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IntroductionNeutrophil and lymphocyte levels and their ratio, the neutrophil-lymphocyte ratio (NLR), in the peripheral blood provide accessible indices of systemic inflammatory activity. In this study, we evaluated whether these blood markers are linked to motor symptoms and cognitive performance during the prodromal stage of Parkinson's disease (PD).MethodsWe analyzed data from the prodromal cohort of the Parkinson's Progression Markers Initiative, which included 1,269 individuals with prodromal PD features (isolated REM sleep behavior disorder [RBD]: n = 116, isolated hyposmia: n = 570, combined: n = 583) and 284 healthy controls. Motor impairment was measured using the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part 3, while cognition was assessed through a broad neuropsychological test battery.ResultsCompared with controls, participants with prodromal PD had lower lymphocyte counts (p ConclusionOur findings indicate that higher NLR, largely reflecting reduced lymphocyte levels, is already present in the prodromal phase of PD and relates to the severity of motor symptoms. Prospective longitudinal studies are needed to clarify whether NLR has predictive value for progression to overt PD.
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