Understanding Parkinson better in order to take better action: the challenges of an evolving disease

The diversity of its manifestations, which differ in particular according to gender, highlights the essential role of research in expanding knowledge and optimizing clinical care.

Why do we need to do more research on Parkinson's?

Dr. Isabelle Beaulieu‑Boire observes the complexity of Parkinson's disease on a daily basis. Despite some scientific advances, this condition is still poorly understood, both in terms of its origin and the factors that contribute to it, as well as the means of prevention, treatments that can slow its evolution and the differences in how it occurs in women and men.

“Several factors can contribute to the development of Parkinson's,” she explains. The average age of onset is around 60, but the disease can occur at any time. For the majority of people affected, it appears to have no clearly identifiable cause. However, there are some forms of genetic origin, about 5 to 10% of cases, and juvenile forms that can start as early as childhood. Over the past decade, we've also seen an increasing number of diagnoses made before the age of 50.”

Since research has not yet made it possible to precisely identify the causes of Parkinson's disease, it remains difficult to explain why it occurs at an earlier and earlier age. In this context, there are still no treatments capable of slowing down or reversing its evolution. However, scientific advances make it possible to better identify certain risk factors.

“We now know that environmental factors play an important role, including exposure to certain pesticides. Parkinson's disease is also recognized as being more common among farmers, with a risk that can be multiplied by four to ten times depending on the types of pesticides used. The diet and the quality of the air we breathe could also influence the development of the disease.”

Deconstructing the image of Parkinson's: a disease that goes far beyond tremors

Parkinson's disease is often associated only with motor disorders. However, the reality is much more complex. In addition to affecting movement, Parkinson's can cause several symptoms such as anxiety, depression, sleep disorders, urinary problems, and even hallucinations.

“Medication is mainly used to treat motor symptoms, but management must go well beyond this aspect,” says Dr. Isabelle Beaulieu‑Boire. It is up to doctors to take care of all the manifestations of the disease. In addition, symptoms may vary by gender. For example, cognitive disorders are generally less common in women, but women have more non-motor symptoms, such as anxiety, depression, or sleep problems.”

The fact that the disease is affecting more and more women under the age of 50 nuances the picture even more. At this age, some symptoms may intermingle with those of premenopause or menopause, which can make it difficult to adjust medication, interpret analyses, and monitor the evolution of the disease.

Parkinson's in women under 50: research that needs to be further developed and adapted

Dr. Isabelle Beaulieu-Boire is particularly interested in early Parkinson's disease in women. She recently joined the committee of Women's Health Fund of the Fondation du CHUS, an initiative led by Dr. Sophie Desindes, where she uses her expertise and contributes to the sharing of knowledge. She is also involved in a research project conducted in collaboration with other centers of medical expertise across Canada. This initiative aims to deepen scientific knowledge on the specificities of Parkinson's disease in women diagnosed before the age of 50.

“This is a subgroup that is still poorly documented in the medical literature. It is in this context that we have set up a research protocol. In our cohort, nearly 50% of women report a marked worsening of their symptoms, beginning about three days before menstruation and lasting up to five to seven days after. We are particularly talking about tremors, involuntary movements, and fatigue.”

This clinical reality raises many questions among patients. As Dr. Beaulieu-Boire points out, “the big question that many women ask themselves is the following: Is it my Parkinson's or my premenopause ? ”.

At present, scientific data remains insufficient to offer a clear answer to them. This uncertainty can be a source of concern for women trying to balance illness, work and family responsibilities.

“If we are able to quantify the number of women who must, for example, adjust their medication at certain times, it will become easier to better support them and offer them clinical advice adapted to their reality,” explains Dr. Beaulieu-Boire. This may be a small group of patients, but they are women for whom the disease has a major impact on their personal and professional lives. We need to think about them.”

Currently, about ten patients are participating in this research project in Sherbrooke, and the objective is to increase the cohort to 50 participants. Other cohorts are already in place at collaborating centres in Toronto and Calgary. The next year will be devoted to the observation phase. Based on the data collected, Dr. Beaulieu-Boire wishes to set up a study aimed at exploring a treatment or developing a strategy for adjusting medication according to the patient's cycle.

“Women have been ignored for far too long in Parkinson's research, and it's time for change. Better understanding the effect of female hormones on the disease could not only improve the quality of life of these fighting women who live with Parkinson's on a daily basis, but also contribute to a better overall understanding of the disease,” concludes Dr. Isabelle Beaulieu-Boire.

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