University of Toronto, Toronto, Ontario, Canada.
Mov Disord. 2011 Apr;26(5):775-83. doi: 10.1002/mds.23609. Epub 2011 Apr 11.
The neurodegenerative process is well established in Parkinson patients presenting to a physician with early motor signs. There is increasing evidence that a variety of nonmotor features can antedate the typical presentation by many years. As the search for successful disease-modifying treatment advances, it is logical to consider how this could be applied to patients in the earliest stages of the disease, indeed before motor features develop, with the obvious goal of delaying and even preventing the onset of the motor syndrome. However, many of these nonmotor symptoms are rather nonspecific and are not uncommon in the general population. Being able to identify individuals in whom these features are more likely to represent true premotor Parkinson's disease represents a major challenge. Until widely applicable and reliable biomarkers for the presence of Parkinson's disease-related pathology are developed (including biomarkers of disease severity and rate of progression), further evaluation of possible premotor features in selected populations will probably serve as the basis for future studies of disease-modifying therapies. This article will review the current status of premotor symptoms of Parkinson's disease and discuss their potential for early diagnosis and the design of neuroprotective trials.
在出现早期运动迹象的帕金森病患者中，神经退行性过程已得到充分证实。越来越多的证据表明，各种非运动特征可能会早于典型表现出现多年。随着寻找成功的疾病修饰治疗方法的进展，考虑如何将其应用于疾病的最早阶段的患者，甚至在运动特征出现之前，以延迟甚至预防运动综合征的发生，这是合乎逻辑的。然而，这些非运动症状中的许多都相当非特异性，在普通人群中也很常见。能够识别出这些特征更可能代表真正的前驱性帕金森病的个体是一项重大挑战。在广泛适用且可靠的帕金森病相关病理存在的生物标志物（包括疾病严重程度和进展速度的生物标志物）开发出来之前，在选定的人群中进一步评估可能的前驱特征可能将作为未来疾病修饰治疗研究的基础。本文将回顾帕金森病前驱症状的现状，并讨论其在早期诊断和神经保护试验设计中的潜力。
