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February 12, 2013; 80 (7) Editorial

Biomarkers for PD

How can we approach complexity?

Daniela Berg, Oliver Bandmann
First published January 16, 2013, DOI: https://doi.org/10.1212/WNL.0b013e3182825184
Daniela Berg
From the Department of Neurodegeneration (D.B.), Hertie-Institute of Clinical Brain Research and German Center for Neurodegenerative Diseases, University of Tübingen, Germany; and Sheffield Institute for Translational Neuroscience (SITraN) (O.B.), University of Sheffield, Sheffield, UK.
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Oliver Bandmann
From the Department of Neurodegeneration (D.B.), Hertie-Institute of Clinical Brain Research and German Center for Neurodegenerative Diseases, University of Tübingen, Germany; and Sheffield Institute for Translational Neuroscience (SITraN) (O.B.), University of Sheffield, Sheffield, UK.
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Biomarkers for PD
How can we approach complexity?
Daniela Berg, Oliver Bandmann
Neurology Feb 2013, 80 (7) 608-609; DOI: 10.1212/WNL.0b013e3182825184

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  • Migraine headache is present in the aura phase: A prospective study - January 29, 2013
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By the time patients present with motor symptoms of Parkinson disease (PD), two-thirds of their dopaminergic neurons will have died and at least some of the remaining dopaminergic neurons may already be affected by the molecular mechanisms that will eventually lead to their death. It is plausible to assume that any neuroprotective therapy for PD might be much more effective if individuals at risk could be started on such therapy while they are still in the premotor stage of the disease. Excellent epidemiologic combined with long-time clinical follow-up studies have unequivocally established that individuals with common but nonspecific symptoms, such as autonomic dysfunction including constipation, erectile and urinary dysfunction, and neuropsychiatric symptoms like depression or hyposmia, are at increased risk of developing PD.1 Other premotor manifestations of PD, in particular REM sleep behavioral disorder (RBD), are much more characteristic for premotor PD, but comparatively rare. Any attempt to base the identification of premotor PD on clinical observation only is therefore limited by low specificity (as would be the case for constipation) or sensitivity (as for RBD). Moreover, low specificity of some markers alludes to another major drawback in the search of biomarkers: the heterogeneity of PD. To evaluate markers reliably, it is therefore important to assess cohorts in whom homogenous pathogenesis can be assumed. This is the case in individuals who share the same genetically determined risk. Monogenetic forms of PD are, however, rare, and it is therefore difficult to recruit such genetically determined cohorts.

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  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.

  • See page 621

  • © 2013 American Academy of Neurology
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