Progress and Prospects in Parkinson's Research/Atypical Parkinsonism
A range of overlapping neurological conditions with similar symptoms gives rise to frequent diagnostic problems.
The following table identifies some common neurological disorders, their 'trademark' pathological characteristics, and the parts of the CNS affected
|Alzheimer's disease||Amyloid plaques, Neurofibrillary tangles||Cerebral cortex, Hippocampus,Basal nucleus of Meynert|
|Corticobasal degeneration||Ballooned neurons with tau inclusions||Cerebral cortex,Basal ganglia|
|Lewy body dementia||Lewy bodies||Cerebral cortex, Basal ganglia, Basal nucleus of Meynert|
|Multiple system atrophy||Alpha-synuclein inclusions||Hindbrain structures involved in balance and autonomic functions|
|Parkinson's disease||Lewy bodies||Substantia nigra, Dorsal nucleus of vagus,Basal nucleus of Meynert|
|Progressive supranuclear palsy||Neurofibrillary tangles||Cerebral cortex, Basal ganglia, Spinal cord, Midbrain|
|Vascular dementia||Vascular infarctions,||Cerebral cortex, Hippocampus|
Hughes et al  re-evaluated 100 patients diagnosed prospectively by a group of consultant neurologists as having idiopathic Parkinson's disease .
In 24 cases without Lewy bodies, diagnoses included progressive supranuclear palsy, multiple system atrophy, Alzheimer's disease, Alzheimer-type pathology, and basal ganglia vascular disease. The retrospective application of recommended diagnostic criteria improved the diagnostic accuracy to 82%. These observations call into question current concepts of Parkinson's disease as a single distinct morbid entity.
Yekhief et al  evaluated the use of MRI scans in the diagnosis of PD and PD+ syndromes.
The “cortical” score distinguished CBD and PSP from MSA with a fair PPV (>90%). The PPV of the “putaminal” score was high (70%) for the differential diagnosis of MSA with PSP and CBD. The “midbrain” score was significantly higher in PSP and CBD compared to MSA. These results are in accordance with the underlying pathology found in these disorders and demonstrate that a simple MRI scoring procedure may help the neurologist to differentiate primary causes of parkinsonism in everyday practice.
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- Hughes, A.J.; Daniel, S.E.: Kilford, L. and Lees, A.J. (1992) Abstract J Neurol Neurosurg Psychiatry 55: (3) 181-184 Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. http://jnnp.bmj.com/content/55/3/181.short
- Yekhief, F.; Ballan, G.: Macia, F.; Delmer, O.; Sourgen, C. and Tison, F. Ful Te(2003)Full Text J. of Neur. Transm.110(2) 151-169 Routine MRI for the differential diagnosis of Parkinson's disease, MSA, PSP, and CBD http://www.springerlink.com/content/rk1v1eeq1a23ry08/