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Premotor Parkinson's disease: Clinical features and detection strategies

Authors

  • Randolph Stephenson MD,

    Corresponding author
    1. Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennysylvania, USA
    • Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, 330 South 9th Street, Philadelphia, Pennsylvania 19107
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  • Andrew Siderowf MD, MSCE,

    1. Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennysylvania, USA
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  • Matthew B. Stern MD

    1. Parkinson's Disease and Movement Disorders Center, Department of Neurology, University of Pennsylvania, Philadelphia, Pennysylvania, USA
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  • Potential conflict of interest: None reported.

Abstract

In many areas of medicine, the focus has shifted from treating existing disease to screening and prevention. The technology to screen for Parkinson's disease (PD) already exists. The current challenge is to define the appropriate use of predictive testing for PD. Imaging technologies currently offer the highest degree of accuracy for identifying premotor PD, but they are expensive as screening tools. Efficiency is greatly enhanced by combining imaging with a prescreening test, such as olfactory testing. This two-step process has the potential to greatly reduce costs while retaining diagnostic accuracy. Ultimately, the role of preclinical 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. Current research to evaluate efficient screening methods and to understand the clinical and physiological features of “premotor” PD will lay the foundation for the screening and prevention strategies of the future. © 2008 Movement Disorder Society

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