In the last 2 decades, it has become increasingly clear that Parkinson disease (PD) has a measurable prodromal stage,1,2 meaning there are early symptoms or signs of neurodegeneration but full parkinsonism has not yet developed. Prodromal PD is characterized by combined motor and nonmotor changes, but in most individuals, nonmotor manifestations start first. The duration of the prodromal stage varies but likely exceeds 10 years in many. Diagnosing prodromal PD will become essential to develop and eventually use neuroprotective therapies. A neuroprotective therapy given in the clinical PD phase, although obviously useful in slowing further disability progression, cannot change the fact that much irreversible neurodegeneration has already occurred. On the other hand, if the same therapy is provided earlier during prodromal stages, it could potentially prevent clinical PD from developing at all.
Postuma RB. Dopaminergic Imaging and Prodromal Parkinson Disease: A Key Biomarker Arrives. JAMA Neurol. 2017;74(8):901–903. doi:10.1001/jamaneurol.2017.0846
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