PREVENTION OF PARKINSONISM SYNDROME: MODERN PREDICTS AND OPPORTUNITIES FOR PERSONALIZED PREVENTION

Abstract

Parkinsonian syndrome is a clinically and pathogenetically heterogeneous group of conditions in which an unfavorable prognosis is determined not only by the severity of bradykinesia, rigidity, and tremor, but also by the accumulation of cognitive-regulatory, autonomic, postural, neurosomatic, and socio-functional impairments. The modern concept of progression is shifting from the assessment of individual symptoms to the analysis of the individual disease trajectory and clinically significant milestones. Of particular interest is the identification of a functionally latent stage, a functionally manifest stage of cognitive-regulatory maladaptation, and an organ-mixed decompensation stage. This review systematizes current data on clinical, neuropsychological, neurophysiological, neuroimaging, and biological markers of progression, including NfL, GFAP, phosphorylated tau, Aβ42/40, neurotrophic and immune-inflammatory indicators, as well as phosphorylated α-synuclein in the skin. Digital gait parameters, autonomic dysfunction, bone fragility, and nutritional deficiencies are considered as components of a reduced functional reserve. The rationale for multi-level risk stratification and personalized prevention aimed at preventing the transition to organ-mixed decompensation is substantiated. The proposed approach can serve as a basis for creating an integrated prognostic model that is accessible for practical healthcare and does not require mandatory cerebrospinal fluid examination.