Early-Onset Parkinson’s Rises In India; AIIMS Doctors Call For Timely Diagnosis And Care

A neurodegenerative condition, Parkinson’s disease is emerging as a growing health concern in India. With a prevalence of 15 to 43 per 100,000 people, cases are expected to rise sharply by 2030. Doctors say a worrying trend is the increase in early-onset cases, i.e., nearly 40–45% of patients in India developing the disease between the ages of 22 and 49.

The average age of onset is around 51 years. This is younger than what is seen in many Western countries. Parkinson’s disease occurs when nerve cells in the area of the brain that control movement and release the brain chemical dopamine become impaired and/or die.

“Traditionally viewed as a disorder of old age, Parkinson’s is increasingly being diagnosed at a younger age in India. Studies indicate that, compared to Western countries, the onset of Parkinson’s disease in India may occur nearly a decade earlier. This form, known as early-onset Parkinson’s disease, is typically identified when symptoms appear before the age of 50, and in some cases, even before 40,” said Prof. (Dr.) Manjari Tripathi, Head of Neurology at AIIMS Delhi.

Doctors say this shift has a serious social and economic impact. Many patients are in their most productive years when diagnosed.

Dr. Elavarasi, Associate Professor of Neurology at AIIMS Delhi, said research shows a possible genetic link in early-onset cases. Around 20% of patients below 50 years may have an underlying genetic factor.

With better access to genetic testing, more such cases are likely to be identified. Studies are underway across India to understand the genetic basis of the disease, which would help in early diagnosis and future targeted treatment, said Dr. Elavarasi.

Dr. Tripathi, however, cautioned against common misconceptions around genetics. “Genetic does not mean inherited,” she explained. “Many people assume that if a disease is genetic, it must pass from one generation to the next. That is not always true. Genetic changes can occur spontaneously and may not exist in the family history.”

She emphasised that genetics is complex and involves different patterns. While some conditions follow an autosomal dominant pattern—where the disease may pass from parent to child—others may be autosomal recessive, sex-linked, or arise from spontaneous mutations without any prior family history.

In Parkinson’s disease, only a small proportion of cases show clear hereditary patterns, such as transmission across generations. In many others, genetic changes may occur independently, without affecting other family members.

Environmental exposure to toxins and pesticides is yet another possible factor. Other theories include mitochondrial dysfunction, which affects energy production in cells, and alterations in the gut microbiome, which may influence brain function, she said.

Another line of research focuses on ageing and neurodegeneration, while some scientists point to an imbalance between protective and damaging chemicals in the body. A decline in antioxidants, coupled with increased inflammatory processes, may contribute to the development of the disease.

While symptoms differ in everyone, common symptoms may include tremors in the hands, arms, legs, and head; muscle stiffness; slowness of movement; difficulty with balance; and a tendency to fall. Non-motor symptoms may also include constipation, depression, and memory problems.

Doctors also highlighted lesser-known warning signs that occur much before the onset of the disease.

One such condition is REM Sleep Behavior Disorder (RBD). In this, people act out their dreams during sleep. They may shout, kick, or fall out of bed. This happens because the body does not relax muscles during sleep.

Dr. Anmesh Das, a neurologist with expertise in movement disorders, said that RBD can appear years before Parkinson’s. It should be taken seriously as an early warning sign.

Treatment options have improved over time. Medicines like levodopa remain the mainstay. But in some patients, symptoms become difficult to control, and there is a role for surgery.

Dr. P. Sarat Chandra, Head of Neurosurgery and Gamma Knife at AIIMS Delhi, said Deep Brain Stimulation (DBS) is now gaining attention as an effective option for selected patients.

“DBS is recommended for patients who do not respond well to medicines or develop complications like fluctuations and dyskinesias,” he said. It helps control symptoms and can reduce the need for high doses of medication.

However, sadly, many patients in India are referred late. “Many patients are referred only in advanced stages, when symptoms like gait problems and balance issues have already developed. These respond less to DBS,” Dr. Chandra said.

Also, DBS is often seen as a last option, which leads to delays. “Early referral can improve outcomes.” Dr. Chandra pointed to other barriers such as high cost, limited specialised centres, and lack of coordination between doctors. Presently, DBS is not covered under Ayushman Card, which has an insurance limitation of Rs 5 lakhs.

Awareness is also low. “Many patients fear surgery. Some general physicians may not identify early signs of complications.”

New treatment options like Focused Ultrasound Therapy (FUS) are now on the anvil. It is likely to be made available at AIIMS, Delhi, within the next six months.

Dr. Chandra said the FUS technique uses targeted ultrasound waves to treat specific brain areas without surgery. It is mainly useful for tremor and symptoms on one side of the body.

However, it has limitations. It is usually done on one side only. Also, unlike DBS, doctors cannot test results during the procedure.