帕金森病临床与运动前期的识别与诊断

The identification and diagnosis of preclinical and premotor Parkinson＇s disease

帕金森病是老年人中最常见的运动障碍疾病，其主要的临床表现包括静止性震颤、运动缓慢、肌强直和姿势异常为主的运动症状及嗅觉减退、便秘、睡眠障碍和抑郁为主的非运动症状。近年来关于帕金森病的Braak病理分级学说革新了既往对帕金森病临床和病理关系的认识。以快速眼球运动睡眠期行为障碍、嗅觉减退、便秘、抑郁为主的非运动症状可在帕金森病运动症状出现之前数十年就出现。还有一些学者提出了帕金森病风险综合征金字塔模型对帕金森病运动症状前的疾病阶段进行描述，该模型可反映帕金森病的客观演变进程。我们对帕金森病风险综合征金字塔模型的分期及其在帕金森病早期诊断中的价值进行了探讨。

Parkinson＇s disease is the most common movement disorder in elderly with clinical manifestations characterized by motor symptoms, such as static tremor, bradykinesia, rigidity, and postural disturbance, and non-motor symptoms, including hyposmia, constipation, sleep disorder, and depression. Recently, progress has been achieved in the research of Parkinson＇s disease, especially the hypothesis of Braak stage about the associations between clinical manifestations and disease pathology. It has been admitted that non-motor symptoms, including rapid eye movement sleep behavior disorder, hyposmia, constipation, and depression could occur decades preceding the appearance of clinical symptoms. Simultaneously, some scholars proposed ＂Parkinson＇s disease at risk syndrome＂ pyramidal model to describe the period before the diagnosis, which was considered to reflect the objective evolution of the disease. In this commentary, we discussed the stages of ＂Parkinson＇s disease at risk syndrome＂ model and their value for early diagnosis of Parkinson＇s disease.