Diagnostic accuracy of parkinsonism syndromes by general neurologists
Diagnostic accuracy of parkinsonism syndromes by general neurologists
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DOI：
10.1016/j.parkreldis.2014.04.019
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发表时间：
2014-08-01
影响因子：
4.1
通讯作者：
Kaasinen, Valtteri
中科院分区：
文献类型：
--
作者：
Joutsa, Juho;Gardberg, Maria;Kaasinen, Valtteri
简介：运动障碍专家在临床诊断帕金森综合征时可以达到很高的准确率。目的：探讨近年来普通神经科医师对帕金森综合征诊断的准确性。方法：对2000-2012年间神经科医师诊断的1362例帕金森综合征尸检病例进行回顾性分析。在这些病例中，111例生前接受临床帕金森综合征诊断，122例死后接受帕金森综合征神经病理诊断，包括11例偶发病例。结果：77例临床诊断帕金森病(PD)的患者中，58例(75.3%)经神经病理检查确诊。临床诊断特发性帕金森病的敏感性为89.2%，特异性为57.8%。进行性核上性麻痹(PSP)和多系统萎缩(MSA)的诊断符合率分别为52.9%和100%，64.3%和99.0%。结论：普通神经科医师对帕金森病的诊断存在严重高估，而帕金森综合征合并综合征的诊断存在漏诊。尽管近几十年来帕金森综合征的诊断方法有所改进，临床诊断标准也有所发展，但帕金森病的诊断准确率仍然较低，四分之一的诊断是不正确的。(C)2014爱思唯尔有限公司。保留所有权利。
Introduction: Movement disorder specialists can achieve a high level of accuracy when clinically diagnosing parkinsonism syndromes. However, data about the diagnostic accuracy among general neurologists is limited.Objectives: This study investigated the recent diagnostic accuracy of parkinsonism syndromes by general neurologists.Methods: A retrospective examination of 1362 post-mortem cases diagnosed in the years 2000-2012 by neuropathologists was performed. Out of these cases, we identified 111 patients who received a clinical parkinsonism diagnosis during life and 122 patients who received a neuropathological diagnosis of a parkinsonism syndrome post-mortem including 11 incidental cases.Results: Fifty-eight (75.3%) of the 77 patients who had received clinical Parkinson's disease (PD) diagnoses were confirmed after the neuropathological examination. The sensitivity of the clinical diagnosis for idiopathic Parkinson's disease (PD) was 89.2% and the specificity was 57.8%. The corresponding numbers for progressive supranuclear palsy (PSP) were 52.9% and 100%, and for multiple system atrophy (MSA) were 64.3% and 99.0%, respectively.Conclusions: Parkinson's disease is heavily overdiagnosed by general neurologists, whereas parkinsonism plus syndromes are underdiagnosed. Despite improvements in the diagnostic methods during recent decades and the development of diagnostic clinical criteria for parkinsonian syndromes, the diagnostic accuracy of Parkinson's disease remains relatively low, and 1/4 of diagnoses are incorrect. (C) 2014 Elsevier Ltd. All rights reserved.