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Teamwork helps

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An open access article:

Multi-disciplinary approach for rehab to improve QOL

From the abstract:

Results:Patients reported higher functional status (d=0.37,p<0.001), general self-efficacy(d=0.28,p<0.01), and quality of life (d=0.32,p<0.001) at three weeks follow-up, comparedto their baseline scores. The regression analysis showed that having a better initial functionalstatus (β=−0.26,p<0.05) and lower quality of life (β=0.51,p<0.001) were associated withmore improvements in quality of life.
Conclusion:The study suggests that actual functioning in persons with Parkinson’s diseaseis a better predictor of improved quality of life than self-efficacy beliefs and that those whohave lower levels of initial quality of life benefit more from rehabilitation.

The program was only three weeks long, but was inpatient and apparently intensive:

The multidisciplinary rehabilitation program had a duration of three weeks and was an inpatient program. Upon arrival, participants were awarded a primary contact to ensure a unified team working toward goals set by the participant him/herself. The multidisciplinary team consisted of 10 different professions, such as occupational therapists, physical therapists, doctors, neurologists, nurses, sports educators, cognitive behavioral therapists, and nutritionists. Commencing the multidisciplinary rehabilitation program, participants were assessed by the relevant professional/s and typically had close follow-up the first week with individual and group-based exercise

 

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New approach – direct brain infusions to regrow dopaminergic neural cells

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This approach might help, but apparently it will take about 18 months to get results in moderately advanced cases. (emphasis added to abstract below).

One wonders whether complementary therapeutic treatments (exercise, dance (movement + rhythm), singing, or music instrument training were being used by any of the participants, or whether this was the only treatment these subjects were using during this time. Certainly worth trying this in combination with other, non-invasive treatments (says the cyborg with electrodes stimulating the subthalamus nigra substantia).

Journal of Parkinson’s Disease research pre-press

Abstract.
Background: Intraputamenal glial cell line-derived neurotrophic factor (GDNF), administered every 4 weeks to patients with moderately advanced Parkinson’s disease, did not show significant clinical improvements against placebo at 40 weeks,
although it significantly increased [18F]DOPA uptake throughout the entire putamen.
Objective: This open-label extension study explored the effects of continued (prior GDNF patients) or new (prior placebo patients) exposure to GDNF for another 40 weeks.
Methods: Using the infusion protocol of the parent study, all patients received GDNF without disclosing prior treatment allocations (GDNF or placebo). The primary outcome was the percentage change from baseline to Week 80 in the OFF state
Unified Parkinson’s Disease Rating Scale (UPDRS) motor score.
Results: All 41 parent study participants were enrolled. The primary outcome decreased by 26.7 ± 20.7% in patients on GDNF for 80 weeks (GDNF/GDNF; N = 21) and 27.6 ± 23.6% in patients on placebo for 40 weeks followed by GDNF for 40 weeks
(placebo/GDNF, N = 20; least squares mean difference: 0.4%, 95% CI: –13.9, 14.6, p = 0.96). Secondary endpoints did not show significant differences between the groups at Week 80 either. Prespecified comparisons between GDNF/GDNF at Week 80 and placebo/GDNF at Week 40 showed significant differences for mean OFF state UPDRS motor (–9.6 ± 6.7 vs. –3.8 ± 4.2 points, p = 0.0108) and activities of daily living score (–6.9 ± 5.5 vs. –1.0 ± 3.7 points, p = 0.0003). No treatment-emergent safety concerns were identified.

Conclusions: The aggregate study results, from the parent and open-label extension suggest that future testing with GDNF will likely require an 80- rather than a 40-week randomized treatment period and/or a higher dose.

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Might mitophagy be enlisted in the fight against Parkinson’s?

