Category Archives: Parkinson’s

Dance, Dance for Parkinson's, depression, Exercise, Music, Parkinson's, Physical Therapy , , , , Leave a comment

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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Palliative Care: It’s Not Just For End Of Life Anymore

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In a discussion recently, the topic of Palliative Care came up. Some of us were under the impression that this was part of Hospice Care, which is usually reserved for the end of a life when the disease process has overwhelmed the body’s defenses. 

So, naturally, I did a search on PubMed Central to see what I could see. It turns out that, as the title says, it isn’t just for end of life. This first link is to a Mayo Clinic Proceedings CME course that expired for credits in 2015. But, the main points are:

  • Palliative care is not just for end of life cancer patients
  • Patients with chronic illnesses or conditions can benefit
  • Palliative care is appropriate at any stage of a serious disease or illness
  • Palliative care is a team effort
  • Palliative care can help reduce pain in chronic illnesses
  • Palliative care teams can help with managing complex communication interactions and with dealing with the emotional impact on patients and their families

Here’s the link:

What everyone should know about Palliative Care

Then, I thought it would be useful to get the World Health Organization’s definition:

Fact sheet: Palliative Care

Then, I found a recent clinical trial of Palliative care vs Standard care for people with PD:

A clinical trial of PC v SC for people with PD.  

The clinical trial showed better quality of life for people that received palliative care vs. those who received standard care. The variables were operationalized as: ” Outpatient integrated PC administered by a neurologist, social worker, chaplain, and nurse using PC checklists, with guidance and selective involvement from a palliative medicine specialist. Standard care was provided by a neurologist and a primary care practitioner.” Unfortunately no significant difference was found on burden for caregivers.

Finally, a citation: Oliver DJ, Borasio GD, Caraceni A, de Visser M, Grisold W, Lorenzl S, Veronese S, Voltz R. A consensus review on the development of palliative care for patients with chronic and progressive neurological disease. Eur J Neurol. 2016 Jan;23(1):30-8. doi: 10.1111/ene.12889. Epub 2015 Oct 1. PMID: 26423203. Although the complete article is not available online, they do make a few points:

  • …there is increasing evidence that palliative care and a multidisciplinary approach to care do lead to improved symptoms … and quality of life of patients and their families …
  • Main areas in which consensus was found and recommendations could made were:
    • the early integration of palliative care,
    • involvement of the wider multidisciplinary team,
    • communication with patients and families including advance care planning,
    • symptom management,
    • end of life care,
    • carer support and training, and
    • education for all professionals involved in the care of these patients and families

So there you have it. And since this blog is primarily about my interests in learning more about my Parkinson’s Disease diagnosis and various comorbidities so that I can live as well as I can for as long as I can, I am reassured by these findings and recommendations. Gesundheit! Mazel Tov! Salut! L’Chaim! and to quote Tiny Tim, “Bless us, every one!” 

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Slow down… or speed up, that is the question…

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This article isn’t about Parkinson’s, but since bradykinesia is one of the signature symptoms of parkinsonism, and the title is about the challenge of being slow, it interested me.

Birgitta Burger & Clemens Wöllner (2021): The challenge of being slow: Effects of tempo, laterality, and experience on dance movement consistency, Journal of Motor Behavior, DOI: 10.1080/00222895.2021.1896469

Basically, the authors found that people who were musically trained were better able to perform the given tasks consistently on both sides of their bodies. In other words, they are bilateral in terms of brain dominance, while other folks showed lower scores in terms of consistently performing the actions at different tempi (speeds). Because they were dominant on one or the other side of their brains. 

As an amateur musician, mostly untrained (or it didn’t take) I have found that during rhythm & drumming classes that I have been in that things like a simple paradiddle are much more difficult at a slower tempo than at a faster tempo. On the other hand, some combinations are more difficult at a faster tempo than at the slower tempo. Just trying to build those cross brain connections, as the prefrontal cortex to the back of the brain and the motor control and reward system parts fade out. So I will play at the piano at a slow speed, ’cause if I pick up the tempo my fingers get even more clumsier than they are.

