pd诊断及鉴别诊断修改.pptVIP

虎眼征 迄今为止，PD的诊断主要依靠临床特征；PD早期诊断的生物学标志的研究已有进展（非运动症状、影像、实验室检查），辅助疾病诊断（临床前诊断），为治疗提供分子学基础，实施保护性治疗。 谢 谢 * 帕金森病(PD)主要有四大症状：静止性震颤(Tremor)、强直(Rigidity)、动作缓慢(Akinesia)及姿势平衡障碍(Postural reflex impairment)，简称为TRAP。近年来发现PD还可出现认知功能下降、情绪障碍等非运动症状。本病起病缓慢，逐渐进展。首发症状可以是震颤，也可以是运动障碍或强直。常从一个肢体或一侧起病，经过一段时间后再扩展到另一侧。双侧受累时严重程度两侧并不完全一致。本病主要见于50岁以上中老年患者，30岁以前发病者较少，男女比例约为3∶2。 * 大约一半PD患者的首发症状为震颤，约15%患者在整个病程中从不发生震颤。静止性震颤是PD的主要症状之一，表现为节律性幅度较大的震颤，一般频率为4～6Hz。手指的节律性震颤使手部不断地作出旋前旋后的动作，即“搓丸样动作”。 * 姿势和平衡障碍(postural reflex impairment)可能是所有PD运动症状之中最不特异的表现，但是对生活的影响却最重。姿势和平衡障碍多见于晚期PD患者，且多与冻结现象同时发生，常常导致髋骨骨折。由于肌肉的强直，患者出现特殊的姿势，表现为头部前倾，躯干俯屈，上肢之肘关节屈曲，腕关节伸直，双手置于前方，下肢之髋及膝关节略为屈曲，由于躯干两侧肌张力增高的不平衡，患者可能出现躯干的侧弯。 此外患者还有步态障碍：走路时步态拖曳，起步困难，迈开步后就以极小的步伐向前冲去，越走越快，不能及时停步或转弯，成为慌张步态。转弯时需采取连续小步使躯干和头部一起转弯。因有平衡障碍，患者在行走时易于向前倾跌。伴有躯干强直和少动的姿势和平衡障碍患者常在试图坐下时，倒在椅子上。 * Is there any treatment? There is currently no effective treatment for PSP, although scientists are searching for better ways to manage the disease. In some patients the slowness, stiffness, and balance problems of PSP may respond to antiparkinsonian agents such as levodopa, or levodopa combined with anticholinergic agents or amantadine, but the effect is usually temporary. The speech, vision, and swallowing difficulties usually do not respond to any drug treatment. Another group of drugs that has been of some modest success in PSP are antidepressant medications. The most commonly used of these drugs are fluoxetine (Prozac), amitriptyline (Elavil), and imipramine (Tofranil). The anti-PSP benefit of these drugs seems not to be related to their ability to relieve depression. Non-drug treatment for PSP can take many forms. Patients frequently use weighted walking aids because of their tendency to fall backward. Bifocals or special glasses called prisms are sometimes prescribed for PSP patients to remedy the difficulty of looking down. Formal physical therapy is of no proven benefit in PSP, but certain exercises can be done to keep the joints limber. A surgical procedure that