JMIR Publications

ABSTRACT

Parkinson’s disease (PD) is a complex neurodegenerative disorder that afflicts >10M people worldwide resulting in debilitating motor and cognitive impairment. In the USA alone (with approx. 1M cases) the economic burden for treating and caring for persons with PD exceeds $50B and myriad therapeutic approaches are under development including both symptomatic and disease modifying agents. The challenges presented in addressing PD are compounded by observations that numerous, statistically distinct patient phenotypes present, with a wide variety of motor and non-motor symptomatic profiles, varying response to current standard of care symptom alleviating medications (D-DOPA and dopaminergic agonists) and different disease trajectories. The existence of these differing phenotypes highlights the opportunities in personalized approaches to symptom management and disease control. The pro-dromal period of PD can span across several decades, allowing the potential to leverage the unique tapestry of composite symptoms presented to trigger early interventions. This may be especially beneficial as disease progression in PD (alongside AD and HD) may be influenced by biological processes such as oxidative stress, offering the potential for individual lifestyle factors to be tailored to delay onset of disease. In this manuscript we offer potential scenarios where emerging diagnostic and monitoring strategies might be tailored to the individual patient under the tenets of P4 medicine. These approaches may be especially relevant as the causative factors and biochemical pathways which are responsible for observed neurodegeneration in PD patients remains a fluid debate. The numerous observational patient cohorts established globally offer an excellent and unprecedented opportunity to test and refine approaches to detect, characterize, control, modify the course and ultimately stop progression of this debilitating disease. Such approaches may also help development of parallel interventive strategies in diseases such as Alzheimer’s and Huntington’s, who share common traits and etiologies with PD. In this overview we highlight near term opportunities to apply P4 medicine principles for PD patients and introduce the concept of the composite orthogonal patient monitoring.