EAN 2026 | The future of personalized Parkinson’s disease care considering differing subtypes

I think it’s a long path. I actually discussed this not only in my work but also in my PhD thesis that I essentially did this year, Because the idea would be that if we look also at the staging of PD that we actually apply, and also the biological staging that is actually in place, we think of the disease as one only rail. Like, essentially, you are a PD patient, you follow trajectories, and these trajectories can be framed across how severe is the disease, how severe is the dopaminergic, let’s say, degeneration, but we don’t allow the disease to be framed in different trajectories, so in different rails, that can evolve differently, can have different markers of the different systems that are involved in PD. The more data we have, the more we understand that PD is a multi-system disease, so it involves autonomic, involves the dopaminergic, obviously, but it involves also the noradrenergic system. But we actually measure only the dopaminergic system, and not in all the frames, because not in all the clinical practice people undergo dopaminergic evaluation, like a DAT scan, for example, or similar things. We also assess, for example, glymphatic dysfunction in the paper that is becoming another, let’s say, marker that is increasingly demonstrated to be important and also associated directly in mediating the effect on motor symptoms. So how much motor symptoms you have depends also on how much glymphatic dysfunction you have, it seems, from the new evidence. So putting all these different and multiple biomarkers together that can be also traced back before the starting of the motor symptoms can help the clinician to make the diagnosis, to detect the PD earlier. And obviously, this will become more and more important when we can start targeting these mechanisms as I was saying before. Because obviously the idea would be having prevention strategies; today we have not a lot of them, we have just a few, you know, like risk-avoidant things that can be helpful, mainly those are the only things that can help prevent PD somehow. But if we look at other fields, for example, the AD fields, where a lot of studies on prevention have come out and now new disease-modifying drugs are finding their path, finding their way in the clinic, that’s where PD is probably gonna go, and obviously, PD has also a lot of symptomatic drugs that help a lot in the real lifestyle of patients, so knowing before what’s your phenotype can also help distinguish which kind of drug, how to let’s say implement the different treatments, both in the advanced phase and in the early phase, so that’s the main idea, yeah.

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