The potential of distributed diagnostics for the early detection of Parkinson's disease.

Parkinson's disease represents a major healthcare burden with over 1 million confirmed cases and economic costs of care exceeding $50 billion in the United States alone. A challenge in the evaluation of potentially disease delaying, preventing, or reversing agents is identification of patients in the very early, prodromal (asymptomatic, non-motor, or early motor) stages, which can span decades. Currently, diagnosis is based almost exclusively on clinical history and physical examination conducted by trained experts. Unfortunately for many patients, access to neurology and movement disorder specialists is geographically limited and coupled with the absence of coordinated disease awareness campaigns can contribute to substantial delays in diagnosis. As with any campaign, a key success factor is having multiple approaches which can appeal to a wide range of patient archetypes. Herein we elaborate on some emerging opportunities, which if fully developed could invigorate the approach to early detection and, critically, engage patients in this process. They include 1) Use of personal digital health technologies and community based point-of-care diagnostic instrumentation, 2) The potential to leverage annual testing services at non-traditional venues including optometry, dental and pharmacy, and 3) A consumer focused campaign to raise awareness of the importance of early detection, paralleling efforts in other diseases. There is every hope that combining traditional and non-traditional approaches to enhance early diagnosis rates can have an overall positive impact on patient outcomes and contribute substantively to efforts to develop new interventions. We urge the community to embrace these possibilities and begin active dialog on how to thoughtfully implement the approaches into routine care.