To the Editor There is now a growing body of evidence that neurodegenerative α-synucleinopathies can begin decades before a clinical diagnosis can be made. The review by Savica et al1 describes the prodromal phase of the α-synucleinopathies. In particular, they review several well-known prodromal markers, including anosmia, constipation, and rapid eye movement sleep behavior disorder. Surprisingly, the authors fail to mention some of the more recent additions to the prodromal α-synucleinopathy literature.
Palma J, Norcliffe-Kaufmann L, Kaufmann H. Orthostatic Hypotension as a Prodromal Marker of α-Synucleinopathies. JAMA Neurol. 2018;75(9):1154. doi:10.1001/jamaneurol.2018.2248
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