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Prodromal symptoms by Mind Map: Prodromal symptoms
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Prodromal symptoms

Is there a relation between anosmia and autonomic dysfunction?

in PD there is (Goldstein 2009)

Is there a relation between RBD and anosmia/hyposmia?

We know about RBD and cognitive dysfunction

We know about RBD and autonomic dysfunction

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


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

idiopathic anosmia but no motor deficit.


Autnomic dysfunction

Cognitive dysfunction

What ways can we measure the prodromal symptoms


Evoked potentials of olfactory nerve

Smell test, University of Pennsylvania Smell identification test, olfactory event related potential (OERP), Brief Smell Identification Test (BSIT), Cross-Cultural Smell Identification Test, Smell testing procedure

Clinical history



Autonomic Dysfunction

Measure heart rate variability

Valsalva manoevre

Orthosatic hypotension

Sweat production

Search for more possible measurements

Acti watch

Clinical history, Impotence, Urinary dysfunction, Constipation,, What is constipation and how to treat it?, Frequency of bowel movements and the future risk of Parkinson’s disease -->, After adjustment for age, pack-years of cigarette smoking, coffee consumption, laxative use, jogging, and the intake of fruits, vegetables, and grains, men with <1 bowel movement/day had a 2.7-fold excess risk of PD versus men with 1/day

Cognitive dysfunction


Depression Test

Parkinson's Disease


DAT scan

Transcranial Doppler

How do the prodromal symptoms relate to Braak stages?

Patient recruitment

PD Association

Family of PD patients

Through PD clinic

Family of PD patients

Inclusion criteria

Relative of PD patient




PD diagnosis by a neurologist / retrospective

Absence of history of (neuropsychiatric) disorders

Absencs of conditions known to influence olfactory function

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

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

Cambridge Examination for mental disorders (CAMCOG)

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

What is the added value of adding a DAT scan?

When is the optimal time to do a DAT scan?

What symptoms need to be present?

What combination of symptoms needs to be present?

Can we challenge the "Dual hit hypothesis"?

Is there a relation between Anosmia/hyposmia and cognition?

In PD patients there is no relation

27. Doty, R.L., D.A. Deems & S. Stellar. 1988. Olfactory dysfunction in parkinsonism: a general  deficit unrelated to neurologic signs, disease stage, or disease duration. Neurology 38:  1237–1244. 28. Doty, R.L., M.B. Stern, C. Pfeiffer, et al. 1992. Bilateral olfactory dysfunction in early stage  treated and untreated idiopathic Parkinson’s disease. J. Neurol. Neurosurg. Psychiatry 55:  138–142. References found in: Parkinson’s Disease The Dual Hit Theory Revisited. Christopher H.  Hawkes,a Kelly Del Tredici,b and Heiko Braak