Advancing Mental Health Care in Parkinson’s

Movement disorders specialist Hiral Shah, MD, assistant professor of neurology at Columbia University Medical Center, is driven to improve access to quality care for people who live with mental health conditions and neurodegenerative disorders like Parkinson’s disease (PD).

Dr. Shah’s impressive career includes pursuing global public-health focused research. She has worked at the World Health Organization (WHO) on public health aspects of neurological illnesses and completed training as a Columbia Global Mental Health Scholar and Global Health and Aging Policy Fellow. With this experience, Dr. Shah always examines best practices surrounding human rights protection for those with cognitive impairment and dementia. WHO is also in the process of publishing a set of action steps to address the global disparities in Parkinson disease care.

Dr. Shah also treats people with PD in clinic at Columbia University Medical Center’s Multispecialty Neurology Division, a Parkinson’s Foundation Center of Excellence.

“I want to be a source of information and comfort to individuals and families who are dealing with PD,” said Dr. Shah. “Seeing the way that Parkinson’s can impact one's cognitive, psychological and motor functioning can be really devastating but it also drives me as a physician to take an active role in providing holistic care.”

At the outset of her career, Dr. Shah completed specialized movement disorders training at Columbia, funded through the Parkinson’s Foundation Movement Disorders Fellowship Program. This program, which supports medical institutions in providing fellows with a two-year, mentored training, has helped 150 neurologists become certified movement disorders specialists.

The Foundation has invested more than $15 million in this fellowship program since the distribution of the first award in 1980, understanding that specialized care is key to better PD outcomes. “My fellowship training was instrumental in my professional development,” said Dr. Shah. “Without the fellowship, I wouldn't be where I am today.”

“Mental health screening should become routine practice in Parkinson’s care.”
-Hiral G. Shah, MD

During her training, Dr. Shah observed that a lot of people with Parkinson’s had mental health issues that were not addressed or recognized. “Individuals and families felt stigma or hesitation about discussing mental health, but also providers often lacked the sensitivity to be able to recognize these issues. The interplay of non-motor mental health conditions on neurological symptoms (motor symptoms), cannot be overstated.”

In Dr. Shah’s medical experience, unrecognized mental health issues often overshadow movement symptoms in terms of quality-of-life impact. The Parkinson’s Outcomes Project, the largest-ever clinical study of Parkinson’s disease, found that non-movement symptoms like apathy and depression are more intrusive and debilitating than movement symptoms for people living with PD. “Mental health screening should become routine practice in Parkinson’s care,” Dr. Shah said.

For Dr. Shah, developing a relationship with her patients is key to understanding how to help them with the nuances of their non-movement symptoms. “It takes time to get to know a person, to really understand their level of health literacy and what allows them to formulate their healthcare beliefs.”

Dr. Shah recalls a patient who, only with time, disclosed a history of substance abuse and dependence. “Medication changes really triggered his memory of those dependency issues, and there was a resistance to medication. Once I learned that, I could better work with him.”

Public health has always been of interest to Dr. Shah, which she credits to her upbringing. “My family is from India and would take me on yearly trips there when I was growing up,” she said. "My father is a physician, so I was routinely exposed to the health care system in India through his friends and colleagues. As a developing nation with limited healthcare resources, the impacts of poverty on care there are very clear.”

Increasing access to healthcare and representation among priority populations in Parkinson’s care is paramount to Dr. Shah. “I think in the western world, a lot of the literature indicated that Parkinson’s was a disorder of the white person. What we are now recognizing is that it affects all ethnicities and races,” said Dr. Shah. “Given that it is the fastest growing neurological disorder globally, we know that this means we need to be ready for the potential impacts in the future.”

In developing educational materials for the PD community, Dr. Shah found that Black people with PD she spoke to in her research felt extremely isolated. “They told me that they have never been in the room with someone else who is Black and has Parkinson's,” she said.

This realization led to her latest project: publishing a book about the Black and African American experience with PD. The book, which is a collection of firsthand accounts from Black people impacted by PD, is due out this summer. “My hope is that people might find a piece of themselves in the stories, something that they can relate to, which helps them to see that they're not alone.”

Dr. Shah credits the Parkinson’s Foundation with being a source of high-quality information for her patients as well as a source of professional connection for her. “The Foundation has always been really enthusiastic and encouraging of my work,” said Dr. Shah. “When people with mutual interests and common concerns come together, it really helps advance the cause. As one of my mentors likes to say, ‘You can go alone or work together. It may take longer to work together, but you'll probably go further.’”

Find a movement disorders specialist in your area at Parkinson.org/Search or call the Parkinson's Foundation Helpline at 1.800.4PD.INFO (1-800-473-4636).