Exploring the surge in Parkinson's disease, particularly among the young in India, recent studies highlight genetic factors and lifestyle links.
Anything younger than 50 years is considered young-onset Parkinson's, or YOPD. (Creative Commons)
In recent years, India has witnessed a worrying surge in cases of Parkinson’s disease (PD), especially among younger people. This condition, traditionally linked to the elderly, is now seen in individuals as young as 40.
While no concrete database validates this trend, neurologists unanimously acknowledge the increased incidence, particularly in the under-50 age group, as supported by a 2023 study published in medRxiv.
The research, conducted by a team of Indian and international researchers, scrutinised 674 PD subjects predominantly with an age of onset 50 years or less, revealing significant insights into the genetic drivers of this condition within the South Asian population.
Dr Shrivarthan R, Consultant Neurologist at MGM Healthcare, tells South First that one of the reasons for Parkinson’s disease seeing an increase is an increase in the diagnosis itself. “A combination of better patient awareness and increased incidence of the disease in recent years is the likely reason,” he says.
Dr Shrivarthan explains that Parkinsonism, an umbrella term for neurological disorders involving tremors, rigidity, balance and gait issues, and posture abnormalities, includes Parkinson’s disease as one of its causes. Other contributing factors may involve side-effects of certain psychiatric medications, exposure to toxins, brain infection, and inflammation.
Interestingly, another study published in 2021, involving 668 Indian subjects with juvenile, young, and early-onset PD, highlighted diverse clinical patterns across age groups, emphasising the need for distinct age cutoffs in understanding and treating these patients.
However, Dr Sudhir Kumar from Apollo Hospitals in Hyderabad notes that PD typically affects those over 40 years. As the aging population grows, there’s an apparent increase in age-related diseases. Additionally, there has been a shift in awareness.
“In the past, symptoms like shaky hands were often dismissed as normal signs of aging. Now, there’s a better understanding that these could be indicators of underlying conditions like Parkinson’s, similar to how forgetfulness was once casually attributed to aging but is now recognised as a potential sign of dementia. This increased awareness is leading more people to seek medical advice and diagnosis,” he explains.
While there is no concrete research on reasons for the onset of Parkinson’s disease, Dr Sudhir Kumar explains that of the various reasons like increased awareness, there is research indicating gut health as one of the reasons for onset of PD.
One of the more recent theories links Parkinson’s disease to gut health. Dr Sudhir Kumar tells South First, “Researchers suggest that a change in the gut microbiota, caused by consuming inflammatory and processed foods, could be a contributing factor to the development of neurological diseases like Parkinson’s and Alzheimer’s. This theory, although compelling, still requires more extensive controlled trials for validation.”
Agreeing with this, Dr Shrivarthan says that the human intestine has several neurons and these nerves are affected early in Parkinson’s disease. “It has been observed that patients with PD have early gut dysfunction in the form of constipation several years before other symptoms develop,” he adds.
He says, “Studies have shown that the gut bacterial composition in patients with PD is quite different from normal individuals. Change in lifestyle and poor dietary practices contribute to this gut microbiome alterations, which, in turn, can increase the risk of PD.”
Interestingly, recent studies have investigated the relationship between different types of screen time, such as TV viewing and computer use, and the incidence of various conditions, including PD.
Citing a study, Dr Sudhir Kumar says, “A comprehensive study using data from the UK Biobank included a large number of participants initially free of dementia, PD, and depression. This study aimed to explore the potential link between screen time and the incidence of these conditions.”
The results indicated that moderate computer use was associated with a reduced risk of developing dementia, PD, and depression compared to the lowest computer use. This is because when using a computer, it is usually for activities like work or playing games, where there is brain activity involved.
In contrast, higher amounts of TV viewing time were associated with an increased risk of these conditions. This is due to the reduced involvement of the brain while only “watching” something on the screen. Hence, the term “idiot box”, adds the doctor.
