Colp 10 million people in the world, and about 250 thousand people in Italy. It represents the second neurological disease by diffusion, after Alzheimer’s dementia. It is the Parkinson’s disease (MP), chronic neurodegenerative pathology, trend progressive, of the central nervous system. The good news is that, if so far the research has focused on the diagnosis of this pathology, today the paradigm is changing: the hopes Finally, therapy finally concern. He explains it, on the occasion of the World Parkinson’s day, which is celebrated today, the professor Maria Salsoneresponsible for the new Operating Unit of Neurology and Stroke Unit of the IRCCS Policlinico San Donatoas well as associated with neurology at the Vita-Salute San Raffaele University. To his credit, over twenty years of research on Parkinson’s disease. And in his studies the future of the care of the MP is already glimpsed: the development of customized therapies guided by biomarkers and tailor -made on the patient.
What are the causes of Parkinson’s disease?
Although its cause is complex, multifactorial and not yet completely defined, several environmental and genetic risk factors have been identified, in particular some genes associated with the disease. The final result of all these complex interactions is the accumulation in the brain of a protein called alphasinuclein, malformed and “badly folded”, which aggregates in “balls” called Lewy bodies.
Are there gender differences in the incidence of the disease?
Men gets sick twice the women, in a critical age around 60 years.
Parkinson’s affects 10 million people worldwide, and about 250 thousand people in Italy (Getty Images)
Treasure is a typical symptom of Parkinson’s. Are there others?
Parkinson’s disease is characterized by three specific symptoms: tremor at rest, slowness in movements and rigidity. Depending on whether the first or other symptoms prevail, at least two manifestations of the disease can be identified, which differ in gravity and prognosis: the tremery form-milder and with a good response to drug therapy-and the rigid-acinetic form.
Are there alarm bells?
The first sign of Parkinson’s disease can be represented by sleep behavior disorder during the Rem phase, the one in which you dream of. Whoever is affected is as if they “lived their dream”, baking and screaming. This happens because the muscle tone is maintained, which, instead, in normal conditions, is relaxed. The RBD (acronym for Rem Sleep Behavior Disorder) can anticipate the appearance of motor symptoms up to 10-15 years, for this reason it is the subject of a strong scientific interest.
In the last ten years, with my research group of Catanzaro and the CNR, we have identified early alterations of brain areas and circuits and modifications of the vegetative nervous system (that, for example, that accelerates or decelerate the heart) that can occur during sleep. In addition, at the San Donato Polyclinic, always with my research team, we are about to leave with an observational screening of large -scale screening to identify the high -risk subjects early to develop Parkinson’s disease, such as the subjects with RBD, and follow them over time.
What are the news on the diagnostics of Parkinson’s disease and how has it changed over time?
To date, the diagnosis of Parkinson’s disease is based on clinical symptoms and confirmed by the response to pharmacological therapy to levodopa (or L-Dopa). One of the most exciting memories of my twenty years dedicated to studying on Parkinson’s is precisely the moment when, thanks to a simple levodopa test administered by mouth, I saw, for the first time, a patient return to smile. And that sudden recovery of facial mimicry, after years of absence, is a moment that moves me every time. In support of the clinical diagnosis, there are, today, different neuroimaging techniques with magnetic resonance imaging and, above all, scintigraphies, brain and myocardics, which take a real photograph of the presence and location of the altered protein, in the brain and in the nerve terminals that innervate the heart.
My research team was among the former, together with the CNR and theMagna University Graecia of Catanzaroto use the combination of these scintigraphies, not only to identify the Parkinson’s disease early, but above all to differentiate it from everything that seems Parkinson’s, but it is not.
Are we coming to a precision neurology, for an increasingly personalized therapy of Parkinson’s disease?
The new frontier of precision neurology concerns the use of plasma biomarkers, to obtain important information on the disease with a simple blood sampling. A 2024 study, published in Nature, has developed a protein panel, which may be present in the blood of patients with Parkinson’s disease, up to 7 years before the appearance of motor symptoms.
With my research group, we just answered the International Call Mjfoxthe most important American foundation dedicated to study and research on Parkinson’s, with a project concerning a panel of substances that can contribute to the accumulation of malformed protein, “sentinel” factors of inflammation.
How can digital neurology be supported by Parkinson’s screening?
The future is digital neurology, based on the use of so -called digital biomarkers, or objective and quantifiable physiological measures, collected by means of wearable digital devices, the so -called Wereable Device. A research published in Nature, in June 2024, validated the use of a smartwatch associated with portable sensors, able to evaluate the presence of tremor and slowness in the movements.
With the CNR and University of Magna Graecia of Catanzaro, we developed a device, thanks to a funding from the Mjfox Foundation, capable of classifying, with the help of artificial intelligence, the expression of the face of patients with Parkinson’s disease. We are also implementing systems, based on digital biomarkers, able to identify sleep disorders early that anticipate Parkinson’s.
And how can it support the therapy monitoring?
Digital neurology can be understood as the possibility of telemonitioning of the effectiveness of MP therapy. In this perspective, it therefore becomes not only a tool of diagnosis and prevention, but could reduce the number of access to the hospital, with an advantage, at all secondary, to reduce the expenditure against the National Health Service.
What are the main news in terms of Parkinson’s disease therapy?
The pharmacological treatment of reference is the oral administration of levodopa, However, in the advanced phases and in genetically predisposed subjects, it can lead to instability in blood levels and cause involuntary motor blocks or movements. A innovative solution is continuous subcutaneous administration, which stabilizes levodopa levels in the blood, improving the quality of life with personalized therapy. A further evolution could be a dopamine infusion pump directly in the brain, as a research published on Nature 2025.
And on the non -pharmacological front?
There Deep cerebral stimulation (DBS)suitable for patients with severely compromised motor capacity, it is an invasive neurosurgery technique which consists of high frequency electrical stimulation on specific deep brain nerve structures. It takes place through the permanent positioning of electrodes, connected to a impulse generator, placed in a subcutaneous pocket, at the clavicle level. However, it is reserved for patients under 70 With good general conditions and response to levodopa, which limits access to 10-15% of patients in advanced phase.
Among the innovative, non -invasive techniques, stand out the Transcranial ultrasound cerebral stimulation and transcranial magnetic stimulation (TMS)both promising in reducing motor symptoms such as tremor and problems on the way.
Finally, l‘Aerobic exercisewith an effective “dose” of 2-3 hours a week, is emerging as a real therapy, with benefits enhanced by activities such as dance, as shown by some recent studies. The improvement on a motor level could be even more effective if the exercise was guided by robotic neurory,.
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