We know what’s good for the “all” but we can’t say yet that we know what’s good for the “one.”

More evidence from experiments on mice on how and why exercise is good for People with Parkinson’s (PwPs):

The popularized article: Link between exercise and dopamine

And from the abstract and significance statement of the original (non-open access) article:

Physical exercise improves motor performance in individuals with Parkinson’s disease and elevates mood in those with depression. Although underlying factors have not been identified, clues arise from previous studies showing a link between cognitive benefits of exercise and increases in brain-derived neurotrophic factor (BDNF). (emphasis added).

and:

Exercise has been shown to improve movement and cognition in humans and rodents. Here, we report that voluntary exercise over 30 days leads to an increase in evoked dopamine (DA) release throughout the striatum, and an increase in BDNF in the dorsal (motor) striatum. The increase in DA release appears to require BDNF, indicated by the absence of DA release enhancement with running in BDNF+/- mice. Activation of BDNF receptors using a pharmacological agonist was also shown to boost DA release. Together these data support a necessary and sufficient role for BDNF in exercise-enhanced DA release, and provide mechanistic insight into the reported benefits of exercise in individuals with dopamine-linked neuropsychiatric disorders, including Parkinson’s disease and depression. (emphasis added).

The citation:

Voluntary exercise boosts striatal dopamine release: evidence for the necessary and sufficient role of BDNF, Guendalina Bastioli, Jennifer C. Arnold, Maria Mancini, Adam C. Mar, Begoña Gamallo-Lana, Khalil Saadipour, Moses V. Chao, Margaret E. Rice,Journal of Neuroscience 16 May 2022, JN-RM-2273-21; DOI: 10.1523/JNEUROSCI.2273-21.2022

So that covers why exercise is good for all. But what about what is good for the one? 

Farrow SL, Cooper AA, O’Sullivan JM. Redefining the hypotheses driving Parkinson’s diseases research. NPJ Parkinsons Dis. 2022 Apr 19;8(1):45. doi: 10.1038/s41531-022-00307-w. PMID: 35440633; PMCID: PMC9018840.

… there is growing recognition that PD is not a single entity but instead reflects multiple diseases, in which different combinations of environmental, genetic and potential comorbid factors interact to direct individual disease trajectories… The clear consequence of there being distinct diseases that collectively form PD, is that there is no single biomarker or treatment for PD development or progression. We propose that diagnosis should shift away from the clinical definitions, towards biologically defined diseases that collectively form PD, to enable informative patient stratification. N-of-one type, clinical designs offer an unbiased, and agnostic approach to re-defining PD in terms of a group of many individual diseases. . (emphasis added).

The citation links to PubMed where you can download the full article, should you be so inclined. The next citation also links to an open access free article.

Riggare S, Hägglund M. Precision Medicine in Parkinson’s Disease – Exploring Patient-Initiated Self-Tracking. J Parkinsons Dis. 2018;8(3):441-446. doi: 10.3233/JPD-181314. PMID: 30124453; PMCID: PMC6130409.

In this article, Riggare reports on self tracking done in 2012 (as a Person with Parkinson’s), and the offer the possibility that self-tracking of symptoms and medications can help to inform the physician’s decisions over the course of treatment. In other words, one should be a self-advocate as a patient and work with your physician to achieve the best combination of treatments to address Parkinson’s and its comorbidities. (At least that’s my takeaway from the article. Others might differ).

Another look at PD aims to categorize it into various sub-types:

Mestre TA, Fereshtehnejad SM, Berg D, Bohnen NI, Dujardin K, Erro R, Espay AJ, Halliday G, van Hilten JJ, Hu MT, Jeon B, Klein C, Leentjens AFG, Marinus J, Mollenhauer B, Postuma R, Rajalingam R, Rodríguez-Violante M, Simuni T, Surmeier DJ, Weintraub D, McDermott MP, Lawton M, Marras C. Parkinson’s Disease Subtypes: Critical Appraisal and Recommendations. J Parkinsons Dis. 2021;11(2):395-404. doi: 10.3233/JPD-202472. PMID: 33682731; PMCID: PMC8150501.

