NEW DELHI: Parkinson’s Disease poses challenges in diagnosis and treatment. Learn how advancements offer hope for personalized care strategies.
Dr. Monisha Banerjee, a distinguished Senior Consultant in Molecular Genomics & Genetic Counseling at Metropolis Healthcare, offers insights into Parkinson’s disease management in an exclusive interview with The Sunday Guardian. With over three decades of expertise in Reproductive Genetics, Dr. Banerjee delves into distinguishing early signs of Parkinson’s from normal aging. She emphasizes the crucial role of advanced diagnostic technologies in accurate diagnosis and the emerging trends in personalized treatment plans tailored to individual symptoms and genetic factors.
Q: What are the most common early signs and symptoms of Parkinson’s disease, and how can individuals differentiate them from normal aging or other health conditions?
A: Parkinson’s Disease (PD) is a progressive neurological disorder affecting the nervous system and is often termed a movement disorder. It is caused by a deficiency of a neurotransmitter in the brain called dopamine. The dopaminergic neurons in substantia nigra, located in the mid-brain usually die leading to characteristic motor problems. The disorder usually manifests after the age of 60 years, although in a small proportion of cases, the symptoms are seen earlier. The early signs of the disease are often noticed by immediate family members and can be mistakenly attributed to the aging process. The most visible features of the disease include change in posture, slow movements, muscle rigidity, tremors, disorientation in writing, drooling etc. Drugs that mimic dopamine are often used to treat these types of deficits. Deep brain stimulations are used to treat symptoms. People can live a reasonable active life with the help of medications and supportive therapies like diet, exercises and speech, occupational and physical therapy.
Q: What is the role of advanced diagnostic technologies, such as brain imaging or genetic testing, in accurately diagnosing Parkinson’s disease, especially in its early stages?
A: Although age, genetics and environmental factors are associated with Parkinson Disease, there is no definitive diagnostic test to affirm the disease in the patient A wide range of diagnostic tests are available for investigation; however, in most cases, clinical presentation is sufficient to diagnose the condition. Symptomatic clinical evaluation, brain imaging and neurological examination are currently the primary diagnostic criteria for PD.
Brain imaging tests such as MRI, USG and PET scans are usually conducted to aid in the diagnosis. DAT (Dopamine transporter) scan that checks for the function of dopamine transporter in the brain can help in differential diagnosis of PD.
Recent developments include the alpha-synuclein seed amplification assay, which detects clumps of the protein alpha-synuclein in blood or CSF specimens of PD patients. These protein clumps are found in Lewy bodies and are hallmarks of PD diagnosis. This test can be considered as predictive markers and can detect PD even before symptoms manifest.
Q: How does early diagnosis of Parkinson’s disease impact treatment outcomes and disease management? Are there any emerging trends or breakthroughs in this area?
A: Presently, the diagnosis of PD primarily depends on clinician’s assessment of symptoms and response to medications. But the classical features appear only when the dopamine neurons are already damaged. Alpha-synuclein degeneration and more than 50% neuronal loss occurs much before the clinical features are seen in the patients.
Besides the classical symptoms of PD, a host of non-motor or prodromal symptoms could provide clues for the onset of the disease. These include REM sleep behavioral disorder, anxiety, depression, cognitive impairment, hyposmia and mood disorders. Parkinson’s disease cannot be reversed, but the symptoms can be controlled with supportive therapies, surgery, and medications including Levodopa, which significantly improve symptoms, quality of life, and life expectancy. Moreover, the significant side effects like cognitive problems, levodopa-induced dyskinesias, neuropsychiatric features makes it imperative to investigate improvised and novel therapeutic approaches to provide a better quality of life for PD patients.
Early diagnosis of the disorder will be beneficial to the patients as they could have early access to support system, opportunity to initiate dopamine replacement therapy and possible targeted therapies. Newer treatments and experimental treatment options include drugs targeting non-dopamine related PD, decreasing inflammation, neurodegeneration, improvised brain stimulation approach and cell based regenerative and gene therapies.