Parkinson’s Disease
Challenges in diagnosing andmonitoring

Paul Blyth
Head of Underwriting and Claims Proposition
3rd September 2024
Institute of Actuaries Japan

AgendaIAJ Parkinson’s Disease

01 What is Parkinson’s disease?
02 What are the existing treatment options?
03 What does the future hold for Parkinson’s disease?
04 Conclusions
05 Questions
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What is Parkinson’sdisease?
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Parkinson’s disease
What is it?
A progressive disease of the nervous
system caused by a loss of nerve
cells in the brain (substantia nigra)
causing a reduction in Dopamine.

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The lack of Dopamine is responsible
for the body being unable to regulate
movement. A reduction in dopamine
is responsible for many of thesymptoms suffered.

Parkinson’s disease
Symptoms
Accompanying symptoms:

Three main symptoms:

Involuntary shaking ofparticular parts of thebody (tremor)
Slow movement(Bradykinesia)
Stiff and inflexible
muscles

Depression and anxiety
Balance problems – this may
increase the chance of a fall
Loss of sense of smell(anosmia)
Problems sleeping(insomnia)
Memory problems

Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic andenvironmental factors is responsible.
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Parkinsonism

Is an Umbrella Term

IPD will look like PK+
syndromes – this because
they’re characterised by thesame symptoms‘Parkinsonism’

Bradykinesia(slowness/lossof initiating
voluntarymovement )TremorParkinsonism is a genericterm for a group of symptoms
that can be seen in someone
with Parkinson's diseasesuch as tremor, stiffness, andslowness of movement.

Rigidity

Posturalinstability

IAJ Parkinson’s diseaseParkinson’s disease
Classical Symptoms

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Parkinson’s disease
Who’s affected?
Parkinson’s affects up to 150,000 people in Japan.

Parkinson's is the second-most common neurodegenerative disease
after Alzheimer's disease.
This is projected to double by 2040, primarily because of population
ageingDiagnosis between 50-60 is considered ‘early’ onset

Diagnosis before 50 is considered ‘young’ onset (M J Fox was 29!)

Men aged 50 to 89 are 1.4 times more likely to be diagnosed with
Parkinson’s than women
IAJ Parkinson’s disease* Right table is based on UK statistics

Parkinson’s disease
Diagnosis
Investigation:

MRI or CT scan – used torule out other causes. A
normal result is usual in
Parkinson’s

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DAT Scan – will show aloss of dopamine
producing cells

An abnormal DaTSCAN
result can't give adefinitive diagnosis of
Parkinson’s in isolation!

Parkinson’s disease
Diagnosis
Medication:
Trial ofmedication(Dopamine) toassess any
response

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A Parkinsonism
may show initial
response, buttrue PD
continues toimprove
symptoms

Parkinson’s disease
Diagnostic Criteria

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Parkinson-plus syndromesGroup ofneurodegenerative
diseases that cause
symptoms like
Parkinson’s disease as
well as other symptoms

The Important 4:

Multiple system
atrophy (MSA)

Characterised by:More rapidly progressive
than PD

Progressive
supranuclear palsy(PSP)

Additional Features

Why Important!?

supranuclear gaze
palsy

Prognosis, treatment,
counselling andsupport

early autonomic
failure, cerebellar
features, alien limb,
apraxia (motor speechdisorder)

Paying a claim too
early detrimental to theindividuals mentalhealth?

Early postural instability
Dementia with lewy
bodies (DLB)

Corticobasal
degeneration (CBD)IAJ Parkinson’s disease

Poor or transient
response to therapy

Parkinson’s disease definition
Definitions
1999 & 2004 – Parkinson’s disease [before age x].
Confirmation by a Consultant Neurologist of a definite diagnosis of Parkinson’s disease [before age X].
Parkinson’s disease secondary to alcohol or drug misuse is not covered.
2006 – Parkinson’s disease [before age x] - resulting in permanent symptoms.
A definite diagnosis of Parkinson’s disease [before age x] by a Consultant Neurologist.
There must be permanent clinical impairment of motor function with associated tremor, rigidity of movement
and postural instability.
For the above definition the following are not covered:• Parkinson’s disease secondary to drug abuse

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Parkinson’s disease
Definitions
2011 – Parkinson’s disease [before age x] - resulting in permanent symptoms.
A definite diagnosis of Parkinson’s disease [before age x] by a Consultant Neurologist.
There must be permanent clinical impairment of motor function with associated tremor, muscle rigidity andpostural instability.
For the above definition the following are not covered:••