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Mitochondrial dysfunction and Parkinson’s

During aging, the process of mitophagy, a system that allows the removal of dysfunctional mitochondria through lysosomal degradation, starts to malfunction. Because of this defect, damaged mitochondria are not removed correctly, and their decomposing components accumulate inside the cells. Dysfunctional mitochondria that are not removed by mitophagy produce high amounts of reactive oxygen species (ROS) and, thus, cause oxidative stress. Oxidative stress, in turn, is very harmful for the cells, neuronal cells, in particular. Consequently, the process of mitophagy plays a crucial role in mitochondria-related disease. Mitochondrial dysfunctions and oxidative stress are well-established factors contributing to Parkinson’s disease (PD), one of the most common neurodegenerative disorders. In this review, we report various known antioxidants for PD treatments and describe the stimulation of mitophagy process as a novel and exciting method for reducing oxidative stress in PD patients. We describe the different mechanisms responsible for mitochondria removal through the mitophagy process. In addition, we review the functional connection between mitophagy induction and reduction of oxidative stress in several in vitro models of PD and also agents (drugs and natural compounds) already known to be antioxidants and to be able to activate mitophagy. Finally, we propose that there is an urgent need to test the use of mitophagy-inducing antioxidants in order to fight PD.

 

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Music on the brain

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Rhythmic Auditory Stimulation (RAS) and Argentinean Tango

Results: Results showed significant improvements in the Tinetti scale total (mean±SD of post-pre change: 5.3±2.8, p<0.01), gait (2.5±1.2 p<0.01), and balance scores (2.8±2.0 p<0.01). TUG also improved by 3.6±0.8 seg (p<0.01). Statistically non-significant changes were recorded in mobility, bodily discomfort, stigma, social support and cognition PDQ-39 domains, with Cohen’s d sizes of 0.5-0.6 and NNTs of 5-7.

Conclusion: RAS could be combined with Argentinean Tango. Positive effects on gait and balance were observed, together with a trend towards improvement in some quality of life domains. A randomized, blinded, controlled trial in a larger number of patients followed-up during a longer period is underway.

And this:Brief review of music and cognition

Given that the participants were not musicians, it can be inferred that the results of the research can be applied in other non-musical contexts, what we call “generalization” in cognitive rehabilitation, which means, non-musical gains can be transferred to daily activities. In this perspective Billhiartz et. al. (2000) argue that there is a link between musical instruction and development in non-musical skills.

… we agree that music is an important element in human life that can be used in many contexts. The musical activity is multisensorial, simultaneously integrating several systems, mainly the sensorimotor, cognitive, and affective, within a specific context, which consecrates in the sphere of embodied musical cognition.

An interview with Tom Moore

This is just a darn interesting interview with a musician and musicologist. You can’t make this stuff up.

 

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back to square one

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Basic clinical features do not predict dopamine transporterbinding in idiopathic REM behavior disorder 

REM sleep behavior disorder (RBD) is strongly associated with development of Parkinson’s Disease and otherα-synuclein-relateddisorders. Dopamine transporter (DAT) binding deficit predicts conversion toα-synuclein-related disorders in individuals with RBD.In turn, identifying which individuals with RBD have the highest likelihood of having abnormal DAT binding would be useful. Theobjective of this analysis was to examine if there are basic clinical predictors of DAT deficit in RBD. Participants referred for inclusionin the RBD cohort of the Parkinson Progression Markers Initiative were included. Assessments at the screening visit including DATSPECT imaging, physical examination, cognitive function screen, and questionnaire-based non-motor assessment. The group withDAT binding deficit (n=49) was compared to those without (n=26). There were no significant differences in demographic orclinical features between the two groups. When recruiting RBD cohorts enriched for high risk of neurodegenerative disorders, ourdata support the need for objective biomarker assessments.npj Parkinson’s Disease (2019) 5:2 ; https://doi.org/10.1038/s41531-018-0073-

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Exergame based therapy and other stuff

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Rehab through exer-games

Conclusion:Recent evidence indicates exergame-based therapy has been widely proven to be feasible, safe, and atleast as effective as traditional PD rehabilitation. Further insight into new sensors, best practices and different cognitivestadiums of PD (such as PD with Mild Cognitive Impairment), as well as task specificity, are required. Also, studieslinking game parameters and results with traditional assessment methods, such as UPDRS scores, are required.

