Premotor Parkinson's disease: concepts and definitions.
Premotor Parkinson's disease: concepts and definitions.
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DOI：
10.1002/mds.24954
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发表时间：
2012-04-15
影响因子：
8.6
通讯作者：
Lang, Anthony E.
中科院分区：
文献类型：
--
作者：
Siderowf, Andrew;Lang, Anthony E.
帕金森氏病（PD）有一个前驱期，在此期间可能存在非运动临床特征以及生理异常。这些运动前标志物可用于在运动异常存在之前筛查PD。在PD达到Braak 3期症状（黑质致密部（SNc）受累）之前识别PD的技术已经存在。目前的挑战是确定PD预测性检测的适当使用范围。成像技术，如多巴胺转运蛋白成像，目前提供了最高程度的准确性，以确定运动前PD，但他们是昂贵的筛查工具和异常，这些研究将只在布拉克阶段3或更高的明显。通过将成像与预筛选测试（如嗅觉测试）相结合，大大提高了效率。这两步过程有可能大大降低成本，同时保持诊断准确性。或者，或与这种方法相一致，评估高风险人群（例如，快速眼动行为障碍（RBD）或LRRK2突变患者）将丰富潜在PD病例的样本。最终，PD临床前检测的作用将取决于新兴疗法影响临床结局的能力。因此，大规模筛查策略的实施等待明确安全有效的治疗方法的到来，这些治疗方法可以解决PD的潜在发病机制。未来的研究将建立更明确的生物标志物，能够在SNc参与之前揭示疾病的存在，并有可能在多巴胺缺乏症的证据出现之前引入疾病修饰疗法。
Parkinson’s disease (PD) has a prodromal phase during which non-motor clinical features as well as physiological abnormalities may be present. These pre-motor markers could be used to screen for PD before motor abnormalities are present. The technology to identify PD before it reaches symptomatic Braak Stage 3 (substantia nigra compacta (SNc) involvement) already exists. The current challenge is to define the appropriate scope of use of predictive testing for PD. Imaging technologies, like dopamine transporter imaging, currently offer the highest degree of accuracy for identifying pre-motor PD, but they are expensive as screening tools and abnormalities on these studies would only be evident at Braak Stage 3 or higher. Efficiency is greatly enhanced by combining imaging with a pre-screening test, such as olfactory testing. This two-step process has the potential to greatly reduce costs while retaining diagnostic accuracy. Alternatively, or in concert with this approach, evaluating high-risk populations (e.g. patients with rapid eye movement behavior disorder (RBD) or LRRK2 mutations) would enrich the sample for cases with underlying PD. Ultimately, the role of pre-clinical detection of PD will be determined by the ability of emerging therapies to influence clinical outcomes. As such, implementation of large-scale screening strategies awaits the arrival of clearly safe and effective therapies that address the underlying pathogenesis of PD. Future research will establish more definitive biomarkers capable of revealing the presence of disease in advance of SNc involvement with the promise of the potential for introducing disease modifying therapy even before the development of evidence for dopamine deficiency.
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影响因子：
4.8
作者：
Boeve, Bradley F.;Molano, Jennifer R.;Ferman, Tanis J.;Smith, Glenn E.;Lin, Siong-Chi;Bieniek, Kevin;Haidar, Wael;Tippmann-Peikert, Maja;Knopman, David S.;Graff-Radford, Neill R.;Lucas, John A.;Petersen, Ronald C.;Silber, Michael H.
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通讯作者：
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通讯作者：
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作者：
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通讯作者：
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影响因子：
9.9
作者：
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通讯作者：
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