Maybe difficulty with moving both sides consistently is part of the reason People with Parkinson’s have difficulty with balance and with falls?  From my own experience, can’t confirm or deny the hypothesis, since I’m not that good as a musician, but seem to have some bilateral skills, and until recently, when immersion in the moment took over the judgement and reason, have not experienced problems with balance or falls. Would be an interesting research question, though…

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Attention, cyborgs: be aware of environmental electrical interference

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I became aware through the news feed that some research is going on regarding electrical interference and DBS implants. Of all the websites and information I found, this page at UC-Davis is the most accessible:

DBS issues – UC-Davis health (PDF)

This next article isn’t accessible to me, but if anyone does have access and could shoot me a copy, it would be greatly appreciated. I might even get around to reading it. In fact, if anyone out there knows how I could get access to research journal subscriptions through an institution, please, please, please leave a note in the comments and I’ll get back to you.

Abstract

Deep brain stimulation (DBS) has evolved into an approved and efficacious treatment for movement, obsessive-compulsive, and epilepsy disorders that are refractory to medical therapy, with current investigation into other disease conditions. However, there are unintentional and intentional sources of external electromagnetic interference (EMI) that can lead to either malfunctioning or damaged DBS devices, as well as injury to human tissue. Comprehensive studies and guidelines on such topics in the medical literature are scarce. Herein, we review the principles behind EMI, as well as the various potential sources of interference, both unintentional (e.g. stray EMI fields) and intentional (e.g. MRI scans, “brainjacking”). Additionally, we employ the Manufacturer and User Device Facility Experience (MAUDE) database to assess real-world instances of EMI (e.g., airport body scanners, magnetic resonance imaging (MRI), and electrosurgery) affecting DBS devices commonly implanted in the United States (US).  (emphasis added above and below).

Highlights
• Electromagnetic equipment in our environment may interfere with implanted deep brain stimulation devices.

• Common EMI sources include airport security gates, antitheft and metal detectors, MRI, and electrosurgical or other medical equipment.

• Intentional EMI to “hack” or “hijack” DBS systems is a growing cause for concern.

• Research on EMI and DBS devices is scarce, and deserving more attention given the gravity of potential adverse events.

• Practical guidelines for patients, healthcare workers, and those who frequently handle electromagnetic devices are lacking.

Intentional EMI to “hack” or “hijack” DBS system?!?  I don’t know about my fellow cyborgs, but I am cautious about letting magnetic and electrical fields get close to the areas where I have my DBS electrodes, wiring, and programmer/battery. However, it sure would be nice. if they would at the least make the “practical guidelines” open access or available somewhere. Seems to be a contradiction. to make someone pay to find out how to protect oneself from harmful electrical interference. Isn’t  part of the Hippocratic oath “First, do no harm?” It seems to me that if you know the bridge is out, and some asks you for directions, and you tell them the directions but fail to mention that the bridge is out, that you are doing harm, The same goes with, “Yeah, I can tell you how to get there safely, but you’ll have to purchase a PDF file of the directions for $45.00 USD..”

Guess I’ll have to search for :”Practical Guidelines to Avoid Electrical Interference for DBS.” 

Boston Scientific has a nice page on EMIs, although it deasl with ICDs (which I take to mean (implanted Cardiac Device or something along those lines) basically a pacemaker for the heart.. So I guess this page will work folks who’ve become cyborgs due to PD DBS implants:  EMI safety

Another list of publicly available guidelines can be found at EMC Devices and risks on the Medtronics website. The list addresses risks related to cardiac devices,  but one can probably generalize to DBS devices (or one can look further than I did). Well, I looked a little further and found the DBS manuals for my model. Appendix A has the list of EMC guidelines. I also found the patient counseling information, which I’ll print here:

