Esther Cubo: «Exercise, diet, social relationships… can delay neurodegenerative diseases»

Esther Cubo: «Exercise, diet, social relationships... can delay neurodegenerative diseases»

Esther Cubo: «Exercise, diet, social relationships… can delay neurodegenerative diseases»ASSIGNED

-He says that Neurology is full of mysteries and challenges…

-Yeah. Many aspects of Neurology are still unknown, but when I started even more so. We still have many answers to offer, we have to continue investigating and I like challenges. It is a complex specialty, but we deal with people because neurological pathologies affect all age groups, from childhood to youth, and I especially dedicate a large part of my work to neurodegenerative diseases that mainly affect the older population. . It is a particularly vulnerable age group that needs a lot of social and health care.

-You are a specialist in movement disorders, what are they specifically?

-These are diseases that present with slowness of movement, difficulty walking or also with excessive movement, which is known as chorea. They affect all age groups, from childhood, youth and the adult population, and are often also associated with other clinical manifestations, such as dementia or psychiatric illnesses, so in order to make a diagnosis and therapeutic intervention we need to have a multidisciplinary team to be able to offer adequate health care.

-What is the diagnosis?

-Diagnosis in Neurology is not simple and in movement disorders it requires a very clinical training. It is very complex because no two patients are the same, but today we have some biomarkers, which are tools that can be at a molecular level, at a genetic level, at a neuroimaging level or even now digital, which also facilitates the diagnosis.

-Which diseases currently present the most challenges?

-I specifically focus on Parkinson’s disease and associated parkinsonism, tics or Tourette syndrome, which also affects the child and adolescent population, and also rare genetic diseases, such as Huntington’s. These are the diseases that are a little more prototypical, but also within movement disorders we see patients with gait disorders, such as ataxias, and others that are also complex because they are a combination of many symptoms that occur with movement disorders.

-What is the prevalence of neurological diseases?

-Parkinson’s disease actually represents the second most common neurodegenerative disease (the first is dementia) and the prevalence can be between 1 and 2% of the population. It is more common in the older population, but we must not forget that we have cases of patients with juvenile Parkinson’s disease, which can even begin at the age of 30. Within diseases considered rare, such as Huntington’s, the prevalence can be between 5 and 7 cases per 100,000 people.

-What are the warning signs that should make us realize that something is not right in our brain or nervous system?

-As a specialist in movement disorders, we all know that tremor is a very common manifestation, it is really the most common movement disorder we have, but many times it does not always have to be associated with Parkinson’s disease. Also an alarm sign is slowness, difficulty walking, frequent falls. And within disorders with excessive movement, those people who move a lot and who are also often associated with neuropsychiatric manifestations.

-Is it precisely because of these symptoms that they continue to suffer stigma?

-Yeah. There is a stigma especially in genetic diseases, such as Huntington’s, as it has a hereditary cause, and then also in other diseases such as Parkinson’s, especially when it occurs in young people because we always associate it as a disease of the elderly patient and we do not realize There may also be young people affected.

-Can something be done to delay or prevent these pathologies and take care of our brain?

-Yeah. We know that lifestyles that include physical exercise, active lifestyles where the person cognitively wants to continue learning, social relationships, the Mediterranean diet, healthy sleep habits, such as a short nap… It has been seen that these lifestyles They delay the onset of neurodegenerative diseases. And we know this from epidemiological studies, from studies in animal models and also because we already have better knowledge with neuroimaging models or even genetic markers with which we know that these people perhaps have a certain propensity but do not develop clinical manifestations.

-What is the most difficult part of your daily job?

-When I have to communicate that a person is a carrier of a mutation of a neurodegenerative disease for which there is still no cure, although we do offer symptomatic treatments.

-What is the first thing the patient asks after that diagnosis?

-If we are talking about Huntington’s disease, they usually ask me when the symptoms will start and the truth is that I cannot give a very precise answer because there are many factors that can influence it. The only thing I can tell you is how we can delay the start, with what we have said about lifestyles. Then also a very important part in those genetic diseases, which of course are hereditary, is the implication of having more offspring, because today they are pathologies with which we can have healthy offspring thanks to the fertilization mechanisms that we have. in vitro and implantation of embryos free of the mutation we are talking about.

-Will the long-awaited cures for diseases like Parkinson’s ever be achieved?

-Yes, we will achieve it and I hope to be alive to be able to see it, but today technological development is going to mean that in those diseases that have a genetic cause, where a gene is involved, that is, it has a monogenic cause, we can implement techniques as gene silencing. In diseases of polysemous cause or with diseases such as Parkinson’s, where there is a gene but with limited expression, we have a significant challenge, but we can be optimistic because we will surely be able to stop the neurodegeneration mechanisms.

-Research is vital for this. How do you assess your situation in Spain?

-For the budget item that exists in general, not only at the central level but also at the regional level, I think that the quality of research in Spain is very good and this is seen by the impact that our scientific publications have. We publish in magazines with high impact and, of course, we have to increase the budget, but what is the gray matter, the human resources, are there. We have research teams and we function very well as multicenter groups. I think we are exemplary at the research level, but we have to continue improving.

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