Category Archives: depression

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RBD and other things PD-related

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Diagnosis of PD is often not made until a person is in their 60s. With all the attention that has been focused on the disease(s) in the last 20 years or so, I suspect that more people are getting diagnosed at an earlier age, although most cases of young onset PD are likely to be genetic in origin.

However, an “early” diagnosis may not be a timely diagnosis, as  the title of one opinion piece I read some time ago said (see link below).

It is now becoming apparent that “Parkinson’s”includes several categories of symptoms, not just rigidity, tremors, and gait, as shown in the table below::

Source for the following table, accessed 11/28/2021:  URL=https://www.frontiersin.org/article/10.3389/fneur.2020.00686

The problem is that treatment and diagnosis are often delayed until PD has already reduced Quality of Life for many folks.

Good evidence for the quality-of-life benefits of existing symptomatic treatment supports the argument for earlier diagnosis at a time when symptoms are already present (emphasis added). This argument would be significantly bolstered by the development of disease-modifying treatments. Benefits of early diagnosis and treatment would affect not only the individual (and their families) but also the wider society and the research community. Ultimately, however, shared decision-making and the principles of autonomy, beneficence, and non-maleficence will need to be applied on an individual basis when considering a “timely” diagnosis.

Therefore, the earlier one can predict the probability or inevitability of PD the sooner one can use treatments – whether pharmacological, surgical, nutritional, or lifestyle in nature – that can either reduce, delay, or defer (and possibly reverse?) the symptoms of PD.

Of all the symptoms associated with PD: tremors, bradykinesia, depression & anxiety, posture, gait issues (difficulties walking), REM Sleep Behavior Disorder (RBD), anosmia (loss of ability to smell), cognitive issues, facial masking, and micrographia (small handwriting) – RBD is the one which is most highly predictive of a later PD diagnosis.

The predictive ‘specificity’ is so strong that if someone has RBD, the chance of being diagnosed with Parkinson’s or related conditions over the next 15 years or more is over 80%

If an 18-21 year old person walked into a physician’s office with RBD, essential tremors, and depression as main symptoms, what would happen? In 1970, probably nothing – one might get treated for depression, but essential tremors are also called “benign”tremors, and were ignored, even if the patient reported being able to feel the tremors while resting, though invisible to the external observer. As for RBD, it would probably also be ignored.

By “a physician,” we are talking about a General Practitioner, or “family doctor,” and not s specialist like a  Movement Disorders Specialist who would be trained to identify varied symptoms, including those that are prodromal. And, of course, the identification of prodromal symptoms has only been investigated within the last decade or so, and are identified as for “research only” purposes – not for clinical diagnosis. A recent survey article (not referenced below) indicated that a majority of general practitioners were either unaware of the Movement Disorders Society’s list of prodromal symptoms, or were not using them to make referrals to Movement Disorders Specialists.

But thanks to the dedication and generosity of folks like Michael J. Fox and others, PD has become a respectable disease for which the person who has it has no reason to be apologetic or ashamed, and can hold their head up (and they ought to, since one symptom is to walk with shoulders stooped down) and proudly proclaim that they have Parkinson’s, which is why they walk funny. And so it goes.

Articles that were quoted above or which contributed to this article are found in the links below.

But first:

I See The Signs of PD

Perspective: Current Pitfalls in the Search for Future Treatments and Prevention of Parkinson’s Disease

An early diagnosis is not the same as a timely diagnosis of Parkinson’s disease

Prodromal REM Sleep Behavior Disorder and PD

10 Early Signs of Parkinson’s Disease / Parkinson’s Foundation

REM Sleep Behavior and Motor Findings in Parkinson’s Disease: A Cross-sectional Analysis

Current Update on Clinically Relevant Sleep Issues in Parkinson’s Disease: A Narrative Review

The prodromes of Parkinson’s disease

Exercise-Induced Neuroprotection of the Nigrostriatal Dopamine System in Parkinson’s Disease

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Late Stage Parkinson’s (LSP): Undertreated?

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This paper (or rather a chapter in a thesis) landed in my newsfeed recently. In it, the authors describe a study done to see whether people with Parkinson’s in the later stages are getting adequate treatment and whether they could benefit from more specific treatment. (A link to the PDf file is at the end of this post).

