Parkinson disease: from hype to hope

Dr Simon Lewis, Professor of Cognitive Neuroscience at the University of Sydney’s Brain and Mind Centre, says pursuing effective treatments to slow, stop or reverse the disease are accelerating globally.

“While our understanding of Parkinson disease has been growing inexorably, this has only served to reveal its ever-increasing complexity,” Professor Lewis says in today's Medical Journal of Australia.

“We’ve revealed several clues about the underlying neuropathology of this disease, including epidemiological factors, genetic factors and preclinical biomarkers.

“We're also becoming increasingly aware of the role of specific cellular and more widespread processes implicated in Parkinson disease.”

Other promising areas of exploration include the theory that Parkinson disease represents a prion-like process, which could be targeted with active or passive immunisation approaches. Other potential therapies include targeting neuro-inflammation, energy processes and protein clearance.

Diabetes medications show some promise although results have been mixed, according to Professor Lewis.

“The recent positive outcome from the phase two trial of the glucagon-like peptide-1 agonist, exenatide, has prompted calls for a larger multicentre validation,” he says.

“Genetic causes of Parkinson disease offer insights for new strategies and there is likely to be increasing exploration of cell-based therapies, gene delivery systems, photo-biomodulation, fasting diets and modulation of the gut microbiome as approaches for slowing disease progression,” he says.

“Despite the shifting balance from hype to hope, we must accept the fact that we may never have a cure for Parkinson disease, and we should continue to focus on delivering the very best of care to patients with whatever we can muster from our armoury.”