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New Diagnostics for PD Might Allow Early Diagnosis, Prevention

Parkinson's diagnosis

A new way of diagnosing Parkinson’s disease based on manifestations that appear decades before motor symptoms — the current hallmarks for diagnosis — might allow early diagnosis and even prevention.

The study, “From Prodromal to Overt Parkinson’s Disease: Towards a New Definition in the Year 2040,” was published in the Journal of Parkinson’s Disease.

Parkinson’s disease is characterized by progressive loss of coordination and movement. Currently, a person is diagnosed when those symptoms appear. However, there are some risk factors and symptoms that precede motor manifestations and constitute the early stages of the disease (called prodromal).

“Brilliant work of many in different scientific fields has paved the way for the concept of prodromal  [Parkinson’s disease]; that is, a phase of years to decades in which non-motor and subtle motor symptoms may indicate spreading PD pathology, but do not meet the threshold for diagnosis according to the classic motor-based clinical criteria,” researchers said.

The development of new diagnostic criteria that allow the identification of prodromal Parkinson’s might help to better understand disease progression, lead to early diagnosis and treatment, and prevent classic motor symptoms.

Now, Parkinson’s experts Daniela Berg, MD, Christian-Albrechts-University of Kiel, Germany, and Ronald B. Postuma, MD, MSc, Montreal General Hospital, Canada, have developed a mathematical model that calculates a person’s risk of being in the prodromal phase of the disease. This model is based on three main premises relative to Parkinson’s prodromal phase:

  • The fact that the neurodegenerative process in Parkinson’s is slow and continuous, possibly starting in the gut or olfactory system, finally reaching the nervous system;

  •  The increased knowledge regarding risk factors and clinical symptoms that occur years or decades prior to motor manifestations. These can be correlated to imaging findings and tissue examinations;

  • Studies have found that people who manifest different combinations of risk and prodromal markers can many times progress to Parkinson’s disease.

Currently, however, the model has some limitations. For example, it does not consider age and sex factors, and cannot predict whether or when motor symptoms will appear.

“The prodromal PD criteria are meant to be research criteria and constitute a first step in what should be a continually updated process,” researchers stated.

New Parkinson’s biomarkers — substances present in the body that indicate the occurrence of a condition — are continually being discovered, providing new information that makes the model more reliable. In time, the hallmarks for diagnosis might be based on the presence of biomarkers instead of motor symptoms.

Wearable technology, such as mobile phones, also allows the continuous capture of movement in daily life, which will benefit “from new methods of data handling and analyses,” researchers said.

“With new data arising from objective movement measurements, the earlier detection of motor symptoms will become possible. Objectively measured markers … wearable-based markers of activity … indicate that we can expect to change our understanding of early motor PD,” researchers said.

The model will be available online, allowing doctors to calculate the risk for patients. Additionally, there will be a platform where experts can share information and discuss the new criteria for diagnosis.

With this collaborative model, researchers expect to incorporate the new criteria and have a functional model by 2040. This is expected to allow early diagnosis and treatment and, in time, prevention of clinical symptoms.

“Our review highlights the importance of making an earlier diagnosis of neurodegenerative diseases, and in particular PD, for now primarily to understand the disease better,” Berg and Postuma said in a press release. “However, in the future, once we have preventive therapy, it will become critical to find patients in the earliest stages of the disease so that we can prevent the disease from developing and affecting quality of life.”

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Parkinson’s Patients Show Reduced Workforce Participation Even Before Diagnosis, Study Finds

workforce participation

Parkinson’s patients show less ability to participate in work life even in the early stages before they are diagnosed with the disease, a study shows.

In combination with biochemical and genetic biomarkers, this finding may help identify patients at risk of developing this progressive neurodegenerative disease before motor symptoms occur, the researchers suggest.

The study, “Reduced workforce participation 5 years prior to first Parkinson’s disease sick-leave,” was published in the journal NPJ Parkinson’s Disease.

Non-motor symptoms, such as depression and anxiety, are recognized as part of the prodromal (early) phase of Parkinson’s disease. These manifestations often arise approximately 10 to 20 years prior to the onset of motor symptoms.

At least 30 percent of people who have Parkinson’s are of working age, according to the study.

“At the group level, persons who later will get diagnosed with PD [Parkinson’s disease] have been reported to exhibit higher medical expenses and a lower employment rate up to 8 years prior to the diagnosis in comparison with controls,” the researchers wrote.

