前驱期
医学
神经退行性变
疾病
快速眼动睡眠行为障碍
病态的
帕金森病
神经影像学
运动障碍
神经保护
神经科学
前驱症状
病理
痴呆
内科学
精神科
心理学
精神病
作者
Daniela Berg,Per Borghammer,Seyed‐Mohammad Fereshtehnejad,Sebastian Heinzel,Jacob Horsager,Eva Schaeffer,Ronald B. Postuma
标识
DOI:10.1038/s41582-021-00486-9
摘要
In Parkinson disease (PD), pathological processes and neurodegeneration begin long before the cardinal motor symptoms develop and enable clinical diagnosis. In this prodromal phase, risk and prodromal markers can be used to identify individuals who are likely to develop PD, as in the recently updated International Parkinson and Movement Disorders Society research criteria for prodromal PD. However, increasing evidence suggests that clinical and prodromal PD are heterogeneous, and can be classified into subtypes with different clinical manifestations, pathomechanisms and patterns of spatial and temporal progression in the CNS and PNS. Genetic, pathological and imaging markers, as well as motor and non-motor symptoms, might define prodromal subtypes of PD. Moreover, concomitant pathology or other factors, including amyloid-β and tau pathology, age and environmental factors, can cause variability in prodromal PD. Patients with REM sleep behaviour disorder (RBD) exhibit distinct patterns of α-synuclein pathology propagation and might indicate a body-first subtype rather than a brain-first subtype. Identification of prodromal PD subtypes and a full understanding of variability at this stage of the disease is crucial for early and accurate diagnosis and for targeting of neuroprotective interventions to ensure efficacy.
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