ObjectivesTo present methods and baseline results for an online screening tool to identify increased risk for Parkinson's disease (PD) in the UK population.MethodsRisk estimates for future PD were derived from the results of a systematic review of risk factors and early features of PD. Participants aged 60–80 years without PD were recruited by self-referral. They completed an online survey (including family history, non-motor symptoms and lifestyle factors), a keyboard-tapping task and the University of Pennsylvania Smell Identification Test. Risk scores were calculated based on survey answers. Preliminary support for the validity of this algorithm was assessed by comparing those estimated to be higher risk for PD with those at lower risk using proxies, including smell loss, REM-sleep behaviour disorder and reduced tapping speed, and by assessing associations in the whole group.Results1324 eligible participants completed the survey and 1146 undertook the keyboard-tapping task. Smell tests were sent to 1065 participants. Comparing the 100 highest-risk participants and 100 lowest-risk participants, median University of Pennsylvania Smell Identification Test scores were 30/40 versus 33/40 (p<0.001), mean number of key taps in 30 s were 55 versus 58 (p=0.045), and 24% versus 10% scored above cut-off for REM-sleep behaviour disorder (p=0.008). Regression analyses showed increasing risk scores were associated with worse scores in the three proxies across the whole group (p≤0.001).ConclusionsPREDICT-PD is the first study to systematically combine risk factors for PD in the general population. Validity to predict risk of PD will be tested through longitudinal follow-up of incident PD diagnosis.
Objectives
The aim of this review was to provide an overview of the literature on imaging in prodromal dementia with Lewy bodies (DLB).
Design
Systematic PubMed search and literature review.
Results
Diagnostic classification of the prodromal DLB stage remains to be established but is likely to require imaging biomarkers to improve diagnostic accuracy. In subjects with mild cognitive impairment with Lewy body disease (MCI‐LB) (here synonymous with prodromal DLB) and REM sleep behaviour disorder, a high risk condition for future conversion to a synucleinopathy, imaging modalities have assessed early structural brain changes, striatal dopaminergic integrity, metabolic brain, and cerebral perfusion alterations. It remains uncertain whether structural brain imaging can differentiate MCI‐LB from mild cognitive impairment with Alzheimer disease (MCI‐AD), but early right anterior insula thinning has been reported to occur in MCI‐LB compared with MCI‐AD. Dopaminergic deficits have been observed in a substantial proportion of MCI‐LB subjects and have a high specificity for Lewy body disease at the pre‐dementia stage. Cardiac sympathetic denervation, occipital hypometabolism, or hypoperfusion is less studied as this pre‐dementia stage and it remains to be determined whether any imaging abnormalities antedate DLB.
Conclusion
Imaging studies in prodromal DLB are still in their infancy but offer great potential to study early in vivo structural and functional biological alterations. Future work should focus on longitudinal multimodal imaging studies with postmortem validation of diagnosis in order to develop and then validate criteria for prodromal DLB.
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