Nils Schröter, Sergiu Groppa, Michel Rijntjes, Gabriel Gonzalez-Escamilla, Horst Urbach, Wolfgang H Jost, Alexander Rau
{"title":"Neuroimaging in advanced Parkinson's disease: insights into pathophysiology, biomarkers, and personalized therapies.","authors":"Nils Schröter, Sergiu Groppa, Michel Rijntjes, Gabriel Gonzalez-Escamilla, Horst Urbach, Wolfgang H Jost, Alexander Rau","doi":"10.1007/s00702-025-02942-y","DOIUrl":null,"url":null,"abstract":"<p><p>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.</p>","PeriodicalId":16579,"journal":{"name":"Journal of Neural Transmission","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neural Transmission","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00702-025-02942-y","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
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.
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.