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Thus, PD is a progressive multiorgan disease clinically associated with various motor and nonmotor symptoms. The earliest PD\u2010related lesions appear to develop in the olfactory bulb, dorsal vagal nucleus, and possibly also the peripheral autonomic nervous system. The brain is closely connected with the enteric nervous system via axons of the efferent fibers of the dorsal nucleus of vagal nerve. Anatomical connections also exist between the olfactory bulb and brainstem. Accumulating evidence from experimental studies indicates that transneuronal propagation of misfolded alpha\u2010synuclein is involved in the progression of PD. However, it cannot be ruled out that alpha\u2010synuclein pathology in PD is multicentric in origin. Based on pathological findings from studies on human materials, the present review will update the progression pattern of alpha\u2010synuclein pathology in PD.<\/jats:p>","DOI":"10.1111\/neup.12691","type":"journal-article","created":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T23:23:29Z","timestamp":1596583409000},"page":"415-425","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":74,"title":["Where and how alpha\u2010synuclein pathology spreads in Parkinson\u2019s disease:"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3756-7209","authenticated-orcid":false,"given":"Koichi","family":"Wakabayashi","sequence":"first","affiliation":[{"name":"Department of Neuropathology Institute of Brain Science, Hirosaki University Graduate School of Medicine  Hirosaki 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