LATEST NEWS IN PARKINSON’S dISEASE
September, 2018: Drug Discovery Today
An analysis from Dr. Catherine Willett and Dr. Lindsay Marshal from the Humane Society of the United States and Humane Society International calls for the implementation of modern, biology-based technologies to better understand pathological processes and improve treatment outcome of Parkinson’s Disease. They reveal a gap between animal models of PD and our understanding of the neurodegenerative processes underlying the disease. While drug therapies have led to tools for the motor symptoms of PD, they have fallen short in identifying preventive or curative therapies.
The report states that animal models typically reproduce specific pathological components but fail to account for the complete biology underlying the disease. Therefore, they have limited capacity to reveal the true causes of, or identify real cures for human Parkinson’s. The doctors believe that new approaches need to focus on human-specific PD characteristics using human cell cultures, human stem-cell derived tissues, computer modelling and new imaging modalities.
There has been not substantial progress in the development of new therapeutic treatments targeting the degenerative mechanisms underlying PD. One of the major reasons that this is the case is that by the time the patient displays PD symptoms, degeneration is already advanced, shifting the focus to symptomatic treatment. Additionally, there has been a high failure rate in translating animal findings to humans. This calls for investment in modern, human based technology to provide the foundation for advance treatment.
JAMA Journal of American Medical Association
In a study by Xuexian Fang, MD, PhD from Zhejiang University School of Medicine in China, it was reported that men who engaged in moderate activity significantly reduced their risk for the Parkinson’s disease. This conclusion was gleaned from the study of numerous studies which may have led to some inconsistencies in interpretation since they were not systematically quantifying the direct relationship between physical activity and PD.
However, with that in mind, Fang found that men who engaged in moderate to vigorous physical activity significantly reduced risk and those who engaged in high levels of physical activities also reduced their risk. Each 10 metabolic equivalent of task-hours per week increase in total activity reduce risk for PD by 10% and by 17% in those who engage in moderate and vigorous activity. This was not seen to be the case in either women nor in men engaged in light physical activity.
It was reported that this study meets the five criteria for establishing causality: strength of association, consistency of findings, temporality, biological gradient (demonstration of dose-response) and biological plausibility.
JAMA Journal of Neurology
Continues the reported belief in the prevalence of Parkinson’s expanding to pandemic proportions in the next 30 years as the fastest growing disorder in the world’s most populous nations. They write that the most pressing needs include: preventing onset, increasing access to care, increasing research funding and decreasing costs of new treatment.
June, 2018: Veteran’s Health Administration
Veterans with traumatic brain had a 71% relative increase in the risk for Parkinson’s disease compared to those without TBI. Results varied from those with moderate or severe injury at an 83% greater risk to those with mile TBI showing a 56% greater risk. Of the 20 million vets alive today, it is estimated that 40% have some history of TBI and 82% of those are considered mild TBI. However, to keep this in perspective, after the age of 60, Parkinson’s affects 1 in 100 people, so if we extrapolate the data for those with mild TBI, the rate of Parkinson’s would only go up 1.56 on 100 people.
A study done using Taiwanese data bases indicated that Parkinson’s should be considered an age related multifactorial syndrome with mainly genetic and environmental components. First degree relatives of PD patients are more likely to develop PD however environmental factors seem to account for an additional 9.1%. Studies need to be done to identify environmental causes.
May, 2018: Stanford Neurosciences Institute
In a project setting out to test a seminal theory of Parkinson’s – rate hypothesis that posits Parkinson’s is the result of an imbalance of brain signals telling the body to start and stop moving, results were found wanting. In fact, the start and stop signals are more complex and structured than what the rate hypothesis suggests and Parkinson’s disease in part reflects a loss of that complexity and structure.
It was discovered that in mice mimicking Parkinson’s treatment with L-dopa restored normal activity in both start and stop pathways but if the dose was too high, random motions could be initiated. This could help to explain one of the most common side effects of the treatment – jerky, uncontrollable movements known as dyskinesia. This may help in testing and screening new drugs by looking directly at neural circuit activity.
Karolinska Instituet of Sweden
To date it is still not fully understood what causes Parkinson’s disease but several environmental and lifestyle factors have been suggested as contributors to this disease. This study looked at BMI – body mass index – as a measure of obesity and physical activity as opposed to sedentary behavior around the house. It was found that there was no significant correlation between baseline body mass and sitting time with the risk of developing Parkinson’s. Future studies should focus on environmental factors in the search for causation.
