J Mov Disord.  2020 Sep;13(3):171-184. 10.14802/jmd.20029.

Emerging Concepts of Motor Reserve in Parkinson’s Disease

  • 1Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
  • 3Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
  • 4Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea


The concept of cognitive reserve (CR) in Alzheimer’s disease (AD) explains the differences between individuals in their susceptibility to AD-related pathologies. An enhanced CR may lead to less cognitive deficits despite severe pathological lesions. Parkinson’s disease (PD) is also a common neurodegenerative disease and is mainly characterized by motor dysfunction related to striatal dopaminergic depletion. The degree of motor deficits in PD is closely correlated to the degree of dopamine depletion; however, significant individual variations still exist. Therefore, we hypothesized that the presence of motor reserve (MR) in PD explains the individual differences in motor deficits despite similar levels of striatal dopamine depletion. Since 2015, we have performed a series of studies investigating MR in de novo patients with PD using the data of initial clinical presentation and dopamine transporter PET scan. In this review, we summarized the results of these published studies. In particular, some premorbid experiences (i.e., physical activity and education) and modifiable factors (i.e., body mass index and white matter hyperintensity on brain image studies) could modulate an individual’s capacity to tolerate PD pathology, which can be maintained throughout disease progression.


Dopamine transporter; Motor reserve; Parkinson’s disease; Positron-emission tomography
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