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The Lancet:骑自行车可简单诊断帕金森氏症类型

来源:新华网 2011-01-10 09:34

荷兰研究人员不久前发现,能否骑自行车可以成为区别普通帕金森氏症和非典型帕金森氏症的简易方法。在一项试验中,大部分普通帕金森氏症患者还能骑自行车,而超过半数的非典型帕金森氏症患者丧失了这个能力。

荷兰奈梅亨大学的研究人员在新一期英国医学杂志《柳叶刀》(The Lancet)上报告说,他们请100多名帕金森氏症患者尝试骑自行车,然后与其实际医学诊断结果对照。结果发现,普通帕金森氏症患者中只有约4%的人不能骑自行车,而非典型帕金森氏症患者中有超过50%的人丧失了骑自行车的能力。

与普通帕金森氏症患者相比,非典型帕金森氏症患者往往在认知、记忆、动作协调能力等方面有更多问题,需要采取不同的治疗手段。研究人员说,骑自行车需要良好的平衡性和动作协调能力,因此非典型帕金森氏症患者往往会丧失这一能力。

据介绍,常规的帕金森氏症医学诊断,需要先给患者服用一系列针对普通帕金森氏症的药物,观察其反应。如这些药未显示出效果,再服用一系列针对非典型帕金森氏症的药物,再观察患者的生理反应,最终才能诊断出是那种类型。这一过程繁琐费事,有时还会耽误治疗时间,而通过骑自行车区别这个方法虽然并非100%准确,但简单易行,因此研究人员认为可将“骑车”诊断法与常规医学诊断配合使用。

帕金森氏症是一种常见于中老年人的神经系统疾病,主要症状是震颤、动作迟缓、肌肉僵硬等。(生物谷Bioon.com)

生物谷推荐原文出处:

The Lancet   doi:10.1016/S0140-6736(11)60018-4

The “bicycle sign” for atypical parkinsonism

MB Aerts a b, WF Abdo a c, BR Bloem a

Differentiation of Parkinson's disease from atypical parkinsonism is important clinically, for adequate patient counselling, and scientifically, to ascertain proper inclusion in clinical trials. The differential diagnosis remains challenging, even with current clinical insights and modern ancillary investigations.1 Here, we suggest that the answer to one simple question—“Can you still ride a bicycle?”—offers good diagnostic value for separating Parkinson's disease from atypical parkinsonism.

We did a prospective observational study in 156 consecutive patients with parkinsonism, but without a definitive diagnosis. At baseline, patients received a structured interview, comprehensive neurological assessment, and cerebral MRI. The interview included a standard question about whether, when, and why cycling had become impossible. The gold standard was the diagnosis after 3 years, which was based on the clinical follow-up including repeat neurological examination, response to treatment, and MRI. All assessments were done by a single, experienced examiner. All patients gave informed consent, as approved by the local ethics committee.

Before their first disease manifestation, 111 patients rode a bicycle (table). 45 went on to develop a gold-standard diagnosis of Parkinson's disease and 64 a form of atypical parkinsonism. At the time of inclusion (median disease duration 30 months), 34 of the 64 patients with atypical parkinsonism had stopped cycling, as opposed to only two of the 45 patients with Parkinson's disease (sensitivity 52%, specificity 96%; AUC 0·74, 95% CI 0·64—0·83). The loss of cycling abilities was present for all forms of atypical parkinsonism. Regression analysis revealed no significant effect of age, parkinsonism, or ataxia on the ability to cycle, suggesting that this was an independent marker of atypical parkinsonism.

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