ArticleFrontiers in aging neuroscience2026
Layered classification in Parkinson's disease: a content analysis of clinical, prodromal, and biological criteria evolution.
Article in Frontiers in aging neuroscience, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Parkinson's disease (PD) is no longer described through a single diagnostic vocabulary. Clinical criteria, prodromal probability models, and biological research classifications now operate in parallel after the 2024 NSD-ISS and SynNeurGe proposals. Objective: To clarify how major PD criteria and research frameworks have justified diagnostic change and redistributed the roles of clinical signs, biomarkers, genetics, and prodromal markers. Methods: We conducted a targeted document-based qualitative content analysis of eight purposively selected landmark PD criteria or criteria-adjacent framework documents, with the 1988 UK Brain Bank/Lewy body source retained as a historical lineage anchor. Document-declared aims and perceived diagnostic problems were coded with a prespecified framework, and twelve diagnostic elements were assigned interpretative ordinal scores according to their document-specific textual roles. Results: Within the selected corpus, stated priorities shifted from clinicopathological specificity, standardization, and differential diagnosis toward early identification, biomarker integration, staging/subtyping, and trial readiness. Diagnostic-element roles moved from motor signs, exclusions, and dopaminergic response toward RBD/olfaction in prodromal probability frameworks and toward α-synuclein SAA, dopaminergic imaging, and genetics in 2024 biological research frameworks. The analyzed documents indicated materially different 2024 architectures: NSD-ISS emphasized biological definition and integrated staging, whereas SynNeurGe used a multidimensional S/N/G structure. Conclusion: Our analysis suggests that contemporary PD classification can be understood as a layered architecture rather than a simple replacement sequence. Clinical criteria remain necessary for care, prodromal criteria support early-risk research, and biological frameworks require longitudinal, pathological, technical, ethical, and global-access validation before clinical translation.
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