An interview with Dr. Molly Cincotta Movement Disorders Specialist at Temple University on April 23, 2024.
Please tell me a little about your background.
My name is Molly Cincotta and I am a Movement Disorders Specialist at Temple University. I actually had no intention of going into medicine early in life. I majored in English and psychology in college and went on to train in massage therapy when my intended career as a novelist did not turn out to be a viable way of paying the bills. In massage school I recognized my passion for learning about the complexities of the human body and could not shake the desire to take that further. I was accepted into a post-baccalaureate pre-medical program at the University of Virginia, which prepared me to apply for medical school, which I also ended up completing at UVA. I then went on to residency in Neurology and fellowship in Movement Disorders at the University of Pennsylvania. I completed training in June of 2022 and went on to my present job as the Movement Specialist at Temple University. Despite my late start and unusual background, I have never regretted the course change.
Can you tell me more about your organization?
Temple Neurology is a small but growing department and I am the only movement specialist at present. Despite that, I have been lucky to be supported by an amazing team who share my passion and goals around Parkinson’s treatment and outreach. Dr. Terry Heiman-Patterson is an ALS expert and has been building a neurodegenerative department with a focus on outreach to underserved communities and the nurse coordinator for the neurodegenerative center, Mary Holt-Paolone, has a background in Parkinson’s disease and mental health as well as ALS. We also recently hired a social worker, Luisa Enriquez, who immediately dove into helping our patients navigate the complex psychosocial landscape around their chronic disease. She is also working to set up a Temple Parkinson’s support group and hopefully will also be expanding this out toward our Spanish speaking patients in the near future.
What is your passion and how did you get involved in Parkinson’s awareness and hope for a cure?
I was drawn to Parkinson’s disease because it represents a lot of what drew me to medicine and neurology in the first place. The networks that control our movements are intellectually fascinating and the ways we have found to manipulate those systems with medications, stimulation and surgery are awe inspiring. On a more practical level, however, I have a lot of tools I can use to improve the quality of life of my patients in a tangible way. There is a lot of creativity involved in treating Parkinson’s’ disease because even though the core symptoms are often similar, what impacts a patient’s life is as much dependent on that person as their disease. I love that I can collaborate with patients to find the treatment plan that works best for them and that often I can use a variety of tools to achieve our shared goals.
Outside of clinical work, my passion is education. In addition to my Parkinson’s work, I help run the neuroscience course for Temple medical students and precept students and residents on the wards. I also see my clinical work as education. I feel strongly that part of the physician’s role is to teach their patients about their disease and help empower them to advocate for themselves. If my patients understand their diagnosis and the goals of a treatment plan, the better I am able to meet their needs.
A related passion of mine is outreach, community education and health equity. Temple is located in North Philadelphia, which is an underserved region with a large Black and immigrant community. Historically, most of the research and awareness outreach had been geared toward white patients, leading to less recognition of Parkinson’s disease amongst general neurologists and primary care doctors who treat non-white patients. Even patients, who might be very aware of symptoms of stroke, heart attack, dementia or COPD, may not have any idea of what Parkinson’s disease looks like outside of a vague awareness of a tremor and the names Michael J. Fox or Muhammad Ali. We know that patients of color tend to be referred at later stages of the disease and are less likely to see a movement specialist or be referred for advanced therapies like DBS. My hope is that through community education and outreach in the region we can spread awareness and recognition amongst patients and non-movement doctors to try to narrow that gap.
What type of goals do individuals with Parkinson’s have when working with you?
Goals are so variable between patients, but typically folks just want to get back to living normal lives as though they don’t have Parkinson’s disease. Sometimes that is achievable, particularly early on in the disease, but sometimes we have to redefine goals based on limitations of the disease. That is where the creativity comes in; I often ask patients what they would be doing if they didn’t have Parkinson’s disease and then we try to brainstorm how to get as close as possible.
What would you like to see as a future goal for your programs?
Our goal is to grow in multiple ways. In the immediate future we are trying to create support groups that cater to the North Philadelphia population as well as provide support group opportunities to Spanish speaking patients. We are trying to improve education about Parkinson’s disease and brain health in the community through outreach and collaboration with other organizations in the Delaware Valley. We are also growing our DBS program and the Neurodegenerative Center in an effort to provide a strong team beyond the physician to provide care for patients.
Long term I also hope we can add more providers to the practice with a mind to expand into clinical research. I feel it is important to have opportunities for patients from a variety of backgrounds to participate in clinical research so we can have a more accurate view of how this disease affects the population as a whole.
What events do you participate in?
I try to participate in a lot of outreach events in Philadelphia, including a Movement and Memory Health Fair for Parkinson’s Awareness Month and the yearly Walk to Stamp out Parkinson’s Disease. We also have a support group at Jeanes Hospital every other month and I have spoken to a few local support groups when I am able.
How does this also assist the caregivers?
In the clinic I try to provide support in various ways. Just validating the experience they are having and recognizing that this isn’t easy can go a long way. A lot of caregivers are constantly feeling like they aren’t doing enough, even when they are going above and beyond for their loved ones.
Just as with patients, I try to figure out where they are having the greatest challenges and consider what resources might help to alleviate that. When the needs are outside of my area of expertise, I will refer them to our social worker Luisa or our nurse coordinator Mary or even to other providers in the area if I feel they can offer something we cannot.
How can someone get in touch? What is your website?
You can find more information about the Temple Movement Disorders Program at https://www.templehealth.org/services/neurosciences/patient-care/programs/movement-disorders
How can others also become advocates for awareness?
Look for events in your area that are raising money for Parkinson’s causes and attend! Get to know the advocates, their organizations and their goals. If there are ones that particularly match with your interests, see what opportunities there are to donate your time or money.
What other activities do you undertake to help improve and support your daily living Eg exercise and alternative remedies?
We know that exercise is the one thing that slows the progression of Parkinson’s disease and delays its onset. Some recent research might even suggest it can reverse some of its effects. The recommendation is for 20 minutes per day of cardiovascular exercise five days per week, but that can be a pretty lofty goal if you’re not already a regular exerciser. I recommend starting small and trying to find a safe activity that you enjoy that gets your heart rate up. Make it a part of a routine.
Physical and occupational therapy are also fundamental to the treatment of Parkinson’s disease. In addition to retraining the brain to adapt to having Parkinson’s disease, Parkinson’s PTs and OTs can give tips on developing an exercise plan and adapting the home environment to make you more safe and independent.
Alternative remedies vary in their usefulness. There are a LOT of products out there that are marketed based on theoretical benefits with no scientific basis. At best these will just be damaging to your wallet, but given the lack of standardization or controlled trials, some could even cause physical harm. I recommend discussing any supplements of interest with your physician and keeping in mind that any medication that can cause a medical benefit can also cause a side effect.
One common question recently has been about medical cannabis. There do seem to be some benefits for specific symptoms, such as sleep, pain and anxiety, but no direct benefit from Parkinson’s disease symptoms specifically. It is important to treat it as a medication like any other, despite the fact that your doctor doesn’t have much control over the form or dose that you take. Start with a low dose, increase slowly and monitor for side effects. Keep in mind your goals in using it and consider stopping if you are not seeing the desired results.