A person in Late Stage Parkinson’s has more than one of the following:

  • Motor symptoms not controlled despite medication.
  • Levadopa-related dyskinesias or dystonia,
  • PD dementia (defined according to MDS Task Force definition (Dubois et al. 2007), and
    not treated with cholinesterase inhibitors,
  • Depression not adequately treated,
  • Neuropsychiatric symptoms, such as agitation/ aggression; anxiety and irritability,
  • Orthostatic hypotension, pain, constipation, urinary symptoms, insomnia or daytime sleepiness (autonomic systems degeneration),
  • Falls on a regular basis,
  • Other symptoms related to risk of choking, speech issues, or producing too much saliva,
  • Inadequate Home environment.

Basically, the study provided a list of recommended activities and treatment on a sheet of paper (the control group) and actually providing the treatments and activities recommended, (the treatment group).

Not surprisingly, the treatment group did better at the end of the study than the controls. The conclusions were that people in late-stage Parkinson’s are often undertreated and could benefit from implementation of movement disorder specialists’ recommendations. (One would hope that the control group would also be provided with the treatments after the study ended. Perhaps, leading to another report)?

I’ve paraphrased the table used to describe late stage Parkinsonism in order not to infringe on their copyright. The title of the entire thesis is “Impairment and Disability in Late Stage Parkinsonism” and the overall author is Danny Hommel. I couldn’t find an email to ask for permission in writing to reproduce anything verbatim.

Other chapters include:

  • The late-stage of parkinsonism’s – motor and non-motor complications
  • The prevalence and determinants of neuropsychiatric symptoms in late-stage parkinsonism
  • Prevalence and prescribed treatments of orthostatic hypotension in institutionalized peoples with Parkinson’s disease (the chapter discussed in this post)
  • Optimizing treatment in undertreated late-stage parkinsonism: a pragmatic randomized trial
  • General discussion/English summary

Published as: ALAJ Hommel, MJ Meinders, NJ Weerkamp, C Richinger,
C Schmotz, S Lorenzl, R Dodel, M Coelho, JJ Ferreira, F Tison, T Boraud,
WG Meissner, K Rosqvist, J Timpka, P Odin, M Wittenberg, BR Bloem,
RT Koopmans, A Schrag and the CLaSP consortium.
Optimizing treatment in undertreated late-stage parkinsonism: a pragmatic
randomized trial.
J Parkinsons Dis. 2020;10(3):1171-1184.

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Depression, Parkinson’s Disease, Cannabis, suicidal ideation, and more…

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There are two types of depression, we are sometimes told: Depression, and bipolar disorder. To my way of thinking, at least, ALL depressions are bipolar in nature. It’s just that those who don’t have the wild swings of high to low, but just from “normal” to low, aren’t considered to be be bipolar. (The report on Cannabis and suicide doesn’t mention PD, but it seemed close enough to the topic of depression that I included it.

But what do I know? I’m not a trained psychiatrist or psychologist.Here’s some articles from some folks who seem to have expertise in the area:

First: find out whether someone with PD is depressed.

Williams JR, Hirsch ES, Anderson K, Bush AL, Goldstein SR, Grill S, Lehmann S, Little JT, Margolis RL, Palanci J, Pontone G, Weiss H, Rabins P, Marsh L. A comparison of nine scales to detect depression in Parkinson disease: which scale to use? Neurology. 2012 Mar 27;78(13):998-1006. doi: 10.1212/WNL.0b013e31824d587f. Epub 2012 Mar 14. PMID: 22422897; PMCID: PMC3310315.

Conclusions: The Geriatric Depression scale (GDS-30) may be the most efficient depression screening scale to use in PD because of its brevity, favorable psychometric properties, and lack of copyright protection. However, all scales studied, except for the UPDRS Depression, are valid screening tools when PD-specific cutoff scores are used. (emphasis added).

And guess what? Comorbidities need to be considered, and depression rating scales don’t really tease out one of the more common ones. 

Calleo J, Williams JR, Amspoker AB, Swearingen L, Hirsch ES, Anderson K, Goldstein SR, Grill S, Lehmann S, Little JT, Margolis RL, Palanci J, Pontone GM, Weiss H, Rabins P, Marsh L. Application of depression rating scales in patients with Parkinson’s disease with and without co-Occurring anxiety. J Parkinsons Dis. 2013;3(4):603-8. doi: 10.3233/JPD-130264. PMID: 24275604.

Conclusions: Co-occurring anxiety disorders do not impact performance of depression rating scales in depressed PD patients. However, depression rating scales do not adequately identify anxiety disturbances alone or in patients with depression.