Parkinson's disease secondary to drug abuse.
Other Parkinsonian syndromes2014 - Parkinson’s disease [before age x] - resulting in permanent symptoms.
A definite diagnosis of Parkinson’s disease [before age x] by a Consultant Neurologist.
There must be permanent clinical impairment of motor function with associated tremor and muscle rigidity.
For the above definition the following are not covered:•Parkinsonian syndromes/Parkinsonism
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Parkinson-plus syndromes
Definitions
Parkinson Plus Syndromes – resulting in permanent symptoms
A definite diagnosis by a Consultant Neurologist of one of the following Parkinson Plus syndromes:• Multiple System Atrophy• Progressive Supranuclear Palsy• Parkinsonism-Dementia-Amyotrophic lateral sclerosis complex• Corticobasal Ganglionic degeneration• Diffuse Lewy Body disease.
There must also be permanent clinical impairment of at least one of the following:• Motor function; or• Eye movement disorder; or• Postural instability; or• Dementia; or• Bladder control and postural hypotension.
IAJ Parkinson’s diseaseTerminal Illness
Definitions
We’ll pay the full amount of Life Protection, Critical Illness Protection or Combined Life and Critical Illness Protection covered if:• You’re diagnosed as being terminally ill and, in the opinion of your attending UK Consultant, your illness is expected to lead to yourdeath within 12 months.
We’ll pay the full amount of Life Protection covered if:• You have a definite diagnosis by a UK Consultant of any illness that satisfies one of the following:• Parkinson-plus syndromes: A definite diagnosis by a UK Consultant Neurologist or Geriatrician of one of the following Parkinsonplus syndromes:– Multiple system atrophy– Progressive supranuclear palsy– Parkinsonism-dementia-amyotrophic lateral sclerosis complex– Corticobasal ganglionic degeneration– Diffuse Lewy body disease
There must also be permanent clinical impairment of at least one of the following:– Motor function– Eye movement disorder– Dementia

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What are the existingtreatment options?
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Parkinson’s treatment options
Medication
Aim to increase the level of dopamine that reaches the brain and stimulate
the parts of the brain where dopamine works..
Levodopa – chemical building block that your body converts into Dopamine
Dopamine agonists – act like Dopamine to stimulate nerve cells
Mao-B inhibitors – help nerve cells make better use of the Dopamine it does
have, by blocking an enzyme that breaks down dopamine in your brain
COMT inhibitors – used in combination with Levodopa to block an enzymethat breaks the Levodopa down, making it more effective
Glutamate antagonists – may affect how the brain reacts to certain chemicals

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Treatment options –Supportive treatments

Occupationaltherapy – coping
strategies, timeplanning, gentle
exercise andrelaxation tips,
strategies foranxiety

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Physiotherapy –keeping you fit, helping
to maintainindependence andkeep mobile,
prevent/manage falls,
provide pain relief,
improve breathing andcirculation problems

Speech and language
therapy – maintaining
communication ability,
alternative ways ofcommunication,
recommend helpful
technology

Dietary therapy – help
with swallowing,
constipation, foodpreparation, adapted
cutlery/cups, choosing
nutritious foods.

Complimentary
therapies –Acupuncture,
Alexander technique,aromatherapy, art
therapy, Ayurveda,
bowen technique,chiropractic,
kinesiology, osteopathy,
reflexology, Reiki etc
etc

Parkinson’s Treatment Options
Deep Brain Stimulation
Currently no cure for Parkinson’s Disease

Aim to reduce symptoms and maintain quality of life for as long as
possible

Mainly used for those who don’t respond to medication. involves
implanting very fine wires with electrodes at their tips into the brain.
These are connected to extensions that are tunnelled under the skinbehind the ear and down the neck. They are connected to a pulse
generator (a device like a pacemaker), which is placed under the skinaround the chest or stomach area.
When the device is switched on, the electrodes deliver high frequency
stimulation to the targeted area. This stimulation changes some of theelectrical signals in the brain that cause the symptoms of Parkinson’s.
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What does the future
hold for Parkinson’s
disease?
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The future of Parkinson’s disease
Detection and Treatment

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The future of Parkinson’s disease
The digital revolution

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The future of Parkinson’s disease
Remote Digital Measurement Opportunities

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The future of Parkinson’s disease
Wearable tech and digital biomarkers

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The future of Parkinson’s disease
Remote Digital Measurement Opportunities

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Summary

There is a need to replace low accuracy
qualitative legacy tests
Digital approaches can provide higher
sensitivity and specificity and capture realworld data at scale
More accurate diagnosis permits bettercare
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Conclusions

IAJ Parkinson’s diseaseConclusions
Most movement disorders will have features of Parkinsonism
Most Neurologist’s treat on a ‘working diagnosis’ – so be certain theevidence suggests a definite diagnosis
PD is differentiated to a Parkinson-plus based on the response totreatment
Being started on dopamine is not enough – this is part of the working
process of elimination
Has treatment been prescribed long enough to say this was poor ortransient?
Don’t forget to use a CMO if unsure!

IAJ Parkinson’s diseaseExpert Views
Parkinson’s disease

IAJ Parkinson’s diseaseThank YouQuestions?
Thank you
Questions?
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