Prodromal symptoms

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Prodromal symptoms by Mind Map: Prodromal symptoms

1. Is there a relation between anosmia and autonomic dysfunction?

1.1. in PD there is (Goldstein 2009)

2. Is there a relation between RBD and anosmia/hyposmia?

2.1. We know about RBD and cognitive dysfunction

2.2. We know about RBD and autonomic dysfunction

3. What's the relative predictive value of the following prodromal symptoms

3.1. anosmia

3.1.1. Hyposmia/Anosmia and motor function and mood -- have been analysed

3.1.2. idiopathic anosmia but no motor deficit.

3.2. RBD

3.3. Autnomic dysfunction

3.4. Cognitive dysfunction

4. What ways can we measure the prodromal symptoms

4.1. Anosmia

4.1.1. Evoked potentials of olfactory nerve

4.1.2. Smell test

4.1.2.1. University of Pennsylvania Smell identification test

4.1.2.2. olfactory event related potential (OERP)

4.1.2.3. Brief Smell Identification Test (BSIT)

4.1.2.4. Cross-Cultural Smell Identification Test

4.1.2.5. Smell testing procedure

4.1.3. Clinical history

4.2. RBD

4.2.1. Questionnaire

4.3. Autonomic Dysfunction

4.3.1. Measure heart rate variability

4.3.2. Valsalva manoevre

4.3.3. Orthosatic hypotension

4.3.4. Sweat production

4.3.5. Search for more possible measurements

4.3.6. Acti watch

4.3.7. Clinical history

4.3.7.1. Impotence

4.3.7.2. Urinary dysfunction

4.3.7.3. Constipation

4.3.7.3.1. http://www.digestivesplus.com/constipation.html

4.3.7.3.2. http://www.medicinenet.com/constipation/page3.htm What is constipation and how to treat it?

4.3.7.3.3. Frequency of bowel movements and the future risk of Parkinson’s disease --> http://www.neurology.org/cgi/content/abstract/57/3/456

4.4. Cognitive dysfunction

4.4.1. MMSE

4.4.2. Depression Test

4.5. Parkinson's Disease

4.5.1. UPDRS

4.5.2. DAT scan

4.5.3. Transcranial Doppler

5. How do the prodromal symptoms relate to Braak stages?

6. Patient recruitment

6.1. PD Association

6.1.1. Family of PD patients

6.2. Through PD clinic

6.2.1. Family of PD patients

7. Inclusion criteria

7.1. Relative of PD patient

7.1.1. Children

7.1.2. Siblings

7.1.3. Parents

7.2. PD diagnosis by a neurologist / retrospective

7.3. Absence of history of (neuropsychiatric) disorders

7.4. Absencs of conditions known to influence olfactory function

7.5. No medication that might influence dopamine transporter binding and/or olfactory function

7.6. Absence of parkinsonism as defined by the UK PD Society brainbank criteria

7.7. Cambridge Examination for mental disorders (CAMCOG)

8. Is it possible to come to a reliable diagnosis when combining the prodromal symptoms?

8.1. What is the added value of adding a DAT scan?

8.2. When is the optimal time to do a DAT scan?

8.2.1. What symptoms need to be present?

8.2.2. What combination of symptoms needs to be present?

9. Can we challenge the "Dual hit hypothesis"?

10. Is there a relation between Anosmia/hyposmia and cognition?

10.1. In PD patients there is no relation