Parkinson’s Under 50? Alarming Rise of Young-Onset Cases and What’s Behind It - Dr Avinash Kulkarni

People who have Parkinson's disease (PD) usually think of an older person who shakes and moves slowly. Parkinson's has long been thought of as an old-age disease, since most people get it after age 60.

But in the past few years, doctors have noticed a worrying trend, more and more people under 50 are being labelled with Young-Onset Parkinson's Disease (YOPD).

This change tests what we thought we knew about the disease and brings up important questions: Why are younger people getting Parkinson's? What makes it different from the more common late-onset form? And what might be making this rise?

What is Parkinson's Disease that Starts in Young Adults (YOPD)?

Parkinson's disease is called "Young-Onset" if the first signs show up before age 50. The main signs of YOPD are tremors, stiffness, slow movement, and trouble keeping your balance. These are similar to the signs of late-onset Parkinson's, but YOPD develops differently and has its own problems.

1. Slower Progress: YOPD tends to progress more slowly than late-onset PD, which means that people with it can stay independent for longer. While this may speed up the evaluation process, it often means that symptoms are mistaken for stress or other neurological conditions.

2. More motor fluctuations: As a side effect of long-term dopamine treatment, younger patients are more likely to have dyskinesia, which means they move without meaning to. Taking care of these side effects becomes very hard because they need medicine for many more years.

3. More Non-Motor Symptoms: Anxiety, sadness, and memory loss can show up earlier and be worse in people with YOPD. It's also common to have trouble sleeping and autonomic dysfunction, which means problems with stomach, blood pressure, and so on.

4. Greater Emotional and Social Impact: Being told you have a neurological problem that gets worse over time when you are young and healthy can be very upsetting. Jobs, relationships, and family duties get messed up, and young people with Parkinson's often feel alone because most support groups are for older people.

What is causing the rise in YOPD cases?

There are probably a mix of genetic and environmental causes for the rise in YOPD cases.

1. Genetic Link

The genetic link is strong in up to 10–20% of YOPD cases, while it is not strong in late-onset Parkinson's cases. Gene changes in LRRK2, PARKIN, PINK1, and SNCA have been linked to cases that start early. These DNA changes can be passed down or happen on their own.

Genetic testing is getting easier to get, which helps doctors find people who are at high risk earlier. However, having a genetic mutation does not mean that someone will get Parkinson's; environmental causes probably play a role as well.

2. Triggers in the environment

Studies are showing that toxic environmental exposures may be a factor in the rise in YOPD cases. Here are some possible suspects:

• Pesticides and herbicides: Chemicals like paraquat and glyphosate, which are found in some pesticides for crops, have been linked to a higher chance of Parkinson's.
• Heavy Metals and Industrial Pollutants: Parkinson's-like symptoms have been linked to being exposed to manganese, lead, or chemicals used in welding and dry cleaning.
• Air Pollution: Some studies show that being exposed to air pollution and particulate matter for a long time may raise the chance of neurodegenerative diseases.

Can We Stop Parkinson's from Starting Early?

Even though we can't change our genes, lowering the chance of environmental triggers may help us avoid the disease earlier.

• Wear safety gear in places of work where toxic chemicals are present to avoid being exposed to them.
• Live a brain-healthy life by eating a diet high in vitamins (like the Mediterranean diet), working out regularly, and making sure you get enough sleep.
• If you notice any early warning signs, like losing your sense of smell, having chronic constipation, or subtle changes in your movement, you should see a doctor right away.

Early Diagnosis and Better Care

Early diagnosis is very important for treating YOPD well. However, because doctors don't usually think Parkinson's in younger people, many YOPD patients get the wrong diagnosis or have to wait longer to start treatment.

People sometimes think that early signs of Parkinson's disease are actually conditions like essential tremor, nervousness, or even carpal tunnel syndrome.

Good news: science is moving forward quickly. Newer ways of treating the disease, like deep brain stimulation (DBS), gene therapy, and disease-modifying drugs, give people hope that they can slow the disease's development and make their lives better.

The fact that more and more young people are getting Parkinson's is a wake-up call for doctors. Even though YOPD is still less common than late-onset Parkinson's, the fact that the numbers are rising suggests that genetic and external factors are changing the world.

To deal with this new health problem, we will need to raise knowledge, detect it early, and study new treatments.

People who have been identified with YOPD do not lose hope. With the right help, changes to their lifestyle, and medical care, many can continue to live full lives for years to come.