Expert opinion from University of Auckland - Waipapa Taumata Rau
Opinion: Parkinson’s disease, a condition that clouds the lives of millions worldwide, has long been a puzzle for researchers. The focus has been on the notorious alpha-synuclein, a neuronal protein gone rogue that clumps together, wreaking havoc in the brains of those affected. Yet, much like the recent struggles faced in Alzheimer’s research, targeting one protein alone might be insufficient. The complexity of Parkinson’s requires a strategy that addresses more than just a single culprit.
A new train of thought is to turn the treatment of Parkinson’s upside down and switch the focus on the risk factors associated with a seemingly unrelated condition: cerebral small vessel disease. This is the most common chronic vascular disease, the risk of which increases with age and shares a surprising and significant overlap with Parkinson’s. Its presence in the brain can exacerbate the symptoms of Parkinson’s disease, worsening gait, cognition, and mood, thereby accelerating the disease’s progression.
This intersection between both diseases opens exciting therapeutic possibilities. Focusing on common vascular health problems such as diabetes, high blood pressure, and high cholesterol, alongside lifestyle changes such as diet and exercise, could potentially slow or halt Parkinson’s progression. It is a strategy borrowed heavily from the playbook used in preserving heart health –applying it to protect the brain.
It is, of course, complicated. The role of high cholesterol, for instance, presents a paradox. Although low-density lipoprotein cholesterol is well known to be detrimental to heart health, high cholesterol levels have been associated with a slower progression of Parkinson’s. This intriguing observation suggests that statins, the most commonly prescribed cholesterol-lowering drugs, could play a dual role in managing cardiovascular health and Parkinson’s progression. However, certain statins might hasten the progression of Parkinson’s, whereas another (lovastatin) has shown promise in a recent trial, reducing the onset of symptoms. These findings hint at a nuanced relationship between cholesterol management and Parkinson’s that merits further exploration.
The relatively low costs and high tolerance of medications for managing vascular risk factors make this a promising, cost-effective therapeutic intervention that could potentially slow Parkinson’s progression. However, the effectiveness and applicability of this approach need to be validated through evaluation in randomised clinical trials, specifically targeting individuals over 50 with Parkinson’s and modifiable risk factors for cerebral small vessel disease. These studies will determine the effectiveness of these treatments and explore how managing heart and blood vessel health could play a role in supporting Parkinson’s treatment.
Just as a balanced, nutritious diet helps manage heart disease, it can also support the management of Parkinson’s. Evidence points to a U-shaped curved relationship between body weight and Parkinson’s, where underweight or overweight conditions are detrimental. The importance of a balanced, nutritious diet becomes increasingly evident. Pilot studies suggest the Mediterranean diet, celebrated for its heart health benefits, could offer a protective edge against disease progression in Parkinson’s and alleviate constipation, enhance cognition, and improve motor symptoms.
The emphasis on regular physical activity further bridges the gap between cardiovascular and neurological health. Engaging in exercises tailored to the individual’s capabilities will help stabilise motor progression and boost cognitive function in Parkinson’s.
This focus on individualised care heart health may also target chronic orthostatic hypotension or postural hypotension, a condition characterised by a significant drop in blood pressure when standing up, which can lead to various quality-of-life challenges. These include sleep disruptions from nocturia (night-time urination), fatigue, fainting, and cognitive difficulties. Studies have linked orthostatic hypotension to an increased risk of developing brain white matter lesions in individuals with Parkinson’s. There is no one-size-fits-all recommendation, but an intervention known as the reverse Trendelenburg position has shown promise in improving symptoms. Although not widely studied, it involves adjusting your sleeping position so that, lying flat on your back, your head is 15°-30° above your feet. This simple, medication-free method can alleviate nocturnal urination, improve body fluid distribution, and lower high blood pressure at night.
Understanding the link and interplay between cardiovascular health and neuroprotection could help us reshape the management of Parkinson’s beyond the limits of traditional treatments. This personalised, multifaceted strategy opens up an additional avenue to Parkinson’s treatments and the slowing of disease progression.
As we stand at the crossroads of cardiovascular health and neuroprotection, combined with the recent discovery of an early biomarker for Parkinson’s disease, the potential to reshape the management of this chronic condition is within our grasp.
