉴别诊断 Autonomic testing (deep breathing, Valsalva, tilt table, sudomotor axon reflex, sweat test) Failed to distinguish between probable MSA and probable PD 推荐于鉴别诊断 Falls at presentation and early stage Poor response to L-dopa Symmetry at onset Rapid progression (to H Y stage 3 in 3 yrs) Lack of tremor Early dysautonomia (姿势低血压、尿便失禁、尿潴留须导尿和勃起不良, esp. several present) 推荐于鉴别诊断 L-dopa and apomorphine challenge (Level B) 拟有PD, 应考虑用于确诊 Olfaction test (Level B) 应考虑用于鉴别 PD 与 PSP,CBD 不用于鉴别 PD 与 MSA 证据不足:比临床诊断标准更好 证据不足:表示联合应用更好 false - =30%; false + 20-30% 推荐于鉴别诊断 鉴别诊断可能无用 (Level C) GH stimulation, electro-oculography, SPECT 证据不足 Urodynamics, autonomic test, urethral or anal EMG, MRI, brain parenchyma sonography, and FDG PET (Level U) 推荐于鉴别诊断 鉴别诊断证据不足 (two Class III) MRI: PD /MSA Putaminal hypointensity on T2 weighted images 21/24 MSA, 3/27 PD: se87.5%, sp88% Putaminal hyperintensity on proton density weighted images 20/24 MSA, none PD: sp100% Putaminal diffusion-weighted images 21/24 MSA, diffusion coefficients: higher in MSAPD * * 意义：focus on SN, Step by step