Are we ready for population-based screening for PD risk?

Werner Poewe & Alastair Noyce

The first debate of the PD Summit set the stage for an exciting and thought-provoking discussion. Titled Are we ready for population-based screening for PD risk? This debate featured two experts presenting opposing views.

Werner Poewe argued in favour of implementing population-based screening, highlighting the potential benefits it offers and advancements in early detection. He emphasised that population screening for PD risk started a decade ago and discussed the Movement Disorder Society’s (MDS’s) research criteria for prodromal PD, which has shown promising population-based performance. To address the psychological effects, privacy and discrimination concerns of population-based screening, he pointed out that the purpose of performing tests in apparently healthy individuals is to instigate early treatment and improve health. He also argued that early detection and risk disclosure from a patient perspective are crucial, as a survey demonstrated that ~70% of patients would have liked to have known their risk for PD years before diagnosis, especially if lifestyle changes could alter the course of the disease.

Arguing for the other side, Alastair Noyce presented a compelling case against being ready for population-based screening for PD risk, and raised important concerns and challenges. He highlighted that we are still a long way from population-based screening for PD, although we are closer to strategies for early detection in those with symptoms such as hyposmia and/or rapid eye movement sleep behaviour disorder. He emphasised the need to evaluate and validate research into biological classifications of PD and create the infrastructure for early detection, including testing, communication and therapeutic pathways, and highlighted the significant role of α-synuclein seeding assays as a disease marker and the necessity for other markers of progression. He pointed out that population-based screening requires an affordable, accurate, accessible and acceptable test available to all, not just some, and that the who, when, how, how often, and what still need to be ascertained.This lively debate captivated the audience and sparked a dynamic exchange of ideas, setting the tone for the rest of the PD Summit.

Can we predict disease progression in the initial stages?

Tom Hähnel & Francisco Cardoso

The engaging second debate delved into the question, Can we predict disease progression in the initial stages? A vote taken before the debate showed that 57% of the audience thought that we can predict disease progression in the initial stages.

This debate featured two experts with contrasting views. Tom Hähnel argued in favour, highlighting the identification of fast-progressing and slow-progressing PD subtypes. He emphasised the high generalisability of these subtypes and noted significant differences in several clinical domains such as survival, treatment response, neurodegeneration and digital gait analysis, pointing out that progression subtypes can be predicted with moderate accuracy using clinical data, and that artificial intelligence-based stratification allows for a significant reduction in sample size in clinical trials. However, he acknowledged the limitation of needing to screen additional patients.

On the other hand, Francisco Cardoso presented a compelling case against the prediction of disease progression in the initial stages. He argued that risk factors of PD are not predictive factors and highlighted the lack of diagnostic accuracy.

A vote taken after the debate showed that 74% of the audience were now persuaded that we cannot predict disease progression in the initial stages