Screening and Targeting Risk Factors for Prodromal Synucleinopathy: Taking Steps toward a Prescriptive Multi-modal Framework

Abstract

As the prevalence of Parkinson’s disease (PD) grows, so too does the population at-risk of developing PD, those in the so-called prodromal period. This period can span from those experiencing subtle motor deficits yet not meeting full diagnostic criteria or those with physiologic markers of disease alone. Several disease-modifying therapies have failed to show a neuroprotective effect. A common criticism is that neurodegeneration, even in the early motor stages, has advanced too far for neuro-restoration-based interventions to be effective. Therefore, identifying this early population is essential. Once identified, these patients could then potentially benefit from sweeping lifestyle modifications to alter their disease trajectory. Herein, we review the literature on risk factors for, and prodromal symptoms of, PD with an emphasis on ones which may be modifiable in the earliest possible stages. We propose a process for identifying this population and speculate on some strategies which may modulate disease trajectory. Ultimately, this proposal warrants prospective studies.

The potential role of chronic pain and the polytrauma clinical triad in predicting prodromal PD: A cross-sectional study of U.S. Veterans

“…If chronic pain contributes to PD pathogenesis, therapeutic interventions that target improvements in measures of chronic pain may also be effective at lowering patient’s later risk of PD development. The identification of such could also trigger more aggressive screening or lifestyle modification to attenuate this risk [34] . If instead chronic pain is driven by reduced dopaminergic tone, medications correcting this dopamine loss may prove more effective than current standard pain management strategies without dopamine replacement therapies.…”