Changing the research criteria for the diagnosis of Parkinson's disease: obstacles and opportunities

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• 作者：Prof Daniela Berg ; MD^a ; ^{daniela.berg@uni-tuebingen.de} ; Prof Anthony E Lang ; MD^b ; Ronald B Postuma ; MD^c ; Walter Maetzler ; MD^a ; Prof Guenther Deuschl ; MD^d ; Prof Thomas Gasser ; MD^a ; Andrew Siderowf ; MD^e ; Prof Anthony H Schapira ; MD^f ; Prof Wolfgang Oertel ; MD^g ; Prof José ; A Obeso ; MD^h ; Prof C Warren Olanow ; MDⁱ ; Prof Werner Poewe ; MD^j ; Prof Matthew Stern ; MD^k
• 刊名：Lancet Neurology
• 出版年：2013
• 出版时间：May, 2013
• 年：2013
• 卷：12
• 期：5
• 页码：514-524
• 全文大小：177 K

文摘

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Summary

Recent findings question our present understanding of Parkinson's disease and suggest that new research criteria for the diagnosis of Parkinson's disease are needed, similar to those recently defined in Alzheimer's disease. However, our ability to redefine Parkinson's disease is hampered by its complexity and heterogeneity in genetics, phenotypes, and underlying molecular mechanisms; the absence of biochemical markers or ability to image Parkinson's disease-specific histopathological changes; the long prodromal period during which non-motor manifestations might precede classic motor manifestations; and uncertainty about the status of disorders diagnosed clinically as Parkinson's disease but without Lewy pathology. Although it is too early to confidently redefine Parkinson's disease, the time has come to establish a research framework that could lead to new diagnostic criteria. We propose the establishment of three tiers encompassing clinical features, pathological findings, and genetics or molecular mechanisms. Specific advances in each tier, bridged by neuroimaging and biochemical data, will eventually lead to a redefinition of Parkinson's disease.