The study utilised Cox proportional hazards regression models to estimate the associations between different types of screen time and the incidence of dementia, PD, depression, and their multi-morbidity status, he explains.
“These findings suggest a complex relationship between screen time and neurological health, with different types of screen activities potentially having varying impacts,” Dr Sudhir Kumar notes.
However, he warns that it’s important to note that these are associations and do not necessarily imply direct causation. More research is required, he adds.
A sedentary lifestyle, characterised by a lack of physical activity, is identified as a potential risk factor for Parkinson’s. Studies indicate that engaging in regular exercise not only improves overall health but may also reduce the risk of developing neurodegenerative diseases.
“Extended periods of inactivity, often linked with excessive screen time, are emerging as potential risk factors for Young Onset of Parkinson’s Disorder (YOPD),” Dr Sudhir Kumar says.
He adds that repeated head injuries, as seen in sports like boxing and football, are also considered risk factors.
Citing the example of Muhammad Ali, a renowned boxer who developed Parkinson’s later in life, he highlights the potential connection between head trauma and the disease.
Interestingly, research indicates that smokers may have a slightly lower risk of developing Parkinson’s. Dr Sudhir Kumar says that this was a known fact and has even been entered into medical journals and textbooks.
“I have read this fact from my MD days. However, the negative health impacts of smoking far outweigh this potential benefit, and it is not suggested as a preventative measure,” he explains.
Doctors emphasise that there is currently no cure for Parkinson’s disease. “Parkinson’s disease, first identified in 1817, still lacks a cure 207 years later,” says Dr Sudhir Kumar. However, various treatments are available to help manage its symptoms.
The focus of Parkinson’s treatment is primarily on symptom management and improving the quality of life, given the progressive and incurable nature of the disease.
The doctor notes that Parkinson’s, especially in rural settings, is often misunderstood, leading many to seek traditional remedies over modern medical treatments. He explains that cultural perceptions and medical realities intersect in the management of this disease.
“In rural areas, the symptoms of Parkinson’s are frequently misattributed to nerve problems or aging, leading to reliance on herbal and Ayurvedic treatments, particularly in regions like Kerala,” Dr Sudhir Kumar explains.
He highlights that while some of these treatments may contain natural sources of dopamine in herbal forms, their effectiveness is questionable. However, if given in tablet form, their efficacy and safety remain uncertain due to unstandardised dosages.
Dr Shrivarthan states that the management of PD encompasses several domains. Medications are utilised for symptom treatment (symptomatic therapy) and to prevent further brain damage, known as disease-modifying therapy.
Additionally, physiotherapy and rehabilitation are employed to address balance and gait issues, improving mandatory muscle strength.
“Patient and caregiver counselling is crucial, covering the nature of the disease, lifestyle changes, fall prevention strategies, dietary modifications, stress management, and exercise schedules,” he adds.
In advanced cases that do not respond to medications, surgical options like deep brain stimulation can be considered, informs Dr Sudhir Kumar.
Dr Sudhir Kumar notes that the early symptoms of Parkinson’s are often distinct and noticeable. One of the most common initial symptoms is tremors or shaking of the hands at rest, unlike essential tremors, which occur during activities.
Another early sign is a reduction in walking speed, where individuals might find themselves lagging behind their usual pace and unable to match others.
Additionally, an asymmetry in arm swing during walking, where one arm swings less or not at all, can also be an early indicator of Parkinson’s.
Dr Sudhir Kumar emphasises that while PD itself is not fatal, it leads to a restricted lifestyle, increasing the risk of secondary complications such as falls, fractures, infections, along with bedsores, etc, reducing the quality of life.
These complications can shorten the life expectancy of individuals with Parkinson’s compared to the general population. Moreover, immobility in later stages can lead to additional health issues like malnutrition and metabolic diseases.
Regular exercise and physical therapies can help manage physical symptoms and improve mobility, balance, and muscle control, doctors explain.
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