Clemens Scherzer is caught between centuries. As a researcher-clinician, and one of three co-directors of the Harvard Biomarker Study, he spends much of the time with his eyes firmly on the future - personalised medicine for people with Parkinson's and Alzheimer's diseases. But he is also a practicing neurologist at Brigham and Women's Hospital, MA, and as such has weekly reminders of just how urgent the need for progress is.
"I see Parkinson's patients every Thursday or Friday," he tells The Lancet Neurology. "The questions I get pretty much every time I'm in the clinic, and which always make me squirm, are 'Doctor, how am I doing? What's my prognosis for the next few years? Am I responding well to my medicines?' Unfortunately, in Parkinson's we just don't have the answers to any of these questions. It's essentially 19th century medicine."
At present, assessment for Parkinson's disease is based on a physical exam and clinical history, which are then used to monitor disease progression. These assessments are not only unspecific but also highly variable, differing from day to day and from neurologist to neurologist. Alzheimer's disease, too, lacks a simple definitive diagnostic test.
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