April, 2018: Neurology
A new study out of UC San Francisco and SF Veterans Medical Center states that risk of developing Parkinson’s goes up by 56% if you ever had even a mild concussion. Any type of TBI raises the risk to 71% higher. The lifetime risk for developing Parkinson’s is probably about 1 to 2 percent, so a greater that 50 percent increase in that risk is not as alarming as it sounds however, the findings lend credence to the idea that some professional athletes have developed Parkinson’s as a result of their chosen careers.
The researchers speculate that possibly TBI could cause abnormal proteins to accumulate in the brain, or that a brain injury might make the brain les resilient to aging. Another possibility is that a head injury might cause damage to dopamine-producing cells.
There was a report that physicians have expressed concerns with Nuplazid, a drug aimed at treating patients reporting hallucinations was approved by the FDA too quickly. Hundreds of deaths are raising more red flags.
Update: FDA will take another look at this drug. Within the first year of use, this drug has been associated with nearly 700 deaths. In nearly 1000 patients, hallucinations persisted even when patients took the drugs. The drug was approved ruling that the benefits outweigh the risks. Deaths reported appear to be in patients taking the drug concomitantly along with other medications among the elderly with advanced stages of Parkinson’s. Patients are generally in poor health and are taking numerous other medications as well.
Study reports findings that 20% of patients with Parkinson’s may be demoralized and of those 29% are not depressed. Demoralization and depression can coexist but the two are clinically separate. Patients who are demoralized frequently have a subjective, persistent sense of failure in stressful situations. Depressed patients on the other hand have an inability to enjoy usually pleasurable activities and decreased motivation. The distinction is important because the treatment approaches are different. Demoralization may be treated with cognitive behavioral therapy rather than antidepressant medication. The authors suggested that the demoralization may be more closely associated with motor dysfunction. Patients with severe Parkinson’s were more likely to not participate which may mean that the prevalence of demoralization was underestimated.
March, 2018: American Psychological Association:
The APA estimates nearly half of all PD patients suffer from depression with some interactive features including cognitive and speech deficits and impairment in emotional expression or processing. It is probably caused by an independent abnormality rather than as a maladaptive response to the disease since the degree of depression is not correlated with PD severity. Prognostically, depressive features may represent a subtle premorbid state heralding the onset of PD or an accelerated cognitive decline thereafter.
Statistical reports state as many as one million Americans live with Parkinson’s – more than the combined number of persons with MS, MD or ALS. Approx. 60,000 persons are diagnosed each year in America. Men are one and a half times more likely to have Parkinson’s than women.
Costs – combined direct and indirect – including treatment, social security payments and lost income from inability to work is estimated to be nearly $25 billion per year in the US alone. Medication costs average $2500 per year and therapeutic surgery can cost up to $10,000 per patient.
February, 2018: IT, Johns Hopkins University and Universidad Politecnica de Madrid
Report on a joint study of non-invasive biomarkers able to identify Parkinson’s disease from the speech of patients. The average time to obtain a diagnosis of Parkinson’s disease is 2.9 years and essentially based on the clinical suspicion. The diagnostic accuracy varies considerably according to the duration of the disease, age, medical expertise and evolution. The uncertainty of the diagnosis, along with the degeneration caused before starting any treatment, has obvious impact on the quality of life of the patients.
The literature has identified for decades that voice and speech are affected on the pre-symptomatic stages of the disease. This study shows that speech is the carrier of information relevant to the differential diagnosis of Parkinson’s disease and the extraction of interest feature can be easily automated. The results find that diagnostic reliability is similar to the current studies based on clinical suspicion.
January, 2018: The Parkinson’s Foundation
Th Foundation has enrolled its 10,000 patient in the largest clinical trial of the disease yet to be conducted. Launched in 2009, the key conclusions drawn to date are:
- Regular visits to neurologists should be a priority for patients and caregivers
- Doctors should give a patient’s physical activity more attentions
- Patient’s mental health should be a priority particularly depression.
- Doctors need to address gender differences between patients.
American Academy of Neurology
Technology has come to the rescue of those expressing gait freezing. Laser shoes equipped with a small laser emitters enable those affected by PD to walk in a normal way. During a freeze, the patient may break out of it just by concentrating on something close to their feet moving their foot toward it or stepping over it. The shoes project a line about 18 inches ahead on the floor based on the pace of the patient’s footsteps and therefore, triggers the patient to walk by stepping toward the line. While in motion, the laser projection turns off allowing the other shoe to project the line.
December, 2017: Reported in JAMA Neurology
Reports on a study from Feinburg University school of Medicine at Northwestern University, that patients taking part in intensive exercise showed almost no decline in scores on their disease scale while those who did not participate declined an average of 3 points. This exercise was over a 6 month period and proved to be tolerable without injury and only sporadic complaints of sore muscles.
