PARKINSON’S DISEASE + MODULATORY SYSTEMS
Michele Tagliati, MD
Director, Movement Disorders Program
Caron and Steven D. Broidy Chair in Movement Disorders
Vice Chair, Department of Neurology
Professor of Neurology
A growing number of researchers and clinicians believe the key to addressing the cause of Parkinson’s—and identifying a cure—may be found in studying the nonmotor symptoms that occur before neurological symptoms of Parkinson’s emerge.
Insulin resistance in the brain, which can be triggered by sympathetic overactivation, can play a key role in the premature death of neurons, resulting in symptoms characteristic of Parkinson’s and other neurodegenerative conditions. This knowledge has made repurposing approved diabetes drugs an appealing target for Parkinson’s treatment. Cedars-Sinai investigators became the first in the world to test liraglutide in patients with Parkinson’s. The results of the trial suggest a significant improvement in nonmotor symptoms and quality of life, offering major promise for management of these symptoms in combination with dopamine.
"This area of research is fascinating because if we start looking at the disease before it manifests as neurological symptoms, there is a window of opportunity to treat or modify its progression."
— Michele Tagliati, MD
Running on Adrenaline
While the connection between Parkinson’s and Type 2 diabetes has long been established, elucidating the relationship between the noradrenergic system and Parkinson’s is a fairly recent focus. In an investigator-led pilot study, Cedars-Sinai neurologists and sleep specialists collaborated to identify patients at high risk of developing Parkinson’s due to a confluence of premotor symptoms, including REM sleep behavior disorder, depression, constipation and other health problems associated with possible noradrenergic dysregulation.
Early findings from biomarker analysis, MRI studies using neuromelanin-sensitive technologies, MIBG cardiac imaging and heart rate variability tests suggest that many individuals at high risk for Parkinson’s have an abnormally increased sympathetic tone. Findings from this and other metabolism-related drug-repurposing studies led by Cedars-Sinai could improve clinicians’ ability to manage some of the most challenging Parkinson’s symptoms, as well as possibly delay or even prevent the onset of disease.
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Cedars-Sinai researchers are studying the relationship between the noradrenergic system and Parkinson’s disease.
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