帕金森病诊断新进展-北京协和医院神经内科+张振馨.pptVIP

帕金森病诊断新进展 张振馨 北京协和医院神经内科 帕金森病的诊断标准 帕金森病的诊断 运动减少： 随意运动在始动时缓慢，疾病进展后，重复性动作的运动速度及幅度均降低。 至少符合下述一项： ⑴肌肉僵直；⑵ 静止性震颤4-6Hz；⑶ 姿势不稳（非原发性视觉，前庭功能，脑功能及本体感受功能障碍造成） 还需要至少符合下列各项条件中3个或3个以上 ⑴ 单侧起病，⑵ 静止性震颤，⑶ 逐渐进展，⑷ 发病后多为持续性的不对称性受累，⑸ 对左旋多巴的治疗反应非常好（70-100%），⑹左旋多巴导致的严重的异动症，⑺ 左旋多巴的治疗效果持续5年或5年以上，⑻ 临床病程10年或10年以上 排除非帕金森病的诊断 帕金森叠加综合征 继发帕金森征 帕金森病病理分级: Braak 2003 帕金森病病理并非始于黑质致密部 运动前期1：(延髓:IX,X神经背核dm,前嗅核,嗅球)嗅觉； 运动前期2：(延髓和桥脑被盖：尾状核、中缝核、巨细胞核，蓝斑下区合成物co) 睡眠，头痛，运动减少，情感； 运动前期3：(+中脑：杏仁核,黑质致密部sn) 色觉，体温调节，认知，抑郁，背疼； 期4：四主症(丘脑,mesocortex mc) ； 期5：(新皮层hc) 运动波动，频发疲劳； 期6：(新皮层fc) 错乱，视幻觉，痴呆，精神症状 The pathological process in PD starting in medulla and olfactory bulb ,then spreading upwards to substantia nigra , then finally into neocortex 帕金森病的临床特征 运动症状 静止性震颤 肌强直 运动迟缓 姿势平衡障碍 Features of dementia associated with Parkinsons disease  Features of dementia associated with PD Ⅱ Associated Clinical Features Cognitive Features Attention: in spontaneous and focused attention, poor performance in attentional tasks; performance may fluctuate during the day and from day to day Executive functions: in tasks requiring initiation, planning, concept formation, rule finding, set shifting, or set maintenance; mental speed Visuospatial functions: in tasks requiring visuospatial orientation, perception, or construction Memory: in free recall of recent events or in tasks requiring learning new material; memory usually improved with cueing; recognition is usually better than free recall Language: Core functions largely preserved Behavioral Features Apathy: decreased spoteneity; loss of motivation, interest, and effortful behavior Changes in personality and mood: including depressive features and anxiety Hallucinations: mostly visual, usually complex, formed visions of people, animals, or objects Delusions: usually paranoid, such as infidelity, or phantom boarder delusions Excessive daytime sleepiness Criteria for the Diagnosis of Probable PDD 疾病严重度评估 UPDRS：创建于1980s 新修订的UPDRS 日常生活的非运动症状 日常生活的运动症状 运动检查 运动并发症 新修订的UPDRS的附件