CONCLUSIONI
Nel presente studio, articolato in due indagini parallele, è stato dimostrato come il quadro clinico e l’evoluzione della MP risentano in modo significativo della presenza di diabete e dell’assunzione di una terapia farmacologica a base di statine. In particolare, relativamente al rapporto tra MP e TDM2 è stato possibile evidenziare la capacità di tale comorbidità di influenzare il fenotipo clinico e la progressione sintomatologica della MP. In letteratura, sebbene gran parte dei lavori riporti una maggiore prevalenza di MP nei pazienti con diagnosi di diabete, mancano studi sistematici che abbiano indagato la possibile influenza esercitata dal diabete sul quadro clinico dei pazienti con storia di MP.
In tal senso, la nostra indagine costituisce una delle prime che abbia ricercato nel diabete una possibile causa in grado di aggravare la sintomatologia motoria dei pazienti con MP, giungendo a ipotizzare l’esistenza di una associazione tra la presenza di diabete ed un particolare insieme di sintomi motori cosiddetti assiali, identificabili nell’instabilità posturale, nel disturbo della marcia e nella postura. É stato osservato come tale associazione si sia mantenuta costante nel prosieguo degli anni di malattia, essendo presente non soltanto all’inizio dell’indagine, ma anche a seguito di un periodo di osservazione della durata di 3 anni.
Poiché, recenti evidenze sottolineano sempre più il ruolo rilevante svolto da una condizione di insulino resistenza nella patogenesi di processi neurodegenerativi, l’importanza dei nostri risultati potrebbe riflettersi in uno stimolo a sviluppare una terapia più mirata e razionale, finalizzata a promuovere un miglioramento della sintomatologia e del quadro di disabilità nei pazienti con MP e concomitante diagnosi di diabete. In questo contesto, un ruolo di primaria importanza potrebbe essere giocato da alcuni farmaci antidiabetici come il pioglitazione e l’exenatide che hanno mostrato, nel corso di trials clinici in cui sono stati impiegati, notevoli benefici nei pazienti con diagnosi di MP.
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Lo studio inoltre ha mostrato, in linea con i numerosi dati presenti in letteratura, lo stretto rapporto tra diabete e declino cognitivo, sebbene unicamente presente al momento del follow-up. Il mancato riscontro di declino cognitivo al T0 è verosimilmente da imputare al fatto che le alterazioni della sfera cognitiva avvengono solitamente nel corso di malattia (in media a partire da 4/5 anni dopo l’ esordio). L’evidenza che la concomitanza di diabete a 3 anni si accompagni ad un maggior declino cognitivo rispetto alla popolazione di controllo (senza diabete) può suggerire che la malattia metabolica costituisca un “ trigger” o un fattore di
anticipazione del disturbo cognitivo in corso di malattia.
Parallelamente a tutte queste evidenze, il presente studio ha dimostrato la capacità delle statine, principali farmaci utilizzati a scopo ipocolesterolemizzante, di attenuare il quadro clinico e la progressione sintomatologica dei pazienti con diagnosi di MP.
Più nello specifico, è stato messo in evidenza come l’assunzione di tali farmaci sia in grado di stabilizzare il quadro motorio dei pazienti con MP, che rispetto ai soggetti non trattati con statine, mostrano punteggi motori sia totali, valutati mediante UPDRS III, che relativi alla bradicinesia, rigidità e postura pressoché costanti ai due estremi del periodo di osservazione considerato.
Poiché la maggior parte dei contributi presenti in letteratura si è dedicata allo studio di una possibile correlazione tra l’insorgenza di MP e l’assunzione di statine, la nostra indagine acquisisce una particolare rilevanza poiché rivolta per la prima volta ad indagare la capacità di tali farmaci di influenzare l’evoluzione clinica dei pazienti con MP e l’evidenza di un potenziale effetto stabilizzante delle statine sulla progressione motoria della MP costituisce certamente un dato incoraggiante ma che necessita di essere confermato su più ampie casistiche e in studi di tipo prospettico.
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