Facilitating Diagnostics and Prognostics of Parkinsonian Syndromes Using Neuroimaging

Eligibility Criteria

• * Diagnosis of Parkinson disease
• * Existence of sufficient clinical data from previous UTS Southwestern longitudinal study to determine progression rate (categorized as fast or slow)
• * Availability of suitable matched participant in the alternate progression group (fast or slow)
• * Willingness to participate in the imaging studies required for this study and to provide written informed consent
• * Duration of PD (since diagnosis) is \< 5 years
• * Willing to participate in imaging and clinical scoring visits, and provide written informed consent
• * Subject and investigator agree that it is highly likely subject will be able to participate throughout the 2-year study period (no plans to move)
• * Duration of MSA (since diagnosis) is \< 5 years
• * Willing to participate in imaging and clinical scoring visits, and provide written informed consent
• * Subject and investigator agree that it is highly likely subject will be able to participate throughout the 2-year study period (no plans to move away during the study)
• * Willing to participate in imaging and clinical scoring visits, and provide written informed consent
• * Subject and investigator agree that it is highly likely subject will be able to participate throughout the 2-year study period (no plans to move away during the study)
• * Roughly age and sex matched with the subjects in the PD cohort
• * No history or examination findings suggestive of any neurodegenerative disease
• * Normal gait, balance, and eye movements for age
• * No clinical evidence for symptomatic orthostatic hypotension
• * Willing to participate in imaging and clinical scoring visits, and provide written informed consent
• * Subject and investigator agree that it is highly likely subject will be able to participate throughout the 2-year study period (no plans to move away during the study)
• * Any contraindications to undergoing the multimodal imaging program
• * All females of child-bearing potential, between the ages of 18-55, will be excluded from the study, unless they are confirmed to be not pregnant with a pregnancy test prior to scanning
• * This study will require constant clear communication throughout the duration of the study; therefore, non-English speakers will be excluded
• * Right-handed finger amputees
• * Cast on right hand or fingers at the time of enrollment
• * Has clinically significant liver, kidney, lung, metabolic or hormone disturbances which pose safety risk
• * Has a current clinically significant heart disease that poses a safety risk
• * Has a current clinically significant infectious disease or a medical comorbidity which poses a safety risk
• * Has a history of relevant severe drug allergy or hypersensitivity
• * Have a history of drug, alcohol, or substance dependence or abuse within the last year, or prior prolonged history of dependence or abuse
• * Currently undergoing chemotherapy or radiation for cancer
• * Recreational drug use in past six months
• * Central nervous systems disease or brain injury that would preclude participation in this study
• * Psychiatric or neurological disorder that would preclude participation in this study
• * Inability to keep or maintain research appointments
• * Severe disease progression such that participation in the imaging tests would be impossible or difficult
• * Non-availability of a suitable matched participant in the alternate progression group (fast or slow)
• 1. Unequivocal cerebellar abnormalities
• 2. Downward vertical gaze limitation or slowing of downward saccades
• 3. Diagnosis of behavioral variant frontotemporal dementia or primary progressive aphasia
• 4. Parkinsonian features restricted to the lower limbs for \> 3 years
• 5. Treatment with dopamine blockers or depleters in a time course consistent with drug induced parkinsonism
• 6. Absence of an observable response to high dose levodopa despite moderate disease severity
• 7. Expert considers a diagnosis of alternative syndrome more likely than PD
• 8. Rapid progression of gait impairment requiring wheelchair within 5 years of onset
• 9. Complete absence of progression of motor symptoms over 5 years unless due to treatment
• 10. Early bulbar dysfunction within the first 5 years since diagnosis
• 11. Inspiratory respiratory dysfunction (stridor or frequent sighs)
• 12. Severe autonomic failure in the first 5 years
• 13. Recurrent falls (\>1 per year) because of impaired balance in the first 3 years
• 14. Disproportionate dystonic anterocollis or hand contractures of hands or feet within 10 years
• 15. Absence of any of the common non-motor features of PD despite 5 years of disease
• 16. Otherwise unexplained pyramidal tract signs (weakness, hyperreflexia, or extensor toe signs)
• 17. Bilateral symmetric parkinsonism
• 1. Clinically significant neuropathy
• 2. Hallucinations not induced by drugs
• 3. Onset after age 75 years
• 4. Family history of ataxia or parkinsonism
• 5. White matter lesions suggesting multiple sclerosis
• 1. Predominant, otherwise unexplained impairment of episodic memory, suggestive of AD (Alzheimer's disease)
• 2. Predominant, otherwise unexplained autonomic failure, e.g., orthostatic hypotension (orthostatic reduction in blood pressure after 3 minutes standing \> 30 mm Hg systolic or \> 15 mm Hg diastolic), suggestive of multiple system atrophy or Lewy body disease
• 3. Predominant, otherwise unexplained visual hallucinations or fluctuations in alertness, suggestive of dementia with Lewy bodies
• 4. Predominant, otherwise unexplained multisegmental upper and lower motor neuron signs, suggestive of motor neuron disease (pure upper motor neuron signs are not an exclusion criterion)
• 5. Sudden onset or step-wise or rapid progression of symptoms, in conjunction with corresponding imaging or laboratory findings, suggestive of vascular etiology, autoimmune encephalitis, metabolic encephalopathies, or prion disease
• 6. History of encephalitis
• 7. Prominent appendicular ataxia
• 8. Identifiable cause of postural instability, e.g., primary sensory deficit, vestibular dysfunction, severe spasticity, or lower motor neuron syndrome