Abcd

baseline 2 years

Fig. 1. [123I]p-CIT SPECT images. A Two year follow-up scan of normosmic relative. B, C Baseline and two year follow-up scans of hyposmic relative, asymptomatic two years from baseline, clinical diagnosis of PD four years from baseline. D Two year follow-up scan of hyposmic relative, clinical diagnosis of PD two years from baseline so far one more hyposmic relative has developed the classical motor signs of PD. Interestingly, baseline striatal [123I] b-CIT binding in this individual was within the range of control values. Two years from baseline, [123I]p-CIT binding in this case had dropped below control values (Fig. 1). In this single individual, hyposmia apparently developed even before the appearance of a significant loss of nigrostriatal dopaminergic terminals. The data obtained thus far in this ongoing prospective study are compatible with the notion of a slowly developing degenerative process that affects the olfactory system prior to the onset of clinical motor signs and quite possibly prior to the onset of nigral dopami-nergic cell loss.

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