Study protocol re: PD movement interventions

The goal of this study is to begin to address this
challenge by piloting a novel, hypothesis-driven, non-
pharmacological intervention to improve motor function
and diminish motor fatigue in PD. This novel approach is
based on the use of hypothesis-driven cognitive task inter-
ventions to stimulate the motor system and ameliorate
motor symptoms

Palmomental reflex is an important clinical marker of REM sleep behavior disorder in patients with Parkinson’s disease Yadav R, Mahale R, Pal PK – Ann Mov Disord

 

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Autism and Parkinson’s, and data-driven subtyping of PD

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Found this reference to a study involving autistic children.
Since Parkinson’s is a movement disorder, it stands to reason that music would be beneficial to both groups as a therapy (and it is).
http://irj.uswr.ac.ir/article-1-889-en.pdf
“Highlights
● A growing body of evidence suggests that motor impairments are frequently present in children with autism.
● Music therapy along with physical activity might benefit children with autism.
● We observed a significant difference between the experimental and control group after applying music therapy along with play therapy.
Plain Language Summary: Children with autism show motor impairments. Music therapy along with physical activity is a significant treatment in improving motor coordination. In this study, 30 children with autism were participated in 15 music therapy sessions. Music therapy are presented in two methods: (a) inactive one; listening to music and (b) active one; playing and rhythmic movements. Based on the results, motor coordination was achieved in the posttest.”
 
Directly related to Parkinson’s is this research paper on data-driven subtyping of PD:
“466 patients with idiopathic PD were investigated and three subtypes were identified. Subtype I (Mild Baseline, Moderate Motor Progression) is comprised of 43.1% of the participants, with average age 58.79 ± 9.53 years, and was characterized by moderate functional decay in motor ability but stable cognitive ability. Subtype II (Moderate Baseline, Mild Progression) is comprised of 22.9% of the participants, with average age 61.93 ± 6.56 years, and was characterized by mild functional decay in both motor and non-motor symptoms. Subtype III (Severe Baseline, Rapid Progression) is comprised 33.9% of the patients, with average age 65.32 ± 8.86 years, and was characterized by rapid progression of both motor and non-motor symptoms. These subtypes suggest that when comprehensive clinical and biomarker data are incorporated into a deep learning algorithm, the disease progression rates do not necessarily associate with baseline severities, and the progression rate of non-motor symptoms is not necessarily correlated with the progression rate of motor symptoms.”
 
In other words, everybody’s Parkinson’s journey is unique.
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Review of exercise and PD, and creativity and PD

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Today’s feed brings me the following two articles, one of which points out that exercise is not a “one size fits all” approach to controlling PD symptoms, and the other which is more exploratory in nature and thought-provoking.

Exercise and PD – review article 

In this review article, the authors

” briefly review the state of the art in key areas and speculate on the likely state of research in each area in the next 20 years. Key areas relate to: (1) the physiological benefits of exercise with respect to disease modification; (2) the best type of exercise; (3) the optimal intensity of exercise; and (4) implementation strategies for increasing exercise/physical activity uptake.”

“Does exercise have significant promise to mitigate the burden and possibly the course of PD? We think so. But to answer that question we will need to design trials that account for the multisystem nature of PD, identify the specific effects of exercise and target the underlying pathophysiology/mechanisms. A better understanding of this would allow for a more personalized approach rather than the current ‘one size fits all’ and could most likely confer greater benefits.”

Art for Better Health and Wellbeing

A provocative article that discusses the relationships among, Dopamine, creativity, and Parkinson’s Disease:

“Dopamine’s role in creativity seems causal: when patients with
Parkinson’s receive dopaminergic medicine to improve their
mobility the treatment also stimulates curiosity, motivation, and
even creativity in as many as 10% of patients.

