Where it’s at (at this moment )

As a person who was diagnosed in late 2011 with Parkinson’s disease after several years of treatment for Essential Tremors that had gotten uncontrollable, I had Deep Brain Stimulation (DBS) shortly thereafter (I had already decided to go for DBS to control the tremors, and in the additional testing, rigidity was observed, allowing the diagnosis).

Since then, thanks to a supportive care partner, a supportive community that provides exercise and dance classes, and now vocal exercises (singing) which I had initiated in 2015 along with a friend, now deceased, I am able to function fairly well. I consider my self ” the luckiest guy” to paraphrase Lou Gehrig.

So instead of my usual posting of an article or a few on a specific topic, I thought I would post this YouTube video documenting my current situation (albeit somewhat exaggerated for dramatic effect) as far as Parkinson’s Disease goes:

I Blame The Parkinson’s

To sleep, perchance to dream… or to stay up all night, that is the question

Other than the sound of Shakespeare rolling in his grave at that title, what else might be involved in insomnia? (disregarding the occasional benefits such as hearing Isaac Hayes’ version of “By The Time I Get To Phoenix” on a radio show titled “For Mushrooms and Night People,” or reading through James Joyce’s “Finnegan’s Wake” in one sleepless night).

Insomnia related to PD – according to this study abstract, the authors found that insomnia disorder co-morbid with Parkinson’s Disease was consistent with that of folks without PD, and they recommend a cognitive behavioral therapy approach to help treat people with this problem.

Insomnia co-morbid with Parkinson’s Disease

On the other hand, insomnia can lead to daytime drowsiness. And that, as this author can attest, can be co-morbid with REM Sleep Behavior Disorder (RSBD) or as narcolepsy for many years without a diagnosis.

Here are a couple of other articles on longitudinal studies related to PD and sleep issues. They are open access, so one can read and draw one’s own conclusions. As usual, one of the conclusions one might reach is that further research is needed on the topic.

Long term effects of STN DBS on sleep     In this study, it was found that DBS improved nocturnal sleep quality but had no effect on excessive daytime sleepiness.

10 year study on daytime drowsiness and PD   In this long term study, it was found that daytime drowsiness did not improve, even while other symptoms of PD progressively got worse.

The author refers you to the paragraph above in which RSBD was co-morbid and precedent to PD diagnosis, as well as narcolepsy, which was only diagnosed in recent years. Although symptoms may be associated with Parkinson’s, they might not be a part of the Parkinson’s Disease, and other causes must be ruled out in order to arrive at accurate diagnoses. For this, a team of medical personnel is required, and not specialists, each working alone in their own silo. (Opinions provided free of charge).

 

A review of non-traditional treatments for PD

Exercise is generally accepted as beneficial for the alleviation of Parkinson’s Disease (PD) symptoms. The Clinical Neurologist International has just published an open-access article that reviews the most recent research with a focus on types of exercise and their benefits for specific motor symptoms:

Martinez-Ramirez D, Kraslow M, Armstrong MJ, Ramirez-Zamora A, Almeida L, Besharat A, et al. Update on Non-Traditional Exercises in Parkinson’s Disease: A Motor Symptom-Focused Approach. Clin Neurol Int. 2019; 1(1): 1004.

From the abstract:

… it is crucial to better characterize the benefits of exercise in PD. … we discuss the most recent studies analyzing the clinical effects of various modalities of exercise in PD, including physical therapy, aerobic exercise, strength and resistance training, and nontraditional forms of activity such as tai chi, dancing, aquatics, and boxing. We also provide … expert recommendations based on current evidence and highlight issues that remain unresolved (e.g. the best type of exercise, symptomatic benefits based on different modalities, optimal frequency and duration, and duration of benefit).

It appears that the authors limited their search to those studies that looked into motor symptoms of PD, and perhaps this is why their list of references doesn’t include Rehfield et al.’s 2018 article on the superiority of a dance program to repetitive physical exercise in increasing brain plasticity. Nor do they look into other approaches, such as musical training and practice, as possible ways to improve cognitive function, brain plasticity, and quality of life.

