Frühe Diagnostik des idiopathischen Parkinson-Syndroms
Frühe Diagnostik des idiopathischen Parkinson-Syndroms
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Original abstract
There is an increasing body of literature on possible substances which may offer disease modification for Parkinson's disease (PD). To name a few, rasagiline, selegiline, dopamine agonists and amantadine may possibly be disease-modifying substances. If this holds true, it becomes necessary and rewarding to diagnose PD earlier than is so far the case. So far, we have treated patients only if they felt impaired by the disease, i. e., by symptoms such as bradykinesia or tremor. We strongly believe that hyposmia is the first clinical marker for PD. At least 90 % of all PD patients suffer from hyposmia, many of them without having noticed it. This large number of hyposmic patients influenced us to introduce hyposmia as the fifth cardinal symptom. REM sleep disturbance is another early clinical symptom but it is certainly less often seen in PD patients than hyposmia. Abnormalities in hand writing are another early clinical sign since most patients develop due to their rigidity a smaller and less clearly readable typeface (micrographia). Another less characteristic symptom is pain in the shoulder girdle, which is also a symptom caused by muscular rigidity. The Farmsworth test is good to objectify problems in colour discrimination. A reduced arm swing and hypomimia are additional early clinical symptoms. Taken together, in our view, hyposmia is the most useful early clinical marker to detect imminent PD. Less specific is depression which occurs in up to 30 % prior to the motor symptoms. The same is true for constipation.