However, it is not fully understood how early non-specific motor and non-motor symptoms can affect workforce participation during prodromal and early Parkinson’s disease.

Researchers in this study aimed to investigate whether individuals eventually diagnosed with Parkinson’s exhibit increased sickness absences one, two, and five years prior to a first sick-leave episode attributed to the disease.

They reviewed clinical records of all sick-leave absences that exceeded 14 days in Sweden between 2008 and 2014. They identified a total of 537 incident Parkinson’s disease sick-leave cases and 537 sick-leave cases of other diagnoses, which were used as controls. Most Parkinson’s sick-leave cases were men (63.7%), and the median age was 59 years.

A larger portion of the Parkinson’s sick-leave cases, compared with sick-leave controls, were found to have had more than one sick-leave episode one, two, and five years prior to the first Parkinson’s sick-leave.

“Persons who later were allowed sick-leave due to PD were more absent from work due to illness than matched sick-leave controls already 5 years prior to the incident PD sick-leave episode,” the researchers wrote.

Those later diagnosed with Parkinson’s had more sick-leave absences due to musculoskeletal problems up to five years prior to the first Parkinson’s sick-leave episode. Total sickness absences were also increased among Parkinson’s sick-leave cases five years prior to the first sick-leave episode due to the disease.

“It is possible that an increased occurrence of pain is a partial explanation of the increased sickness absence due to musculoskeletal diagnoses in the present study,” the researchers noted. Increased pain, tremor, fatigue, dizziness, shoulder pain or stiffness, balance impairments, rigidity, and reduced blood pressure were factors that “either on their own or indirectly could result in sickness absence due to musculoskeletal diagnoses,” they added.

The incidence of sick-leave absences due to mental and behavioral problems was similar between the two groups.

In general, Parkinson’s sick-leave cases were less likely to be of patients working in occupations with lower education requirements compared with the control group. In addition, Parkinson’s patients were 2.16 times more likely to be self-employed or unemployed than sick-leave cases with other diagnoses.

This pattern could be caused by the gradual increase of symptoms that prodromal and early Parkinson’s patients may experience.

Based on these findings, the team believes that “the capacity to participate in working life is reduced already at the early prediagnostic stages of Parkinson’s disease.”

“This finding can be used as a basis for further research into the process of identifying individuals at risk for developing Parkinson’s, particularly in combination with further investigation into biochemical, genetic, and imaging biomarkers,” they concluded.

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Foot Problems as an Early Sign of PD: Oh, What a Drag It Is!

foot drag

Search on the internet for early signs of Parkinson’s disease. Surprisingly, you will not find foot drag on most of the lists. Yet, Ali Samil, in the chapter “Cardinal Features of Early Parkinson’s Disease,” in the book “Parkinson’s Disease: Diagnosis and Clinical Management,” lists foot drag as an important early symptom.

I have been dealing with foot drag for a few years — that squeak of the sneaker on the kitchen floor when the foot drag catches, scuff marks left behind. While at a professional conference, the foot drag caught the top edge of a stair just as I was headed down, and down I went, grasping the handrail to rescue an awful fall. Recently, it has been much worse, and oh, what a drag it is now.

Reflecting on it, it seems almost impossible that I could seriously hurt my foot walking on a flat, carpeted surface with no obstacles in the way. But that is exactly what happened. Walking barefoot on a carpeted floor, my foot dragged, and then my big toe jammed into the carpet — HARD! I screamed, tears flowed, and I fell to the floor weeping from the pain. The toe turned a nice purple shortly thereafter, but luckily nothing was broken. I don’t walk barefoot anywhere now, except for a few steps in and out of the shower.

I am surprised that there is not more mention of foot drag in the lists of early PD symptoms. If it is a cardinal early symptom, then both patients and care providers should be given the heads up (or maybe feet down), along with some guidelines on how to adjust.

If a patient does have this symptom, then perhaps it doesn’t show up all the time, but rather only during off periods and deep fatigue. If the patient has a favorite pair of shoes, then perhaps signs of the foot drag can be seen on the wear pattern in the shoes.

The indications of foot drag problems don’t have to be as dramatic as my story before they become something that needs attention. My attention is given to the footwear I purchase, limiting my walking during deep fatigue, and carefully watching my feet when changing surface levels (such as a curb on sidewalks).

Maybe there are readers out there who have dealt with foot drag and have a story to tell with suggestions about how to cope. Next time someone says to you, “Quit dragging your feet on this,” tell them about this column.

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Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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