THE LANCET NEUROLOGY | APRIL 10, 2019

Parnetti L, Gaetani L, Eusebi P, Paciotti S, Hansson O, El-Agnaf O, Mollenhauer B, Blennow K and Calabresi P.

Lancet Neurol. 2019 Apr 10. pii: S1474-4422(19)30024-9

DOI: 10.1016/S1474-4422(19)30024-9

ABSTRACT

In the management of Parkinson’s disease, reliable diagnostic and prognostic biomarkers are urgently needed. The diagnosis of Parkinson’s disease mostly relies on clinical symptoms, which hampers the detection of the earliest phases of the disease-the time at which treatment with forthcoming disease-modifying drugs could have the greatest therapeutic effect. Reliable prognostic markers could help in predicting the response to treatments. Evidence suggests potential diagnostic and prognostic value of CSF and blood biomarkers closely reflecting the pathophysiology of Parkinson’s disease, such as α-synuclein species, lysosomal enzymes, markers of amyloid and tau pathology, and neurofilament light chain. A combination of multiple CSF biomarkers has emerged as an accurate diagnostic and prognostic model. With respect to early diagnosis, the measurement of CSF α-synuclein aggregates is providing encouraging preliminary results. Blood α-synuclein species and neurofilament light chain are also under investigation because they would provide a non-invasive tool, both for early and differential diagnosis of Parkinson’s disease versus atypical parkinsonian disorders, and for disease monitoring. In view of adopting CSF and blood biomarkers for improving Parkinson’s disease diagnostic and prognostic accuracy, further validation in large independent cohorts is needed.