Narrative Review of Body-First Versus Brain-First Prodromal Neuropsychiatric Symptoms in Parkinson's Disease.
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing literature without systematic review methodology
PubMed 42441366 · doi:10.7759/cureus.110371
What was done
This narrative review synthesized literature published between 2003 and 2025 from PubMed, Scopus, and Google Scholar. Search terms covered Parkinson's disease (PD), prodromal symptoms, neuropsychiatric symptoms, alpha-synuclein, and body-first versus brain-first disease models. Selection prioritized review articles, original studies, clinical trials, Movement Disorder Society criteria, and neuropathological models.
What was found
The abstract reports no numerical findings, effect sizes, or quantitative data. It qualitatively describes support for a dual-pathway model of PD progression: body-first pathology begins peripherally and ascends to the brainstem with early REM sleep behavior disorder and autonomic dysfunction, whereas brain-first pathology originates in olfactory or limbic regions with early hyposmia, anxiety, and depression.
Why it matters
Categorizing prodromal neuropsychiatric and nonmotor symptoms by body-first versus brain-first pathways may enhance early clinical recognition, risk stratification, and patient selection for biomarker and disease-modifying trials.
Limits
This is a narrative review without systematic screening protocols, formal risk-of-bias evaluation, or quantitative meta-analysis. The abstract provides no primary data, sample sizes, effect estimates, or prospective validation metrics.
Cited by
- supports Anxiety and depression can precede the onset of motor symptoms in Parkinson's disease by up to two years.