Delighted to see this one published now... encourage you to have a read...
Lancet Neurol. 2016 Mar 15. pii: S1474-4422(16)00060-0. doi: 10.1016/S1474-4422(16)00060-0. [Epub ahead of print]
Salat D, Noyce AJ, Schrag A, Tolosa E.
Neurodegeneration in Parkinson's disease starts years before a clinical diagnosis can be reliably made. The prediagnostic phase of the disease offers a window of opportunity in which disease-modifying therapies-ie, those aimed at delaying or preventing the progression to overt disease and its many complications-could be most beneficial, but no such therapies are available at present. The unravelling of the mechanisms of neurodegeneration from the earliest stages, however, could lead to the development of new interventions whose therapeutic potential will need to be assessed in adequately designed clinical trials. Advances in the understanding of this prediagnostic phase of Parkinson's disease (for which the clinical diagnostic and prognostic markers used in more advanced disease stages are not applicable) will lead to the identification of biomarkers of neurodegeneration and its progression. These biomarkers will, in turn, help to identify the optimum population to be included and the most appropriate outcomes to be assessed in trials of disease-modifying drugs. Potential risks to minimally symptomatic participants, some of whom might not progress to manifest Parkinson's disease, and individuals who do not wish to know their mutation carrier status, could pose specific ethical dilemmas in the design of these trials.
Perhaps this isn't the best of places to comment, but given that this posting involves early, prediagnostic PD suspect treatment there actually a variety of things to do at that phase. I follow you research blog regularly, but from the standpoint of a patient that is on the edge of PD or other neurological disorder.
ReplyDeleteFrom my experiences and studies only I would advise ..
1. genetic testing and analysis
2. act upon genetic indicators, such as using selegiline if dopamine levels are genetically low, etc. (my situation)
3. test the possibility of small intestinal invasion of bacteria such as candida in small intestine, which consumes B vitamins, and if so supplement with select B vitamins to ensure methylation, after dealing with candida. Also h pylori (again my situation, and I'll wager fairly common and rarely diagnosed)
4. supplement with lithium, preferably orotate. This increases BDNF production and B12 cellular absorption, which naturally declines in aging and is responsible for a lot of brain waste removal processes.
5. look for signs of REM sleep disorders
There are a range of neuroprotective aids to try as well instead of waiting for PD to be diagnosable. Diet for instance, with fruit polyphenols, low temp food prep to reduce cytotoxins, reduced red meats, increased fish, increased vegetables, etc.
If the patient presents with mysterious headaches try vinpocetine for increased cranial blood flow.
If I were a doctor on the front lines I would look for these things at the outset.
I would also advise patients accordingly that these are all steps to increase brain health overall which may prove useful in delaying the onset of more serious neurology issues. So far you only get one chance to do anything about these brain diseases, and that's to be aggressive in prevention.