Journal, Research, Social Science

Understanding Parkinson’s Disease: Causes, Challenges, and Hope for the Future : by Zhang Chenxi

Understanding Parkinson’s Disease: Causes, Challenges, and Hope for the Future by Zhang Chenxi

Understanding Parkinson’s Disease: Causes, Challenges, and Hope for the Future by Zhang Chenxi

Parkinson’s disease is conventionally known as a brain disorder which mainly affects motor aspects of the patient. It is characterised by jerky or involuntary movements[1] , such as tremors, shaking, muscle stiffness, and inability to move the limbs in synonymity. The hindrance caused to the patient’s mobility has increased their susceptibility to physical accidents, as well as making daily tasks a lot more time-consuming and tough. Besides the physical impairment, Parkinson’s disease can also cause detrimental psychological symptom like depression, anxiety, hallucinative episodes, impulsive and compulsive behaviours. Notably, anxiety is known to be present in 60%[2] of patients with Parkinson’s disease. As a progressive disease, the symptoms of Parkinson’s deteriorate over time gradually, eventually affecting its patients to the point where the completion of simple tasks become daunting. For these patients, their employability and social interactions are adversely affected by the physical and cognitive handicap caused by Parkinson’s, therefore lowering their standards of living. 

Understanding the Root Causes

Parkinson’s disease is caused by the loss of striatal dopaminergic neurons[3], as well as possibly in nondopaminergic areas as well. When these neurons are damaged, they produce less dopamine, which plays a critical role in regulating body functions such as movement and memory. A less prominent cause in scientific literature is the deficiency of norepinephrine[4], which is an important hormone to regulate blood pressure of the patient. The lack of norepinephrine causes other sources of physical discomfort such as feeling nauseous, lightheaded, as well as compromising decision making in daily life.

Available Treatments and Therapies

While there is no concrete cure for Parkinson’s yet, there are treatments such as drugs and therapy which attempt to help Parkinson patients attain a life of normalcy. Pertaining to dopamine deficiency, levodopa is consumed by patients to control the movement-related symptoms in the body[6]. Furthermore, the symptoms of fatigue and lightheadedness are treated by the oral medicine Northera which can be metabolized to increase norepinephrine levels in the body[7]. Besides medication, vigorous exercise is shown to slow down the deterioration of Parkinson’s disease through improving the physical dexterity of the patients. A minimum of 2.5 hours per week of physical exercise can slow down the progressive nature of Parkinson’s disease. There are also available therapy like the surgically implanted deep brain stimulation which is performed on patients when medications are no longer sufficient for them to retain a life of normalcy. 

Demographics and Possible Causes

Known to mainly affect the elderlies in the age range of sixties, Parkinson’s disease is even able to affect patients from the age range of 30 to 40. Demographically speaking, it is scientifically reported that men are twice as likely to suffer from Parkinson’s disease compared to women[7]. The difference in sex causes biological differences which makes the individual to more susceptible to Parkinson’s. For instance the production of estrogen in the body has a buffering effect on the dopaminergic system of the patient, hence decreasing the loss of striatal dopaminergic neurons. While the possible cause of Parkinson’s disease is speculated to be mostly hereditary, environmental factors may also play a role in genetic mutations, which results in the disease[8][9]. For instance, pesticides and herbicides used in farming contains toxins from the environment which may cause genetic mutations[10]. As the exact cause of Parkinson’s has yet to be discovered, there are no known methods to stop it at its root cause.

Challenges in Diagnosis

There are several challenges when it comes to the diagnosis of Parkinson’s disease. The diagnosis is based on the patient’s medical history, a review of symptoms, and a thorough neurological examination on the patient’s body. The clinical assessments of Parkinson have largely been subjective, instead of having an objective marker to immediately detect Parkinson’s disease. When it is diagnosed, the disease has already reached the stage where there are visible physical disabilities that the patient experiences, such as the difficulty in controlling their movements due to tremors, bradykinesia, stiffness, and lack of coordination[11]. It may take one or two years for a patient to be actually diagnosed with Parkinson’s and receive treatment. As a result, patients may have to suffer from mild symptoms for years before an accurate diagnosis can be provided. Due to the gradual and unpredictable trajectory of the Parkinson’s disease, the rate of progression of symptoms may differ from person to person, hence it may be tough to extrapolate how the disease affects the patient even if it is detected at an early stage[12].

