Japanese

Title	Parkinson病とその類縁疾患の鑑別 : 画像と神経病理を中心に
Subtitle	特集 / メディカルスタッフレクチャー11
Authors	高橋牧郎**
Authors (kana)
Organization	**日本赤十字社大阪赤十字病院脳神経内科
Journal	神経治療学
Volume	36
Number	4
Page	404-409
Year/Month	2019 /
Article	報告
Publisher	日本神経治療学会
Abstract	「はじめに」 Parkinson病(Parkinson disease : PD)は静止時振戦, 無動, 筋強剛などの運動症状を呈し, levodopaが奏効するが, 他のPD関連疾患としばしば鑑別が困難な場合がある. PDでは, 発症以前より便秘, 発汗過多, 起立性低血圧などの自律神経症状, レム期睡眠行動異常症(REM sleep behavior disorder : RBD)などの睡眠障害, うつ, アパシーなどの精神症状, 嗅覚障害などの非運動症状を高率に合併することが知られており, 初発症状から判断つくことも多いが, しばしば非典型例に遭遇する. MRI画像検査や核医学検査, 血液, 髄液のα-synucleinをはじめとするバイオマーカーの測定などにより正診率は上昇するが, 進行期PDでは認知症を伴い, アミロイド病理を合併するなどoverlapした病態は臨床的にも問題となる. 本項ではPDと他のParkinson症候群の臨床症状, 画像, 病理学的な鑑別点となるtipsにつき, 症例を交えて概説する.
Practice	臨床医学：内科系
Keywords	Parkinson's disease, pathology, α-synuclein, neuroimaging, atypical parkinsonism

English

Title	Differentiation of Parkinson's disease and its related disorders from the view of neuroimaging and neuropathology
Subtitle
Authors	Makio TAKAHASHI
Authors (kana)
Organization	Department of Neurology, Japanese Red Cross Osaka Hospital
Journal	Neurological Therapeutics
Volume	36
Number	4
Page	404-409
Year/Month	2019 /
Article	Report
Publisher	Japanese Society of Neurological Therapeutics
Abstract	Parkinson's disease (PD) exhibits motor symptoms such as resting tremor, bradykinesia, and rigidity for which levodopa is successful, but often needs to be differentiated from other PD-related disorders resistant to levodopa. In PD, non-motor symptoms including autonomic symptoms such as constipation, hyperhidrosis, orthostatic hypotension, REM sleep behavior disorder (RBD), psychological symptoms such as depression and apathy, and olfactory dysfunction are merged at a high rate. Since non-motor symptoms develop before the onset of motor symptoms in PD, most of the PD cases are judged from the initial symptoms, however, atypical cases often encountered. Although conventional MRI do not show any abnormalities in PD, disappearance of nigrosome 1 can be confirmed by high magnetic field MRI susceptibility weighted images. Further, dopamine transporter scintigraphy (DaT-SPECT) is a sensitive for parkinsonism and iodine-123-metaiodobenzylguanidine (123I-MIBG) has higher specificity of PD diagnosis myocardial scintigraphy. However, the advanced stage of PD involves dementia with overlapping Aβ and tau pathology, leading to the mixed pathology of PDD/DLB which are clinically problematic. Differentiation from DLB, AD, PSP, CBD is also enabled by brain SPECT. Progress of these diagnostic tools is improving the correct diagnosis of PD, but quite a few familial PD and atypical cases exist. In this lecture, the tips as the clinical and pathological discrimination points of PD and other parkinsonian syndromes are outlined with specific cases. Further, not only various pathological background but also trauma and inflammation of the brain are required to consider the modifying factor for the diagnosis and treatment of PD.
Practice	Clinical internal medicine
Keywords	Parkinson's disease, pathology, α-synuclein, neuroimaging, atypical parkinsonism

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