The challenges of Parkinson’s disease

The first challenge for the healthcare professionals is to preserve as long as possible the autonomy of the patients in the daily life.
The disability of  Parkinson’s disease has a high social impact and an important economic cost.
To preserve the patients’ autonomy, the neurologist has to identify and treat not only the « motor » but also the « non motor » symptoms (mood disorders, sleep, low blood pressure, pain, constipation and so on).
Another challenge is defining the mechanisms which cause the onset of the disease and its progress in time. The research focuses on the biomarkers, which can be identified 10 or 20 years before the onset of the first symptoms. Probably, the cure will be possible only in the prodromal phase of the disease. In the advanced phases the intent would be stabilizing the disease or avoiding its progression.
On a clinical perspective, we have to focus on the early « non motor » symptoms of the disease (taste and olfaction reduction, depression and anxiety, the sleep REM phase behavioral disorder, cognitive trouble, constipation and so on.). By better defining these early symptoms we can individuate the patients at risk to develop the disease and obtain an early diagnosis by means of biomarkers or functional imaging.
The hereditary cases of Parkinson’s disease are not so rare (10%) and, for them, the first symptoms appear before the age of 40 or 50. Now, we know the mutations of several genes which are determinant for these cases. The study of these genes can suggest some mechanisms of the sporadic disease.
Another challenge is the treatment of those  symptoms of Parkinson’s disease (dysarthria, gait and equilibrium dysfonction), which are less improved by pharmacological treatments. We need further treatments for the motor fluctuations of the advanced phase of the disease.

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