title: Personalized medicine strategies for managing patients with parkinsonism and cognitive deficits.
abstract: Patients exhibiting the classic manifestations of parkinsonism - tremors, rigidity, postural instability, slowed movements and, sometimes, sleep disturbances and depression - may also display severe cognitive disturbances. All of these particular motoric and behavioral symptoms may arise from Parkinson's disease [PD] per se, but they can also characterize Lewy Body dementia [LBD] or concurrent Parkinson's and Alzheimer's diseases [PD & AD]. Abnormalities of both movement and cognition are also observed in numerous other neurologic diseases, for example Huntington's Disease and the frontotemporal dementia. Distinguishing among these diseases in an individual patient is important in "personalizing" his or her mode of treatment, since an agent that is often highly effective in one of the diagnoses (e.g., L-dopa or muscarinic antagonists in PD) might be ineffective or even damaging in one of the others. That such personalization, based on genetic, biochemical, and imaging-based biomarkers, is feasible is suggested by the numerous genetic abnormalities already discovered in patients with parkinsonism, Alzheimer's disease and Huntington's disease (HD) and by the variety of regional and temporal patterns that these diseases can produce, as shown using imaging techniques.
authors.affiliation: Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. dick@mit.edu
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wurtman
mesh_terms: D000544:Alzheimer Disease / Q000175:diagnosis / Q000235:genetics; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis* / Q000235:genetics*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D057180:Frontotemporal Dementia / Q000175:diagnosis / Q000235:genetics; D005819:Genetic Markers / Q000235:genetics*; D005820:Genetic Testing; D005962:Glucosylceramidase / Q000235:genetics; D006801:Humans; D006816:Huntington Disease / Q000175:diagnosis / Q000235:genetics; D000071158:Leucine-Rich Repeat Serine-Threonine Protein Kinase-2; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects; D020961:Lewy Body Disease / Q000175:diagnosis / Q000235:genetics; D009154:Mutation; D010300:Parkinson Disease / Q000175:diagnosis* / Q000235:genetics*; D057285:Precision Medicine / Q000379:methods / Q000639:trends*; D017346:Protein Serine-Threonine Kinases / Q000235:genetics; D051844:alpha-Synuclein / Q000235:genetics
chemical_list: D000978:Antiparkinson Agents; D015415:Biomarkers; D005819:Genetic Markers; D051844:alpha-Synuclein; D007980:Levodopa; C495280:LRRK2 protein, human; D000071158:Leucine-Rich Repeat Serine-Threonine Protein Kinase-2; D017346:Protein Serine-Threonine Kinases; D005962:Glucosylceramidase