Premotor Parkinson's disease: Clinical features, detection, and prospects for treatment
Identifieur interne : 000E96 ( Main/Corpus ); précédent : 000E95; suivant : 000E97Premotor Parkinson's disease: Clinical features, detection, and prospects for treatment
Auteurs : Andrew Siderowf ; Matthew B. SternSource :
- Annals of Neurology [ 0364-5134 ] ; 2008-12.
Abstract
The period immediately before the onset of motor symptoms of Parkinson's disease (PD) often has a recognizable phenotype with features including autonomic dysfunction and impaired olfaction. Subclinical dopaminergic cell loss can also be detected at this time using molecular imaging techniques. A greater recognition of the features of premotor PD and improvements in screening technologies have opened the possibility of predictive testing for PD. In addition to molecular imaging of the dopamine system, screening tests that can potentially be used to identify the physiological abnormalities in premotor PD include olfactory testing, imaging of the sympathetic innervation of the heart, transcranial ultrasound, and genetic testing for mutations known to cause hereditary PD. All of these technologies have trade‐offs as screening tests for accuracy, availability, and costs. Using these tests in combination may produce a more favorable combination of reasonable cost and accuracy than using any single test alone. Ultimately, the value of screening for PD depends on development of neuroprotective treatments for PD that would create an imperative for early identification and treatment. Ann Neurol 2008;64 (suppl):S139–S147
Url:
DOI: 10.1002/ana.21462
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ISTEX:5341BF0D9691240B11E22FE2E30386C28C0EE4A4Le document en format XML
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In addition to molecular imaging of the dopamine system, screening tests that can potentially be used to identify the physiological abnormalities in premotor PD include olfactory testing, imaging of the sympathetic innervation of the heart, transcranial ultrasound, and genetic testing for mutations known to cause hereditary PD. All of these technologies have trade‐offs as screening tests for accuracy, availability, and costs. Using these tests in combination may produce a more favorable combination of reasonable cost and accuracy than using any single test alone. Ultimately, the value of screening for PD depends on development of neuroprotective treatments for PD that would create an imperative for early identification and treatment. 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href="#fn1"></link></title><title type="short" xml:lang="en">Premotor Parkinson's Disease</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1 #af2 #af3" corresponding="yes"><personName><givenNames>Andrew</givenNames><familyName>Siderowf</familyName><degrees>MD, MSCE</degrees></personName><contactDetails><email>siderowa@pahosp.com</email></contactDetails></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1 #af2 #af3"><personName><givenNames>Matthew B.</givenNames><familyName>Stern</familyName><degrees>MD</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="US" type="organization"><unparsedAffiliation>Parker Family Professor of Neurology Director, Parkinson's Disease and Movement Disorder Center, University of Pennsylvania</unparsedAffiliation></affiliation><affiliation xml:id="af2" countryCode="US" type="organization"><unparsedAffiliation>Parkinson's Disease and Movement Disorders Center, University of Pennsylvania, Philadelphia, PA</unparsedAffiliation></affiliation><affiliation xml:id="af3" countryCode="US" type="organization"><unparsedAffiliation>330 South 9th St., Philadelphia, PA 19107</unparsedAffiliation></affiliation></affiliationGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>The period immediately before the onset of motor symptoms of Parkinson's disease (PD) often has a recognizable phenotype with features including autonomic dysfunction and impaired olfaction. Subclinical dopaminergic cell loss can also be detected at this time using molecular imaging techniques. A greater recognition of the features of premotor PD and improvements in screening technologies have opened the possibility of predictive testing for PD. In addition to molecular imaging of the dopamine system, screening tests that can potentially be used to identify the physiological abnormalities in premotor PD include olfactory testing, imaging of the sympathetic innervation of the heart, transcranial ultrasound, and genetic testing for mutations known to cause hereditary PD. All of these technologies have trade‐offs as screening tests for accuracy, availability, and costs. Using these tests in combination may produce a more favorable combination of reasonable cost and accuracy than using any single test alone. Ultimately, the value of screening for PD depends on development of neuroprotective treatments for PD that would create an imperative for early identification and treatment. Ann Neurol 2008;64 (suppl):S139–S147</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p>Potential conflicts of interest: This article is part of a supplement sponsored by Boehringer Ingelheim (BI). A.S. has received consulting fees and speaking honoraria from BI. A.S. has also received honoraria from Teva and Merck Serano. M.S. has received speaking and consulting honoraria from BI. 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Subclinical dopaminergic cell loss can also be detected at this time using molecular imaging techniques. A greater recognition of the features of premotor PD and improvements in screening technologies have opened the possibility of predictive testing for PD. In addition to molecular imaging of the dopamine system, screening tests that can potentially be used to identify the physiological abnormalities in premotor PD include olfactory testing, imaging of the sympathetic innervation of the heart, transcranial ultrasound, and genetic testing for mutations known to cause hereditary PD. All of these technologies have trade‐offs as screening tests for accuracy, availability, and costs. Using these tests in combination may produce a more favorable combination of reasonable cost and accuracy than using any single test alone. Ultimately, the value of screening for PD depends on development of neuroprotective treatments for PD that would create an imperative for early identification and treatment. Ann Neurol 2008;64 (suppl):S139–S147</abstract><note type="content">*Potential conflicts of interest: This article is part of a supplement sponsored by Boehringer Ingelheim (BI). A.S. has received consulting fees and speaking honoraria from BI. A.S. has also received honoraria from Teva and Merck Serano. M.S. has received speaking and consulting honoraria from BI. 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