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Papers > Literature on "Parkinson's Disease" in the Last Decade

Parkinson's disease. ​

Literature Information ​

DOI10.1016/S0140-6736(21)00218-X
PMID33848468
JournalLancet (London, England)
Publication Year2021
Times Cited1342
KeywordsParkinson's disease, neurodegenerative condition, personalized management, genetic factors, motor symptoms
Literature TypeJournal Article, Review
ISSN0140-6736
Pages2284-2303
Issue397(10291)
AuthorsBastiaan R Bloem, Michael S Okun, Christine Klein

TL;DR ​

This study examines the growing prevalence of Parkinson's disease, highlighting its multifaceted clinical presentations and the significant role of both genetic and environmental risk factors. While current treatments, primarily involving levodopa, focus on symptom management, the research underscores the importance of personalized care and the potential for future disease-modifying strategies as understanding of the disorder advances.

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Parkinson's disease · neurodegenerative condition · personalized management · genetic factors · motor symptoms

Abstract ​

Parkinson's disease is a recognisable clinical syndrome with a range of causes and clinical presentations. Parkinson's disease represents a fast-growing neurodegenerative condition; the rising prevalence worldwide resembles the many characteristics typically observed during a pandemic, except for an infectious cause. In most populations, 3-5% of Parkinson's disease is explained by genetic causes linked to known Parkinson's disease genes, thus representing monogenic Parkinson's disease, whereas 90 genetic risk variants collectively explain 16-36% of the heritable risk of non-monogenic Parkinson's disease. Additional causal associations include having a relative with Parkinson's disease or tremor, constipation, and being a non-smoker, each at least doubling the risk of Parkinson's disease. The diagnosis is clinically based; ancillary testing is reserved for people with an atypical presentation. Current criteria define Parkinson's disease as the presence of bradykinesia combined with either rest tremor, rigidity, or both. However, the clinical presentation is multifaceted and includes many non-motor symptoms. Prognostic counselling is guided by awareness of disease subtypes. Clinically manifest Parkinson's disease is preceded by a potentially long prodromal period. Presently, establishment of prodromal symptoms has no clinical implications other than symptom suppression, although recognition of prodromal parkinsonism will probably have consequences when disease-modifying treatments become available. Treatment goals vary from person to person, emphasising the need for personalised management. There is no reason to postpone symptomatic treatment in people developing disability due to Parkinson's disease. Levodopa is the most common medication used as first-line therapy. Optimal management should start at diagnosis and requires a multidisciplinary team approach, including a growing repertoire of non-pharmacological interventions. At present, no therapy can slow down or arrest the progression of Parkinson's disease, but informed by new insights in genetic causes and mechanisms of neuronal death, several promising strategies are being tested for disease-modifying potential. With the perspective of people with Parkinson's disease as a so-called red thread throughout this Seminar, we will show how personalised management of Parkinson's disease can be optimised.

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Primary Questions Addressed ​

  1. What are the latest advancements in understanding the non-motor symptoms of Parkinson's disease?
  2. How do genetic factors influence the progression of Parkinson's disease compared to environmental factors?
  3. What are the challenges in early diagnosis of Parkinson's disease and how can they be addressed?
  4. How do different neurotransmitter systems interact in the pathology of Parkinson's disease?
  5. What potential therapeutic approaches are being explored to slow the neurodegenerative process in Parkinson's disease?

Key Findings ​

1. Research Background and Objective: Parkinson's disease (PD) is a prevalent neurodegenerative disorder characterized by a diverse range of causes and clinical presentations. The increasing incidence of PD globally resembles a pandemic, although it lacks an infectious origin. The objective of this research is to elucidate the multifactorial etiology of PD, establish criteria for diagnosis, and explore the implications of genetic factors on its management and treatment.

2. Main Methods and Findings: The study emphasizes a clinical diagnostic approach for PD, primarily based on the presence of bradykinesia combined with either rest tremor or rigidity. Genetic analysis reveals that 3-5% of PD cases are attributable to known monogenic causes, while 90 genetic risk variants account for 16-36% of the heritable risk in non-monogenic cases. Additional identified risk factors include familial history, non-smoking status, and conditions like constipation, each doubling the risk of developing PD. The research also notes a potentially prolonged prodromal phase prior to clinical manifestation, although current recognition of these symptoms lacks therapeutic implications. Treatment strategies are highlighted, stressing the importance of personalized management tailored to individual patient needs, with a multidisciplinary approach recommended for optimal outcomes.

