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By Nancy Lapid, Health Science Editor

Hello Health Rounds readers! Today we highlight a potential breakthrough discovery that could enable diagnosis of Parkinson’s disease before symptoms are evident and that might allow for earlier intervention and better design of clinical trials. We also report on research showing that common blood pressure drugs don’t work equally well for everyone, and that over-the-counter hearing aids can be easy to use without professional help.

In breaking news, see these stories from our Reuters journalists: US appeals court preserves limited access to abortion pill; China won’t participate in UN’s wildlife survey for pandemic controls; and final details of President Biden’s drug pricing reform plan to be published in July.

Personalizing blood pressure treatment by figuring out which drug will work best for a given patient would be ideal, researchers say. REUTERS/Karen Pulfer Focht.

Early detection of Parkinson’s disease before classic symptoms are present may get a boost from a new technique that identifies the build-up of abnormal protein deposits linked to the illness, researchers reported on Wednesday in The Lancet Neurology.

An editorial published with the study calls the findings “a game-changer in Parkinson’s disease diagnostics, research, and treatment trials.”

Researchers looked for the protein alpha-synuclein using a “seed amplification assay” on samples of cerebrospinal fluid obtained from 1,123 volunteers with either a Parkinson’s disease diagnosis, “prodromal” or early signs and symptoms that may predict development of the disease, or gene variants linked to the condition.

Nearly 90% of individuals with Parkinson’s disease had a positive result.

Most prodromal participants also had positive results, despite not yet being diagnosed with Parkinson’s disease. Scans of these patients’ brains did not show a decline in brain cells that is usually present before diagnosis, suggesting that build-up of alpha-synuclein aggregates may be a very early indicator of disease onset.

In participants with genetic risk variants but without Parkinson’s disease or prodromal symptoms, fewer than 10% had positive results for alpha-synuclein.

Eventually, researchers say, blood tests for the protein will be developed.

“Validation of this biomarker launches a new, biological era in Parkinson’s research,” Dr. Kenneth Marek of the Institute for Neurodegenerative Disorders in New Haven, Connecticut, one of the study’s principal investigators, said in a statement.

“We are already unlocking new understanding of Parkinson’s, which will transform every aspect of drug development and ultimately clinical care,” he said.

The study was funded by The Michael J. Fox Foundation for Parkinson’s Research and a consortium of more than 40 private and philanthropic partners.

Read more about Parkinson’s disease on Reuters.com

• U.S. Parkinson’s disease incidence far higher than earlier estimates
• U.S. FDA declines to approve AbbVie’s Parkinson’s disease therapy
• Teva, Viatris win U.S. appeal in patent fight over Parkinson’s drug

There are substantial variations in how well blood pressure-lowering medicines work for each person, and finding the class of hypertension drug likely to work best for each individual can improve their results, according to a Swedish study.

The study involved 270 adults with systolic blood pressure – the top number in a blood pressure readout – ranging from 140 to 159 mmHg at some point in the past five years who were otherwise at low risk for cardiovascular events.

Each patient was treated in random order with four types of drugs that are typically used for initial treatment of high blood pressure: an angiotensin-converting enzyme (ACE) inhibitor; an angiotensin-receptor blocker (ARB); a diuretic; and a calcium channel blocker.

Daytime systolic pressure was measured at the end of each eight-week treatment period.

“On average, personalized treatment” – determining what worked best for each patient – “had the potential to provide an additional 4.4 mmHg–lower systolic blood pressure,” the researchers reported on Tuesday in JAMA.

An editorial published with the report notes that nearly half of U.S. adults have hypertension but only about one-in-four of them have their systolic blood pressure well controlled.

More work is needed to identify patient characteristics that would predict in advance which drug or drugs will be most effective, the researchers said, noting that it is too cumbersome to spend half a year comparing various drugs in every patient.  

Buying an over-the-counter hearing aid and adjusting it yourself can yield the same benefit as having the device fitted by a professional, a small trial suggests.

At the University of Pretoria in South Africa, 64 seniors with mild to moderate hearing loss in both ears were randomly divided into two groups. Half received over-the-counter U.S.-approved, behind-the-ear hearing aids, then downloaded an accompanying app and followed detailed instructions to fit the devices on both ears. The other half had the same hearing aids fitted by audiologists, who used calibrated tools to measure hearing and adjust the devices.

Six-weeks later, there were no meaningful differences between the groups on any measure of hearing quality, including ease of communication, speech recognition, problems with background noise, and overall benefit, according to the report published on Thursday in JAMA Otolaryngology – Head & Neck Surgery.

In the interim, 66% of participants in the professionally-fitted group had gone back to the audiologists for fine-tuning, whereas only 6% of participants in the self-fitting group had requested remote troubleshooting support from the manufacturer’s call center.

Most people experience hearing loss with age. But hearing aid use is low, with only 20% of U.S. adults who could benefit from hearing aids using them, often because of the cost, the researchers said.

Original Medicare plans insuring nearly 35 million older Americans do not cover the cost of hearing aids and exams.

When hearing loss is not severe, “affordable, self-fitting over-the-counter hearing aids may be an accessible hearing intervention option with outcomes similar to those of audiologist-fitted hearing aids,” the researchers concluded.

This newsletter was edited by Bill Berkrot. Additional reporting by Shawana Alleyne-Morris.

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