Objective: The STRAT-PARK initiative aims to stratify Parkinson’s disease (PD) according to underlying molecular mechanisms, and to develop clinically applicable biomarkers for patient stratification.

Background: Efforts to understand and treat PD are hindered by patient heterogeneity. While referred to as a single entity, PD is a heterogeneous clinical syndrome, exhibiting high interindividual variability in terms of clinical and pathological features. This phenotypical diversity suggests that PD may encompass multiple distinct biological entities, or subtypes, each driven by different molecular mechanisms. This would dilute the biological signal in both observational and interventional studies, thereby preventing mechanistic and therapeutic breakthroughs alike. Thus, successful molecular stratification of PD and identification of disease subtypes should be a key-priority in PD-research.

Method: STRAT-PARK is a multi-center, multinational longitudinal cohort, which recruits and prospectively follows individuals with PD and neurologically healthy controls from Norway and Canada. A total of 1500 individuals with PD and 500 demographically matched controls will be collected. Clinical assessment is performed annually, including collection of digital and neurophysiological biomarkers, with extensive biosampling and neuroimaging (MRI) every second year. The type of collected measures and material is carefully tailored to address the detection of candidate molecular processes currently associated with PD, as well as to accommodate a broad spectrum of future targets.

Results: Recruitment rate is ~150 participants per year. As of March 9^th, 2023, 252 participants were included in the cohort, comprising 204 individuals with PD and 48 controls. The male to female ratio is 1.9:1 for PD patients and 0.5:1 for controls. The mean age at baseline is 66.1 ± 7.9 years for patients and 63.1 ± 10.2 for controls. Disease duration in terms of motor symptoms is 7.7 ± 5.4 years, mean MDS-UPDRS III score (ON-phase) is 25.4 ± 12.1, and the distribution of the motor phenotype (using TDPIGD-classification at baseline) shows 46.9 % postural instability and gait disorder (PIGD) phenotype and 42.8% tremor-dominant (TD) phenotype.

Conclusion: STRAT-PARK is a powerful stratification initiative for PD, which is anticipated to become a global research resource, contributing to personalized care in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/strat-park-a-biomarker-and-stratification-initiative-for-parkinsons-disease/