Neuroimaging in advanced Parkinson's disease: insights into pathophysiology, biomarkers, and personalized therapies.

IF 3.2 4区 医学 Q2 CLINICAL NEUROLOGY
Nils Schröter, Sergiu Groppa, Michel Rijntjes, Gabriel Gonzalez-Escamilla, Horst Urbach, Wolfgang H Jost, Alexander Rau
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Abstract

Advanced Parkinson's disease (APD) represents a late stage of Parkinson's disease and is characterized by complex motor and non-motor symptoms that are less responsive to oral dopaminergic therapies. While APD has a relevant impact on patients' quality of life and requires intensified treatment, consistent diagnostic criteria have only recently been proposed. The precise pathophysiology underlying the symptoms of APD remains poorly understood, making early prognostication and intervention difficult. Neuroimaging has emerged as a promising tool for elucidating the mechanisms driving APD, identifying biomarkers for disease staging, and predicting therapeutic response. Techniques such as molecular imaging and magnetic resonance imaging provide insight into molecular and structural changes associated with the progression of PD, including protein aggregation, neuroinflammation, and regional neurodegeneration. While positron emission tomography imaging of alpha-synuclein and other pathologies offers avenues for staging and differential diagnosis, advanced magnetic resonance imaging approaches have the potential for capturing subtle microstructural changes i.e. through neuromelanin-sensitive or diffusion-weighted imaging. However, the majority of imaging studies has focused on early Parkinson's disease, leaving their applicability to APD uncertain. Future research should prioritize the validation of neuroimaging findings in well-defined APD cohorts and extend their use to predict clinical milestones such as motor fluctuations, dyskinesia, and cognitive decline. These efforts are essential to advance personalized therapeutic strategies and bridge the gap between research and clinical management of APD.

晚期帕金森病的神经影像学:病理生理学、生物标志物和个性化治疗的见解
晚期帕金森病(APD)代表帕金森病的晚期,其特征是复杂的运动和非运动症状,对口服多巴胺能治疗反应较差。虽然APD对患者的生活质量有相关影响,需要加强治疗,但一致的诊断标准直到最近才提出。APD症状背后的确切病理生理机制仍然知之甚少,这使得早期预测和干预变得困难。神经影像学已成为阐明驱动APD的机制、识别疾病分期的生物标志物和预测治疗反应的有前途的工具。分子成像和磁共振成像等技术可以深入了解与PD进展相关的分子和结构变化,包括蛋白质聚集、神经炎症和局部神经退行性变。虽然α -突触核蛋白和其他病理的正电子发射断层成像为分期和鉴别诊断提供了途径,但先进的磁共振成像方法有可能通过神经黑色素敏感或弥散加权成像捕捉细微的微结构变化。然而,大多数影像学研究都集中在早期帕金森病上,使得它们对APD的适用性不确定。未来的研究应优先考虑在明确定义的APD队列中验证神经影像学结果,并将其应用于预测临床里程碑,如运动波动、运动障碍和认知能力下降。这些努力对于推进个性化治疗策略和弥合APD研究与临床管理之间的差距至关重要。
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来源期刊
Journal of Neural Transmission
Journal of Neural Transmission 医学-临床神经学
CiteScore
7.20
自引率
3.00%
发文量
112
审稿时长
2 months
期刊介绍: The investigation of basic mechanisms involved in the pathogenesis of neurological and psychiatric disorders has undoubtedly deepened our knowledge of these types of disorders. The impact of basic neurosciences on the understanding of the pathophysiology of the brain will further increase due to important developments such as the emergence of more specific psychoactive compounds and new technologies. The Journal of Neural Transmission aims to establish an interface between basic sciences and clinical neurology and psychiatry. It intends to put a special emphasis on translational publications of the newest developments in the field from all disciplines of the neural sciences that relate to a better understanding and treatment of neurological and psychiatric disorders.
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