Department of Neurology, Christian-Albrechts University, Kiel, Germany.
Department of Neurology, Christian-Albrechts University, Kiel, Germany.
Parkinsonism Relat Disord. 2020 Dec;81:213-218. doi: 10.1016/j.parkreldis.2020.10.003. Epub 2020 Oct 5.
The clinical diagnosis of Parkinson's disease (PD) based on motor signs is often preceded by several non-motor symptoms that can indicate early prodromal neurodegenerative processes. Such prodromal symptoms can aid the early detection of PD, but their specificity for prodromal PD in comparison to prodromes of other movement disorders is still largely unclear. We here aim to give a first insight into the published evidence of prodromal non-motor symptoms in PD, dementia with Lewy bodies (DLB), multiple system atrophy (MSA), Huntington's disease (HD), progressive supranuclear palsy (PSP) and spinocerebellar ataxia (SCA). REM-sleep behavior disorder (RBD) and autonomic dysfunction have been observed in the prodromes of PD, MSA, DLB and SCA. Depression and cognitive decline have been reported for prodromal PD, DLB, HD, SCA, and PSP. Olfactory loss has only been described in prodromal PD/DLB. However, estimating the specificity of prodromal non-motor symptoms in PD is so far complicated by scarce prospective evidence and study limitations. Information on marker specificity is a prerequisite for an accurate early (differential) diagnosis of prodromal diseases, as well as specific recruitment for targeted neuroprotective interventions. We here would like to raise awareness of these issues and encourage further prospective research of prodromal non-motor symptoms in neurodegenerative movement disorders and other diseases.
基于运动迹象的帕金森病 (PD) 的临床诊断通常先于几种非运动症状,这些症状可以表明早期的神经退行性前病变过程。这些前驱症状可以帮助早期发现 PD,但它们在 PD 前驱期与其他运动障碍前驱期相比的特异性仍然很大程度上不清楚。我们旨在首次深入了解 PD、路易体痴呆 (DLB)、多系统萎缩 (MSA)、亨廷顿病 (HD)、进行性核上性麻痹 (PSP) 和脊髓小脑共济失调 (SCA) 的前驱期非运动症状的已发表证据。在 PD、MSA、DLB 和 SCA 的前驱期观察到 REM 睡眠行为障碍 (RBD) 和自主功能障碍。前驱性 PD、DLB、HD、SCA 和 PSP 报告了抑郁和认知能力下降。嗅觉丧失仅在 PD/DLB 的前驱期描述过。然而,迄今为止,估计 PD 前驱期非运动症状的特异性受到前瞻性证据和研究局限性的困扰。关于标志物特异性的信息是对前驱性疾病进行准确早期(鉴别)诊断的前提,也是对有针对性的神经保护干预措施进行特定招募的前提。我们希望引起对这些问题的关注,并鼓励对神经退行性运动障碍和其他疾病的前驱期非运动症状进行进一步的前瞻性研究。