"Hand tremor" suspected Parkinson's disease? Diagnostic criteria see here!

For medical professionals only

Parkinson's disease (PD) is a common middle-aged and elderly neurodegenerative disease, usually 40~70 years old, male slightly more insidious onset, slow
onset.
With the growth of China's middle-aged and elderly population, the number of Parkinson's disease patients will continue to rise
in the future.

Tremor is a major clinical feature of PD, so many patients will report symptoms of "hand tremor" when they come to the doctor, worrying about whether they have Parkinson's disease
.
PD≠ hand tremor, as a front-line clinical doctor, how to correctly grasp the diagnostic criteria? Let's take a look!

➤1.
Core symptoms: Parkinson's disease

Parkinson's disease
can be diagnosed with bradykinesia, plus one of the two symptoms of resting tremor (4~6Hz) and/or rigidity.

➤2.
Clinically diagnosed Parkinson's disease:

• There are no absolute exclusion criteria and warning
  signs.
  

• At least 2 supporting standards
  .
  

➤ 3.
Clinically likely Parkinson's disease:

• There is no absolute exclusion criterion
  .
  

• The number of supported standards is greater than the number of
  warning signs.
  

• No more than 2 warning signs
  .
  

➤ 4.
Support standards:

4.
1 Definite and significant efficacy
in dopaminergic therapy.
During initial treatment, the patient's function returns to normal or near-normal levels
.
In the absence of clear documentation of initial treatment, significant efficacy includes:

• Symptom improvement is related to drug dose, documented by objective assessment [Unified Parkinson's Disease Rating Scale (UPDRS) III score improvement >30%] or subjective assessment (a clear record of credible significant changes provided by the patient or caregiver), and mild symptoms are not indicative
  .
  

• Significant "on-off" phase fluctuates in symptoms and, to some extent, includes predictable end-of-dose phenomena
  .
  

Note: The phenomenon of "on-off" refers to the fluctuation of symptoms between sudden relief (opening period) and exacerbation (closing period), which is unpredictable regardless of the time and blood concentration of medication
.
The end-of-dose phenomenon means that the time to maintain the effect of the drug is getting shorter and shorter after each dose, and the symptoms of Parkinson's disease will worsen in the later stage of each dose, and the symptoms will gradually improve until they take the drug again
.

4.
2 Presence of levodopa-induced dyskinesia
.

4.
3 Resting tremor
of a single limb in the past or present physical examination.

4.
4 Presence of anosmia, or abnormal hyperechoic (>20^mm2) or MIBG scintigraphy on brain ultrasound, suggests cardiac sympathetic innervation
.

What are the diagnostic criteria for major diseases?

What are the preferred therapeutic drugs and regimens?

What clinical signs and symptoms are prioritized for diagnosing a disease?

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