The Agenda with Steve Paikin (Audio) - Is Parkinson's Becoming a Pandemic?

Episode Date: April 25, 2024

The escalating rates of Parkinson's disease both globally, and here in Canada, have led some researchers to warn that it is becoming a pandemic. To help shed light on a disease that still has no cure, we welcome: Dr. Lorraine Kalia, neurologist and senior scientist at the University Health Network's Krembil Brain Institute. She is also an associate professor at the University of Toronto's Faculty of Medicine.See omnystudio.com/listener for privacy information.

From epic camping trips to scenic local hikes, spending time outdoors is a great way to create lasting memories to share with friends and family. This summer, TVO is celebrating the natural wonders that inspire unforgettable adventures with great documentaries, articles, and learning resources about beloved parks in Ontario and beyond. Visit tvo.me slash Ontario summer stories for all this and more. And be sure to tell us your stories for a chance to win great prizes. Help TVO create a better world through the power of learning. Visit TVO.org and make a tax-deductible donation today. The escalating rates of Parkinson's disease, both globally and here in Canada,

have led some researchers to warn that it is becoming a pandemic. To help shed light on a disease that still has no cure, we welcome Dr. Lorraine Kalia. She is a neurologist and senior scientist at the University Health Network's Kremble Brain Institute. She's also an associate professor at the University of Toronto's Faculty of Medicine, and we are happy to have you here on our program tonight. Thanks for coming in. Thanks for having me. Let's just, before we get you to answer some Q&A here, Sheldon, would you bring this graphic up, and we'll do some of the 411 for background here. According to Parkinson Canada, this disease is

the fastest-growing neurological disease in the world. By the year 2040, the global prevalence of Parkinson's is expected to double, from 6 million to 12 million. Its prevalence in Canada has increased nearly 50% over the past 10 years. More than 100,000 Canadians live with Parkinson's, and 30 more are diagnosed every day. But by 2031, which is not that far away, that number is expected to rise to more than 50 people a day, almost double where we are today. All right, let's learn more about this. What is Parkinson's disease? So first off, I mean, it's a disease that we need to know about

for all of the reasons that you explained. The simple answer is it's a neurological condition that's really a brain disease, that we categorize as a neurodegenerative disorder, meaning that brain cells die faster than normal. All of our brain cells are dying in adulthood, but in Parkinson's disease, a certain population of brain cells die faster for reasons we don't entirely understand. And as a consequence, people can have a myriad of symptoms, movement abnormalities, cognitive difficulties, constipation, mood difficulties. And so it's a disease that is progressive. And as you already mentioned, something that we don't have a cure for yet. Are you born with it or do you pick it up some

way later in life? And so that's a great question in terms of why do some people get it and some people don't. We know that there's a small proportion of people who have a very clear genetic cause, and so they will carry that genetic abnormality from birth, but for some reason not actually manifest the disease until adulthood. But the majority of people probably develop the disease for a combination of different reasons

that include environmental exposures, a combination of genetics, and in some cases, I mean just overall kind of a bad luck of a combination of genetics, and in some cases, I mean, just overall, kind of a bad luck of a combination of things. So in most cases, when people come to the clinic and get diagnosed with Parkinson's disease, their first question is, why me? And really, at this point in time,

for the vast majority of people, we don't have a really good answer as to why. What role does dopamine play in all of this? Yeah, so dopamine is central to this condition. Those brain cells that have a tendency to die faster than normal, they are brain cells that make the chemical dopamine. And we all have dopamine in our brain.

We all need it for a variety of things. But because these brain cells die faster, there's then less dopamine in the brain. And as a consequence, the symptoms that people have with Parkinson's are as a consequence of primarily dopamine deficiency or a lack of dopamine in the brain. And as a consequence, the symptoms that people have with Parkinson's are as a consequence of primarily dopamine deficiency or a lack of dopamine in the brain. Apparently, if you're on TikTok a lot, you get a hit of dopamine. Is one of the cures to Parkinson's potentially just spend a lot of time on TikTok? Definitely not. That's a bit of a facetious

question. Yes, of course. So, but I mean, to your point though, things that can kind of boost dopamine are not necessarily a cure for Parkinson's, but can be helpful. So exercise would be one example. So there's probably a variety of reasons why exercise is beneficial for people with Parkinson's disease. But one of the consequences of exercising is a release of dopamine. And many people who have Parkinson's and exercise will clearly tell you how much better they feel after they exercise, as we all feel better when we exercise. And in part, that's probably because

of this extra dopamine release. Who was this guy, Parkinson, anyway? Yeah, so, I mean, he was a physician from the early 1800s. He described this disease in 1817 with an essay on what he called the shaking palsy. He was a bit of a Renaissance man, as I think most physicians were at that time,

a chemist and a geologist, but he had observed three people in his clinical practice, three people on the streets of London, not his own patients. And from what he observed of these six different patients, put together basically a constellation of observations that he then described as this disease. It was the, you know, preeminent neurologist in the 1900s, Charcot, who decided that this disease should be named after him because he was the first person who really described it clearly in a clinical context. Although we know from ancient writings, Indians and, you know, in China, these descriptions were actually made back in 1000 BC.

