Risk and sub phenotype in Parkinson’s disease

Excerpt

Parkinson’s disease (PD) is the world’s second most common neurodegenerative disease after Alzheimer’s disease (AD), with prevalence estimated at between 1 and 2 % for those over the age of 65. PD is widely recognised to be disabling as a result of classical movement-related symptoms including rigidity, shaking, bradykinesia, and postural instability, but patients commonly experience a range of equally problematic non-motor symptoms. As a result, neurologists frequently confront significant management issues attempting to address the multitude of symptoms faced by patients with PD, with further layers of complexity added by individual disease heterogeneity in terms of age of onset, presentation, and rates of disease progression. However, in common with many other neurodegenerative disorders, the drug therapies and operative procedures currently available for this disorder predominantly address symptomatic problems and are unable to modify the disease progression. Although the recent emphasis in research into PD has been on pathogenesis, the balance now seems to be changing towards the identification of risk factors that may allow very early intervention before significant nigrostriatal reserve has been lost and symptoms develop, as well as biomarkers of disease progression and treatment response. …