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Chapter 18 - Prodromal Manifestations of Parkinson’s Disease

from Section 2: - Hypokinetic Movement Disorders

Published online by Cambridge University Press:  07 January 2025

By
Heinz Reichmann  and
Wolfgang H. Jost
Edited by
Erik Ch. Wolters  and
Christian R. Baumann
Erik Ch. Wolters
Affiliation:
Universität Zürich
Christian R. Baumann
Affiliation:
Universität Zürich
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Summary

In recent years, careful clinical analyses of Parkinson’s disease (PD) patients showed that the neuropathologic hallmarks in PD are Lewy bodies, mainly containing alpha-synuclein. It nowadays seems likely that abnormal alpha-synuclein travels from the gut (and maybe also the olfactory bulb) to the brain, and spreads in various brain regions before affecting the dopaminergic system in the substantia nigra (the premotor or prodromal phase). In this chapter, features of this prodromal phase in PD, enabling early diagnosis, which is relevant when disease-modifying interventions such as antibodies against misfolded alpha-synuclein become available, are discussed. Starting points for detecting and diagnosing prodromal PD are mainly prodromal markers. The highest risk for later development of PD is found for otherwise healthy patients suffering REM sleep behavioral disorders, with a 130-fold increased risk, followed by abnormal PET/SPECT analyses of the dopaminergic system, subthreshold parkinsonism, olfactory loss, neurogenic hypotension, erectile dysfunction, constipation, and depression, among others.

Keywords

Prodromal PDprodromal markersREM sleep behavioral disorderolfactory losserectile dysfunction
Type
Chapter
Information
International Compendium of Movement Disorders , pp. 212 - 220
Publisher: Cambridge University Press
Print publication year: 2025

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