Neurological Evaluations: Recognizing Subtle Signs for Early Diagnosis of Neurodegenerative Diseases

Neurological evaluations are an essential tool in clinical practice for the early diagnosis of neurodegenerative diseases. Recognizing subtle signs of these diseases can be challenging, but it is crucial for initiating timely treatment and improving patient prognosis. In this article, we will explore how to identify these subtle signs and the importance of a detailed clinical examination.

Identification of Subtle Signs in Neurodegenerative Diseases

Neurodegenerative diseases, such as Parkinson's and dementia with Lewy bodies, often begin with subtle symptoms that may go unnoticed. For instance, in the case of Parkinson's disease, early symptoms may include loss of smell, sleep disturbances, and changes in handwriting, which can appear up to 20 years before the clinical diagnosis [1]. In dementia with Lewy bodies, patients may present with acute confusion and sensitivity to antipsychotics, along with subtle parkinsonian signs [2].

Additionally, in conditions like spinocerebellar ataxia, elevated levels of neurofilament light chain in plasma can predict cerebellar atrophy and clinical progression, even before symptoms become evident [3]. These biomarkers can be useful for identifying patients in the early stages of the disease.

A neurological evaluation should include a detailed physical examination and, when necessary, complementary tests such as electroencephalography (EEG) to detect subclinical alterations in brain function [4]. In some cases, such as neurofibromatosis type 1, subtle neurological signs may include motor deficits and executive planning issues, which can be early indicators of the disease [5].

Conclusions

Recognizing subtle signs in neurological evaluations is fundamental for the early diagnosis of neurodegenerative diseases. A thorough clinical examination, supported by complementary tests and biomarkers, can facilitate the identification of these signs and allow for early intervention. As physicians, it is our responsibility to remain vigilant for these indications and utilize all available tools to enhance the care of our patients.

Referencias

• [1] Evolution of prodromal Parkinson's disease and dementia with Lewy bodies: a prospective study
• [2] Acute presentation of dementia with Lewy bodies
• [3] Plasma neurofilament light chain predicts cerebellar atrophy and clinical progression in spinocerebellar ataxia
• [4] Electroencephalography in encephalopathy and encephalitis
• [5] Presence of neurologic signs in children with neurofibromatosis type 1

Created 13/1/2025