3. Core Conclusion: The study concludes that Parkinson's disease is a complex syndrome requiring a nuanced understanding of both genetic and environmental factors. While symptomatic treatments, particularly with levodopa, are essential, there is currently no available therapy to halt disease progression. Future advancements in recognizing prodromal symptoms and understanding genetic mechanisms may lead to novel disease-modifying treatments, emphasizing the importance of personalized care in managing PD.

4. Research Significance and Impact: This research is significant as it underscores the complexity of Parkinson's disease, highlighting the interplay of genetic predisposition, clinical presentation, and treatment strategies. It advocates for a patient-centered approach in managing PD, recognizing the need for timely intervention to manage symptoms and improve quality of life. The emphasis on establishing a multidisciplinary treatment framework reflects a shift toward comprehensive care models in neurodegenerative diseases. Furthermore, the insights into genetic factors and prodromal symptoms may pave the way for future therapeutic innovations, influencing clinical practice and research directions in the management of Parkinson's disease.

Literatures Citing This Work ​

  1. The Importance of Drosophila melanogaster Research to UnCover Cellular Pathways Underlying Parkinson's Disease. - Melissa Vos;Christine Klein - Cells (2021)
  2. The state of telemedicine for persons with Parkinson's disease. - Robin van den Bergh;Bastiaan R Bloem;Marjan J Meinders;Luc J W Evers - Current opinion in neurology (2021)
  3. Proteolytic α-Synuclein Cleavage in Health and Disease. - Alexandra Bluhm;Sarah Schrempel;Stephan von Hörsten;Anja Schulze;Steffen Roßner - International journal of molecular sciences (2021)
  4. Parkinson's Disease in Romania: A Scoping Review. - Elena Cecilia Rosca;Raluca Tudor;Amalia Cornea;Mihaela Simu - Brain sciences (2021)
  5. Ethical Aspects of Personal Science for Persons with Parkinson's Disease: What Happens When Self-Tracking Goes from Selfcare to Publication? - Sara Riggare;Maria Hägglund;Annelien L Bredenoord;Martijn de Groot;Bastiaan R Bloem - Journal of Parkinson's disease (2021)
  6. From blood to brain: blood cell-based biomimetic drug delivery systems. - Yong-Jiang Li;Jun-Yong Wu;Jihua Liu;Xiaohan Qiu;Wenjie Xu;Tiantian Tang;Da-Xiong Xiang - Drug delivery (2021)
  7. Integrated network analysis identifying potential novel drug candidates and targets for Parkinson's disease. - Pusheng Quan;Kai Wang;Shi Yan;Shirong Wen;Chengqun Wei;Xinyu Zhang;Jingwei Cao;Lifen Yao - Scientific reports (2021)
  8. Moving towards Integrated and Personalized Care in Parkinson's Disease: A Framework Proposal for Training Parkinson Nurses. - Marlena van Munster;Johanne Stümpel;Franziska Thieken;David J Pedrosa;Angelo Antonini;Diane Côté;Margherita Fabbri;Joaquim J Ferreira;Evžen Růžička;David Grimes;Tiago A Mestre - Journal of personalized medicine (2021)
  9. Predictors of Global Non-Motor Symptoms Burden Progression in Parkinson's Disease. Results from the COPPADIS Cohort at 2-Year Follow-Up. - Diego Santos-García;Teresa de Deus;Carlos Cores;Hector Canfield;Jose M Paz González;Cristina Martínez Miró;Lorena Valdés Aymerich;Ester Suárez;Silvia Jesús;Miquel Aguilar;Pau Pastor;Lluis Planellas;Marina Cosgaya;Juan García Caldentey;Nuria Caballol;Ines Legarda;Jorge Hernández-Vara;Iria Cabo;Lydia López Manzanares;Isabel González Aramburu;Maria A Ávila Rivera;Maria J Catalán;Victor Nogueira;Victor Puente;Julio Dotor;Carmen Borrué;Berta Solano;Maria Álvarez Sauco;Lydia Vela;Sonia Escalante;Esther Cubo;Francisco Carrillo;Juan C Martínez Castrillo;Pilar Sánchez Alonso;Gemma Alonso;Nuria López Ariztegui;Itziar Gastón;Jaime Kulisevsky;Marta Blázquez;Manuel Seijo;Javier Rúiz Martínez;Caridad Valero;Monica Kurtis;Oriol de Fábregues;Jessica Ardura;Ruben Alonso;Carlos Ordás;Luis M López Díaz;Darrian McAfee;Pablo Martinez-Martin;Pablo Mir; Coppadis Study Group - Journal of personalized medicine (2021)
  10. Probing the Pre-diagnostic Phase of Parkinson's Disease in Population-Based Studies. - Lisanne J Dommershuijsen;Agnita J W Boon;M Kamran Ikram - Frontiers in neurology (2021)

... (1332 more literatures)

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