As a person with PD, I personally find that an eclectic and inclusive approach, using medications, Deep Brain Stimulation (DBS), physical exercise (including dance-related, vocal/singing and breathing exercise), diet, and social activities related to specific interests (like native plants and photography) works best for me. For others, the mix will differ.

The authors of this review reach much the same conclusion:

…evidence suggesting that any and all types of exercise can provide short-term clinical and quality of life benefits. More research is needed to help understand if exercise programs provide generalized benefits or what strategies should be used to address particular deficits. Balance, flexibility, and stretching seem to improve motor symptoms and decrease falls, contributing to an improvement in overall function. Aerobic training appears to improve cognition, cardiovascular health, gait, and reaction time. Resistance training provides the strongest benefit in strength. Nontraditional exercise programs, including tango, tai chi, cycling, aquatic therapy, and boxing are potentially beneficial options for each patient

In short: Find out what types of exercise you like to do, do what you like to do, and keep on doing it to help reduce the symptoms of PD.

(Coincidentally, most of the authors are associated with my alma mater, the University of Florida in Gainesville, FL).

 

December in July

The title refers to the fact that this post was drafted back in December 2016 as an email InfoShare for the Capitol Area Parkinson’s Support (CAPS) group, which is meeting today (July 15 2017) at 2 PM. Never did send it out. So here it is, a few months late, but the news is still timely. Especially the value of early treatment and diagnosis of PD.  So, here it is:
The London School of Economics and Political Science recently released a report on the “Value of Early Diagnosis and Treatment in Parkinson’s Disease”, a literature review of recent studies with recommendations for action. It can be downloaded at http://www.braincouncil.eu/wp-content/uploads/2016/11/Parkinson-report-2016-1.pdf 
On a broader view of PD,  here’s a link to a page that has links to just about everything Parkinson’s – The National Institutes of Health (NIH) U.S. National Library of Medicine (NLM) Medline Plus topic page on Parkinson’s Disease.
OK – you can spend a week going through all of that information. 
So here are the items mentioned in the subject headline:
First, evidence that DBS is helpful in early stages of PDS, not just in later stages. Benefits extend for at least 5 years.
The PDF copy of the research paper referenced in the above news article can be found at this link:
A less drastic approach than brain surgery might be helpful for motor symptoms:
Next, contradictory evidence regarding whether statins used to lower cholesterol levels offer a protective effect for PD – previous analyses said yes, but further massage of the data reveals that the answer is not as simple as it seemed at first.
Here are links to related articles, papers, and abstracts:
Earlier this year, an analysis of ten reports that yielded different conclusions after adjusting for cholesterol levels.
In 2012, the JAMA Neurology journal published a prospective analysis that indicated statins reduced the risk of PD. (PDF of full article is available for free download):
Several years ago, an analysis found publication bias in favor of positive results, and both a protective effect for statin use and no protective effect for long term statin use:
And last year, an analysis of published reports that found that use of statins was not protective for PD, in contrast to the hypothesis that statins are protective.

Not just a “last resort”- Deep Brain Stimulation (DBS) works for early stages of PD symptoms, too.

Science marches on. Researchers found evidence that DBS is helpful in early stages of PDS, not just in later stages. Benefits extend for at least 5 years:

BALTIMORE — Patients with Parkinson’s disease treated with deep-brain stimulation (DBS) in the early stage of disease show significant improvements in motor skills extending out to 5 years of follow-up, offering encouraging, though preliminary, evidence that the known benefits seen in advanced and midstage disease could also apply to earlier stages.

“We found that not only is DBS combined with medicine better than medicine alone, but we have this longitudinal data showing a sustained benefit for 5 years,” senior author David Charles, MD, professor and vice-chairman of neurology and chief medical officer of the Vanderbilt Neuroscience Institute at Vanderbilt University Medical Center, in Nashville, Tennessee, told Medscape Medical News.

“Even with these small numbers of patients, the separation favoring DBS is dramatic, so this is very encouraging,” he said.

The PDF copy of the research paper referenced in the above news article can be found at this link:
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