Why should we care? Because depression has an adverse effect on daily living for those with PD.

Pontone GM, Bakker CC, Chen S, Mari Z, Marsh L, Rabins PV, Williams JR, Bassett SS. The longitudinal impact of depression on disability in Parkinson disease. Int J Geriatr Psychiatry. 2016 May;31(5):458-65. doi: 10.1002/gps.4350. Epub 2015 Aug 18. PMID: 26284815; PMCID: PMC6445642.

Objective: Depression in Parkinson disease (PD) is a common problem that worsens quality of life and causes disability. However, little is known about the longitudinal impact of depression on disability in PD. This study examined the association between disability and DSM-IV-TR depression status across six years.

Results: A total of 43 participants were depressed at baseline compared to 94 without depression. Depressed participants were more likely to be female, were less educated, were less likely to take dopamine agonists, and more likely to have motor fluctuations. Controlling for these variables, symptomatic depression predicted greater disability compared to both never depressed (p = 0.0133) and remitted depression (p = 0.0009). Disability associated with symptomatic depression at baseline was greater over the entire six-year period compared to participants with remitted depressive episodes or who were never depressed.

Conclusions: Persisting depression is associated with a long-term adverse impact on daily functioning in PD. Adequate treatment or spontaneous remission of depression improves ADL function. (emphasis added).

Teamwork is needed. If the person with PD can’t be their own advocate, then someone needs to help coordinate and communicate.

Taylor J, Anderson WS, Brandt J, Mari Z, Pontone GM. Neuropsychiatric Complications of Parkinson Disease Treatments: Importance of Multidisciplinary Care. Am J Geriatr Psychiatry. 2016 Dec;24(12):1171-1180. doi: 10.1016/j.jagp.2016.08.017. Epub 2016 Sep 3. PMID: 27746069; PMCID: PMC5136297.

Abstract

Although Parkinson disease (PD) is defined clinically by its motor symptoms, it is increasingly recognized that much of the disability and worsened quality of life experienced by patients with PD is attributable to psychiatric symptoms. The authors describe a model of multidisciplinary care that enables these symptoms to be effectively managed. They describe neuropsychiatric complications of PD itself and pharmacologic and neurostimulation treatments for parkinsonian motor symptoms and discuss the management of these complications. Specifically, they describe the clinical associations between motor fluctuations and anxiety and depressive symptoms, the compulsive overuse of dopaminergic medications prescribed for motor symptoms (the dopamine dysregulation syndrome), and neuropsychiatric complications of these medications, including impulse control disorders, psychosis, and manic syndromes. Optimal management of these problems requires close collaboration across disciplines because of the potential for interactions among the pathophysiologic process of PD, motor symptoms, dopaminergic drugs, and psychiatric symptoms. The authors emphasize how their model of multidisciplinary care facilitates close collaboration among psychiatrists, other mental health professionals, neurologists, and functional neurosurgeons and how this facilitates effective care for patients who develop the specific neuropsychiatric complications discussed.

And, with a cautionary reminder that correlation does not equal causation, and that the new release about the referenced article comes from the Council on Drug Abuse: (which could possibly have a conflict of interest regarding the results of the data):

B Han, WM Compton, EB Einstein, ND Volkow. Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status(link is external). JAMA Network Open. DOI: 10.1001/jamanetworkopen.2021.13025 (2021).

An analysis of survey data from more than 280,000 young adults ages 18-35 showed that cannabis (marijuana) use was associated with increased risks of thoughts of suicide (suicidal ideation), suicide plan, and suicide attempt. These associations remained regardless of whether someone was also experiencing depression, and the risks were greater for women than for men. The study published online today in JAMA Network Open and was conducted by researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

“While we cannot establish that cannabis use caused the increased suicidality we observed in this study, these associations warrant further research, especially given the great burden of suicide on young adults,” said NIDA Director Nora Volkow, M.D., senior author of this study. “As we better understand the relationship between cannabis use, depression, and suicidality, clinicians will be able to provide better guidance and care to patients.”

On the other hand, it could be that young adults are depressed or suicidal because they live in a world in which constant war is being fought, in which war profiteering is not a crime, in which they see politics reduced not to a game of collaboration and mutual benefit, but a zero sum game in which the winner takes all. Perhaps they are depressed over the failure of the governments to address the mounting scientific evidence that climate “change” is resulting in climate chaos, and yet the governments of the world, funded by the fossil fuel industries, are “rearranging deck chairs on the Titanic” while the media band plays on. I could go on, but I won’t.

