Value of combined midbrain sonography, olfactory and motor function assessment in the differential diagnosis of early Parkinson's disease
Identifieur interne : 000025 ( Main/Exploration ); précédent : 000024; suivant : 000026Value of combined midbrain sonography, olfactory and motor function assessment in the differential diagnosis of early Parkinson's disease
Auteurs : Knut Busse [Allemagne] ; Robert Heilmann [Allemagne] ; Sabine Kleinschmidt [Allemagne] ; Mazen Abu-Mugheisib [Allemagne] ; Jacqueline Höppner [Allemagne] ; Christian Wunderlich [Allemagne] ; Irene Gemende [Allemagne] ; Lara Kaulitz [Allemagne] ; Alexander Wolters [Allemagne] ; Reiner Benecke [Allemagne] ; Uwe Walter [Allemagne]Source :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2012-04.
Abstract
Objective Characteristic features of Parkinson's disease (PD) are asymmetric parkinsonian motor signs, hyposmia and substantia nigra (SN) hyperechogenicity on transcranial ultrasound. However, each of these features has limited diagnostic value as they may be present, albeit less frequently, in other parkinsonian disorders. Here, the diagnostic sensitivity and specificity of combined assessment of these three features are evaluated. Methods 632 patients with parkinsonism (PD, vascular parkinsonism, atypical parkinsonian syndromes, essential tremor and major depressive disorder with motor slowing) were assessed on the Unified Parkinson's disease Rating Scale for motor asymmetry (right–left score difference ≥2), the 12 item Sniffin' Sticks test (SS-12) and transcranial ultrasound. The derivation (validation) cohort consisted of 517 (115) subjects (193 (35) women; age 65.4±9.6 (62.3±10.3) years) of whom 385 (68) had PD and 132 (47) non-PD parkinsonism; another 21 (6) subjects were not included due to missing transcranial insonability. Of the validation cohort, all patients had a disease duration ≤2 years and observers were blind to diagnoses. Results The optimum cut-off values for discrimination of PD were SS-12 score <8 (hyposmia) and SN echogenic size ≥0.24 cm2 (SN hyperechogenicity). Sensitivity, specificity and positive predictive values for the diagnosis of PD were as follows, for the derivation cohort: motor asymmetry 88%, 54% and 85%; hyposmia 75%, 70% and 88%; SN hyperechogenicity 90%, 63% and 88%; two features present 96%, 72% and 91%; three features present 57%, 94% and 97%; and for the validation cohort: two features present 91%, 77% and 85%; three features present 49%, 98% and 97%. Conclusion The combined assessment of motor asymmetry, hyposmia and SN hyperechogenicity improves diagnostic specificity and allows early diagnosis of PD.
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DOI: 10.1136/jnnp-2011-301719
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Höppner</name></author><author><name sortKey="Wunderlich, Christian" sort="Wunderlich, Christian" uniqKey="Wunderlich C" first="Christian" last="Wunderlich">Christian Wunderlich</name></author><author><name sortKey="Gemende, Irene" sort="Gemende, Irene" uniqKey="Gemende I" first="Irene" last="Gemende">Irene Gemende</name></author><author><name sortKey="Kaulitz, Lara" sort="Kaulitz, Lara" uniqKey="Kaulitz L" first="Lara" last="Kaulitz">Lara Kaulitz</name></author><author><name sortKey="Wolters, Alexander" sort="Wolters, Alexander" uniqKey="Wolters A" first="Alexander" last="Wolters">Alexander Wolters</name></author><author><name sortKey="Benecke, Reiner" sort="Benecke, Reiner" uniqKey="Benecke R" first="Reiner" last="Benecke">Reiner Benecke</name></author><author><name sortKey="Walter, Uwe" sort="Walter, Uwe" uniqKey="Walter U" first="Uwe" last="Walter">Uwe Walter</name></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno 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Mazen" sort="Abu Mugheisib, Mazen" uniqKey="Abu Mugheisib M" first="Mazen" last="Abu-Mugheisib">Mazen Abu-Mugheisib</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, University of Rostock, Rostock</wicri:regionArea><wicri:noRegion>Rostock</wicri:noRegion><wicri:noRegion>Rostock</wicri:noRegion></affiliation></author><author><name sortKey="Hoppner, Jacqueline" sort="Hoppner, Jacqueline" uniqKey="Hoppner J" first="Jacqueline" last="Höppner">Jacqueline Höppner</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Psychiatry and Psychotherapy, University of Rostock, Rostock</wicri:regionArea><wicri:noRegion>Rostock</wicri:noRegion><wicri:noRegion>Rostock</wicri:noRegion></affiliation></author><author><name sortKey="Wunderlich, Christian" sort="Wunderlich, Christian" uniqKey="Wunderlich C" first="Christian" last="Wunderlich">Christian Wunderlich</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Parkinson Clinic ‘Waldklinik Bernburg GmbH’, Bernburg</wicri:regionArea><wicri:noRegion>Bernburg</wicri:noRegion><wicri:noRegion>Bernburg</wicri:noRegion></affiliation></author><author><name sortKey="Gemende, Irene" sort="Gemende, Irene" uniqKey="Gemende I" first="Irene" last="Gemende">Irene Gemende</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Parkinson Clinic ‘Waldklinik Bernburg