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MDS 2021 | How valid is the brain-first vs body-first model of Parkinson’s disease?

Alberto Espay, MD, FAAN, University of Cincinnati, Cincinnati, OH, shares his thoughts on the accuracy of the brain-first versus body-first hypothesis of Parkinson’s disease pathology. The concept separates patients by the site of pathology initiation. Patients whose disease begins in the body are said to show symptoms in a different order to those where pathology starts in the brain. Prof. Espay highlights the limitations of this dichotomization, particularly noting the issues with assuming that pathology detection represents the start of the disease. This interview took place during the 2021 International Congress of Parkinson’s Disease and Movement Disorders.


Prof. Espay has received grant support from the NIH and the Michael J Fox Foundation; personal compensation as a consultant/scientific advisory board member for Abbvie, Neuroderm, Neurocrine, Amneal, Acadia, Acorda, Kyowa Kirin, Sunovion, Lundbeck, and USWorldMeds; honoraria from Acadia, Sunovion, Amneal, USWorldMeds; and publishing royalties from Lippincott Williams & Wilkins, Cambridge University Press, and Springer. He cofounded REGAIN Therapeutics, owner of a patent application that covers synthetic soluble non-aggregating peptide analogs as a replacement treatment in proteinopathies. He serves on the editorial boards of the Journal of Parkinson’s Disease, Journal of Alzheimer’s Disease, European Journal of Neurology, and JAMA Neurology.