Why are more people being diagnosed with Parkinson's disease?

This is a translation from Dutch of a superb article written by Dr. Bas Bloem: Parkinson’s Disease: ‘This illness can happen to anyone’ More and more people, including those in their 30s and 40s, are being diagnosed with Parkinson’s disease. Professor Dr. Bas Bloem, an international authority on the condition, even describes it as a pandemic. But why is this happening, and is there anything we can do about it? What exactly is Parkinson’s disease? “It’s the fastest-growing neurological disease and one of the most disabling conditions. In the past ten years, the number of Parkinson’s patients in our country has increased by 30%. The numbers in China and the U.S. are even more alarming. In Parkinson’s disease, dopamine-producing brain cells gradually break down. Dopamine is a neurotransmitter, a chemical that carries messages between nerve cells, essential for smooth movement. A common misconception is that Parkinson’s only causes physical symptoms like tremors, slow movement, or a blank facial expression. However, it is a classic example of a disease that affects both physical and mental health, making it complex. Patients may suffer from anxiety, severe mood swings, memory loss, planning difficulties, sleep problems, and even depression. Not all patients experience the same symptoms — for example, one in three does not have tremors. Most patients report that their motor symptoms are just the tip of the iceberg, and they suffer more from other symptoms.” Parkinson’s is a progressive disease, meaning symptoms worsen over time. This progression makes it a deeply impactful illness. In studies on the effect of diseases on quality of life, Parkinson’s ranks second, both in mental health (just after dementia) and physical health (just after severe spinal cord injury). What causes Parkinson’s disease? “We know it’s a combination of genetic and environmental factors, but there is still so much we don’t know. Personally, I believe environmental factors play the largest role. Parkinson’s was first described in 1817 by the London physician James Parkinson, around the time of the Industrial Revolution. Before we started polluting our environment, Parkinson’s was extremely rare. A recent study in Korea confirmed the link between air pollution and Parkinson’s. There are also major concerns around pesticides. Studies show that farmers and people living near agricultural areas worldwide are at a higher risk of developing Parkinson’s. Many pesticides have been banned in recent decades, but we still don’t know if current chemicals are safe. More and more studies suggest they are not, but this hasn’t been proven yet.” “I believe it’s not the responsibility of doctors like me to prove that a chemical is dangerous; it should be up to the industry to prove it’s safe. We also don’t know what these substances do when they enter the food chain. How much do consumers ingest? For example, red wine in supermarkets contains seven different pesticides, including glyphosate, which is widely used in agriculture. The quantities are small, but what happens when these add up over time? And what about the combination of different chemicals? We’re investigating this. A study from Wageningen University and Radboud University found that house dust near farms contains over 100 types of pesticides. While the amounts are tiny, we don’t know the effect of long-term exposure to small quantities.” Who is at risk of developing Parkinson’s? “It’s often seen as an age-related illness, but it’s not just the elderly who are affected. Similar to lung cancer, the longer you live, the more time you’ve had to be exposed to environmental risks like pesticides. Aging doesn’t directly cause Parkinson’s. In fact, one in three Parkinson’s patients is under 65, and a significant portion is under 50. We recently opened a clinic for people in their 30s and 40s. There’s even ongoing research into Parkinson’s and pregnancy. This disease can affect anyone. Currently, there are 63,000 Parkinson’s patients in the Netherlands, and 40,000 in Belgium. As in other countries, more men are diagnosed than women, likely because men (such as farmers and metalworkers) are more exposed to harmful substances. The number of new cases is exploding worldwide, and I’m not afraid to call it a pandemic.” Can Parkinson’s disease be cured? “No, that’s the bad news. There’s no medication to stop the progression of the disease yet. However, there are drugs that can correct the dopamine deficiency, which significantly improves the quality of life. Unfortunately, these drugs cause side effects after a few years, making it harder to manage the disease effectively.” “But medication is just one aspect. I compare good treatment to a table with four legs; all four are needed to keep the table stable. Medication is one leg. When drugs stop working well due to side effects, a second option comes into play: brain surgery, where the dopamine system is continuously stimulated. The third leg is multidisciplinary care, involving around 30 different specialists, from psychologists to urologists and speech therapists to dietitians. This shows how complex Parkinson’s is. Through ParkinsonNet, we’ve trained specialists and created a network to provide the best possible care.” “And finally, lifestyle changes, which are crucial. With recent research, we’ve proven that exercising for at least half an hour three times a week can reduce symptoms. The exercise must be intense enough to get you out of breath. Scans show that exercise can even help damaged brain areas communicate better with healthy ones, which is a hopeful discovery.” What really helps: exercise three times a week until you’re out of breath What else can patients do themselves? “Good nutrition is part of the lifestyle changes. Studies show that a Mediterranean diet — rich in vegetables, fruits, nuts, legumes, fish, and olive oil — is associated with a lower risk of developing Parkinson’s. We’re now investigating whether this diet can also slow the progression in diagnosed patients. Stress management is another key factor. Parkinson’s is an extremely stress-sensitive illness. Dealing with stress requires dopamine, which patients lack. Even small amounts of stress can increase tremors. Yoga and mindfulness can help control this tension. I cannot stress enough the importance of lifestyle changes. In consultations, I sometimes feel like a lifestyle guru.” What’s the current outlook? “Research is ongoing worldwide, looking into ways to slow, cure, or prevent the disease. I believe that within ten years, we’ll have a drug to slow down progression. But for now, the first line of treatment remains exercise. One of the studies my team is currently working on is investigating the effect of pesticides in our food. We’re also studying whether patients exposed to pesticides after diagnosis deteriorate faster than others. Together with the Dutch National Institute for Public Health and the Environment (RIVM), we’re developing better policies to assess the risks of pesticides.” “My ultimate goal is to prevent Parkinson’s disease in the future. There’s still so much to learn about this illness. In the past 20 years, the number of patients worldwide has doubled. If we don’t change our environment, this number will double again in the next 20 years. Parkinson’s affects people in the prime of their lives, who want to enjoy life. My mission is to help make that possible.”