Parkinson's disease (PD) is a neurological disorder where the brain decreases in the amount of neurons that produce dopamine – a type of neurotransmitter. As a result, there is a shortage of dopamine in the brain. These neurotransmitters are located in the basal ganglia, which plays an important role in movement, which causes both motor and non-motor symptoms associated with Parkinson's disease. The symptoms of PD can vary between individuals, but the motor symptoms typically include tremors, stiffness, slowness of movement, and difficulty with balance. The non-motor symptoms may include pain, low motivation, and depression (NIH, 2022).
Research has shown that people from minority groups face unique challenges in managing their PD symptoms and accessing appropriate care. In particular, minority populations with PD often get delayed diagnosis or misdiagnosis. A study constructs a plot graph to see the relationship between misdiagnose and race. In the y axis is the self-reported disability scale and the x axis is the motor impairment. A line of best fit is drawn for White and African American to see the relationship. The result shows that, at the same level of motor impairment, African Americans self report with less disability than White Americans. Also, with the same level of education and age, African American get diagnosed at a later stage for PD with a p value of 0.05, which is significant (Dahodwala, 2011). In a study in the National Library of Medicine, African American patients were 1.5 times more likely to experience a delayed diagnosis, while Hispanic patients were 2.5 times more likely to experience a delayed diagnosis (Dorsey et al., 2015). This information all demonstrated how race led to later being diagnosed with Parkinson, which also leads to a later in treatment.
Figure 1. (Dahodwala,2011)
Clinical trials play an important role in improving the understanding of medical conditions. They may reveal the efficiency of different PD medication and treatment, and help address the disparities in Parkinson’s Care. However, there is a lack of minority participants. Specifically, only 3% of African Americans and 1% of Hispanics, who make up 12.6% and 16.3% of the US population, respectively, participated in PD research studies (Tanner et al. 2014). The lack of diversity in clinical trial can limit the understanding of how diseases and treatment different ethnic and racial differently, which causes the minority to receive treatment that might not even work the best on them.
Some might argue that there is no difference in symptoms among different ethnic groups since it is the same medical condition, but that is simply not true. According to research published in the Journal of Parkinson's Disease, non-Hispanic White individuals with Parkinson's were more likely to experience slowness of movement as their primary symptom than African American patients (Marras et al., 2016). In addition, a study Rodriguez-Violante reports Hispanic individuals tend to have hallucinations as the primary non-motor PD symptoms more often than White patients (Rodriguez-Violante et al., 2017). These are pieces of that support the fact that minority have different symptoms
Why do minorities have different symptoms? According to “Relationship of age, gender, and ethnicity with motor complications of Parkinson's disease. Movement Disorders”, LRRK2 gene, associated with Parkinson's disease risk, is less prevalent among African Americans and Hispanics than among whites (Marder et al., 2015). So, the difference in gene expression might lead to the difference in PD symptoms present among racial groups and that difference contributes to the delayed diagnoses in minority populations .
Overall, minorities with PD might present differently due to genetic variation and lack of diversity in clinical research. One possible solution to address the problem with minorities getting later treatment for Parkinson’s is to increase awareness of the disease. It would create an opportunity for people to notice symptoms in the early stage and seek medical consultation. Second of all, greater language accessibility can encourage participation in clinical trials and seeking treatment as language barriers can make patients hesitant. Therefore, it's important to increase language interceptors and multilingual doctors. Furthermore, minorities might have limited access to high quality PD care and treatment due to financial reasons and limited PD care in the community (Cheng, 2008). Dr. Jose Cabassa, a Parkinson’s specialist, who has been serving the minority for the past 15 years, proposes high intensity exercise to improve the quality of life of individuals with PD. To support this proposal, he created the first free physician-monitored fitness class for people with PD. It is every Wednesday from 10 to 12 at Woman’s World of Boxing in NYC. All fighters are welcome. In conclusion, it is important to increase diversity in clinical trials and doctors/Parksinon’s specialist who can speak another language to helped improve the quality of health in minority.
References:
Cheng EM;Siderowf AD;Swarztrauber K;Lee M;Vassar S;Jacob E;Eisa MS;Vickrey BG; (n.d.). Disparities of care in veterans with Parkinson's disease. Parkinsonism & related disorders. Retrieved April 2, 2023, from https://pubmed.ncbi.nlm.nih.gov/17702625/
Dorsey, E. R., Venuto, C., Venkataraman, V., Harris, D. A., Kieburtz, K., & de Roulet, J. (2015). Randomized controlled clinical trial of “virtual house calls” for Parkinson disease. JAMA neurology, 72(8), 857-862.
Gao, X., Simon, K. C., & Schwarzschild, M. A. (2018). Racial and ethnic disparities in Parkinson's disease. Neuroepidemiology, 50(1-2), 1-16.
Marder, K. S., Gu, Y., Eberly, S., Tanner, C. M., & Scarmeas, N. (2013). Relationship of age, gender, and ethnicity with motor complications of Parkinson's disease. Movement Disorders, 28(8), 1144-1149.
NIH National Institute on Aging (NIA). (2022, April 14). Parkinson's disease: Causes, symptoms, and treatments. National Institute on Aging. Retrieved March 10, 2023, from https://www.nia.nih.gov/health/parkinsons-disease
Goldman, D. P., Bateman, B. T., & Romley, J. A. (2014). Low-income minority patients with Parkinson’s disease: a target for medical homes?. Movement Disorders, 29(7), 921-926.
Nikpour, A., Shirzadi, M., & Freedman, M. (2015). Cultural factors influencing Parkinson’s disease management. Journal of Parkinson's Disease, 5(4), 737-740.
Tanner, C. M., Goldman, S. M., Aston, D. A., & Ottman, R. (2014). Minority involvement in Parkinson’s disease research. Journal of Racial and Ethnic Health Disparities, 1(4), 311-318.
Dahodwala, N., Karlawish, J., Siderowf, A., Duda, J. E., & Mandell, D. S. (2011). Delayed parkinson's disease diagnosis among African-Americans: The role of reporting of disability. Neuroepidemiology. Retrieved April 2, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095837/?report=reader#!po=34.0909