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Abstract Body

A Biological Classification of Parkinson’s Disease: Its Time Has Come

Recent developments justify the establishment of a biologically based definition of Parkinson's disease similar to the ATN classification of Alzheimer’s disease. It is proposed that criteria for a biological classification of PD use a three-component ‘S-N-G’ (or ‘SynNeurGe’) system. A critical development supporting this proposal is the fact that α-Synuclein pathology (‘S’), as found in most but not all patients with Parkinson’s disease, can now be reliably demonstrated in life with pathological α-synuclein deposition in tissues or positive seeding assays in tissue or cerebrospinal fluid. Specific neuroimaging procedures of the central and peripheral nervous systems can provide evidence of underlying neurodegeneration (‘N’). Finally, it is imperative to consider the presence of selected pathogenic gene variants (‘G’), which cause or strongly predispose to Parkinson’s disease in an important minority of cases. These components may or may not be associated with single high-specificity or multiple lower-specificity clinical features (‘C’). The initial application of criteria for the biological classification of PD should be exclusively for research. There are a number of important ethical implications and limitations that should be addressed as well as the critical need for prospective validation of this approach. This biological classification acknowledges the complexity and biological heterogeneity of Parkinson’s disease and will fuel a wide variety of studies in both basic and clinical research. The hope is that this approach will eventually move the field closer to the precision medicine required to develop clinically meaningful disease-modifying therapies.