This article is a “desk review”of other studies, using specific criteria to either include/exclude each study in the results. Their conclusion: 

Conclusion: Subtyping studies undertaken to date have significant methodologic shortcomings and most have questionable clinical applicability and unknown biological relevance. The clinical and biological signature of PD may be unique to the individual, rendering PD resistant to meaningful cluster solutions. New approaches that acknowledge the individual-level heterogeneity and that are more aligned with personalized medicine are needed. (emphasis added).

Among the articles cited in the bibliography is this one (another open access article):

Lawton M, Baig F, Toulson G, Morovat A, Evetts SG, Ben-Shlomo Y, Hu MT. Blood biomarkers with Parkinson’s disease clusters and prognosis: The oxford discovery cohort. Mov Disord. 2020 Feb;35(2):279-287. doi: 10.1002/mds.27888. Epub 2019 Nov 6. PMID: 31693246; PMCID: PMC7028059.

In this, the authors describe their methodology and results from the Oxford cohort (one of several cohorts of PwPs and controls that have been used for research. (I would take the time and effort to locate the original publication describing the different cohorts involved in the effort to find biomarkers, but I am currently experiencing a wave of Parkinson’s related apathy. Check my past posts, or do a search on PubMed – I do remember that Oxford and Boston were two of the cohorts of PwPs.  But I digress).

Results: Apolipoprotein A1 and C-reactive protein levels differed across our PD subtypes, with severe motor disease phenotype, poor psychological well-being, and poor sleep subtype having reduced apolipoprotein A1 and higher C-reactive protein levels. Reduced apolipoprotein A1, higher C-reactive protein, and reduced vitamin D were associated with worse baseline activities of daily living (MDS-UPDRS II).

Conclusion: Baseline clinical subtyping identified a pro-inflammatory biomarker profile significantly associated with a severe motor/nonmotor disease phenotype, lending biological validity to subtyping approaches. No blood biomarker predicted motor or nonmotor prognosis. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society. (emphasis added).

In other words: Close, but no cigar. But I, for one, certainly could have benefited from this knowledge had it been available 60 years ago. (don’t get me started – I’ve played that tape many times before).

Oh well, let’s end on a high note:

More research on Dance

Not a lot to discuss: just a bunch of articles from the last couple of years.

Bearss KA, DeSouza JFX. Parkinson’s Disease Motor Symptom Progression Slowed with Multisensory Dance Learning over 3-Years: A Preliminary Longitudinal Investigation. Brain Sci. 2021 Jul 7;11(7):895. doi: 10.3390/brainsci11070895. PMID: 34356129; PMCID: PMC8303681.

Bek J, Groves M, Leventhal D, Poliakoff E. Dance at Home for People With Parkinson’s During COVID-19 and Beyond: Participation, Perceptions, and Prospects. Front Neurol. 2021 May 31;12:678124. doi: 10.3389/fneur.2021.678124. PMID: 34140925; PMCID: PMC8204717.

Fontanesi C, DeSouza JFX. Beauty That Moves: Dance for Parkinson’s Effects on Affect, Self-Efficacy, Gait Symmetry, and Dual Task Performance. Front Psychol. 2021 Feb 5;11:600440. doi: 10.3389/fpsyg.2020.600440. PMID: 33613357; PMCID: PMC7892443.

Emmanouilidis S, Hackney ME, Slade SC, Heng H, Jazayeri D, Morris ME. Dance Is an Accessible Physical Activity for People with Parkinson’s Disease. Parkinsons Dis. 2021 Oct 22;2021:7516504. doi: 10.1155/2021/7516504. PMID: 34721836; PMCID: PMC8556098.

Christensen-Strynø MB, Phillips L, Frølunde L. Revitalising sensualities of ageing with Parkinson’s through dance. J Aging Stud. 2021 Dec;59:100978. doi: 10.1016/j.jaging.2021.100978. Epub 2021 Oct 23. PMID: 34794724.

