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早期帕金森病亚型的分类方法。

Approaches to Early Parkinson's Disease Subtyping.

机构信息

Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.

Department of Nuclear Medicine & PET, Aarhus University Hospital, Aarhus, Denmark.

出版信息

J Parkinsons Dis. 2024;14(s2):S297-S306. doi: 10.3233/JPD-230419.


DOI:10.3233/JPD-230419
PMID:39331104
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11492007/
Abstract

Parkinson's disease (PD) unfolds with pathological processes and neurodegeneration well before the emergence of noticeable motor symptoms, providing a window for early identification. The extended prodromal phase allows the use of risk stratification measures and prodromal markers to pinpoint individuals likely to develop PD. Importantly, a growing body of evidence emphasizes the heterogeneity within prodromal and clinically diagnosed PD. The disease likely comprises distinct subtypes exhibiting diverse clinical manifestations, pathophysiological mechanisms, and patterns of α-synuclein progression in the central and peripheral nervous systems. There is a pressing need to refine the definition and early identification of these prodromal subtypes. This requires a comprehensive strategy that integrates genetic, pathological, imaging, and multi-omics markers, alongside careful observation of subtle motor and non-motor symptoms. Such multi-dimensional classification of early PD subtypes will improve our understanding of underlying disease pathophysiology, improve predictions of clinical endpoints, progression trajectory and medication response, contribute to drug discovery and personalized medicine by identifying subtype-specific disease mechanisms, and facilitate drug trials by reducing confounding effects of heterogeneity. Here we explore different subtyping methodologies in prodromal and clinical PD, focusing on clinical, imaging, genetic and molecular subtyping approaches. We also emphasize the need for refined, theoretical a priori disease models. These will be prerequisite to understanding the biological underpinnings of biological subtypes, which have been defined by large scale data-driven approaches and multi-omics fingerprints.

摘要

帕金森病(PD)在明显运动症状出现之前就已经有病理过程和神经退行性变,这为早期识别提供了机会。扩展的前驱期允许使用风险分层措施和前驱标志物来确定可能发展为 PD 的个体。重要的是,越来越多的证据强调了前驱期和临床诊断的 PD 中的异质性。该疾病可能包含不同的亚型,表现出不同的临床表现、病理生理机制以及中枢和外周神经系统中α-突触核蛋白进展的模式。因此,需要对这些前驱亚型进行更精细的定义和早期识别。这需要一个综合的策略,包括遗传、病理、影像学和多组学标志物,以及对细微运动和非运动症状的仔细观察。这种早期 PD 亚型的多维分类将改善我们对潜在疾病病理生理学的理解,提高对临床终点、进展轨迹和药物反应的预测,通过识别亚型特异性疾病机制为药物发现和个性化医学做出贡献,并通过减少异质性的混杂效应来促进药物试验。在这里,我们探讨了前驱期和临床 PD 中的不同亚型划分方法,重点关注临床、影像学、遗传和分子亚型划分方法。我们还强调需要细化、理论上的先验疾病模型。这些将是理解通过大规模数据驱动方法和多组学指纹定义的生物学亚型的生物学基础的前提。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac54/11492007/4f09c6c57108/jpd-14-jpd230419-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac54/11492007/e55dd294e3b8/jpd-14-jpd230419-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac54/11492007/4f09c6c57108/jpd-14-jpd230419-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac54/11492007/e55dd294e3b8/jpd-14-jpd230419-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac54/11492007/4f09c6c57108/jpd-14-jpd230419-g002.jpg

相似文献

[1]
Approaches to Early Parkinson's Disease Subtyping.

J Parkinsons Dis. 2024

[2]
Clinical criteria for subtyping Parkinson's disease: biomarkers and longitudinal progression.

Brain. 2017-7-1

[3]
Prodromal PD: A new nosological entity.

Prog Brain Res. 2020

[4]
The prodromes of Parkinson's disease.

Eur J Neurosci. 2018-12-5

[5]
Prodromal Parkinson disease subtypes - key to understanding heterogeneity.

Nat Rev Neurol. 2021-6

[6]
Ethical Considerations for Identifying Individuals in the Prodromal/Early Phase of Parkinson's Disease: A Narrative Review.

J Parkinsons Dis. 2024

[7]
Progression of clinical markers in prodromal Parkinson's disease and dementia with Lewy bodies: a multicentre study.

Brain. 2023-8-1

[8]
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Mol Med. 2021-9-16

[9]
Evolution of prodromal Parkinson's disease and dementia with Lewy bodies: a prospective study.

Brain. 2019-7-1

[10]
Prodromal features for Parkinson's disease--baseline data from the TREND study.

Eur J Neurol. 2014-5

引用本文的文献

[1]
Hot Topics and Frontiers of Resting-State fMRI in Parkinson's Disease: Research Trends and Paradigm Shifts From a Bibliometric Perspective.

Parkinsons Dis. 2025-8-7

[2]
Redefining Non-Motor Symptoms in Parkinson's Disease.

J Pers Med. 2025-4-26

[3]
Introduction: The Earliest Phase of Parkinson's Disease: Possibilities for Detection and Intervention.

J Parkinsons Dis. 2024

本文引用的文献

[1]
A biological classification of Parkinson's disease: the SynNeurGe research diagnostic criteria.

Lancet Neurol. 2024-2

[2]
A biological definition of neuronal α-synuclein disease: towards an integrated staging system for research.

Lancet Neurol. 2024-2

[3]
Transitioning from Subtyping to Precision Medicine in Parkinson's Disease: A Purpose-Driven Approach.

Mov Disord. 2024-3

[4]
Impaired cholinergic integrity of the colon and pancreas in dementia with Lewy bodies.

Brain. 2024-1-4

[5]
Cholinergic innervation topography in GBA-associated de novo Parkinson's disease patients.

Brain. 2024-3-1

[6]
Severe cholinergic terminal loss in newly diagnosed dementia with Lewy bodies.

Brain. 2023-9-1

[7]
Combining skin and olfactory α-synuclein seed amplification assays (SAA)-towards biomarker-driven phenotyping in synucleinopathies.

NPJ Parkinsons Dis. 2023-5-29

[8]
Dopaminergic Dysfunction Is More Symmetric in Dementia with Lewy Bodies Compared to Parkinson's Disease.

J Parkinsons Dis. 2023

[9]
A Phase 1B Trial in GBA1-Associated Parkinson's Disease of BIA-28-6156, a Glucocerebrosidase Activator.

Mov Disord. 2023-7

[10]
The brain-first vs. body-first model of Parkinson's disease with comparison to alternative models.

J Neural Transm (Vienna). 2023-6

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