. Association of Cerebrospinal Fluid β-Amyloid 1-42, T-tau, P-tau181, and α-Synuclein Levels With Clinical Features of Drug-Naive Patients With Early Parkinson Disease. JAMA Neurol. 2013 Aug 26; PubMed.


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  1. This publication is interesting because it presents some of the first cerebrospinal fluid (CSF) biomarker findings from the Parkinson’s Progression Markers Initiative (PPMI) study, which many—including myself—consider a landmark study in PD. The PPMI is unique for several reasons, but in particular because it is specifically designed to identify biomarkers to predict and track disease progression in PD. This is a major unmet need the field.

    In my view, the main finding is the observed association of lowered CSF biomarkers, Aβ1-42 and p-tau in particular, with the so-called postural instability–gait disturbance (PIGD) phenotype, which is known to signal a more rapid disease course in PD, both in terms of motor and cognitive decline. This is consistent with our own observations in patients with early, drug-naïve PD, and we share the authors’ hope that these markers could become promising and—importantly—very early prognostic markers of disease progression in PD. Although there are a few small longitudinal studies that provide some support for this view, we need to bear in mind that the data presented by Kang et al. are cross-sectional and include only the initial 102 subjects (63 with PD) of the PPMI cohort. Still, the PPMI has finished recruitment of more than 400 de novo PD patients earlier this year, and I assume that we can expect the first longitudinal results from this unique cohort in the near future.

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  1. Fluid Biomarkers Give Clues to Disease Progression in Parkinson’s