Parkinson's: a syndrome rather than a disease?

[aspergerian]

"Pathological and neurotransmitter basis of the Parkinson’s

syndrome: it is not all dopamine".

Parkinson's:

a syndrome rather than a disease?

J Neural Transm (Vienna) 2017

Aug;124(8):907-914.

ncbi.nlm.nih.gov/pmc/articl...

Emerging concepts suggest that a multitude of pathology ranging

from misfolding of alpha-synuclein to neuroinflammation,

mitochondrial dysfunction, and neurotransmitter driven alteration of

brain neuronal networks lead to a syndrome that is commonly known as

Parkinson's disease. The complex underlying pathology which may

involve degeneration of non-dopaminergic pathways leads to the

expression of a range of non-motor symptoms from the prodromal stage

of Parkinson's to the palliative stage. Non-motor clinical subtypes,

cognitive and non-cognitive, have now been proposed paving the way

for possible subtype specific and non-motor treatments, a key unmet

need currently. Natural history of these subtypes remains unclear

and need to be defined.

In addition to in vivo biomarkers which suggest variable

involvement of the cholinergic and noradrenergic patterns of the

Parkinson syndrome, abnormal alpha-synuclein accumulation have now

been demonstrated in the gut, pancreas, heart, salivary glands, and

skin suggesting that Parkinson's is a multi-organ disorder. The

Parkinson's phenotype is thus not just a dopaminergic motor

syndrome, but a dysfunctional multi-neurotransmitter pathway driven

central and peripheral nervous system disorder that possibly ought

to be considered a syndrome and not a disease.

[GymBag]

Good news, more knowledge

Bad news, its much more complicated than we thought

another confirmation that it appears that the more we learn about it the much more complex it becomes and we do not seem closer to understanding anything, except that we do not understand .

[PDConscience]

"Syndrome", "disease", "condition", etc., etc... WHO CARES??? Doesn't really matter until it can be called "cured".

[ddmagee1 in reply to PDConscience]

That is why I think of PD as a neuro-degenerative disorder. Wherever the neuro-degeneration comes from ( primarily substantia nigra area of brain) , spreading to other areas, is what causes the losses ( symptoms) with patients. This is just a simplified explanation of, basically, the process of neuro-degeneration. Actually, the pathophysiology of neuro-degeneration of this particular disorder, is very complicated, involving Lewy Bodies and other neuronal specific elements only referenced to the type of destruction one sees with Parkindon’s disease (s). There are many studies and articles on neuro-degeneration in PD, and one can see why there are so many variants of symptoms amongst patients. Some can run and have few symptoms for years, while others have many motor and autonomic system systems that make their daily lives challenging. So, call it whatever you like, but when it impacts one’s life greatly, like it does mine, and others, we hope for a cure from the bonds of this debilitating ailment!

[aspergerian]

Findings in regard to non-motor symptoms are increasing awareness of

mechanisms oter than and preceding neuronal loss in the substantia

nigra. Dopaminergic dysfunction does not stand alone. Here's a small

sampling. I hope it's not too badly reformatted.

Where does parkinson disease pathology begin in the brain?

ncbi.nlm.nih.gov/pubmed/120...

The emerging role of norepinephrine in cognitive dysfunctions of

Parkinson's disease.

ncbi.nlm.nih.gov/pmc/articl...

Parkinson's disease (PD) is the second most common neurodegenerative

disorder, affecting 1% of the population over age 60. In those

patients cognitive dysfunction is a persistent issue that impairs

quality of life and productivity. Neuropathological studies

demonstrate significant damage in brain regions outside the nigral

dopamine (DA) system, including early degeneration of locus

coeruleus norepinephrine (LC-NE) neurons, yet discussion of PD and

treatment focus has remained dopaminergic-based. Motor symptoms

benefit from DA replacement for many years, but other symptoms

including several cognitive deficits continue unabated. Recent

interest in non-DA substrates of PD highlights early involvement of

LC-NE neurons and provides evidence for a prodromal phase, with

cognitive disturbance, even in sporadic PD.

Neuropathological basis of nonmotor manifestations of Parkinson's

disease.

ncbi.nlm.nih.gov/pmc/articl...

Nonmotor symptoms and Parkinson disease in United States farmers and

spouses.

ncbi.nlm.nih.gov/pmc/articl...

The underlying mechanism of prodromal PD: insights from the

parasympathetic nervous system and the olfactory system.

ncbi.nlm.nih.gov/pmc/articl...