title: Parkinson's: a syndrome rather than a disease?
abstract: Emerging concepts suggest that a multitude of pathology ranging from misfolding of alpha-synuclein to neuroinflammation, mitochondrial dysfunction, and neurotransmitter driven alteration of brain neuronal networks lead to a syndrome that is commonly known as Parkinson's disease. The complex underlying pathology which may involve degeneration of non-dopaminergic pathways leads to the expression of a range of non-motor symptoms from the prodromal stage of Parkinson's to the palliative stage. Non-motor clinical subtypes, cognitive and non-cognitive, have now been proposed paving the way for possible subtype specific and non-motor treatments, a key unmet need currently. Natural history of these subtypes remains unclear and need to be defined. In addition to in vivo biomarkers which suggest variable involvement of the cholinergic and noradrenergic patterns of the Parkinson syndrome, abnormal alpha-synuclein accumulation have now been demonstrated in the gut, pancreas, heart, salivary glands, and skin suggesting that Parkinson's is a multi-organ disorder. The Parkinson's phenotype is thus not just a dopaminergic motor syndrome, but a dysfunctional multi-neurotransmitter pathway driven central and peripheral nervous system disorder that possibly ought to be considered a syndrome and not a disease.
authors.affiliation: Federal State Budgetary Educational Institution of Higher Education, N.I. Pirogov Russian National Research Medical University, Ministry of Healthcare of the Russian Federation, Moscow, Russia.
authors.forename: Nataliya
authors.initials: N
authors.lastname: Titova
authors.affiliation: Parkinson's Disease Service for the Older Person, Rankin Park Centre, John Hunter Hospital, HNELHD, Newcastle, NSW, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Padmakumar
authors.affiliation: Brain and Mind Centre, University of Sydney, NSW, Australia.
authors.forename: Simon J G
authors.initials: SJG
authors.lastname: Lewis
authors.affiliation: National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, UK. ray.chaudhuri@kcl.ac.uk.|National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, UK. ray.chaudhuri@kcl.ac.uk.
authors.forename: K Ray
authors.initials: KR
authors.lastname: Chaudhuri
mesh_terms: D006801:Humans; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D013577:Syndrome
keywords: Individualized medicine; Neurotransmitter; Non-motor subtypes; Non-motor symptoms; Parkinson’s disease; Parkinson’s syndrome