Right. So this goes way back. But James Parkinson was the guy who got his name put on it. Yes. And he laid it out very clearly. And there's many observations that we all find quite fascinating that he made just from looking at people that have held true in terms of what the disease is till today. If you had a parent who died of Parkinson's, how likely are you to get it? That's a great question and often a question that people ask because a lot of people will have family members who have Parkinson's disease. who have Parkinson's disease. The straight answer, if we don't look at specific genetic testing,

is you probably have a three times chance of what people who don't have a family member. And if we kind of use numbers, so if you're six years older, you have a 1% chance of getting Parkinson's disease. So three times might seem like a lot, but ultimately it's 3% chance. So it's still a far minority. But going back to the genetics question,

we do know now that about 10% of people will have an identifiable gene that causes their Parkinson's disease. And in some cases, we can actually test for that gene. And, you know, some of the optimism that we have in the field is that there are treatments that are in development for people who have genetic forms of disease. And we wonder whether or not it may be there where we have the first breakthroughs for treatments that actually can prevent the progression of the disease. True or false? Most people who get this are over age 60. So the answer to that is true.

But I just want to emphasize that it's not only people over age 60. So the majority of people, for sure, age 60 and over are the people who get Parkinson's. And we know that the risk for Parkinson's increases with age. So you have a higher risk of getting Parkinson's when you're 80 versus when you're 60. But I also, I think this is Parkinson's Awareness Month. And I think one important thing to make people aware of, in addition to everything that we're talking about, is that Parkinson's disease is not only a disease of people who are 60 and older. Many people in their 50s, in their 40s will actually develop Parkinson's disease.

It will look different, but obviously it has huge impacts on people at that age. They're starting, you know, they have families, they're in the middle of jobs, and their needs might be different than people who are 80. And we have to kind of be aware of that and make sure that we approach, you know, the needs of those patients in an appropriate way. What's the youngest person you've seen or treated who has Parkinson's? The youngest person that I've treated is in their 30s, but I do know my colleagues at the Hospital for Sick Children do see, you know, rarely there's patients who can manifest disease in their teens.

If you get it when you're younger and therefore presumably more vigorous, are you able to, I don't know, fight it off better? Yeah. So it's interesting because in general, the earlier you develop the disease, it appears that the progression of your disease is slower. So it seems a little bit counterintuitive because you think of somebody developing a disease early and that that means that, you know, they're going to have years and years of this disease and things are obviously progressing.

But actually the rate of progression is slower the earlier you get it compared to the later you get it. And we don't understand that at all. But compensatory mechanisms, I think, and some resilience that you have at a younger age may be reasons why that would be the case. How difficult is it to diagnose? In some cases, it's very straightforward. I don't advise this, but you know, I have some patients who come to me when they saw their first neurologist and they're told,

I could tell from the waiting room that you had Parkinson's disease. That's not the way to diagnose Parkinson's disease, although one could argue that's the way that James Parkinson's diagnosed Parkinson's disease with patients that he saw on the street. But it requires a combination of things. Basically, what I see in the clinic, so what the actual physical findings are on examination, what the patient tells me in terms of the way things have progressed for them over the past couple of months to years, and then also looking for features that tell me it's not Parkinson's disease. Often I talk about there, and many of us talk about there being a test of time, because really what helps us making a more definitive diagnosis is how the disease progresses and how it responds to medications. But right now, today,

we don't have a blood test or a brain scan that we're able to do and then definitively say, yes, you have Parkinson's disease, or no, you don't have Parkinson's disease. And so one of the major unmet needs in Parkinson's disease research is having a clear diagnostic test. In the same way that Alzheimer's is a particular type of dementia, is Parkinson's a particular type of, I don't know what, something else? Well, they're both an already generative diseases.

And so the parts of the brain where brain cells die faster in Alzheimer's are different than in Parkinson's, which is why they look different. But again, I think an important kind of awareness piece is we often think of Alzheimer's disease and dementia and Parkinson's disease and movement problems. But in fact, Parkinson's disease can very much be associated with cognitive impairment, and that might be mild early in the disease. But for many patients, studies have shown that 10 years into this disease, approximately 80% of people will actually have dementia. And I think that sometimes can come to a surprise for people who have family members with Parkinson's disease,

because that's not what they kind of anticipated is what the disease is going to look like, but an important component for many people to deal with. We have made so many great strides in finding the whys behind some of these diseases, the cure for some of these diseases, progress we've made in cancer and so on, COVID vaccination pretty quick, et cetera.

