FEB 05, 2019 9:22 AM PST

Proposed New Criteria For Diagnosing Parkinson's

WRITTEN BY: Amy Loriaux

A new review published in the Journal of Parkinson’s Disease suggests that our previous diagnostic criteria for Parkinson's Disease (PD) is inadequate and should be revised. This revised criteria would involve examining patients for prodromal symptoms associated with the disease. Prodromal symptoms are symptoms that are non-PD-like but have a high rate of occurrence in individuals that go on to develop PD. Earlier detection of these symptoms could promote earlier treatment and better outcomes.

Photo source: UnSplash.com

What constitutes prodromal symptoms have been debated, however, the typical symptoms of prodromal PD are mood disorders, autonomic disturbances, cognitive impairment, and sleep disturbances. Other symptoms that have been shown to correlate with a future diagnosis of PD are hyposmia, constipation, and idiopathic REM Sleep Disorder. These symptoms present themselves before the classic motor symptoms that are currently used to diagnose PD (bradykinesia, tremor, rigidity, and postural instability).

The authors of the present review suggest that prodromal PD can last as long as years to decades. This, according to the authors Drs. Daniela Berg, MD, of the Christian-Albrechts-University of Kiel, Germany, and Ronald B. Postuma, MD, MSc, of Montreal General Hospital, suggests that non-motor and subtle motor symptoms may indicate a slow spreading PD pathology. Essentially, PD may not start at the level of the substantia nigra but spread to this area during the prodromal phase. Unfortunately, even the classical motor-based diagnosis is not definitive. To get an absolute diagnosis of PD one has to confirm it with an autopsy.

The authors of the review advocate a new system of diagnostics, which includes an acceptance that prodromal symptoms are actually signs of PD. They also recommend a closer look at the increasing data pointing to certain risk factors and correlate them to imaging and histopathological findings. Finally, they implore for more longitudinal studies that observe conversion to PD in cohorts of individuals with different combinations of risk and prodromal markers. The main idea is to find more diagnostic criteria and link it to current imaging methods to find where in the brain certain changes are taking place. Furthermore, their goal is to screen for legitimate prodromal symptoms so that they can be addressed in the clinician's office.

Photo source: UnSplash.com

Prodromal symptoms are not the same as pre-clinical symptoms for PD. Pre-clinical refers to a stage where no PD-related symptoms are present and the diagnosis of PD has not been declared. The prodromal period, however, begins before the loss of dopamine cells in the substantia nigra that are necessary for movement. This suggests that PD is a slowly spreading neurological disease which may even start outside of the brain. The gut has been suggested as a candidate. The olfactory system may also play a role. Essential, PD may start elsewhere and slowly encompass much of the nervous system.

Thus, if clinicians and scientists accept legitimate prodromal symptoms to diagnose PD, this will lead to earlier detection and earlier treatment. Yet, in doing so, they will have to accept the idea of PD as a slowly progressive neurological disorder with a possible etiology outside of the brain, if not just the substantia nigra. The concept of PD as a motor-disorder, and waiting for the motor symptoms to arise, could shave off years of treatment to either halt the progression of the disease or slow it down. It may be time to start looking for earlier warning signs.

Here is a video from Dr. Wolfgang H. Oertel, MD, Ph.D. from the University of Marburg, Marburg, Germany with further explanation.

Sources: Journal of Parkinson’s Disease, Movement Disorders, European Journal of Neurologyhttps://en.wikipedia.org/wiki/Hyposmia, Journal of Neurology

About the Author
  • I currently work at a small CRO involved in clinical trial management.
You May Also Like
AUG 01, 2021
Technology
Actually, You DO Know You Are a Brain in a Vat: Exoskeleton Pros and Cons
AUG 01, 2021
Actually, You DO Know You Are a Brain in a Vat: Exoskeleton Pros and Cons
Exoskeletons promise mobility and enhance strength, but a new study shows they can be debilitating for the brain
AUG 03, 2021
Neuroscience
A Tree Falls in the Forest: A Neuroscientist on the World Our Brain Creates
AUG 03, 2021
A Tree Falls in the Forest: A Neuroscientist on the World Our Brain Creates
Neuroscientist, Donald Hoffman, thinks a mathematical model will solve the hard problem of consciousness
AUG 10, 2021
Health & Medicine
When Grandma's optimism bias gets in the way of perceiving COVID-19 risks
AUG 10, 2021
When Grandma's optimism bias gets in the way of perceiving COVID-19 risks
Researchers used Socioemotional Selective Theory to generate personalized interventions to heighten perceived risk
AUG 31, 2021
Clinical & Molecular DX
How Quickly Will Alzheimer's Progress? Inflammatory Proteins Have the Answers.
AUG 31, 2021
How Quickly Will Alzheimer's Progress? Inflammatory Proteins Have the Answers.
Alzheimer's is a neurodegenerative disease that affects over 26 million worldwide and is associated with memory prob ...
AUG 31, 2021
Coronavirus
Researchers Use Newer Approach to Analyze Long Haul COVID-19 and Post Traumatic Stress Symptoms
AUG 31, 2021
Researchers Use Newer Approach to Analyze Long Haul COVID-19 and Post Traumatic Stress Symptoms
fMRI of some COVID-19 survivors suffering from posttraumatic stress symptoms reveal altered functional brain connectivit ...
SEP 27, 2021
Earth & The Environment
Nudging Closer to a Sustainable Future
SEP 27, 2021
Nudging Closer to a Sustainable Future
Attitudes toward sustainable solutions have rapidly changed in the last few decades as environmental issues like climate ...
Loading Comments...