[ad_1]
The disease of Parkinson’s affects in Spain about 200,000 peoplea good part of which are older, and this number is expected to continue growing in the coming years, as the population ages, due to the inversion of the demographic pyramid. It is estimated that heGlobal prevalence will grow by more than 100% in the coming decades, exceeding 25 million cases in 2050.
The care and treatment of the pathology is, along with that of Alzheimer’s, one of the most important socio-health challenges which today’s society has to face.
And it is a neurodegenerative disorder that progresses silently for years and, when it manifests itself, especially in more advanced stages, requires a large number of resources to guarantee that the patient can have a certain autonomy and quality of life.
On the occasion of World Parkinson’s Day, Alvaro Sanchez, neurologist and coordinator of the Movement Disorders Study Group Spanish Society of Neurology (SEN), talk to 65AND MORE and explains to this newspaper at what point the research against this disease is and what’s left to do.
A disease that is not only for the elderly
First of all, the expert banishes one of the most deeply rooted myths about this ailment: It is not an exclusive condition of age.
Although it usually appears on average among “60 and 65 years”, Clinical reality shows that “one in five are under 50 and we have patients under 30, 40.”
Now, he regrets, the diagnosis It’s still very late, since, at the beginning, the symptoms are not clear.
In that initial phase, he details, the person “notices that he has a stiff arm, that it hurts or some other problem, because he moves a little worse or is slower.”
This symptomatic ambiguity causes detection to be delayed “sometimes even up to two years,” since it is common to think “that it is something traumatological” or, when a certain lack of energy is detected, “they think that it is depression.”
Once this bump has been overcome and after the emotional impact of the diagnosis, the expert continues, the person usually experiences a stage of good pharmacological control that can last “5 or 10, and even, for some patients, 15 or 20 years.” And after this time, the known as “fluctuations”, where “the response to medication becomes more erratic” and begins to manifest greater disability and dependency.
A moment of “cautious hope”
Of course, this journey of the disease, which thousands of people and those close to them face, could change in the future, since the scientific panorama is going through a turning point.
The neurologist defines the current stage as “a moment of hope.” Until now, medicine only had symptomatic tools, but now “there are beginning to be disease-modifying drugs that show some effect.”
The origin of this revolution, still in an embryonic state, lies in the biological understanding of pathology. Sánchez comments that, in Parkinson’s, “some proteins that we all have are deposited in the brain, but with an abnormal configuration”. And these toxic accumulations play a fundamental role in neuronal damage, he argues.
Taking this mechanism into account and thanks to investment in R&D, researchers have tried to correct this process.
For example, he details, currently there is “a phase three clinical trial” –the prelude to the commercialization– of an innovative treatment: the monoclonal antibody Prasinezumabdeveloped by the Swiss company Roche, and which has the objective of “eliminate these abnormal proteins and thereby try to positively impact the progression of the disease.”
It is “an intravenous drug that is given monthly and is aimed at people a little In the earliest stages of the disease, less than 3 years,” he points out.
In addition to this important avenue, science is exploring the potential of drugs anti-GLP-1 –usually used for obesity–, with notable studies in the United Kingdomas well as specific treatments for genetic variants of the disease developed in United States, details.
And looking to the future in the medium and long term, he foresees that the approach will imitate the oncological model, using a combination of several simultaneous drugs that attack different biological mechanisms. to maximize its effectiveness.
However, Sánchez proposes maintaining a “cautious hope”, since it still needs to be proven that, indeed, these therapies come to fruition.
Early diagnosis
Another area in which progress is being made, he adds, is in early detection. The expert explains that there is a phase preclinical which can even be 10, 15 or 20 years, in which the brain uses “compensatory mechanisms.”
However, currently, the medical diagnosis remains symptomatic, based on neurological examination and specifically supported by nuclear medicine tests, which allows us to observe “how the brain uses dopamine.”
However, he points out, researchers are already working – even in limited environments – with the use of biomarkers, as through the “essays of alpha-synuclein seed amplification“, a technique that analyzes the “cerebrospinal fluid” to look for “these proteins that are being deposited abnormally.”
Thus, the medium-long term vision, in an estimated cycle of “more than 5 or 10 years”is to combine these tests with new drugs. That is, identify people with “premonitory symptoms” – loss of smell, sleep problems… – or “mutations in some genes”, confirm the presence of toxic proteins with a puncture, and apply a therapy to “stop the appearance.”
Prevention
And while these advances arrive, what is known is what habits help delay the onset of the disease and environmental factors can cause it.
Specifically, he points out, the origin is multifactorial. There is a genetic weight, but linked elements also intervene “to aging” or, for example, with exposure to certain toxins – such as certain pesticides.
Faced with these threats, the neurologist highlights the immense power of prevention, highlighting that, in the absence of definitive cures, “Physical exercise is a fundamental pillar, because it has also been seen that it has a certain neuroprotective effect”, in particular, an “aerobic activity of at least an intermediate degree, more than 120 minutes a week.” And to this is added the strict control of the “cardiovascular risk factors”, through a balanced and correct diet and proper rest.
Fragmented healthcare
And there is also room for improvement at a macro level, that is, in the care of patients already diagnosed, since, despite scientific advances, where Spain stands out as a “power at the level of participation in this type of clinical trials”, the care “holistic” required by people suffering from the disease is not adequate.
“We have a drama, the truth,” says Sánchez, above all, when addressing “the entire rehabilitation part, speech therapy…”.
According to the complaint, “hospitals do not accommodate “Only patient associations are covered” and the result is that there are those “who can access, others who cannot.”
“The system is still not very prepared to help,” laments the expert, evidencing that the financial, emotional and physical weight “a lot continues to fall on families,” forced to “use their own resources”.
To reverse this precariousness, the neurologist demands a radical transformation of the public system inspired by other severe pathologies: “The model to follow is that of ALS.” This approach, he comments, would imply the creation of multidisciplinary units where the affected person “can access the different specialists they may need: neurologist, nursing, social work, physiotherapy, rehabilitation, speech therapy, psychiatry, endocrine, nutrition, urology…”.
[ad_2]
Source link