I used to be suicidal, but my life has changed. 

More to the point:

The National Suicide Prevention Lifeline is available today, providing suicide prevention and mental health crisis assistance at 1-800-273-8255 and through online chats. 988 is not a nationwide calling code right now. The Veterans Crisis Line is available today, providing Veteran specific suicide prevention and crisis assistance at 1 800 273 8255 (Press 1), by texting 838255, and through online chats at veteranscrisisline.net. On July 16, 2020, the FCC adopted rules to establish 988 as the new, nationwide, easy-to-remember 3-digit phone number for Americans in crisis to connect with suicide prevention and mental health crisis counselors.

And a final note: one of the main defenses against depression is activity is physical activity and human or non-human interaction. So get out here and run a mile, walk along a nature trail, play some music, call a friend, join a group or club, hug a tree, kiss a girl/boy, and get connected with the world we live in. 

You’ll feel better if you do.

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What to do?

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When it comes to diseases like cancer, the UK medical folks have decided that the “fighting” and “warrior” mentality are counter-productive. For one, this mindset causes people to delay seeking treatment. I don’t have the exact citation at hand, but it is referenced in this blog somewhere, and you’re welcome to search for it. (Thankfully, this is not a dissertation or scholarly article, or I couldn’t have written the previous sentence and gotten away with it).

But when it comes to exercise as a good way to slow, and sometimes reverse the physical or cognitive symptoms of Parkinson’s Disease (PD), there ain’t no doubt in some folks minds that dance is one of the finer things around to combine aerobic exercise, movements, and cognitive challenges to build new connections between neurons in the brain.

From the Digital Commons at Sarah Lawrence College comes this Master’s Thesis:

Rajan, Sneha, “Embodied Medicine: Integrating Dance/Movement Therapy into Physical Medicine & Rehabilitation” (2021). Dance/Movement Therapy Theses. 79. https://digitalcommons.slc.edu/dmt_etd/79

Long story short: “Overall, physiatry and dance/movement therapy have separately helped so many people but developing a synergy between these fields has the potential to transform rehabilitative medicine.”(emphasis added).

Specifically addressing Parkinson’s Disease issues, she writes:

For individuals with Parkinson’s disease, studies have shown that physical rehabilitation is an effective way to manage motor and non-motor symptoms (Mitra et al., 2020). However, maintaining motivation for treatment is difficult because of progressive difficulties with physical disability and co-existing emotional factors, so as a result not many adults engage with enough physical exercise (Mitra et al., 2020). By incorporating cognitive, emotional, and social components, the exercise environment could become more engaging and multidimensional (Mitra et al., 2020). One experimental study examined the effects of dance/movement therapy sessions on the cognition, quality of life, and motor symptoms of patients with Parkinson’s disease (Mitra et al., 2020). They used a variety of techniques such as targeted body exercises, memory games, movement improvisation, guided imagery, rhythm work, contact improvisation, mirroring, body coordination and movement reflexes (Mitra et al., 2020). Music was also used to incorporate rhythm and sensory motor cues (Mitra et al., 2020).

As a result, participants showed a significant increase in cognitive functioning and a decrease in Parkinson’s related health difficulties. Additionally, patients reported improvements in coordination, mood, and memory (Mitra et al., 2020). Another study analyzed the effectiveness of music-based movement therapy on gait related activities in Parkinson’s patients (Dreu et al., 2011). They examined both individual music-based gait training and partnered-dance interventions. The music provides rhythmic cues that help synchronize movements and also facilitates emotional responses in the participants (Dreu et al., 2011). Participants showed improvements in walking velocity and balance (Dreu et al., 2011). (Emphasis added.)

 If I were to judge this Master’s thesis, I would suggest more sources, and more recent ones than the one she used in material about Parkinson’s in the paragraphs before the ones I quoted above. But I’m not on the faculty of Sarah Lawrence College, so that’s their loss.

And the answer to the question posed in the title of this blog entry “What to do?” is simple: Don’t Stop Moving To The Music!

 

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Dee Bee Ess (Deep Brain Stimulation (DBS))

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First of all, something I have suspected seems to have some clinical evidence:

It seems that the earlier one has Deep Brain Stimulation (DBS) following a Parkinson’s Disease diagnosis, the better one fares:

Pre-dopa Deep Brain Stimulation: Is Early Deep Brain Stimulation Able to Modify the Natural Course of Parkinson’s Disease?

