Diagnostic debriefing to a fictional patient in 2042

That’s the question Alberto Espay, MD, sought to answer in a recent essay that won the Lancet Neurology 20th Anniversary Essay Competition. The essay, “Your Post-Visit Summary: May 29, 2042” revolves around the diagnostic debriefing to a fictional patient of his new diagnosis of Parkinson’s disease in 20 years, with a biomedical analysis of the test results informing a plan of personalized treatment.

In the trial, Espay tells the patient that while symptoms such as slow walking, difficulty typing, intermittent forgetfulness, and constipation all suggest what has been clinically diagnosed as Parkinson’s disease for over 100 years, blood sample analyzes provided more detailed information on how to personalize and guide treatment.

Rather than saying, “You have Parkinson’s disease in my experience; trust me,” we’ll say, “You have something we called Parkinson’s disease, but you have no idea what it means. We are committed to identifying the biological drivers of each affected person, recognizing that treatments to slow progression can only be successful if tailored to those most biologically fit to benefit..”

Alberto Espay, James J. and Joan A. Gardner Family Center for Parkinson’s Disease Research Endowed Chair, Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati

Espay said he was delighted to win the competition “because it meant the vision of the trial, a very different picture of what we did to care for our patients, could gain traction with a global readership. of neurologists”.

According to Espay, medicine is about a decade away from realizing the vision of his essay. He adds that the trial was inspired by work currently underway by the Cincinnati Cohort Biomarker Program (CCBP), which is trying to unravel the individual biological abnormalities of people with neurodegenerative disorders.

“We’re interested in finding out what’s different between affected people and what can be used to ‘match’ them with therapies that are already available for reuse,” Espay said. “In fact, we are developing biological tests of therapies developed over the past decades that have proven unsuccessful in clinical trials, but that we know are there who could benefit. CCBP will allow us to find out who they are. , so that we can process them.

“Ultimately, clinical diagnosis is just a human construct that nature has no clue about,” Espay continued. “And since nature cannot be fooled, we must be agnostic about our labels and subtype individuals with neurodegenerative disorders based on their biology, not the classification we use at the bedside. patient for more than a century.”


Journal reference:

Epsay, A. J (2022) Your summary after visit – May 29, 2042. The Lancet Neurology. doi.org/10.1016/S1474-4422(22)00129-6

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