Patient information
Programming and patient control devices
Patient control devices may affect other implanted devices – Do not place the patient
control device over another type of active implanted medical device (eg, pacemaker,
defibrillator, another type of neurostimulator). The patient control device could
unintentionally change the operation of the other device.
Patient activities
Activities requiring excessive twisting or stretching – Patients should avoid activities
that may put undue stress on the implanted components of the neurostimulation system.
Activities that include sudden, excessive or repetitive bending, twisting, or stretching can
cause component fracture or dislodgement. Component fracture or dislodgement may
result in loss of stimulation, intermittent stimulation, stimulation at the fracture site, and
additional surgery to replace or reposition the component.
Component manipulation by patient – Advise your patient to avoid manipulating the
implanted system components (eg, the neurostimulator, the burr hole site). This can result
in component damage, lead dislodgement, skin erosion, or stimulation at the implant site.
Manipulation may cause device inversion, making a rechargeable neurostimulator
impossible to charge.
Patient activities and environmental warnings – Patients should exercise reasonable
caution in avoidance of devices that generate a strong electric or magnetic field. Close
proximity to high levels of electromagnetic interference (EMI) may cause a
neurostimulator to switch on or off. The system also may unexpectedly cease to function.
(emphasis added)- For these reasons, the patient should be advised about any activities that would be
potentially unsafe if their symptoms unexpectedly return. For additional information about
devices that generate electromagnetic interference, call Medtronic. Refer to the contacts
listed at the end of this manual.
Scuba diving or hyperbaric chambers (emphasis added)- Patients should not dive below 10 meters
(33 feet) of water or enter hyperbaric chambers above 2.0 atmospheres absolute (ATA).
Pressures below 10 meters (33 feet) of water (or above 2.0 ATA) could damage the
neurostimulation system. Before diving or using a hyperbaric chamber, patients should
discuss the effects of high pressure with their clinician.
Skydiving, skiing, or hiking in the mountains (emphasis added).- High altitudes should not affect the
neurostimulator, however, the patient should consider the movements involved in any
planned activity and avoid putting undue stress on the implanted system. Patients should
be aware that during skydiving, the sudden jerking that occurs when the parachute opens
may cause lead dislodgement or fractures, which may require surgery to repair or replace
the lead. (emphasis added).

My Practical Guidelines search uncovered another article, but it wasn’t open access. so I won’t even bother to link to it. I was going to add the Medtronics Appendix A, but it simply repeated the information above,

And there you have it. Don’t go putting strong magnets next to your brain, avoid Tesla Coils, and try not to get hit by lightning. 

And don’t let the EMS guys or ER folks stick you in an MRI machine.

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More physical therapy, more research & guidelines

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Perhaps it is because one is in rehabilitation, that one’s interest turns towards rehabilitation and Parkinson’s Disease. Sounds like a reasonable explanation.

This article from 2017 looked at rates of utilization of rehabilitative services, looking at several demographics:  Utilization of rehabilitation therapy services in Parkinson disease in the United States    (This article is on PubMed and is open access).

  The authors. …”found that 75% of Medicare beneficiaries diagnosed with PD did not receive rehabilitative therapies over a 36-month period. While it is not clear what the appropriate utilization rate should be, utilization among patients with PD in the Netherlands and the United Kingdom greatly exceeds what we found in the United States: at least 57% and 54%, respectively., In this study, predictors of higher (but still low) rates of therapy utilization included PD care by a neurologist, Asian or Caucasian race, and geographic location. 

The NICE folks in the UK have a link where one may download their entire set of guidelines for treatment of people with Parkinson’s:

Parkinson’s disease in adults

After looking at their recommendations on DBS, I’m not sure I am in total agreement with them there. But other that, they seem to be solid, aimed at the general practitioner, though, not to the Movement Disorders Specialist (my impression).

This article is not available for open access, but here’s the citation:

Rafferty, M.R., Nettnin, E., Goldman, J.G. et al. Frameworks for Parkinson’s Disease Rehabilitation Addressing When, What, and How. Curr Neurol Neurosci Rep 21, 12 (2021). https://doi.org/10.1007/s11910-021-01096-0

There is moderate to strong evidence supporting physical therapy, occupational therapy, and speech-language pathology soon after diagnosis and in response to functional deficits.

We propose a framework of three pathways for rehabilitation care:

(1) consultative proactive rehabilitation soon after diagnosis for assessment, treatment of early deficits, and promotion meaningful activities;

(2) restorative rehabilitation to promote functional improvements; and

(3) skilled maintenance rehabilitation for long-term monitoring of exercise, meaningful activities, safety, contractures, skin integrity, positioning, swallowing, and communication.   (emphasis added).