This observational study evidences that DBS treatment exerts beneficial effects on motor symptoms and quality of life in early stages of PD, if applied when first functional and QoL-impairments occur, even before L-Dopa treatment initiation. These novel data and paradigm shift proposal challenge current algorithms for PD treatment and grants further studies evaluating the disease course-modulating potential of very early DBS application in larger populations.

I was fortunate enough to have opted for DBS due to Essential Tremors, when eventually the testing revealed the cardinal traits of Parkinson’s. Had I not received DBS implants at that time, but waited until the disease had progressed to a later stage, I would not likely be in the shape I am today.

Another Item of Interest is the article titled “Personality dimensions of patients can change during the course of parkinson’s disease” to which I can also add an affirmation. DBS programming has enabled me (along with a long term psychiatric neurobehavioral specialist  relationship) to stop having episodes of Major Depressive Disorder (MDD) and have now been off antidepressants for over a year. Although this is not necessarily what the authors had in mind when they did their study, it does suggest that DBS had something to do with it. Particularly after one DBS programming session, I apparently went into a manic state, which caused my wife to report the change in mood and behavior to my Movement Disorders Specialist, so that the programming was “dialed back a few notches.”

And of course, a good deal of the credit goes to my wife, who looks after my diet so that I am eating nutritious and organic foods as much as possible, and the good folks at Power for Parkinson’s and the Georgetown Area Parkinson’s Support group, which provide exercise classes and social connections. I have noticed a more outgoing personality than previously, though it would be difficult to disentangle the various factors influencing any supposed changes in my alleged personality. 

As Michael Jackson said to Paul McCartney in “The Girl Is Mine,” I’m a lover, not a fighter.” 

or as David Bowie sang, “Ch-ch-ch-changes.”

okay, now I’m just being silly.

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PD Treatment with Cannabis?

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One form of treatment that has a lot of anecdotal evidence but has resisted scientific inquiry due to archaic legal issues is the use of Cannabis. Although there haven’t been a lot of studies related to Parkinson’s Disease, quite a few have been conducted related to other medical conditions, including addiction and other drug abuse/misuse issues and psychiatric conditions. This post provides a look at a few studies that are open access and which might have a relationship to mental issues related to Parkinson’s Disease (such as anxiety, depression, apathy…not that anyone cares…)

Cannabis, a complex plant…   

Atakan Z. (2012). Cannabis, a complex plant: different compounds and different effects on individuals. Therapeutic advances in psychopharmacology, 2(6), 241–254. https://doi.org/10.1177/2045125312457586

an overview of the biochemical basis of cannabis research by examining the different effects of the two main compounds of the plant and the endocannabinoid system, and then go on to review available information on the possible factors explaining variation of its effects upon different individuals.

A review of the chemical compounds of greatest interest to researchers.

The Genetic Structure of Marijuana and Hemp

journals.plos.org (2015)

We find a moderate correlation between the genetic structure of marijuana strains and their reported C. sativa and C. indica ancestry and show that marijuana strain names often do not reflect a meaningful genetic identity. We also provide evidence that hemp is genetically more similar to C. indica type marijuana than to C. sativa strains.

Hemp has more CBD and less THC, marijuana (as C. sativa is commonly referred to, as more THC,  in general.

The effectiveness of Cannabis Flower for the relief of depression

YALE JOURNAL OF BIOLOGY AND MEDICINE 93 (2020), pp.251-264.

The findings suggest that, at least in the short term, the vast majority
of patients that use cannabis experience antidepressant effects, although the magnitude of the effect and extent of side effect experiences vary with chemotypic properties of the plant.

Contrary to some of the other reports, this one suggests that most people get an antidepressant effect, although each person’s experience might be different.

The Impact of Cannabidiol on Psychiatric and Medical Conditions

J Clin Med Res. 2020;12(7):393-403

a systematic review of literature reviewing the available clinical data on
CBD, for use in various medical and psychiatric conditions with focus
on a review of the pharmacology and toxicity. 

As up to date a review one can get at this point in time.

Changes in patient health questionnaire (PHQ-9) scores in adults with medical authorization for cannabis

Round et al. BMC Public Health (2020) 20:987  https://doi.org/10.1186/s12889-020-09089-3

Although the majority showed no clinically important changes in PHQ-9 scores, a number of patients showed improvement or deteriorations in PHQ-9 scores. Future studies should focus on the parallel use of screening questionnaires to control for PHQ-9 sensitivity and to explore potential factors that may have attributed to the improvement in scores pre- and post- 3-6 month time period.