GmbH’, Bernburg</wicri:regionArea><wicri:noRegion>Bernburg</wicri:noRegion><wicri:noRegion>Bernburg</wicri:noRegion></affiliation></author><author><name sortKey="Kaulitz, Lara" sort="Kaulitz, Lara" uniqKey="Kaulitz L" first="Lara" last="Kaulitz">Lara Kaulitz</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, University of Rostock, Rostock</wicri:regionArea><wicri:noRegion>Rostock</wicri:noRegion><wicri:noRegion>Rostock</wicri:noRegion></affiliation></author><author><name sortKey="Wolters, Alexander" sort="Wolters, Alexander" uniqKey="Wolters A" first="Alexander" last="Wolters">Alexander Wolters</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, University of Rostock, Rostock</wicri:regionArea><wicri:noRegion>Rostock</wicri:noRegion><wicri:noRegion>Rostock</wicri:noRegion></affiliation></author><author><name sortKey="Benecke, Reiner" sort="Benecke, Reiner" uniqKey="Benecke R" first="Reiner" last="Benecke">Reiner Benecke</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, University of Rostock, Rostock</wicri:regionArea><wicri:noRegion>Rostock</wicri:noRegion><wicri:noRegion>Rostock</wicri:noRegion></affiliation></author><author><name sortKey="Walter, Uwe" sort="Walter, Uwe" 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type="istex">118E80CF4A0EB49CB4D6B6B931550341F37D28FE</idno><idno type="DOI">10.1136/jnnp-2011-301719</idno><idno type="href">jnnp-83-441.pdf</idno><idno type="ArticleID">jnnp-2011-301719</idno><idno type="PMID">22362921</idno><idno type="local">jnnp;83/4/441</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Objective Characteristic features of Parkinson's disease (PD) are asymmetric parkinsonian motor signs, hyposmia and substantia nigra (SN) hyperechogenicity on transcranial ultrasound. However, each of these features has limited diagnostic value as they may be present, albeit less frequently, in other parkinsonian disorders. Here, the diagnostic sensitivity and specificity of combined assessment of these three features are evaluated. Methods 632 patients with parkinsonism (PD, vascular parkinsonism, atypical parkinsonian syndromes, essential tremor and major depressive disorder with motor slowing) were assessed on the Unified Parkinson's disease Rating Scale for motor asymmetry (right–left score difference ≥2), the 12 item Sniffin' Sticks test (SS-12) and transcranial ultrasound. The derivation (validation) cohort consisted of 517 (115) subjects (193 (35) women; age 65.4±9.6 (62.3±10.3) years) of whom 385 (68) had PD and 132 (47) non-PD parkinsonism; another 21 (6) subjects were not included due to missing transcranial insonability. Of the validation cohort, all patients had a disease duration ≤2 years and observers were blind to diagnoses. Results The optimum cut-off values for discrimination of PD were SS-12 score <8 (hyposmia) and SN echogenic size ≥0.24 cm2 (SN hyperechogenicity). Sensitivity, specificity and positive predictive values for the diagnosis of PD were as follows, for the derivation cohort: motor asymmetry 88%, 54% and 85%; hyposmia 75%, 70% and 88%; SN hyperechogenicity 90%, 63% and 88%; two features present 96%, 72% and 91%; three features present 57%, 94% and 97%; and for the validation cohort: two features present 91%, 77% and 85%; three features present 49%, 98% and 97%. Conclusion The combined assessment of motor asymmetry, hyposmia and SN hyperechogenicity improves diagnostic specificity and allows early diagnosis of PD.</div></front></TEI><affiliations><list><country><li>Allemagne</li></country></list><tree><country name="Allemagne"><noRegion><name sortKey="Busse, Knut" sort="Busse, Knut" uniqKey="Busse K" first="Knut" last="Busse">Knut Busse</name></noRegion><name sortKey="Abu Mugheisib, Mazen" sort="Abu Mugheisib, Mazen" uniqKey="Abu Mugheisib M" first="Mazen" last="Abu-Mugheisib">Mazen Abu-Mugheisib</name><name sortKey="Benecke, Reiner" sort="Benecke, Reiner" uniqKey="Benecke R" first="Reiner" last="Benecke">Reiner Benecke</name><name sortKey="Gemende, Irene" sort="Gemende, Irene" uniqKey="Gemende I" first="Irene" last="Gemende">Irene Gemende</name><name sortKey="Heilmann, Robert" sort="Heilmann, Robert" uniqKey="Heilmann R" first="Robert" last="Heilmann">Robert Heilmann</name><name sortKey="Hoppner, Jacqueline" sort="Hoppner, Jacqueline" uniqKey="Hoppner J" first="Jacqueline" last="Höppner">Jacqueline Höppner</name><name sortKey="Kaulitz, Lara" sort="Kaulitz, Lara" uniqKey="Kaulitz L" first="Lara" last="Kaulitz">Lara Kaulitz</name><name sortKey="Kleinschmidt, Sabine" sort="Kleinschmidt, Sabine" uniqKey="Kleinschmidt S" first="Sabine" last="Kleinschmidt">Sabine Kleinschmidt</name><name sortKey="Walter, Uwe" sort="Walter, Uwe" uniqKey="Walter U" first="Uwe" last="Walter">Uwe Walter</name><name sortKey="Walter, Uwe" sort="Walter, Uwe" uniqKey="Walter U" first="Uwe" last="Walter">Uwe Walter</name><name sortKey="Wolters, Alexander" sort="Wolters, Alexander" uniqKey="Wolters A" first="Alexander" last="Wolters">Alexander Wolters</name><name sortKey="Wunderlich, Christian" sort="Wunderlich, Christian" uniqKey="Wunderlich C" first="Christian" last="Wunderlich">Christian Wunderlich</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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