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Original Question

rephrase “There is no diagnostic marker for PD.102 The diagnosis of PD is based on the history and clinical features of the disease. Causes of secondary parkinsonism are first excluded. Specific gene panels and imaging studies are evolving for early diagnosis.103 Early nonmotor symptoms of PD can precede motor symptoms, and their identification may assist early diagnosis and guide disease-modifying strategies.104 Treatment of PD is symptomatic, with drug therapy to protect or restore striatal dopamine levels and decrease akinesia and manage nonmotor symptoms.105 However, because of troublesome side effects and loss of effectiveness, drug therapy may not be started until the symptoms become incapacitating.106,107 Recent studies of the gut microbiome in mice indicate that gut dysbiosis is a cause of synucleinopathies and neuroinflammation, with early manifestations of subtle motor and gastrointestinal symptoms, such as constipation. More research is needed to assist with early diagnosis and preventive strategies.108 Deep brain stimulation (i.e., subthalamic neurostimulation) is replacing surgery to treat persons unresponsive to drug therapy. Implants of stem cells and fetal cells, as well as gene therapy, are strategies for future treatments.109 Nonmotor symptoms and general immobility are special problems requiring interdisciplinary efforts to improve functional status.

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