Parkinson's seems to be particularly stubborn and doesn't want to let us in. Why is that? For a number of reasons. One, I think the brain is complicated. You know, I would argue it's the most complicated organ we have. I can, you know, have debates with my cardiology colleagues and my hepatology colleagues, but I think the brain is a complicated structure, complicated the way it works, complicated the way that neurons function. And so just understanding of the disease has been

a challenge. I do think over the past two decades, we have actually made significant strides in understanding why these brain cells die. And when you understand the why, then you can start to address that with potential therapies. And so I think we're on the cusp of that place where now we really understand the culprits in Parkinson's disease and can try and target them. Other aspects and practical aspects, to understand a disease, you obviously have to do research, and research is fueled not just by people motivated to do research and people who are talented

and motivated to understand the disease, but practical things like funding. And Parkinson's disease, I'd say, has been underfunded in comparison to other conditions, in part because I don't think there's a lot of awareness in terms of what the needs are. And I think earlier on, many people weren't really touched by Parkinson's disease. So it seemed like a kind of quiet disease, a silent disease that maybe didn't really need to be addressed. But I think there is some appreciation now with this concept of a potential pandemic of Parkinson's disease,

with the huge escalation of number of cases, that it is really going to be a significant public health issue that could potentially be thwarted by a cure or something that could stop the progression of the disease, because then we could actually prevent people's progression and worsening of the condition. Yeah, I hate to put it this way, but you know people who are in the fundraising business talk about it this way. There you know people who are in the fundraising business talk about it this way. There are other diseases that are quote-unquote sexier and easier to raise money for.

And Parkinson's has never been one of those. Is that part of your problem here? Yeah, I mean, yes, for sure. I think so. And I think one demonstration of how important funding has been has been, for example, the Michael J. Fox Foundation, which has been able to fund a huge amount of research. And that, I think, has been one of the important aspects, not the only one, but obviously a very important aspect to the progress that we've been able to make over the past couple of decades.

A blood test. How close are you to that game changer? So I think the field is close. I think obviously Alzheimer's disease is closer to having a blood test that they're going to be able to use. People often talk about us being a little bit behind Alzheimer's disease, which we typically are, again, probably due to the amount of research that's going into the area. But there are tests right now that look quite promising where you take either a piece of skin or some spinal fluid that may be quite useful for diagnostics. We appreciate that that's not going to be the most practical approach. And there is initial work, interesting research that's looking like we can probably tweak that test to be able to do a similar test out of blood and so

i think it's going to be within the next several years i do think it's going to be a game changer in terms of us being able to diagnose the disease more definitively and i think where people are very very excited and this won't have implications for people who have parkinson's today and now but that we may be able to diagnose the disease very, very early, even before I would make a diagnosis in clinic. And so then it opens up the possibility of prevention. One of the things we did see during COVID

is that research facilities and research teams all over the world work together in an unprecedented fashion, and they made a hell of a lot of progress pretty quickly. Is any of that happening with Parkinson's? It is, and I think it's super important. I mean, back in the day, people would work in silos, and each individual researcher could make some progress,

but the actual scientific fields, the technologies, each person's expertise is so individualized and specialized now that for us to really be able to make progress, we have to work together. There's no doubt about it. And so there is more and more, not just work along collaborations within institutions or across countries, but more there is global collaboration. And I think this is clearly going to be key for us to make more progress. Just finally, you ever met the federal health minister, Mark Holland? No, I haven't. Okay. He's sitting right over there. What do you want to tell him?

First thing I'll tell him is I had the opportunity this week to spend some time in Ajax at the senior center. That's his writing. I know. And I'll just say that his constituents were friendly, enthusiastic, and wonderful to spend time with. But when I asked the people in the room how many of them had been touched by Parkinson's, half of them raised their hand. And so I just put that out there for him to know about his seniors group constituency.

And what I would ask him for is putting Parkinson's disease high on his agenda, especially from a CHR point of view for consideration of... CHR? CIHR, the Canadian Institute of Health Research, for funding. I think that understanding the disease further, funding research that's going to really push us towards finding actual therapies, is what we need in this field. Gotcha.

Well, we thank you for coming onto our agenda tonight and helping us understand this much better. Thanks for having me. That's Dr. Lorraine Kalia, neurologist, senior scientist, University Health Network's Kremble Brain Institute. Thanks so much.

Thank you. Thank you for supporting TVO's journalism.