It’s Time to Redefine Early Stage Parkinson’s
The symbiotic conductor/exercise training, which centers on a mental construct for shifting perspective that I’ve described in previous columns, helps me to live better with Parkinson’s. Putting it in place as an early intervention (unknowingly on my part) was a crucial piece of this successful outcome. If we are to explore the utility of conductor/exercise training for other people with Parkinson’s, then we need to know what early Parkinson’s looks like.
There is quite a buzz in scientific literature about prodromal (“early”) features of Parkinson’s. The disease is currently clinically defined by a set of cardinal motor features centered on the presence of bradykinesia and at least one additional motor symptom of tremor, rigidity, or postural instability.
However, converging evidence from clinical, neuropathological, and imaging research suggests there may be initiation of Parkinson’s-specific pathology prior to appearance of these classical motor signs. This latent phase of neurodegeneration in Parkinson’s is relevant in relation to the development of disease-modifying or neuroprotective therapies, which would require intervention at the earliest stages of disease.
Therefore, a key challenge in Parkinson’s research is to identify and validate markers for the preclinical and prodromal stages of the illness. In an article published in the Journal of Parkinson’s Disease, Philipp Mahlknecht and his co-authors found that many of these prodromal symptoms may precede the classic Parkinson’s motor symptoms by as many as 10 to 20 years.
Following is a brief list of possible new early stage criteria.
- Reduced ability to smell
- Idiopathic REM sleep behavior
- Executive function in brain
- Reduced arm swing
- Changes in walking patterns (foot drag)
- Slowed movements (bradykinesia)
I identified foot drag as one of my early symptoms in a previous column. I have a rigid variation of Parkinson’s and only a mild tremor. A study of early, nonmedicated Parkinson’s patients published in the journal Movement Disorders by A Winogrodzka et al. states, “When the confounding influence of rigidity is taken into account, no significant direct relationship between dopaminergic degeneration and the degree of tremor could be found.” If you’re looking for a tremor, I don’t demonstrate it consistently.
In addition to these symptoms, the new early stage might demonstrate episodic motor movement problems. Who hasn’t done the finger-to-nose or repetitive finger-tapping test in the neurology office? In an article published in The American Journal of Occupational Therapy, authors Jennifer C. Uzochukwu and Elizabeth L. Stegemöller write:
“Changes in movement amplitude and movement rate may influence fine-motor dexterity tasks differently. Thus, it is important to consider the quantitative assessment of both movement rate and movement amplitude because they may indicate differential clinical applications in the treatment of people with PD.”
Ask me to repeat finger-to-nose and I will only miss occasionally. I more often knock over the water cup or bump into my partner while navigating through a narrow open space because of a problem with movement amplitude regulation.
Pain has also been identified in the early stage and been a topic of my columns. As reported in Parkinson’s News Today in 2018, researchers at the Bangur Institute of Neurosciences in India conducted a combined hospital and community-based study and identified several types of pain more prevalent in people with early Parkinson’s, such as nocturnal leg cramps and frozen shoulder.
“This is an indirect evidence that pain can be an important early clinical marker of [Parkinson’s],” the study authors wrote.
Scientists are developing a better understanding of Parkinson’s, and a new picture of the early stage of the disease is emerging, but it is still a fledgling science, and there is a good chance my description of early stage Parkinson’s is subject to change. The current description of a new early stage is not the final description.
As we expand our understanding of Parkinson’s, science will redefine the disease. The medical community predicts that improved research and recognition of prodromal symptoms will dramatically change the face of Parkinson’s. A 2018 study from the Journal of Parkinson’s Disease states:
“By 2040, it is hoped that prodromal criteria will be incorporated into active neuroprotective treatment programs, allowing a program of population-based screening followed by early treatment and ultimately the prevention of clinical PD from ever becoming manifest.”
You can help my search for early stage criteria. Comment below describing the first motor and non-motor symptoms you experienced with the disease. Your experiences help inspire my writing and research into this important topic.
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, and are intended to spark discussion about issues pertaining to Parkinson’s disease.