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The prediagnostic phase of Parkinson's disease
  1. Alastair John Noyce1,
  2. Andrew John Lees1,
  3. Anette-Eleonore Schrag2
  1. 1Department of Molecular Neuroscience, Reta Lila Weston Institute for Neurological Studies, UCL Institute of Neurology, London, UK
  2. 2Department of Clinical Neuroscience, UCL Institute of Neurology, London, UK
  1. Correspondence to Professor Anette Schrag, Department of Clinical Neuroscience, UCL Institute of Neurology, Royal Free Campus, University College London, London NW3 2PF, UK; a.schrag{at}


The field of prediagnostic Parkinson's disease (PD) is fast moving with an expanding range of clinical and laboratory biomarkers, and multiple strategies seeking to discover those in the earliest stages or those ‘at risk’. It is widely believed that the highest likelihood of securing neuroprotective benefit from drugs will be in these subjects, preceding current point of diagnosis of PD. In this review, we outline current knowledge of the prediagnostic phase of PD, including an up-to-date review of risk factors (genetic and environmental), their relative influence, and clinical features that occur prior to diagnosis. We discuss imaging markers across a range of modalities, and the emerging literature on fluid and peripheral tissue biomarkers. We then explore current initiatives to identify individuals at risk or in the earliest stages that might be candidates for future clinical trials, what we are learning from these initiatives, and how these studies will bring the field closer to realistically commencing primary or secondary preventive trials for PD. Further progress in this field hinges on greater clinical and biological description, and understanding of the prediagnostic, peridiagnostic and immediate postdiagnostic stages of PD. Identifying subjects 3–5 years before they are currently diagnosed may be an ideal group for neuroprotective trials. At the very least, these initiatives will help clarify the stage before and around diagnosis, enabling the field to push into unchartered territory at the earliest stages of disease.


This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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