Krotinger A, Loui P. Rhythm and groove as cognitive mechanisms of dance intervention in Parkinson’s disease. PLoS One. 2021 May 6;16(5):e0249933. doi: 10.1371/journal.pone.0249933. PMID: 33956853; PMCID: PMC8101757.

Bar A, Czamanski-Cohen J, Federman JD. I Feel Like I Am Flying and Full of Life: Contemporary Dance for Parkinson’s Patients. Front Psychol. 2021 Jul 5;12:623721. doi: 10.3389/fpsyg.2021.623721. PMID: 34290638; PMCID: PMC8287013.

Gyrling T, Ljunggren M, Karlsson S. The impact of dance activities on the health of persons with Parkinson’s disease in Sweden. Int J Qual Stud Health Well-being. 2021 Dec;16(1):1992842. doi: 10.1080/17482631.2021.1992842. PMID: 34694957; PMCID: PMC8547839.

Bevilacqua R, Benadduci M, Bonfigli AR, Riccardi GR, Melone G, La Forgia A, Macchiarulo N, Rossetti L, Marzorati M, Rizzo G, Di Bitonto P, Potenza A, Fiorini L, Cortellessa Loizzo FG, La Viola C, Cavallo F, Leone A, Rescio G, Caroppo A, Manni A, Cesta A, Cortellessa G, Fracasso F, Orlandini A, Umbrico A, Rossi L, Maranesi E. Dancing With Parkinson’s Disease: The SI-ROBOTICS Study Protocol. Front Public Health. 2021 Dec 21;9:780098. doi: 10.3389/fpubh.2021.780098. PMID: 34993171; PMCID: PMC8724049.

Ismail SR, Lee SWH, Merom D, Megat Kamaruddin PSN, Chong MS, Ong T, Lai NM. Evidence of disease severity, cognitive and physical outcomes of dance interventions for persons with Parkinson’s Disease: a systematic review and meta-analysis. BMC Geriatr. 2021 Sep 22;21(1):503. doi: 10.1186/s12877-021-02446-w. PMID: 34551722; PMCID: PMC8456607. (This is a desk review of articles rather than original research. Personally, I am skeptical of the conclusions of such reviews [unless they support my biases, of course]).

Hsu P, Ready EA, Grahn JA. The effects of Parkinson’s disease, music training, and dance training on beat perception and production abilities. PLoS One. 2022 Mar 8;17(3):e0264587. doi: 10.1371/journal.pone.0264587. PMID: 35259161; PMCID: PMC8903281.

Walton L, Domellöf ME, Åström ÅN, Elowson Å, Neely AS. Digital Dance for People With Parkinson’s Disease During the COVID-19 Pandemic: A Feasibility Study. Front Neurol. 2022 Feb 3;12:743432. doi: 10.3389/fneur.2021.743432. PMID: 35185746; PMCID: PMC8850348.

Izbicki P, Stegemöller EL, Compton J, Thompson J. Dancing for Parkinson’s: A Gateway for Connectedness to Peers and Social Assurance. CBE Life Sci Educ. 2021 Jun;20(2):ar27. doi: 10.1187/cbe.20-05-0101. PMID: 33944618; PMCID: PMC8734394.

Sundström M, Jola C. “I’m Never Going to Be in Phantom of the Opera”: Relational and Emotional Wellbeing of Parkinson’s Carers and Their Partners in and Beyond Dancing. Front Psychol. 2021 Jul 29;12:636135. doi: 10.3389/fpsyg.2021.636135. PMID: 34393878; PMCID: PMC8358682.

Carapellotti AM, Rodger M, Doumas M. Evaluating the effects of dance on motor outcomes, non-motor outcomes, and quality of life in people living with Parkinson’s: a feasibility study. Pilot Feasibility Stud. 2022 Feb 9;8(1):36. doi: 10.1186/s40814-022-00982-9. PMID: 35139914; PMCID: PMC8827282.

