The diagnostic criteria of Parkinson’s disease developed by the Movement Disorders and Parkinson’s Disease Group of the Chinese Medical Association Neurology Branch.
I. Clinical features of Parkinson’s disease
(A) 50% reduction of dopaminergic neurons causes the main motor symptoms: reduced movement or inability to move, rigidity, resting tremor, postural balance disorder.
(ii) Non-motor symptoms due to involvement of non-dopaminergic neurons (cholinergic, adrenergic, pentasensory-tryptophanergic, glutamatergic).
(1) Psychiatric: depression, anxiety, cognitive impairment, hallucinations, apathy, sleep disorders (poor quality of sleep at night and sleepiness during the day).
2, autonomic: constipation, low blood pressure, excessive sweating, sexual dysfunction, urinary disorders, salivation.
3, sensory disorders: numbness, pain, spasm, restless leg syndrome, smell disorder.
Second, the diagnosis of Parkinson’s disease steps
1, detailed medical history: time of onset, distribution of symptoms and the order of symmetric symptoms, the type of symptoms (motor or non-motor, including initiation, movement amplitude, speed, movement volume, volume, expression, continuous movement, fine motor, rising gait, step distance, step base, accompanying movements, etc.). The rate of disease progression and symptom change onset triggers, tests that have been performed and the results, treatment and response, also including the effect of experimental treatment, etc.
2.Physical examination: Internal examination pays attention to blood pressure in different positions, cornea, thyroid, heart, liver, kidney, etc. The neurological examination should pay attention to the manifestations that can be explained by non-Parkinson’s disease, in addition to the movement disorders based on the Unified Parkinson’s Disease Symptom Rating Scale (UPDRS).
3, laboratory tests: mainly for the exclusion of other diseases and differential diagnosis, including routine, biochemical, electrophysiological, neuroimaging. Early Parkinson’s disease dopaminergic neuron reduction can be detected by functional neuroimaging (such as PET, SPECT, etc.).
4. Diagnosis: Firstly, symptom diagnosis (motor or non-motor), consider whether it is consistent with Parkinsonism and its possible causes, and then consider whether it is consistent with Parkinson’s disease and its severity.
Third, the diagnostic criteria of Parkinson’s disease
(A) Diagnosis consistent with Parkinson’s disease
1. Decreased movement: slow initiation of random movements. After disease progression, the speed and amplitude of repetitive movements are reduced.
2. At least 1 of the following features is present.
(1) Muscle rigidity ;
(2) Resting tremor of 4-6 Hz;
(3) Postural instability (not caused by primary visual, vestibular, cerebellar and proprioceptive dysfunction).
(b) Three or more of the following features must be present to support the diagnosis of Parkinson’s disease
1, unilateral onset;
2.Static tremor;
3, gradual progression;
4, the onset of the disease is mostly persistent asymmetric involvement;
5.Good response to levodopa treatment (70% to 100%)
6.Severe allodynia caused by levodopa;
7.The treatment effect of levodopa lasts for 5 years or more;
8.The clinical course of the disease is 10 years or more.
(C) Non-parkinsonism must be excluded
The following signs and symptoms do not support Parkinson’s disease and may be Parkinson’s superposition or secondary Parkinson’s syndrome
1. history of recurrent stroke episodes with stepwise progression characteristic of Parkinson’s disease;
2. history of recurrent brain injury;
3, clear history of encephalitis and/or non-drug induced motility crisis;
4. Application of antipsychotic and/or dopamine-depleting drugs at the onset of symptoms;
5. More than 1 relative with the disease;
6. Intracranial tumor or traffic hydrocephalus visible on CT scan;
7, exposure to known neurotoxic classes;
8.Continued remission or rapid progression of the disease;
9.Ineffective treatment with high doses of levodopa (except for absorption disorders);
10.Still strictly unilateral involvement after 3 years of onset;
11, the appearance of other neurological signs and symptoms, such as vertical gaze palsy, ataxia, early that is severe autonomic involvement, early that is severe dementia with memory, speech and executive dysfunction, positive pyramidal fasciculus sign, etc.
IV. Issues to note in differential diagnosis
The typical features of Parkinson’s disease can also be seen in other movement disorders, so the following issues need to be noted in the differential diagnosis.
Resting 4-6 Hz tremor is seen in 70% to 90% of Parkinson’s disease, and can also occur in 17% of progressive supranuclear palsy (PSP), 29% of corticobasal degeneration (CBD) and 55% of diffuse Lewy body disease (DLBD).
2, reduced movement and rigidity, if the head and trunk distribution is predominantly seen in PSP, if it starts on one side, it is seen in 72%-75% of Parkinson’s disease.
A degree of asymmetry is seen in 27%-56% of MSA and 19%-50% of PSP, and is a typical feature of CBD.
4. Levodopa resistance is rare, and early PD is weakly responsive to levodopa treatment. Patients with Parkinson’s disease can have a transient response to treatment with levodopa, as seen in 35% of PSP, 87% of DLBD and 75% of MSA, and 1/3 of patients can maintain treatment response until death.
Early motor fluctuations are an indication of MSA, and the age of onset of MSA is mostly younger than that of Parkinson’s disease.
6, Irregular dystonia is seen in 2% Parkinson’s disease, especially in adolescent onset Parkinson’s disease, and is also a typical feature of PARK2 Parkinson’s disease and levodopa-responsive dystonia.
7, Pathologically confirmed Parkinson’s disease can also have atypical features such as early onset of severe dementia, early onset of severe autonomic dysfunction, fluctuating taciturn states, disuse, myoclonus and focal dystonia.