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Lookup NU author(s): Dr Dag Aarsland, Professor David BurnORCiD
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Increasing recognition that Parkinson's disease (PD) may start outside of the substantia nigra has led to a rapidly expanding effort to define prodromal stages of PD, before motor signs permit classical diagnosis. Many of these efforts center around the identification of clinical non-motor symptoms and signs of disease. There is now direct evidence that olfaction, rapid eye movement (REM) sleep behavior disorder (RBD), constipation, and depression can be present in prodromal PD. In addition, there is suggestive evidence that visual changes, other autonomic symptoms, and subtle cognitive changes may also be present at prodromal stages. A critical issue in utility of these prodromal markers will be assessment of sensitivity, specificity, and positive and negative predictive values. Although these have yet to be fully defined, olfactory deficits, some visual changes, and autonomic symptoms occur in the majority of PD patients at diagnosis, suggesting good potential sensitivity. However, with the exception of RBD and perhaps some specific autonomic measures, specificity, and positive predictive value of these markers may be insufficient to be used alone as identifiers of prodromal disease. The evidence for the utility of olfaction, RBD, autonomic markers, visual changes, mood disorders, and cognitive loss as markers of prodromal PD and the potential sensitivity and specificity of these markers are summarized. (C) 2012 Movement Disorder Society
Author(s): Postuma RB, Aarsland D, Barone P, Burn DJ, Hawkes CH, Oertel W, Ziemssen T
Publication type: Review
Publication status: Published
Journal: Movement Disorders
Year: 2012
Volume: 27
Issue: 5
Pages: 617-626
Print publication date: 16/04/2012
ISSN (print): 0885-3185
ISSN (electronic): 1531-8257
Publisher: WILEY-BLACKWELL
URL: http://dx.doi.org/10.1002/mds.24996
DOI: 10.1002/mds.24996
