Rees, Richard Nathaniel;
(2022)
Exploring the prodromes of Parkinson’s: identification of motor and non-motor features in at-risk individuals.
Doctoral thesis (M.D(Res)), UCL (University College London).
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Abstract
The underlying pathology of Parkinson’s disease (PD) is already well established by the time a diagnosis based on cardinal motor signs is made. However, retrospective studies have shown that the non-motor features of PD, which are known to contribute significantly to morbidity are present before the diagnosis, indicating a ‘prodromal’ phase. Several prospective studies have shown a subclinical motor dysfunction in this phase, but there is little understanding of the broader phenotype. The PREDICT-PD study, from which this project is derived, calculates individuals’ risk of PD through an evidence-based algorithm of risk and protective factors. It has previously been shown that higher-risk participants have greater motor dysfunction along with DAT-SPECT as a marker of PD-pathology. This thesis aims to better delineate detectable dysfunction in multiple motor and non- motor domains in the prodromal phase of PD in those with higher PREDICT-PD risk scores. It starts with an overview of the evidence supporting the concept of a prodromal phase of PD, from a pathological as well as epidemiological perspective. In chapter 2, the methods of assessment are detailed, including validated tools to assess cognition, autonomic dysfunction, sleep, pain and mood, and the MDS-UPDRS parts I-III. I will compare the motor and non-motor features in higher-risk, age- and gender-matched lower-risk controls, and PD patients, and examine association of risk scores with function. In chapter 3 I assess whether transcranial sonography (TCS) which has been identified as a biomarker of PD, is associated with any of the prodromal features that are present in this population. I then move focus from the general public to a specific cohort believed to be at risk of PD - patients with idiopathic anosmia, and what clinical features are present in this population. I conclude with a review of the ethics of giving an individual a diagnosis of prodromal PD.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | M.D(Res) |
| Title: | Exploring the prodromes of Parkinson’s: identification of motor and non-motor features in at-risk individuals |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author [2022]. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| Keywords: | Parkinson's, prodromal, neurodegeneration, anosmia, transcranial sonography, non-motor |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Movement Neurosciences UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10150494 |
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