I would agree with the overall framework – I have had some postural issues since the beginning (pre-PD), and assessment and promotion of meaningful activities would have been helpful. I did receive some physical. therapy to correct posture, which did so, only to reveal spinal stenosis.  Later on, I had bunionectomies which kept me wheelchair bound or with limited mobility for a year, and restorative rehabilitation was provided and needed. Finally, my own hubris regarding my mobility led to several falls in 2019 and 2020, and are now being addressed with both restorative rehabilitation and skilled maintenance rehabilitation which will hopefully correct the problems and provide the the tools to maintain posture, etc. over the (hopefully) years to come.

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It’s PT (Physical Therapy) time again

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I have described myself as “71 going on 17” frequently enough lately to others that isn’t getting funny anymore. But a couple of things have happened that go beyond a palindromic allusion to the soundtrack from “The Sound Of Music.”

On March 27, 2019, I was reaching over a landscape boulder in my yard, trying to put in place a sun shade umbrella stand that would serve as a solar panel stand for a small water feature, when I lost my balance, fell forward, and broke my fall with my left hand. I was actually in physical therapy at the time for rehabilitation following a couple of bunionectomies on the same foot, so after X-rays confirmed there was no fracture, I continued with both rehabs. This past October, 2020, I managed to step off a different landscape boulder in my yard with no apparent damage while falling on my back. Then later in the month, on the 24th and 31st, while out photographing wildflowers in a preserve, I fell backwards stepping off – again, no apparent damage. On the 31st, I attempted to catch up with the group I was with by taking a shortcut, stepping up on a boulder using my walking stick. I almost made it, but teetered and fell backwards. Fortunately there were no apparent fractures. But it did make the symptoms from the 2019 return. Short story long – my Primary Care Provider referred me to rehab, I was assigned to a PT who had seen me before, and she quickly focused in on the worst pain, and then worked on the other, postural habits and problems that continued to cause problems. And noted that when I step up, I tend to lean back, which probably had something to do with my October 31 fall.

All of which is a roundabout way to lead in to this review article: Physiotherapy in Parkinson’s Disease:A Meta-Analysis of Present Treatment Modalities   

Results:

  •  Conventional physiotherapy significantly improved motor symptoms, gait, and quality of life.
  • Resistance training improved gait.
  • Treadmill training improved gait.
  • Strategy training improved balance and gait.
  • Dance, Nordic walking, balance and gait training, and martial arts improved motor symptoms, balance, and gait.
  • Exergaming improved balance and quality of life.
  • Hydrotherapy improved balance.
  • dual task training did not significantly improve any of the outcomes studied.

citation info: Neurorehabilitation and Neural Repair 2020, Vol. 34(10) 871–880 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1545968320952799 journals.sagepub.com/home/nnr

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Cannabis and Parkinson’s Disease (PD)

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This article popped up in my email alerts. Although I do not have access to the journal in which it appeared, I thought I would post it anyway, along with several article titles that appeared in the same journal. (If my former employer would grant me access to their technical library, I would be most grateful, and might even forego any patent filing awards that I would be eligible for if I hadn’t retired. I come across at least one new Human-Computer Interface issue that could be solved each week, But I digress). (The actual link to the article was in Medscape News).

Despite high interest (no pun intended(?)) in the use of cannabis as a treatment for Parkinson’s Disease symptoms, this study  finds that actual use remains low (at least in Germany). The article appeared in  Journal of Parkinson’s Disease: Yenilmez, Ferhat et al. ‘Cannabis in Parkinson’s Disease: The Patients’ View’. 1 Jan. 2021 : 309 – 321. 11, no. 1, pp. 309-321, 2021.

Sadly, it is not available as open access, but fortunately the methods and results provide adequate data regarding the study.

Abstract:

Background: Little is known about the patients’ view on treatment with medical cannabis (MC) for Parkinson’s disease (PD). Objective: To assess the PD community’s perception of MC and patients’ experience with MC.Abstract:

Methods: Applying a questionnaire-based survey, we evaluated general knowledge and interest in MC as well as the frequency, modalities, efficacy, and tolerability of application. Questionnaires were distributed nationwide via the membership journal of the German Parkinson Association and locally in our clinic to control for report bias.

