Tatyana Fedorova

When a doctor tells a patient they have Parkinson’s disease, they will naturally ask: “How can I expect the disease to progress? Will it take its course over many years – and what will be the impact on my mental state and physical mobility?”

Doctors who work with Parkinson's patients find these kinds of questions difficult to answer. A model has not yet been developed that will give a realistic description of the progression of the disease in an individual patient based on their Parkinson's diagnosis.

Tatyana Fedorova wants to try to do something about that. She is a doctor and PhD student at the Department of Clinical Medicine - Nuclear Medicine and PET, Aarhus University Hospital, and she is also one of the five young scientists who have recently been awarded a 2021 Lundbeck Foundation Talent Prize.

‘A key aspect of my research is to explore whether it could be possible to identify a number of different sub-groups of Parkinson's, based on studies of the symptoms experienced by large numbers of patients,’ Fedorova explains.

‘We currently have an entire battery of scanning methods for use in connection with Parkinson's. But if you want to track the development of the disease in an individual patient, it’s important to use the right combination of methods. And this is where I hope my research will be able to provide new knowledge to improve the course of the disease for the individual patient.’

One aspect that complicates treatment, diagnosis and the medical understanding of Parkinson's is that the disease seems to emerge and spread to the rest of the body either “from the bottom up” or “from the top down”.

‘The theory is that these are two major sub-groups,’ says Fedorova.

‘In the first case, the disease starts in the gut, in the peripheral nervous system, and then spreads from there to the brain where it attacks the central nervous system. In the second case, it is assumed that the progression is the other way around.’

If the disease starts from the bottom, the patient may experience symptoms in the peripheral nervous system, such as constipation, abnormal blood pressure and insomnia, for some years before Parkinson's disease is finally diagnosed.

Together with colleagues at Aarhus University Hospital, Tatyana Fedorova has studied the sleep patterns of newly diagnosed Parkinson's patients. The studies were conducted at a sleep laboratory, and the results were extremely interesting.

The patients with severe insomnia also exhibited damage to the peripheral nervous system. On the other hand, the nerve damage in patients who had no serious difficulty sleeping was located in the central nervous system – so, in the brain. Fedorova explains:

‘This has never been shown so clearly before, and it underpins our theory that, in some cases, the disease emerges and spreads “from the bottom up”, whereas in other cases it progresses “from the top down”. We will now follow two groups of patients over a number of years to see how nerve damage develops in the two variants of the disease. This will hopefully give us information about how the disease can be expected to spread – and how we can attempt medical intervention by designing new drugs.’