Preclinical (premotor) Parkinson's disease

Parkinson's disease (PD) is an idiopathic disease caused by necrosis and ap optosis of dopaminergic cells in the brainstem, which are probably induced by oxidative stress. Current therapeutic strategies comprise symptomatic an d restorative treatment. Neuroprotective treatment, however, is close to be coming reality. As neuroprotective therapy may be of particular benefit to the preclinical and/or very early PD patients, identifying patients in the early stages of the disease is a priority. Both [F-18]dopa positron emissio n tomography (PET) and [I-123]beta-CIT single photon emission computed tomo graphy (SPECT) imaging may be useful tools in diagnosing early (preclinical ) PD. As screening the whole population for preclinical PD is not realistic , one has to select subjects with a high risk for this disease. Ol-factory disturbances, subtle neurocognitive dysfunction, visuomotor control abnorma lities and, to a lesser degree, mood and personality disorders, have lately been suggested to precede or accompany early clinical motor hallmarks of P D. In an epidemiological study, 500 first-degree relatives of PD patients w ere assessed fur these signs and symptoms, and [I-123]P-CIT SPECT was perfo rmed on patients in the top 10% and the bottom 10% with regard to sense of smell. In this report, the study design and initial data from this ongoing study will be presented.