Results: Overall, 1.348 questionnaires (1.123 nationwide, 225 local) were analysed. 51% of participants were aware of the legality of MC application, 28% of various routes of administration (ROA) and 9% of the difference between delta9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD).

PD-related cannabis use was reported by 8.4% of patients and associated with younger age, living in large cities and better knowledge about the legal and clinical aspects of MC. Reduction of pain and muscle cramps was reported by more than 40% of cannabis users. Stiffness/akinesia, freezing, tremor, depression, anxiety and restless legs syndrome subjectively improved for more than 20% and overall tolerability was good. Improvement of symptoms was reported by 54% of users applying oral CBD and 68% inhaling THC-containing cannabis. Compared to CBD intake, inhalation of THC was more frequently reported to reduce akinesia and stiffness (50.0% vs. 35.4%; p < 0.05). (emphasis added) Interest in using MC was reported by 65% of non-users.

Conclusion: MC is considered as a therapeutic option by many PD patients. Nevertheless, efficacy and different ROA should further be investigated.

Some other articles on the same issue that might be of interest (All are at the above link):

The Subjective Experience of Living with Parkinson’s Disease: A Meta-Ethnography of Qualitative Literature

Does Gut Microbiota Influence the Course of Parkinson’s Disease? A 3-Year Prospective Exploratory Study in de novo Patients

Association Between Thyroid Diseases and Parkinson’s Disease: A Nested Case-Control Study Using a National Health Screening Cohort  ” The rates of levothyroxine treatment for more than 3 months, hypothyroidism, and hyperthyroidism were higher in the PD group than the control group (3.2%, 3.8%, and 2.8% vs. 2.5%, 2.9%, and 1.9%, respectively, p  < 0.05). The adjusted odds ratios (ORs) in model 2, which was adjusted for all potential confounders, for hypothyroidism and hyperthyroidism in the PD group were 1.25 (95% confidence interval (CI) 1.01–1.55, p  = 0.044) and 1.37 (95% CI 1.13–1.67, p  = 0.002), respectively. 

Subthalamic Stimulation Improves Quality of Sleep in Parkinson Disease: A 36-Month Controlled Study

Diet Quality and Risk of Parkinson’s Disease: A Prospective Study and Meta-Analysis

Identification of Pre-Dominant Coping Types in Patients with Parkinson’s Disease: An Abductive Content Analysis of Video-Based Narratives

Dissonance in Music Impairs Spatial Gait Parameters in Patients with Parkinson’s Disease “ Conclusion: Our observations suggest that dissonant music negatively affects particularly spatial gait parameters in PD by yet unknown mechanisms, but putatively through increased cognitive interference reducing attention in auditory cueing.”

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So.. what’s new?

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A couple of recently published reviews (for folks that want to stay on top of things) :

What do we know about PD and what can we do about it?   This one is more of a commentary piece, that is to say, it isn’t an experiment or a structured desk review of other papers. It covers PD in (almost) layman’s terms, the causes (genetic, environmental, and perhaps lifestyle choices – nicotine and caffeine seem to have a neuroprotective effect), and the signs and symptoms:

… symptoms appear in other diseases as well so that not everyone with one or more of these symptoms has
the disease. In some people, the disease evolves more quickly than in others and it is not possible to predict what course the disease will take.

According to the author, the younger the age at onset, the more likely it is to be genetically related. Later onset symptoms appear more gradually. ( my note: I had many of the prodromal symptoms beginning around age 16, including REM Sleep Behavior Disorder, depression (probably due to environmental (e.g., workplace management) factors), essential tremors,  and have the LINGO1 gene variant that has been linked to both essential tremors and Parkinson’s. A recent Michael J. Fox Foundation – 23AndMe study found another couple of dozen or more gene variants associated with a higher risk for Parkinson’s. Clearly, there is a need for earlier detection and mitigation of Parkinson’s and parkinsonism conditions).

PD dementia and dementia with Lewy bodies differ in when dementia occurs, among other things. In PD, dementia occurs after PD diagnosis, in the latter, dementia occurs before PD symptoms become apparent. 

The author continues to provide an overview. But for me the sentence that stuck out glaringly was “Scientists still do not know what causes cells that produce dopamine to die.” (I need to finish reading this one… Will have to put it on my to-do list). 

