title: Early diagnosis of Parkinson's disease.
abstract: In idiopathic Parkinson's disease (IPD) approximately 60 % of the nigrostriatal neurons of the substantia nigra (SN) are degenerated before neurologists can establish the diagnosis according to the widely accepted clinical diagnostic criteria. It is conceivable that neuroprotective therapy starting at such an 'advanced stage' of the disease will fail to stop the degenerative process. Therefore, the identification of patients at risk and at earlier stages of the disease appears to be essential for any successful neuroprotection. The discovery of several genetic mutations associated with IPD raises the possibility that these, or other biomarkers, of the disease may help to identify persons at risk of IPD. Transcranial ultrasound have shown susceptibility factors for IPD related to an increased iron load of the substantia nigra. In the early clinical phase, a number of motor and particularly non-motor signs emerge, which can be identified by the patients and physicians years before the diagnosis is made, notably olfactory dysfunction, depression, or 'soft' motor signs such as changes in handwriting, speech or reduced ambulatory arm motion. These signs of the early, prediagnostic phase of IPD can be detected by inexpensive and easy-to-administer tests. As one single instrument will not be sensitive enough, a battery of tests has to be composed measuring independent parameters of the incipient disease. Subjects with abnormal findings in this test battery should than be submitted to nuclear medicine examinations to quantify the extent of dopaminergic injury and to reach the goal of a reliable, early diagnosis.
authors.affiliation: Department of Neurology, University of Saarland, Gebäude 90, 66421 Homburg/Saar, Germany. georg.becker@uniklinik-saarland.de
authors.forename: Georg
authors.initials: G
authors.lastname: Becker
authors.forename: Antje
authors.initials: A
authors.lastname: Müller
authors.forename: Stefan
authors.initials: S
authors.lastname: Braune
authors.forename: Thomas
authors.initials: T
authors.lastname: Büttner
authors.forename: Reiner
authors.initials: R
authors.lastname: Benecke
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Greulich
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Klein
authors.forename: Günter
authors.initials: G
authors.lastname: Mark
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rieke
authors.forename: Reiner
authors.initials: R
authors.lastname: Thümler
mesh_terms: D019797:3-Iodobenzylguanidine; D000339:Affect; D015415:Biomarkers / Q000032:analysis; D006236:Handwriting; D006321:Heart / Q000294:innervation; D006801:Humans; D007501:Iron / Q000378:metabolism; D019964:Mood Disorders / Q000175:diagnosis / Q000209:etiology*; D009069:Movement Disorders / Q000175:diagnosis / Q000209:etiology*; D009154:Mutation; D000857:Olfaction Disorders / Q000175:diagnosis / Q000209:etiology*; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D011597:Psychomotor Performance; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D012307:Risk Factors; D013060:Speech; D013378:Substantia Nigra / Q000000981:diagnostic imaging; D014055:Tomography, Emission-Computed; D015899:Tomography, Emission-Computed, Single-Photon; D014463:Ultrasonography; D014785:Vision, Ocular
chemical_list: D015415:Biomarkers; D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine; D007501:Iron