Furthermore, accurate diagnosis of Parkinson’s disease is still an issue since many of the symptoms overlap with other neurodegenerative conditions. With the lack of biomarkers, there is no specialised test to detect Parkinson’s and make a definitive diagnosis made in the nascent stages. A recent study has shown that more than a quarter of people living with Parkinson’s were misdiagnosed in the initial stage, and as a result treated for an entirely different neurodegenerative condition[13]. The plethora of similar diseases further compounded the issue, as it is tough to distinguish from the other just by subjective diagnosis. Furthermore, a third of Parkinson patients who responded in a survey by Parkinson’s UK felt that they did not receive enough information about Parkinson’s during the diagnosis[14]. There was a lack of communication between the patient and their clinician, which compromised the quality of treatment and might even extend the diagnosis duration unnecessarily.

Hope for the Future

Yet, we can be optimistic about such challenges given the recent developments of the disease. There is increased research on the identification of genetic subtypes associated with an increased risk of Parkinson’s. With the specialization of the disease made possible by understanding the different subtypes and variants of Parkinson’s, possible treatments made for Parkinson patients can be more specific, with different remedies catered to different types of symptoms. The advent of technology integrated into healthcare means that there is also an availability of devices to help the patients improve their standards of living or cope with the symptoms of Parkinson’s. For instance, the Health app SleepFit can be utilised to track the symptoms of Parkinson patients, which allow the medical experts to assess the patient’s conditions in more accurate and quantifiable forms[15]. This then helps these patients to procure better treatment in the long run.

Furthermore, there are undoubtedly numerous scientific breakthroughs to resolve the issues surrounding diagnosis of Parkinson’s disease. Researchers have invented a medical test which can detect alpha synuclein in brain and body cells in both diagnosed individuals and individuals who have a high risk of developing Parkinson’s disease. This is in stark contrast to the time-consuming and tough test of using spinal fluids to detect abnormal alpha synuclein. 93% of the patients[16] who suffer from the Parkinson’s are accurately diagnosed using the criteria of abnormal alpha-synuclein levels, hence making this procedure a highly viable for detecting Parkinson. This is a large step towards a quick and early diagnosis for the disease, which can nip the issue in the bud. There is even the development of an AI tool called CRANK-MS which can detect Parkinson’s from measuring patients’ blood samples up to 15 years[17] before the symptoms settle in. This yielded a high accuracy of 96% in accurately detecting the patients who developed Parkinson’s[18]. It is predicted that this tool can even be applied to other similar neurodegenerative diseases to monitor different biomarkers to diagnose the disease.

A Promising Future for Parkinson Patients

In conclusion, Parkinson’s disease poses complex challenges, but ongoing research and technological advancements offer hope. As we uncover the intricacies of the disease, we can develop more effective treatments, improve early detection, and enhance patients’ quality of life. Our collective efforts will lead to a brighter future for those affected by Parkinson’s, where accessible and timely solutions are the norm, not the exception.

