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Premotor Parkinson's disease: Clinical features, detection, and prospects for treatment

Authors

  • Andrew Siderowf MD, MSCE,

    Corresponding author
    1. Parker Family Professor of Neurology Director, Parkinson's Disease and Movement Disorder Center, University of Pennsylvania
    2. Parkinson's Disease and Movement Disorders Center, University of Pennsylvania, Philadelphia, PA
    3. 330 South 9th St., Philadelphia, PA 19107
    • Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, 330 South 9th Street, Philadelphia, PA 19107
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  • Matthew B. Stern MD

    1. Parker Family Professor of Neurology Director, Parkinson's Disease and Movement Disorder Center, University of Pennsylvania
    2. Parkinson's Disease and Movement Disorders Center, University of Pennsylvania, Philadelphia, PA
    3. 330 South 9th St., Philadelphia, PA 19107
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  • 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. M.S. has held consulting relationships with Teva, NuPathe, Vernalis, and Novartis.

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

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