Chẩn đoán phân biệt
Parkinsons Disease and Dementia_Differential DiagnosisRed Flags
Potential signs that would indicate alternate pathology, although with low specificity, include:
- Gait impairment that has rapid progression within 5 years onset
- Absence of motor symptoms progression or signs for ≥5 years
- Presence of early bulbar dysfunction (severe dysphonia/dysarthria/dysphagia) within first 5 years
- Presence of inspiratory respiratory dysfunction
- Presence of severe autonomic failure in the initial 5 years of the disease
- Fall that is recurrent or more than once a year due to impaired balance within 3 years of onset
- Presence of disproportionate anterocollis or contractures of hand or feet within the first 10 years
- Despite the 5-year duration of the disease, there is absence of any common nonmotor features of Parkinson’s disease
- Presence of pyramidal weakness or clear pathologic hyperreflexia
- Presence of bilateral symmetric parkinsonism with no side predominance
Absolute Exclusion Criteria
- Presence of unequivocal abnormalities of the cerebellum (eg cerebellar gait, limb ataxia or cerebellar oculomotor abnormalities)
- Presence of downward vertical supranuclear gaze palsy or selective slowing of downward vertical saccades
- In the initial 5 years of the disease there is a diagnosis of probable behavioral variant frontotemporal dementia or primary progressive aphasia
- For >3 years parkinsonian features are restricted to the lower limbs
- Presence of current or within the past year treatment with a dopamine receptor blocker or a dopamine-depleting agent in a dose and time-course consistent with drug-induced parkinsonism
- There is no observable response to high-dose Levodopa despite at least moderate severity of disease
- Presence of unequivocal cortical sensory loss, clear limb ideomotor apraxia or progressive aphasia
- Neuroimaging shows normal function of the presynaptic dopaminergic system
There is a documentation of the presence of an alternative condition known to produce parkinsonism that can be connected to the patient’s symptoms.