On WorldParkinsonsDay we spoke to Professor Michele Hu from NDCNOxford UniofOxford Parkinsons ParkinsonsDisease Disease
Interview conducted by Danielle Ellis, B.Sc.
What are the clinical manifestations of PD? What is happening in the brain during PD on a pathophysiological level? We now recognize that the process that leads to motor symptoms of Parkinson's happens over the 20 years before diagnosis. They start with early changes in sleep patterns and losing the ability to smell particular herbs.
How is PD currently diagnosed? What are the challenges associated with PD diagnosis? Parkinson's is what we call a clinical diagnosis. So if, for example, you had a prostate issue, we would be able to take a fine tissue biopsy of the prostate gland, look at it under a microscope, and tell you very definitively that that tissue has benign prostate hypertrophy or cancer.
We also have functional brain imaging, which allows us to estimate the brain neurotransmitters happening in an individual. These include a dopamine transporter single photon emission computerized tomography scan. It involves an injection of radioactive dye from an arm vein going to the brain, and then we can estimate how much dopamine your brain can produce. In Parkinson's, dopamine is significantly reduced to 50% or less in the basal ganglia, where the dopamine neurons project.
If you have had RBD for ten years, your risk of future Parkinson's is 60%. This is the strongest known risk factor for future Parkinson's, greater than genetic forms or the forms that come from idiopathic hyposomnia, which is loss of sense of smell that we cannot relate to head trauma, sinusitis, or other problems.
My research looks at ways to diagnose a person with RBD at home. That is much more representative of a typical night's sleep. Many people go to the hospital, and they don't sleep normally. Secondly, home recordings are a lot cheaper. Furthermore, we think we can get as much information from a limited sleep study at home to get the diagnosis.
Parkinson's is the fastest-growing neurological condition in the world. What does the future of PD look like? The way that we manage Parkinson's has to change. We are already in an NHS crisis of care. Over the last five years, there's been a 15% average increase year-on-year in new Parkinson's referrals. This is consistent with population predictions that the prevalence of Parkinson's will double or triple in the next 20 years because people are living longer.
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