Currently there is not one test that will definitely say if you have Parkinson’s or not. So we use a combination of biomarkers, or medical signs that can be objectively measured, to make a clinical diagnosis. The most common biomarkers currently used in Parkinson’s research and clinical practice include:

Alpha-synuclein: Alpha-synuclein (α-synuclein) is a protein that forms clumps called Lewy bodies, which are a hallmark feature of Parkinson’s disease. Researchers are exploring ways to measure alpha-synuclein levels or detect abnormal forms of the protein in cerebrospinal fluid (CSF) or through imaging techniques as a potential biomarker.

Dopamine transporter imaging (DaTscan): DaTscan is a type of SPECT (Single Photon Emission Computed Tomography) imaging that measures dopamine transporter levels in the brain. Reduced dopamine transporter binding is indicative of dopamine neuron loss, which occurs in Parkinson’s.

Brain iron imaging: MRI techniques that assess iron accumulation in specific brain regions associated with Parkinson’s have shown promise as biomarkers. Higher iron levels in the substantia nigra, where dopamine-producing neurons are located, may indicate progression.

Cerebrospinal fluid (CSF) biomarkers: Biomarkers found in the CSF, such as α-synuclein, tau protein, and beta-amyloid, are being studied to assess neurodegenerative processes in Parkinson’s. Changes in these biomarkers may indicate progression or severity. The current biomarker breakthrough is the α-synuclein seeding amplification assay (αSyn-SAA) which mixes CSF with some chemicals to test if your α-synuclein is prone to clumping.

Genetic biomarkers: Specific genetic mutations or variations, such as mutations in the LRRK2, SNCA, PINK1, PARK2 (Parkin) or GBA genes, are associated with an increased risk of Parkinson’s (i.e. risk does not equate to certainty of Parkinson’s). Genetic testing can identify individuals at higher risk and provide insights into potential for individualised care for that ‘type’ of Parkinson’s as well as early intervention strategies if you are a carrier.

Neuroimaging biomarkers: Structural and functional neuroimaging techniques, including MRI, PET (Positron Emission Tomography), and fMRI (functional MRI), can reveal brain changes associated with Parkinson’s, such as atrophy, metabolic alterations, and abnormal neural activity patterns.

Why can’t we use something easier like serum biomarkers (blood or saliva)? Although a reliable CSF or imaging biomarker would be extremely valuable for a PD diagnosis, the ultimate goal is to find a serum biomarker that would not require the expertise for invasive procedures or expensive imaging equipment. Research continues to explore and validate these biomarkers to improve early diagnosis, monitor progression, and evaluate the effectiveness of treatments in Parkinson’s. Incorporating biomarkers into clinical practice holds promise for personalised medicine approaches and advancing therapeutic strategies for individuals affected by Parkinson’s.

Sources: 

Kyla Y. Yamashita, Sweta Bhoopatiraju, Bret D. Silverglate, George T. Grossberg, biomarkers in Parkinson’s disease: A state of the art review, Biomarkers in Neuropsychiatry, Volume 9,
2023, 100074, ISSN 2666-1446, https://doi.org/10.1016/j.bionps.2023.100074. (https://www.sciencedirect.com/science/article/pii/S266614462300014X)

New Parkinson’s Biomarker Found, MJFF https://www.michaeljfox.org/news/breaking-news-parkinsons-disease-biomarker-found

Strimbu K, Tavel JA. What are biomarkers? Curr Opin HIV AIDS. 2010 Nov;5(6):463-6. doi: 10.1097/COH.0b013e32833ed177. PMID: 20978388; PMCID: PMC3078627.

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