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Patients are frequently identified with PD only in the presence of tremor and other symptoms, by which time 6080% of the substantia nigra (SN) dopamine neurons have been lost, which occurs 5 to 15 years after the start of neuronal degeneration (Sulzer et al., 2018) (see Figure 1)

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Myoishi M, Hao H, Minamino T, Watanabe K, Nishihira K, Hatakeyama K, Asada Y, Okada K, Ishibashi-Ueda H, Gabbiani G, Bochaton-Piallat ML, Mochizuki N, Kitakaze M

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There was nothing dramatic