Similar to the last study cited, that supported the hypothesis that Cannabis use didn’t seem to have an effect of whether one was anxious or depressed.

Attenuated reward activations associated with cannabis use in anxious/depressed individuals

Spechler, P.A., Stewart, J.L., Kuplicki, R. et al. Attenuated reward activations associated with cannabis use in anxious/depressed individuals. Transl Psychiatry 10, 189 (2020). https://doi.org/10.1038/s41398-020-0807-9

… data support the hypothesis that cannabis use in individuals with mood/anxiety disorders is associated with attenuated brain processing of reward magnitude, which may contribute to persistent affective symptoms.

In other words, I think that what they are saying is that if you are anxious or depressed, Cannabis won’t necessarily change that.

Health-related quality of life in young people: the importance of education

Gil-Lacruz et al. Health and Quality of Life Outcomes (2020) 18:187
https://doi.org/10.1186/s12955-020-01446-5

The dimensions of HRQOL are influenced by educational level. The influence is greatest among girls and the youngest members of the poorest area of the district. Public authorities should contemplate the development of an equitable education system from the beginning of the life cycle as a public health strategy.

Not specifically related to PD either, this has a broader impact. Better education leads to better health (and probably better schools, better businesses, and better public services and elected officials, one might wager).

That’s all for now. Time to relax. Take five. Smoke ’em if you got ’em, as the saying goes…

 

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I would definitely volunteer…

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For a longitudinal followup study. The longer the better. This is the sort of study you can sink your teeth into…

Food for thought, indeed.

Dark chocolate consumption versus depressive symptoms

Well, the results aren’t conclusive, but apparently the theory is that dark chocolate contains Flavonoids and possibly activates the endocannabinoid receptors in the brain, which make folks feel good instead of angry and hostile or depressed.

And chocolate is still legal in all 50 states of the USA.

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Kazoos are good for youse

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All of the following links have to do with improving voice for PD folks, and also the use of kazoos.

I used to write for this student newspaper:

Music therapy helps tackle Parkinson’s (The Miami Hurricane July 5, 2019)

This is a fairly long honors project paper reviewing voice therapy techniques:

Voice Therapy Techniques in Combination with the Group Therapy Setting for Individuals withParkinson’s Disease

Not necessarily for PD, but the study used spectrographic analysis to measure the improvement in voice in addition to qualitative results.

Finger Kazoo: spectrographic acoustic modifications and vocal self-assessment

I might have already mentioned this in a previous entry, but kazoos were used:

Individual Therapeutic Singing Program for Vocal Quality and Depression in Parkinson’s Disease

Vocal warmups for the individual: Vocal warmups

Vocal warmups for the group: Anatomy of a choral warmup

 

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I got rhythm, I got music…

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Put together a slide presentation trying to synthesize some of the research on Parkinson’s Disease (PD) and the possibility of music, singing, playing musical instruments, and dance as means to counteract the progressive effects of dopaminergic neurons lost in the course of PD. Due to the length of the presentation and the limits of my computer resources, the narration seems to have gotten a little out of sync towards the end. But it is what it is, as they say: (note: added a PDF file of the presentation on 6-9-19 to make it easier to download and view)

Rhythm, Music, Singing, Dancing and the Brain

2019-06-05-Rhythm Music Singing and the brain  (PDF file)

and an even smaller file with all the blue and yellow intact (6-15-2019):

Rhythm Music Singing Dancing and the Brain

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Old drugs in new bottles

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An interesting development, or in this case, two interesting developments, is the finding that currently available medications might be repurposed for their neuroprotective effects. Here are two articles on two drugs that show promise.

This is a report on a hypertension medication that provides neuroprotection in mice and may be transferable to humans… Are mice brains similar enough to humans for it to work? A recent report on isradipine, another hypertension medication, reported no differences in symptoms between controls and those receiving the medications. We shall see.

Felodipine induces autophagy in mouse brains with pharmacokinetics amenable to repurposing

Nrct we have a case in which a tricyclic antidepressant, nortriptyline, has been found to slow down the aggregation of alpha synuclein proteins in the brain.

Nortriptyline inhibits aggregation and neurotoxicity of alpha-synuclein

 Not sure whether either will pan out, but anyone with either hypertension or depression could discuss these articles with their doctor(s) and come to a mutually agreeable course of action.

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