Identifying prodromal Parkinson's disease: Pre‐Motor disorders in Parkinson's disease

Abstract

Abstract Increasing recognition that Parkinson's disease (PD) may start outside of the substantia nigra has led to a rapidly expanding effort to define prodromal stages of PD, before motor signs permit classical diagnosis. Many of these efforts center around the identification of clinical non‐motor symptoms and signs of disease. There is now direct evidence that olfaction, rapid eye movement (REM) sleep behavior disorder (RBD), constipation, and depression can be present in prodromal PD. In addition, there is suggestive evidence that visual changes, other autonomic symptoms, and subtle cognitive changes may also be present at prodromal stages. A critical issue in utility of these prodromal markers will be assessment of sensitivity, specificity, and positive and negative predictive values. Although these have yet to be fully defined, olfactory deficits, some visual changes, and autonomic symptoms occur in the majority of PD patients at diagnosis, suggesting good potential sensitivity. However, with the exception of RBD and perhaps some specific autonomic measures, specificity, and positive predictive value of these markers may be insufficient to be used alone as identifiers of prodromal disease. The evidence for the utility of olfaction, RBD, autonomic markers, visual changes, mood disorders, and cognitive loss as markers of prodromal PD and the potential sensitivity and specificity of these markers are summarized. © 2012 Movement Disorder Society

Keywords

Affiliated Institutions

• University of Salerno IT
• Klinik und Poliklinik für Psychotherapie und Psychosomatik DE
• McGill University CA
• Newcastle Hospitals - Campus for Ageing and Vitality GB
• Philipps University of Marburg DE
• Stavanger University Hospital
• Technische Universität Dresden DE
• Newcastle University GB
• Hôpital du Sacré-Cœur de Montréal CA
• Queen Mary University of London GB
• Canadian Sleep & Circadian Network CA
• Montreal General Hospital CA

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