Towards an improved early diagnosis of neurodegenerative diseases: the emerging role of in vitro conversion assays for protein amyloids

Table 3 The spectrum of synucleinopathies: Main clinical features and diagnostic tests

Disease	Mean duration	Main affected brain regions	Main clinical features	Main diagnostic tests
PD	10–20	Brainstem	L-DOPA responsive parkinsonism	DaTSCAN (ioflupane)
DLB	8	Neocortices, limbic system, brainstem	Cognitive decline with fluctuations, parkinsonism, visual hallucinations, changes to cognitive ability, RBD	DaTSCAN (ioflupane), MIBG, PSG, EEG
MSA	7–9	Striatum, cerebellum, brainstem	Autonomic failure with various degree of parkinsonism, cerebellar and pyramidal signs	DaTSCAN (ioflupane), MRI, autonomic tests, FDG-PET
PAF	^a	PNS	Isolate autonomic failure	Autonomic tests
iRBD	^a	Lower brainstem	IRBD	PSG

Abbreviations: PD Parkinson’s disease, DLB Dementia with Lewy bodies, MSA Multiple system atrophy, PAF Pure autonomic failure, iRBD Isolate REM sleep behavior disorder, PNS Peripheral nervous system, MIBG Metaiodobenzylguanidine, PSG Polysomnography, EEG Electroencephalography, FDG-PET Fluorodeoxyglucose-positron emission tomography
^a Duration as “isolate” disorder, and rate of phenotypic conversion are highly variable

ISSN: 2051-5960