Mele B, Ismail Z, Goodarzi Z, Pringsheim T, Lew G, Holroyd-Leduc J. Non-pharmacologic interventions to treat apathy in Parkinson’s disease: A realist review. Clin Park Relat Disord. 2021 May 25;4:100096. doi: 10.1016/j.prdoa.2021.100096. PMID: 34316673; PMCID: PMC8299975.

Kang SH, Kim J, Kim I, Moon YA, Park S, Koh SB. Dance Intervention Using the Feldenkrais Method Improves Motor, and Non-Motor Symptoms and Gait in Parkinson’s Disease: A 12-Month Study. J Mov Disord. 2022 Jan;15(1):53-57. doi: 10.14802/jmd.21086. Epub 2021 Nov 3. PMID: 34724780; PMCID: PMC8820889.

And there you have it. A bunch of research or reviews over the last year and a half involving dance and Parkinson’s Disease. I did a search and haven’t had enough time to read any of these yet, but That’s part of the reason for this blog: to serve as a repository of links to articles. All of these are open access articles so the full text should be available.

Meanwhile… 

Keep on moving to (and making) music

The evidence that rhythm, movement, and making music continues to accumulate as a therapeutic approach to address the symptoms and Quality of Life issues related to Parkinson’s Disease (PD).

Today we look at an article just out in Frontiers of Human Neuroscience, titled

Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives  

Over the last quarter of a century, increasing research results point to rhythm and music as effective and useful tools for treatment and rehabilitation of people with neurological disorders. This article reviews the evidence for four different approaches, what the consensus is at the present time, and, of course, suggests future directions.

The authors look at four different approaches:

  1. Rhythmic Auditory Stimulation (RAS)
  2. Music-Supported Therapy (MST)
  3. Therapeutic Instrumental Music Performance therapy (TIMP) and
  4. Patterned Sensory Enhancement (PSE)

The consensus of recent meta-analyses and systematic reviews is that, for Parkinson’s Disease (PD), is that RAS is an effective tool for improving gait, stride, and speed – folks walk faster and with longer steps with RAS. Additionally, evidence is showing that it also reduces freezing of gait (FOG), improves balance and reduces the occurrence of falls.

Neither MST nor TIMP have been studied much beyond the rehabilitation of stroke patients. They involve practicing on a keyboard or drums, beginning with the patient’s comfort level and increasing in difficulty. Some studies have begun to be used to investigate effectiveness as treatments for PD.  Some have shown improvements in motor dexterity. More research is needed, but in the meantime, learning to play drums or keyboards can’t hurt, and may enrich one’s quality of life (QOL).

Growing evidence in neurological and brain imaging have shown increased activity in the auditory and motor areas of the brain, indicating that brain plasticity might be achieved through music and rhythmic interventions. The authors note that RAS has been well studied with stroke and PD populations, but not with other movement disorders and Alzheimer’s populations. In addition MST and TIMP have only begun to be investigated as a means of restoring fine motor coordination.

The authors also call for neuroimaging use in studies, to better understand the physiological basis of the rehabilitation process. They point out the gaps in research and hope to provide a framework for future research – not so much a roadmap, I would think, but a laying out of what we know and what we don’t know, and what kinds of studies are needed to answer the questions about what we don’t know..  They state that “musical rhythm is a powerful tool” for therapy, and our understanding and exploration of how it modulates brain networks is in the initial stages.

 In other words, “We’ve only just begun.”

Meanwhile: Don’t stop moving to the music.

 

Citation:
Braun Janzen T, Koshimori Y, Richard NM and Thaut MH (2022) Rhythm and Music-Based Interventions in Motor Rehabilitation: Current Evidence and Future Perspectives. Front. Hum. Neurosci. 15:789467. doi: 10.3389/fnhum.2021.78946

 

Can Parkinson’s be predicted using Artificial Intelligence (AI)??