References:

  1. National Institute on Aging, Parkinson’s Disease: Causes, Symptoms, And Treatments, https://www.nia.nih.gov/health/parkinsons-disease
  2. Ji Won Han, Yebin D. Ahn, Won-Seok Kim, Cheol Min Shin, Seong Jin Jeong, Yoo Sung Song, Yun Jong Bae, Jong-Min Kim(2018), Psychiatric Manifestation in Patients with Parkinson’s Disease, National Library of Medicine, National Center for Biotechnology Information, Journal of Korean Medical Science https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236081/
  3. George DeMaagd, Ashok Philip(2015), Parkinson’s Disease and Its Management, PubMed Central, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517533/
  4. US National Library of Medicine, Nonerepinephrine-targeted Therapy for Action Control in Parkinson Disease, https://classic.clinicaltrials.gov/ct2/show/NCT03115827
  5. Kavita R.Gandhi, Abdolreza Saadabadi(2023), Levodopa, National Library of Medicine, National Center for Biotechnology Information https://www.ncbi.nlm.nih.gov/books/NBK482140/#:~:text=Levodopa%20is%20typically%20prescribed%20to,due%20to%20carbon%20monoxide%20intoxication.
  6. Parkinson’s News Today, Northera(Droxidopa), https://parkinsonsnewstoday.com/parkinsons-disease-treatments/non-motor-symptoms/northera-droxidopa/#:~:text=Northera%20(droxidopa)%20is%20an%20oral,neurological%20disorder%20like%20Parkinson’s%20disease.
  7. Parkinson’s NSW, Men and Parkinson’s Disease, https://www.parkinsonsnsw.org.au/men-and-parkinsons-disease/#:~:text=But%20since%20this%20Day%20focuses,dysfunction%2C%20or%20genetic%20risk%20factors.
  8. National Institute of Neurological Disorders and Stroke, Parkinson’s Disease: Challenges, Progress, and Promise, https://www.ninds.nih.gov/current-research/focus-disorders/focus-parkinsons-disease-research/parkinsons-disease-challenges-progress-and-promise
  9. Parkinson’s Foundation, Understanding Genetics, https://www.parkinson.org/understanding-parkinsons/causes/genetics/understanding-genetics
  10. John Hopkins Medicine, Can Environmental Toxins Cause Parkinson’s Disease? https://www.hopkinsmedicine.org/health/conditions-and-diseases/parkinsons-disease/can-environmental-toxins-cause-parkinson-disease
  11. Eduardo Tolosa, Alicia Garrido, Sonja W. Scholz, Werner Poewe, Challenges in the diagnosis of Parkinson’s disease, PubMed Central, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185633/
  12. Liza Torborg(2015), Mayor Clinic Q and A: Rate of progression of Parkinson’s disease hard to predict, https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-rate-of-progression-of-parkinsons-disease-hard-to-predict/
  13. Joe Mc Aweaney(2020), Over a quarter of people living with Parkinson’s were initially misdiagnosed, study finds, Parkinson’s Life, https://parkinsonslife.eu/over-a-quarter-people-living-with-parkinsons-were-initially-misdiagnosed-study-finds/
  14. Geoffrey Chang(2016), Over ⅓ of patients don’t receive enough info about Parkinson’s at diagnosis, Parkinson’s Life, http://parkinsonslife.eu/parkinsons-uk-audit-one-third-of-patients-dont-receive-enough-info-about-parkinsons-at-diagnosis/
  15. Simge Eva Dogan(2019), New Parkinson’s health app to track symptoms more accurately, Parkinson’s Life, https://parkinsonslife.eu/parkinsons-health-app-sleepfit/
  16. Beth Chute(2023), Breaking News: Parkinson’s Disease Biomarker Found, https://www.michaeljfox.org/news/breaking-news-parkinsons-disease-biomarker-found
  17. Annie Lennon(2023), AI tool detects Parkinson’s up to 15 years early with 96% accuracy, MedicalNewsToday, https://www.medicalnewstoday.com/articles/ai-tool-detects-parkinsons-up-to-15-years-early-with-96-accuracy#:~:text=Researchers%20developed%20an%20AI%20tool,adapted%20for%20diagnosing%20other%20conditions.
  18. Paul McClure(2023), Machine Learning tool may diagnose Parkinson’s years before symptoms appear, New Atlas, https://newatlas.com/medical/crank-ms-machine-learning-early-parkinsons-diagnosis/