Some develop beautiful art, even if their creative intelligence had never
expressed itself before. Other patients change their existing
artistic expressions under dopaminergic stimulation, sometimes
strikingly.

Perhaps even more provocative is the recent finding that healthy
people who had chosen an artistic profession early in life had
a reduced risk of developing Parkinson’s disease.”

 

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A couple of studies on gait improvement in PD, and a thesis on music therapy

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What looked promising turned out to be fairly lackluster as far as results – although it appears that putting in time on a treadmill might be better for Parkinson’s patients than some other forms of exercise, when it comes to gait and balance. And challenging courses of treatment were recommended for people with PD.

Exercise and Parkinson’s – comparison

Background and Purpose: Impaired gait, balance, and motor function are common in Parkinson disease (PD) and may lead to falls and injuries. Different forms of exercise improve motor function in persons with PD, but determining which form of exercise is most effective requires a direct comparison of various approaches. In this prospective, controlled trial, we evaluated the impact of tango, treadmill walking, and stretching on gait, balance, motor function, and quality of life. We hypothesized tango and treadmill would improve forward walking and motor symptom severity, and tango would also improve backward walking, balance, and quality of life.
Results: In this study, treadmill walking improved forward and backward walking.

Healing Sounds: an anthropology of Music Therapy

explore embodiment, relationship – building and aesthetic creation as three areas n which music can allow the harnessing of affect towards health goals. I note music’s powerful affect on the human body and movement, and the ways in which these affects are mobilized towards specific clinical goals. I explore the various human –  to – human and human – to sound relationships that are mobilized, created or strengthened through music therapy interventions, and how they relate to health and to the affect of “becoming”. Finally, I note the strong evidence for musical and esthetic creation as a part of self – care, both by music therapists and by their clients, and argue for a broader understanding of how creativity impacts health, by allowing people to affect their environments

Exercise and Gait

Methods: Forty-seven PwPD (mean age: 73 years; 19 females, Hoehn and Yahr stages 2-3) who had participated in 10 weeks of highly challenging gait and balance training were included. Baseline demographics, disease-related factors, physical and cognitive ability, and perceived health were used for the prediction of percent change in balance performance (the Mini-BESTest) and comfortable gait speed between the pre- and postassessments, using multiple linear regression analyses.
Results: Thirty-five percent of the variance of change in balance performance was explained by General Health Perceptions (β = −0.36), the Timed Up and Go test (β = −0.33), and the single-task performance of a cognitive task (β = −0.24). Forty-nine percent of change in gait speed was explained by gait speed while performing a dual task (β = −0.46), dual-task interference while walking (β = 0.43), time to complete the Timed Up and Go test (β = −0.29), and percent error on a cognitive task (β = −0.25).
Discussion and Conclusions: The results may suggest that the PwPD with overall lower perceived health, functional mobility, and cognitive functions are the ones most likely to benefit from highly challenging and attention-demanding gait and balance training.
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High cholesterol < lower Parkinson's Risk

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http://www.medscape.com/viewarticle/881576?src=wnl_edit_tpal

Higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are associated with a decreased risk for Parkinson’s disease (PD) in men, a large observational study shows.

Just my luck – my total cholesterol has always been low, even though recently my HDL has been a high percentage of LDL and total cholesterol.

261,638 persons aged 40 to 79 years not taking statins.

…followed from baseline to death, end of study, or PD diagnosis.

From annual blood tests, researchers collected information on levels of TC, LDL-C, and high-density lipoprotein cholesterol (HDL-C).

They categorized TC levels into upper (210 mg/dL or more), middle (180 to 209 mg/dL), and low tertiles and LDL-C levels into upper (140 mg/dL or more), middle (110 to 139 mg/dL), and low tertiles.

Among men, compared with low levels, middle and upper levels of TC and LDL-C were significantly associated with lower risk for PD.