Today we take a look at a review of other papers (a way to get a paper published without having to do any actual research yourself, and the drudge work can be delegated to grad students, someone once told me), but nevertheless, there’s much to be learned from looking at the big picture instead of focusing on individual studies, so we’ll forge ahead. Next article will be on rehabilitation therapies that address motor and cognitive issues in PD.

Interestingly enough, this article comes from Indonesian Journal of Electrical Engineering and Computer Science – not the first place you’d probably look for information n Parkinson’s (PD). And, unless you’re a computer science major or are developing applications using AI, I wouldn’t recommend looking this one up.

Most of the studies reviewed used various techniques to analyze datasets of speech recordings, and tried to differentiate between “healthy”people and people with PD. Some of the approaches were fairly accurate (in the 90% plus range) while others were not that much better than reliance on the four cardinal symptoms to be observed clinically (resting tremor, rigidity, bradykinesia and postural instability). 

This one will either be good reading before going to sleep (unless you’re into neural networks and Bayesian prediction) or a good way to induce a headache. The authors do call for more research (naturally) in this area, especially in regard to developing biomarkers using either neuro-imaging or biofluids. And they note that fine-tuning of biomarkers must be  done, so that there is an acceptable balance between false positives and false negatives in predicting whether a person will likely get PD in the near or distant future.

Citation for this is:

A comparative and comprehensive study of prediction of Parkinson’s Disease, (2021) Pandi, V., et al., Indonesian Journal of Electrical Engineering and Computer Systems, vol. 23, No. 2, September 21, pp. 1748-1760.

It’s an open access article, so if you are interested in computer systems. go ahead and search for it. 

 

Verbal fluency, DBS, and parkinson’s

How many animals can you name in one minute?

Wait one year, and do the same test. 

How did you do? better or worse? Basically, that’s what this post is about.

Several articles in this post (all free PubMedCentral articles):

  1. Changes in Verbal Fluency in Parkinson’s Disease
  2. Semantic and phonemic verbal fluency in Parkinson’s disease: Influence of clinical and demographic variables
  3. The Verbal Fluency Decline After Deep Brain Stimulation in Parkinson’s Disease: Is There an Influence of Age?
  4. Worsening of Verbal Fluency After Deep Brain Stimulation in Parkinson’s Disease: A Focused Review
  5. Striatal volume is related to phonemic verbal fluency but not to semantic or alternating verbal fluency in early Parkinson’s disease

The first two studies looked at verbal fluency as measured by counting the number of animals one could name during a timed minute. Basically, the further along folks were in the stage of the disease, the lower their verbal fluency, and the lower their quality of life. Analysis indicated that several other factors were involved, such as depression, age, and executive functioning. People with Parkinson’s (PWP) with higher verbal fluency scores had better quality of life and lower caregiver burden, as measured by scores on standardized rating scales such as the PDQ-29 and The Modified Caregiver Strain Index (MCSI)

In the  second pair of articles, The first suggests that age might be accountable for the reported decline in Verbal Fluency (VF) following Deep Brain Stimulation (DBS) surgery, and provides data to support that hypothesis. The second article is a review of the literature, which notes that the effect seems to be moderate, and that studies to find the reason for the observed decline in VF have been inclusive overall.

Based on recent and earlier meta-analyses, there is reliable evidence for a worsening of both phonemic and semantic VF after DBS. This primarily pertains to STN-DBS…  …disease progression does not seem to be able to account for the worsening of VF in DBS patients. Also, DBS-related reductions in dopaminergic medication (mainly in STN-DBS patients) cannot account for the VF decline. …it seems that either surgery or stimulation itself or both together in combination with the electrode positions are driving factors. However, the evidence in this relation is inconclusive and sparse…. …recommendations for future studies on VF include optimizing study designs to include both ON and OFF stimulation as well as baseline measures, calculating reliable change indices (RCI) for neuropsychological results, and acquiring diffusion-weighted MRI on patients for tractography of cortical and subcortical connections to and from STN/GPi

The fifth article reports on brain imaging studies which indicate that the verbal fluency decline is related to different areas of the brain for VF and semantic fluency.

