image: 1A. The patient is diagnosed with early PD soon after the onset of motor symptoms and is enrolled in a disease modifying clinical trial. The red dashed line represents the potential disease slowing that might be associated with a potential disease modifying therapy.
1B. The patient has waited to be evaluated until they need symptomatic therapy. They are no longer eligible to participate in a disease modifying clinical trial and the Golden Year has been wasted.
1C. The patient is diagnosed with early PD soon after the onset of motor symptoms but is immediately placed on symptomatic therapy. The patient is no longer eligible to participate in a disease modifying clinical trial and the Golden Year has been wasted.
Credit: Robert A. Hauser, M.D., University of South Florida
The time between diagnosis and the institution of symptomatic treatment is critical in the effort to find a cure for Parkinson's Disease (PD). A paper published in npj Parkinson's Disease notes too many early PD patients wait too long before seeking medical attention, or start taking symptomatic medications before they are required, thereby dramatically shrinking the pool of candidates for clinical trials.
Parkinson's disease is a disorder of the central nervous system that affects movement. Symptoms include tremors, stiffness, and slow and small movement. The pace of progression varies among patients, making the months following diagnosis crucial to researchers studying the disease's progression.
"The critical time of about one year from when the patient can be diagnosed with early PD based on mild classic motor features until they truly require symptomatic therapy can be considered the Golden Year," said lead author Robert A. Hauser, MD, director of the Parkinson's & Movement Disorder Center at the University of South Florida. "It is during this early, untreated phase, that progression of clinical symptoms reflects the progression of the underlying disease."
Hauser says that in order to determine whether or not a potential disease slowing therapy is actually working, they must be able to compare the therapy to a placebo without interference from symptomatic treatment. Otherwise, they won't know if the therapy is slowing the disease's progression or if they are just seeing the effects of symptomatic treatment.
This requires patients to seek assessment soon after they notice the onset of tremor or slow movement. In addition, physicians should consider referring patients to clinical trials soon after diagnosis and delay prescribing symptomatic medication until it's necessary. If a patient waits until symptomatic treatment is necessary, the opportunity to participate in these crucial clinical trials is lost.
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