Schröter Nils, Groppa Sergiu, Rijntjes Michel, Gonzalez-Escamilla Gabriel, Urbach Horst, Jost Wolfgang H, Rau Alexander
Department of Neurology, Saarland University Medical Center, Building 90, Kirrberger Straße, 66421, Homburg, Germany.
Department of Neurology and Clinical Neuroscience, Medical Center, Faculty of Medicine, University of Freiburg, University of Freiburg, Freiburg, Germany.
J Neural Transm (Vienna). 2025 May 12. doi: 10.1007/s00702-025-02942-y.
Advanced Parkinson's disease (APD) represents a late stage of Parkinson's disease and is characterized by complex motor and non-motor symptoms that are less responsive to oral dopaminergic therapies. While APD has a relevant impact on patients' quality of life and requires intensified treatment, consistent diagnostic criteria have only recently been proposed. The precise pathophysiology underlying the symptoms of APD remains poorly understood, making early prognostication and intervention difficult. Neuroimaging has emerged as a promising tool for elucidating the mechanisms driving APD, identifying biomarkers for disease staging, and predicting therapeutic response. Techniques such as molecular imaging and magnetic resonance imaging provide insight into molecular and structural changes associated with the progression of PD, including protein aggregation, neuroinflammation, and regional neurodegeneration. While positron emission tomography imaging of alpha-synuclein and other pathologies offers avenues for staging and differential diagnosis, advanced magnetic resonance imaging approaches have the potential for capturing subtle microstructural changes i.e. through neuromelanin-sensitive or diffusion-weighted imaging. However, the majority of imaging studies has focused on early Parkinson's disease, leaving their applicability to APD uncertain. Future research should prioritize the validation of neuroimaging findings in well-defined APD cohorts and extend their use to predict clinical milestones such as motor fluctuations, dyskinesia, and cognitive decline. These efforts are essential to advance personalized therapeutic strategies and bridge the gap between research and clinical management of APD.
晚期帕金森病（APD）代表帕金森病的晚期阶段，其特征是复杂的运动和非运动症状，对口服多巴胺能疗法反应较差。虽然APD对患者的生活质量有重大影响且需要强化治疗，但直到最近才提出了一致的诊断标准。APD症状背后的确切病理生理学仍知之甚少，这使得早期预后和干预变得困难。神经影像学已成为一种有前景的工具，可用于阐明驱动APD的机制、识别疾病分期的生物标志物以及预测治疗反应。分子成像和磁共振成像等技术可深入了解与帕金森病进展相关的分子和结构变化，包括蛋白质聚集、神经炎症和局部神经退行性变。虽然α-突触核蛋白和其他病理学的正电子发射断层扫描成像为分期和鉴别诊断提供了途径，但先进的磁共振成像方法有可能捕捉细微的微观结构变化，即通过对神经黑色素敏感或扩散加权成像。然而，大多数影像学研究都集中在早期帕金森病上，其对APD的适用性尚不确定。未来的研究应优先在明确界定的APD队列中验证神经影像学结果，并将其应用扩展到预测运动波动、异动症和认知衰退等临床里程碑。这些努力对于推进个性化治疗策略以及弥合APD研究与临床管理之间的差距至关重要。
