БОЛЕЗНЬ ПАРКИНСОНА: СОВРЕМЕННЫЕ КЛИНИКО-ПАТОГЕНЕТИЧЕСКИЕ ПРЕДСТАВЛЕНИЯ, РАННЯЯ ДИАГНОСТИКА, БИОМАРКЕРЫ И ПЕРСОНАЛИЗИРОВАННЫЕ ПОДХОДЫ К ЛЕЧЕНИЮ И НЕЙРОРЕАБИЛИТАЦИИ

Abstract

Background. Parkinson's disease is a chronic progressive neurodegenerative disorder characterized by degeneration of the nigrostriatal dopaminergic system, basal ganglia dysfunction, and heterogeneous motor and nonmotor manifestations. Contemporary research emphasizes substantial clinical and molecular heterogeneity involving α-synuclein aggregation, mitochondrial dysfunction, impaired lysosomal-autophagic pathways, neuroinflammation, and genetic susceptibility. Molecular biomarkers capable of identifying pathological α-synuclein aggregation have introduced new opportunities for biological characterization and earlier identification of neurodegenerative disease.

Materials and Methods. A narrative analytical review of international clinical guidelines, prospective cohort studies, randomized controlled trials, systematic reviews, and investigations addressing molecular biomarkers, neuroimaging, deep brain stimulation, and neurorehabilitation was conducted. Clinical diagnostic criteria and emerging biological classification frameworks were examined.

Results. Major pathogenic mechanisms, clinical phenotypes, diagnostic criteria, and molecular biomarkers were systematically characterized. Comparative analyses addressed dopaminergic pharmacotherapy, continuous levodopa delivery systems, subthalamic and pallidal deep brain stimulation, and structured rehabilitation. Six analytical tables and an original conceptual framework, NEURO-PD-CARE, were developed to integrate clinical, molecular, neurological, and functional parameters.

Conclusion. Modern Parkinson's disease management requires integration of neurological assessment, nonmotor symptom evaluation, individualized dopaminergic treatment, identification of motor complications, and multidisciplinary rehabilitation. Molecular biomarkers and adaptive neuromodulation offer important opportunities for precision medicine, although further validation and evidence of clinical utility remain necessary.