Clinicopathologic discrepancies in a population-based incidence study of parkinsonism in olmsted county: 1991-2010.
Clinicopathologic discrepancies in a population-based incidence study of parkinsonism in olmsted county: 1991-2010.
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DOI：
10.1002/mds.27125
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发表时间：
2017-10
期刊：
影响因子：
--
通讯作者：
Savica R
中科院分区：
文献类型：
--
作者：
Turcano P;Mielke MM;Josephs KA;Bower JH;Parisi JE;Boeve BF;Savica R
在一个以人群为基础的帕金森病队列中，研究帕金森病临床诊断与神经病理学结果之间的差异。帕金森综合征的具体临床诊断是具有挑战性的，明确的确认需要神经病理学评估。目前，尸检很少进行，大多数脑尸检代表非典型或诊断未解决的情况。我们使用了1991-2010年明尼苏达州奥姆斯特德县罗切斯特流行病学项目中定义的基于人群的临床帕金森症发病率队列（n=669）。我们回顾了所有在尸检时接受神经病理学检查的患者（n= 60; 9%）的报告，并应用共识病理学指南进行神经退行性疾病诊断。在60例病理检查的患者中，从最后记录的临床诊断到死亡的中位时间为7年（范围从2年到17年）。52例（86.7%）临床病理符合，8例（13.3%）临床病理不符。4例临床诊断为特发性帕金森病的患者没有Lewy小体或α-突触核蛋白病的病理学证据;其中，病理学诊断为阿尔茨海默病（2例）、进行性核上性麻痹（1例）和血管性帕金森综合征（1例）。2例临床诊断为“路易体痴呆”的患者和1例“未指明的帕金森综合征”的患者的病理诊断为阿尔茨海默病，无伴随的α-突触核蛋白病变。1例临床诊断为“进行性核上性麻痹”的患者尸检时病理结果不确定，无α-突触核蛋白、Aβ或tau免疫反应性病变。总体而言，帕金森病亚型的临床诊断与病理证实有良好的一致性（86.7%）。然而，13.3%的患者记录了临床病理学差异。
To examine discrepancies between the clinical diagnosis of parkinsonism and neuropathological findings in a population-based cohort with parkinsonian disorders. The specific clinical diagnosis of parkinsonism is challenging, and definite confirmation requires neuropathological evaluation. Currently, autopsies are seldom performed, and most brain autopsies represent atypical or diagnostically unresolved cases. We used a defined population-based incidence cohort with clinical parkinsonism (n=669) from the Rochester Epidemiology Project in Olmsted County, MN, 1991–2010. We reviewed reports of all patients who underwent neuropathologic examination at autopsy (n= 60; 9%) and applied consensus pathologic guidelines for neurodegenerative disease diagnosis. Among the 60 patients examined pathologically, the median time from the last recorded clinical diagnosis to death was 7 years (range from 2 to 17 years). Clinical-pathological concordance was found in 52 cases (86.7%), whereas 8 (13.3%) had a clinical-pathological discrepancy. Four patients with a clinical diagnosis of idiopathic Parkinson’s disease had no pathological evidence of Lewy bodies or α-synucleinopathy; of these, pathological diagnoses were Alzheimer’s disease (2 cases), progressive supranuclear palsy (1 case), and vascular parkinsonism (1 case). Two patients with clinical diagnoses of "dementia with Lewy bodies" and one patient with an "unspecified parkinsonism" had a pathological diagnosis of Alzheimer’s disease without concomitant α-synuclein lesions. One patient with clinically diagnosed "progressive supranuclear palsy" had indeterminate pathological findings without α-synuclein, Aβ- or tau-immunoreactive lesions at autopsy. Overall, the clinical diagnoses of parkinsonian subtypes had good concordance with pathological confirmation (86.7%). However, clinical-pathological discrepancies were documented in 13.3%.
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影响因子：
48
作者：
Irwin, David;Grossman, Murray;Weintraub, Daniel;Hurtig, Howard I.;Duda, John E.;Xie, Sharon X.;Lee, Edward B.;Van Deerlin, Vivianna M.;Lopez, Oscar L.;Kofler, Julia K.;Nelson, Peter T.;Jicha, Gregory A.;Woltjer, Randy;Quinn, Joseph F.;Kaye, Jeffery;Leverenz, James B.;Tsuang, Debby;Longfellow, Katelan;Yearout, Dora;Kukull, Walter;Keene, C. Dirk;Montine, Thomas J.;Zabetian, Cyrus P.;Trojanowski, John Q.
通讯作者：
Trojanowski, John Q.
影响因子：
14
作者：
Brookmeyer, Ron;Johnson, Elizabeth;Arrighi, H. Michael
通讯作者：
Arrighi, H. Michael
影响因子：
11
作者：
HUGHES, AJ;DANIEL, SE;LEES, AJ
通讯作者：
LEES, AJ
影响因子：
9.9
作者：
Becker, Claudia;Jick, Susan S.;Meier, Christoph R.
通讯作者：
Meier, Christoph R.
影响因子：
5.8
作者：
Gilman, S;Low, P;Wenning, G
通讯作者：
Wenning, G