Parkinson’s patients’ needs during the pandemic   This was a survey study done in Northern Italy with PD patients. Findings included:

(i) fearing the risk of contracting coronavirus,

(ii) the reduction of physical activity,

(iii) perception of the risk of not being able to access outpatient clinics or support services, and

(iv) the suffering from the important reduction in socialization.

The authors also noted that the perception could be greater than the actual difference, especially for item iii.

Enhanced differentiation of human induced pluripotent stem cells toward the midbrain dopaminergic neuron lineage through GLYPICAN-4 downregulation    I just tossed this link in for kicks – it is way outside of my area of expertise, but might be of interest to someone who knows something about the workings of the brain.

A scoping review of the nature of physiotherapists’ role to avoid fall in people with Parkinsonism – Now, here’s something I have a little more experience with – having fallen 3 times in October 2020 while stepping backward off of boulders, or trying to step up onto a boulder, either in my yard or in a park/preserve. Fortunately, I was referred to an excellent Physical Therapist who zeroed in on the greatest source of pain and then has moved toward improving strength, balance and posture. She noted my habit of leaning back when stepping high, and suggested that this might have caused the last, and most painful fall. 

As for the review, it noted that PT can have a positive effect on many issues related to falls in Parkinsonism. But the many studies were so varied, that many more studies would have to be done to specify which therapy works best for which problem at what stage of the disease. (surprise, surprise).

And now, to sleep, perchance to dream (Shakespeare) and hopefully, not to be tossin’ and turnin’ all night (Phillip Upchurch).

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Discrete choice experiment

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Published in the Australian Journal of Physiotherapy as an open access article, we have an experiment in which several factors were used to determine participants’ preferences in a hypothetical exercise program.

People with Parkinson’s disease are more willing to do additional exercise if the exercise program has specific attributes

Conclusions were:

People with Parkinson’s disease were more willing to participate in exercise programs that cost less, involve less travel, provide physical or psychological benefits and are supervised by qualified professionals. To enable more people with Parkinson’s disease to exercise, health services should provide programs addressing these factors and account for sex differences. [emphasis added. Men were more likely to favor strength training, women were averse to aerobic exercise, and folks already exercising 300 minutes per week were less likely to favor adding more exercises.]

The group to which I subscribe on their YouTube channel, and support in various ways, is Power For Parkinson’s® (PFP). I also am a member of the Georgetown Area Parkinson’s Support group (GAPS) and the Capital Area Parkinson’s Society (CAPS) Both PFP and GAPS sponsor several exercise groups aimed directly at people with Parkinson’s Disease (PD) and their needs, so I am usually working out at least one hour daily. So I might fall into the last group of folks not willing to add more exercises.

On a different tangent, A couple of articles showed up that deal with the idea of Multiple Intelligences. Actually, one is a book excerpt with selected portions available on Google Books, and the other is the cover, Table of Contents, Bibliography, and Index of a different book. Granted, the Index does list Parkinson’s Disease on at least 2 pages. Why bother? Because, as those who have read the earlier blog post(s) on Moses Maimonides and Me, I don’t particularly subscribe to Maimonides’ categories of four ways in which humans strive to achieve perfection.

These books are:

Eastern European Perspectives on Emotional Intelligence

in which some of the available pages include charts of Howard Gardner’s Multiple Intelligences, and some of the results which seem to show a clustering of several factors (using factor analysis). Since that is outside of my area of expertise, I won’t comment on it. (This is all copyrighted material, provided only for personal education, etc.

The other is Mind Ecologies: Body, Brain and World which has the extensive bibliography and index. Probably well worth looking into the bibliography, if one has a mind to do so (but not today). The TOC reads:

1. Life, Experimentalism, and Valuation 16
2. Pragmatism and Embodied Cognitive Science 51
3. Social Cohesion, Experience, and Aesthetics 94
4. Pragmatism and Affective Cognition 124
5. Perception, Affect, World 156
6. Broadening Ecologies 184 

and the whole thing is copyright The Columbia University Press.

My pulmonologist prescribed a nap in the morning and afternoon, and since I missed the morning nap, will head off to do one this afternoon.

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