The fact that phonemic fluency, but not semantic or alternating fluency, was associated with caudate gray matter volume at early stage PD suggests that different fluency tasks rely on different neural substrates, and that language networks supporting semantic search and verbal-semantic switching are unrelated to brain gray matter volume at early disease stages in PD.

Since previous research on dance have indicated increased gray matter volume in dancers (somewhere earlier in this blog, search on “dance” to find it); this would suggest that one way to combat the decline in VF is to dance, preferably in classes that are specifically geared towards Parkinson’s symptoms.

At least that’s my take-away from these articles. Your mileage may vary.

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

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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Darwin’s notebooks and Parkinson’s Disease?

What connection could there be between Charles Darwin’s notebooks and PD?

According to Roger Barker, writing in the Advanced Clinical Neuroscience Rehabilitation journal on Parkinson’s disease over the last 20 years – new concepts and developments, it took Cambridge University that much time to realize that it had lost two priceless original notebooks belonging to Charles Darwin, and during that time, in the field of PD much new knowledge has been gained, partly due to

  • Stem cell creation discoveries, (how to create induced pluripotent stem cells {iPSCs)),
  • Gene cell editing with CRISPR/Cas9,
  • and the ability to do single cell RNA analyses.

Much has been gained directly from observational and clinical studies, however.

First, alpha synuclein proteins were observed in tissues which had been transplanted, which led to hypotheses that

  • Alpha synuclein fibrils  can spread seed pathology in the adult Central Nervous System (CNS), which led to the hypothesis that
  • PD begins in the gut/olfactory system and then spreads along the connecting nerves to the brain, seeding the pathology as it goes until it finally reaches the STN (subthalamic nigra) dopaminergic cells.

This in turn led to

  • The concept of a prodromal stage of PD before the cardinal symptoms of tremor, bradykinesia and rigidity are evident in the motor control brain cells, and
  • The possibility of targeting pathological alpha synuclein proteins to slow down or stop the progression of PD.

In addition, PD has been hypothesized to have two different origin points

  • H1: The disease starts in the PNS and spreads centrally or
  • H2: The disease tarts within the CNS itself and then out to more peripheral sites. 
  • Recent imaging studies support this concept of PD falling into these two subtypes
  • Not either/or, but both could be true (Blog author’s note: which could be a reason why the course of PD is different for each person?)

Many different methods have been used to study the course of PD

  • The most powerful are those using community based epidemiological studies following patients over time
    • avoids possible bias in selection
    • Results:
      • younger patients tend to do better than older patients and
      • that those with more PD related symptoms and signs at diagnosis do less well

Another area of interest has been the relation between PD and the gut biome and inflammation

  • Alpha synuclein pathology starts in the gut and travels to the brain and CNS
  • People on anti-inflammatory medication seem to have lower rates for PD
  • Result is:
    • Repurposing of anti-inflammatory medications to treat PD and
    • Use of drugs specifically targeting the gut biome or alpha synuclein
  • Further advances include
    • stem cell transplants (now in clinical trials)
    • autologous cell transplants
    • As to whether these therapies will prove effective not yet known

Twenty years of research on PD has produced a great deal more knowledge than the previous 200 years since Dr. James Parkinson wrote his essay on the “Shaking Palsy.” The concept of prodromal stages and symptoms (to me) seems to be one of the most important ways to diagnose probable PD before the cardinal symptoms appear – resting tremors, bradykinesia, and rigidity – and thus provide the possibility of delaying the onset of the disease through lifestyle or nutritional changes, or both.

Dr Barker’s review can be read at:  Barker R. Adv Clin Neurosci Rehabil 2021;20(2):13-15

And that’s my slide presentation of Dr. Barker’s article. Hope I hit all the major points and didn’t miss anything.

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More physical therapy, more research & guidelines

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.

Cannabis and Parkinson’s Disease (PD)

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?

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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