[New concepts of pathogenesis, diagnosis, and treatment of neurodegenerative diseases]

Millions of patients all over the world suffer from chronic neurodegenerative diseases (NDD) (Parkinson's disease, Alzheimer's disease, Huntington disease, hyperprolactinemia, etc.) which result first in disability and then in fatal outcome. The key component of NDD pathogenesis is the degeneration of specific neurons leading with time to dysfunction, e.g. cognitive problems in Alzheimer's disease, disturbed motor behavior in Parkinson's disease, etc. Over the initial twenty-thirty years, NDD are developed as a preclinical condition, and their first symptoms appear only after degeneration of a greater part of specific neurons. The lag in the manifestation of NDD at the organismic level is explained by late triggering mechanisms of brain plasticity serving to compensate functional insufficiency of dying neurons. In this context, the appearance of initial symptoms is considered as a manifestation of irreversible degradation of the specific regulatory brain system and the exhaustion of compensatory resources of the brain that probably explains low efficiency of pharmacotherapy. This implies the necessity to develop preclinical diagnostics and preventive therapy aimed at arresting or at least slowing down of the neurodegenerative process and prolongation of the preclinical stage for many years. The development of preclinical diagnostics is based on a search for specific clinical forerunners of NDD and endogenous peripheral markers circulating in cerebrospinal fluid and blood. NDD diagnostics in the preclinical stage should be developed by identification of risk groups during prophylactic examination of healthy population based on detection of disease markers. The final diagnosis can be made by non-invasive neurovisualizing techniques. The new concept of NDD pathogenesis promotes further development of novel approaches to their diagnostics and treatment.