Colorado University School of Medicine
Reporting very early stage finding with limited implications for patients as the study was in mice, doctors believe that vigorous exercise could be linked to increased production of a brain protecting protein molecule, DJ-1. Researchers believe that DJ-1 plays a role in preventing the build-up of defective molecules which form harmful protein clumps, known as Lewy bodies, in the brains of Parkinson’s patients.
November, 2017: Reported in JAMA Neurology
Building on the Global Burden of Disease study, physicians from the University of Rochester and Radboud University in the Netherlands commented that neurological disorders are not the leading cause of disability in the world and the fastest growing among them is Parkinson’s. Between 1990 and 2015, the prevalence of Parkinson’s more than doubled and it is estimated that 6.9 million people across the globe have the disease. By 2040, an estimated 14.2 million people with have Parkinson’s outpacing Alzheimer’s.
The physicians deem this a “looming pandemic” and argue that active and aggressive advocacy must be pursued to the pharmaceutical industry and policy makers demanding immediate action to fight this enormous threat. They call for an all-out assault as was done with HIV-AIDS to understand the causes and risk factors to help prevention, to increase access to care – an estimated 40% of people with the disease do not see a neurologist, to increase research funding and to lower the cost of treatments.
Survey of Parkinson’s patients of GeneFo, an online community
Responding to questions about the daily challenges of living with Parkinson’s over 5000 responses shed some new light on some aspects of the condition that might need to be taken into consideration by researchers, clinicians and even policymakers.
In regard to mood, the survey also looked at the differences between men and women finding men are more likely to feel depressed and anxious that women. Men are also more trusting of their doctor’s recommendations and more likely to fully adhere to their prescribed medications. But men reported more use of homeopathy and preferred music as opposed to prayer and meditation preference by women.
September, 2017: Mayo Clinic weighs in on possible causes of PD
While the exact cause in unknown, there are four possible theories that may cause Parkinson’s;
- Genetics: There are certain genes, that when they become mutated, cause Parkinson’s. However, these mutated genes are very rare, except when Parkinson’s runs in the family. Additionally, there are some gene variations which seem to slightly increase the risk.
- Environment: There are some environment factors and toxins which may trigger the disease but the increased risk is very small.
- Presence of Lewy bodies in the brain: Lewy bodies are proteins found in brain cells which are biomarkers of the disease.
- Alph-synuclein in Lewy Bodies: Scientists are focusing on studying alpha-syncuclien proteins that from clumps in the brain cells and thought to contribute to the disease.
Anxiety in Parkinson’s
According to the National Parkinson’s Foundation, chemical changes occurring in the brain can trigger mood disorders such as anxiety and depression. Often and extremely low level of the chemical GABA is linked to the onset of these disorders. In this case medication can help rebalance the brains chemicals and reduce anxiety.
There may also be psychological factors that stem from dealing with a chronic disease as well as possible anxiety attacks when medications wear off or are no longer working.
July, 2017: Lifestyle changes that can improve Quality of Life for Parkinson’s Patients
Exercise is one of the most important things a person with PD can do to improve their life.
Diet is also important. Eating a healthy, balance diet and drinking lots of water will help avoid the gastrointestinal issues often associated with Parkinson’s and will help medication work to its full potential.
Getting regular quality sleep where you awake refreshed can help the brain produce dopamine. Nap during the day if you feel fatigued to restore energy.
World’s First Blood Test to Aid Diagnosis of Parkinson’s
Isreali researcher Abd-Elhadi has developed a minimally invasive, highly sensitive kit to test for Parkinson’s called “lipid ELISA” ( ELISA stands for enzyme-linked immunosorbent assay) PD is associated with the protein alpha-synuclin, the pathological form of which appears first in peripheral nerves usually in the digestive system. Patients in early stages of PD have digestive system problems and swallowing even before the disease pathology reaches the brain. Alpha-synuclin binds to fat molecules, called lipids on cell membranes. Using the lips to which the alpha-synuclin binds best, she developed the test. Earlier diagnosis can help by seeing how a given drug affects the progress of the disease.
Fighting off Parkinson’s, One punch at a time
Twice weekly boxing classes have found improvements in balance, gait speed and gait endurance along with helping to overcome symptoms of hypokinesia (small movements) by giving patients a defined, meaningful task like hitting a target. The therapists at Northeast Rehab in NH believe that the exercise increases dopamine synthesis and release which in turn controls movement function. In a study by the Parkinson’s Disease Foundation, Parkinson’s patients who participate in rigorous activity like boxing are able to use and create dopamine more easily than patients who do not exercise. This means that exercising patients are able to prevent their symptoms for getting worse and even mitigating the effects.
COMPASSIONATE, EFFECTIVE, AFFORDABLE CARE