Are we facing a Parkinson’s pandemic?

As the world observed World Parkinson’s Awareness Month in April, a new report reminds us that the once rare condition has now become commonplace. Indeed, experts warn that we are on the cusp of a potential global crisis.

For most of human history, Parkinson's disease (PD) has been a rare disorder. But demographic changes and the by-products of industrialisation, such as pesticides and heavy metals, are now contributing to an impending Parkinson's pandemic, say experts writing in the Journal of Parkinson’s Disease.

According to the Mayo Clinic, PD is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes with a barely noticeable tremor in just one hand and can later cause stiffness or slowing of movement. In the early stages, a patient’s face may show little or no expression, and the arms may not swing when walking. Speech can become soft or slurred.

PD symptoms typically worsen over time, and, while the disease cannot be cured, medications can significantly improve symptoms. Occasionally, surgery can help regulate certain regions of the brain and improve symptoms.

In people with PD, certain nerve cells, or neurons, in the brain gradually break down or die. Many of the symptoms are due to a loss of neurons that produce a chemical messenger in the brain called dopamine. When dopamine levels decrease, it causes abnormal brain activity, leading to symptoms of Parkinson’s.

Unfortunately, its cause is still unknown, but several factors seem to play a role. One is genes. Researchers have identified specific genetic mutations that can cause Parkinson’s disease, although this is still uncommon.

Environmental triggers are another possible cause. Exposure to certain toxins or environmental factors may increase the risk of later PD, but the chances are still relatively small.

“Other factors that may lead to the disease include family history of the disease, drinking well water, prior head injuries, or living in the rural area,” said Dr Ooi Phaik Yee, a consultant neurologist with Gleneagles Hospital in Kuala Lumpur at a conference organised for World Parkinson’s Day.

Neurological disorders are now the leading cause of disability globally, and the fastest growing neurological disorder in the world is PD. Between 1990 and 2015, the number of people with PD has soared worldwide to over six million.

Driven mostly by ageing, this number is projected to double again to over 12 million by 2040. Other factors, such as declining smoking rates and increasing industrialisation, could raise the burden to over 17 million.

Based on a 2018 report by the Department of Statistics Malaysia, the number of patients with PD in that country is expected to increase sixfold from the current estimated 20,000 to 120,000 by 2040, according to the MalayMail. While the current numbers compare favourably to the estimated 60,000 in Thailand and 120,000 in the Philippines, the trend is concerning.

“By 2040, we can truly talk about a pandemic that will result in increased human suffering, as well as rocketing societal and medical costs. How can the community be made aware of this scenario and implement changes in research priorities and care programmes to lessen the burden of the upcoming pandemic?” cautioned Dr Patrik Brundin, the editor-in-chief of the Journal of Parkinson’s Disease, to the media.

“The tide of PD is rising and spreading. PD exacts an enormous human toll on those with the disease and those around them. The strain of caregiving has adverse health consequences of its own. The economic costs of PD are also substantial, poised to grow, and at least in the US, overwhelmingly directed at institutional care, which few desire,” wrote the paper’s lead author Dr Ray Dorsey, a neurologist with the Department of Neurology and the Center for Health and Technology at the University of Rochester Medical Center in New York.

One of the worrying trends is that, as the world’s population ages, so will the incidence of PD, given that the number and proportion of individuals over 65 are rapidly growing. The combined result is an unprecedented rise in the number of people with PD.

Exacerbating the age-PD link is that the by-products of industrialisation may be contributing to the rising rates of PD. And with industrialisation still emerging in many parts of the world, new cycles of PD incidence are expected.

But the spread is not inevitable. This is because, while pesticides, solvents, and heavy metals have been linked to PD, there are ways to minimise exposure and decrease the risk of getting PD.

“There’s no known cause for Parkinson’s disease. People from all walks of life get it. Nevertheless, I suggest that people should live healthily, eat and sleep well, and avoid any places or things that are deemed dangerous to health,” said Sara Lew, President of the Malaysian Parkinson’s Disease Association (MPDA), to Global Health and Travel (GHT).

Lew also has some advice for those who have PD and their families. “On the individual level, understanding Parkinson’s is very important for the patient as well as the caregivers to deal with the condition, as misconceptions or lack of understanding might lead to fear, depression, or poor management. Don’t isolate yourself from family functions, outings, etc. Go travel,” she told GHT, noting that the MPDA ran educational and rehabilitative activities that can help patients become more informed and improve their quality of life.

She also suggests joining a PD support group, as sharing experiences and learning from each other are important to help cope with the condition. If you can’t find one where you live, social media may come to your rescue. “There’s a wealth of knowledge there online. Get connected with friends from all over the world through PD Facebook groups and learn from their sharing or input online, e.g., through blogs, YouTube, etc.,” she recommended.

Lew also stressed the importance of national-level lobbying for better healthcare and models of care for people with PD. In 2012, the MPDA successfully advocated for PD to be recognised as a disability in Malaysia, and now patients can apply for disability status to get free medication from government hospitals, special rates for public transportation, and other benefits.

“This is especially helpful for people with Parkinson's who are below 60 years of age who do not enjoy the Senior Citizen privileges,” she said.