Old problems, new solutions: harnessing technology and innovation in Parkinson’s disease—evidence and experiences from Thailand

The rise of Parkinson’s disease is a global challenge, but efforts to tackle this must begin at a national level: a protocol for national digital screening and “eat, move, sleep” lifestyle interventions to prevent or slow the rise of non-communicable diseases in Thailand

“…There is also preliminary evidence that associations between some environmental and lifestyle factors and PD may be modified by the person’s genotype ( 9 ). Therefore, in our efforts to control the rise of PD, a critical aspect to consider is minimizing what in many cases are modifiable risk factors with strategies that can include simple lifestyle changes ( 12 , 13 ). Similarly, we need to be aware of independent protective effects, namely consumption of coffee, nicotine, green and black tea, urate, non-steroidal anti-inflammatory drugs, and physical activity that have been identified in various studies ( 6 , 14 ).…”

“…Although the rise in PD prevalence is a global burden, the reported PD prevalence patterns are not uniform across all world regions. Particularly steep increases have been observed in highly populous nations in Asia ( 15 ), and in low-to-middle income countries (LMICs) ( 12 , 16 , 17 ). Using data from the Global Burden of Disease (GBD) 2019 study, it has been estimated that the prevalence of PD over the period from 1990 to 2019 increased by 256% in East Asia, 216% in South Asia, 174% in South-East Asia, and 57% in Central Asia ( 18 ).…”

“…Achieving timely and effective diagnosis of PD is heavily reliant on national economics and healthcare infrastructure in order to provide the necessary resources to meet these demands ( 12 ). Thailand has a total population of almost 69 million and is served by 927 government hospitals, 363 private hospitals, and 9,768 primary health care units with 99.5% of the population having health protection coverage ( 27 ).…”

“…Added to this, in certain world regions, including some countries in Africa and parts of Asia, PD is associated with supernatural beliefs and sufferers may face extreme marginalization, stigmatization and persecution for having the disease, resulting in social isolation, poor attendance at healthcare facilities, lack of access to care, definitive diagnosis, and treatment ( 35 ). In the experience of the largest tertiary for PD management in Thailand, the Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders (ChulaPD, www.chulapd.org ) in Bangkok, PD patients are generally diagnosed when they have already had symptoms on average for 3–5 years, so they are often very symptomatic ( 12 ). Considering that dopaminergic neuron degeneration is already severe in the early stage of PD, reaching at least 60%, achieving a definitive diagnosis after several years of being symptomatic is likely to be too late.…”

“…The rise in PD is recognized as a global challenge, but efforts to tackle it need to begin at a national level ( 36 ). Effective diagnostic strategies need to be put in place but in many countries, including Thailand and other LMICs, there is a lack of specialist movement disorders neurologists and limited healthcare resources to achieve this ( 12 ). In Thailand, up to 80% of PD patients have never been assessed by a specialist neurologist, only by non-specialist clinicians or not being evaluated by medical practitioners at all ( 37 ).…”