Parkinson’s is not one but two diseases, starting either in the brain or in the intestines, which is why patients describe very different symptoms.
- For some patients, the disease begins in the intestines and spreads to the brain.
- For others, the disease starts in the brain and spreads to the intestines and other organs like the heart.
- Each disease must have an appropriate treatment.
Behind Parkinson’s actually hides two diseases. This discovery explains why patients report very different symptoms and why generic treatments are the least effective. “We have shown that Parkinson’s disease can be divided into two variants, which start at different places in the bodydetails Per Borghammer, co-author of the study. For some patients, the disease begins in the intestines and spreads to the brain. For others, the disease starts in the brain and spreads to the intestines and other organs like the heart..” This result is the result of work carried out by Danish researchers. The study was published on August 24 in the journal Neurology Brain.
Two different origins
For this study, the researchers relied on “advanced scanning techniques”, reveals Per Borghammer. They used advanced PET and MRI imaging techniques to examine people with Parkinson’s. People who have not yet been diagnosed but are at high risk of developing the disease were also included in the study. Those who have been diagnosed with REM sleep behavior syndrome have an increased risk of developing the disease. As a reminder, Parkinson’s is characterized by a slow deterioration of the brain due to the accumulation of alpha-synuclein, a protein that damages nerve cells. This leads, in particular, to the slow and stiff movements that many people associate with the disease.
The results revealed that some patients have damage to the brain’s dopamine system before gut and heart damage occurs. In other patients, scans showed damage to the nervous systems of the gut and heart before damage to the brain’s dopamine system was visible. “Until now, many people viewed the disease as relatively homogeneous and defined it based on the classic movement disorderssays the researcher. But at the same time, we were puzzled as to why there was such a big difference in patient symptoms. With this new knowledge, the different symptoms have more meaning and this is also the perspective in which future research should be considered..”
Body first and brain first
The researchers named the two diseases based on where they appeared: “body first”, for that which is born in the intestine, and “brain first” for the one that first develops in the brain. For the first, the study of the microbiota allows a better understanding of the pathology and perhaps the key to future treatments. “It has long been shown that patients with Parkinson’s have a different gut microbiome than healthy people, but we don’t really understand what it means.advances Per Borghammer. Now that we are able to identify both types of disease, we can look at the risk and possible genetic factors that may be different. The next step is to examine whether, for example, Parkinson’s ‘body first’ can be treated through the intestines with, for example, faecal transplantation or by other means that affect the microbiome.”
For the other disease, the “brain first”, the problem is different and turns out to be more complicated. “Discovery of Parkinson’s ‘brain first’ is a bigger challengeconfirms the researcher. This variant of the disease is relatively symptomless until symptoms of movement disorder appear and the patient is diagnosed. It will therefore be more difficult to find patients early enough to be able to slow the disease..”
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