Tag Archives: treatments

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

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

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

First: find out whether someone with PD is depressed.

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

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

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

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

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

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

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

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

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

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

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

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

Abstract

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

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

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

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

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

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

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

More to the point:

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

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

You’ll feel better if you do.

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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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diet, Exercise, Parkinson's, Research , , , , Leave a comment

The link between environmental chemicals and Parkinson’s

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Jane Brody of the New York Times wrote a recent review of a new book, co-written by several experts in the field of neurology. These include Dr. Ray Dorsey, neurologist at the University of Rochester; Todd Sherer, neuroscientist with the Michael J. Fox Foundation for Parkinson’s Research; Dr. Michael S. Okun, neurologist at my other hometown at the University of Florida; and Dr. Bastiaan R. Bloem, neurologist at Radboud University Nijmegen Medical Center in the Netherlands.

The book titled “Ending Parkinson’s Disease” calls the occurrence of PD a “man-made pandemic” with references to to many studies that show the high correlation of PD to the exposure to toxic chemicals on farms and in the workplace, as well as animal studies in which PD symptoms were replicated.

Here’s one YouTube video about the book:

Brief overview of the book of Ending Parkinson’s Disease

And here’s a forty minute Zoom presentation by Dr. Michael Okun at the University of Florida on the book’s topics. (unfortunately, there are distracting sounds from participants/attendees who didn’t mute their microphones):

Ending Parkinson’s Disease with Dr. Michael Okun

My next action will be to order the book.

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A review on dance and PD

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Dance classes for Parkinson’s patients was one of the things that got me involved in Power for Parkinson’s© and the Georgetown Area Parkinson’s Support group to begin with. For me, it has helped to improve symptoms and quality of life tremendously.

In this desk review of many studies, the authors came to the following conclusions:

Overall, the reviewed evidence demonstrated that dance can improve motor impairments, specifically balance and motor symptom severity in individuals with mild to moderate PD, and that more research is needed to determine its effects on non-motor symptoms and QOL. RCTs that use a mixed-methods approach and include larger sample sizes will be beneficial in fully characterizing effects and in determining which program elements are most important in bringing about positive, clinically meaningful changes in people with PD.

 Carapellotti AM, Stevenson R, Doumas M (2020) The efficacy of dance for improving motor impairments, non-motor symptoms, and quality of life in Parkinson’s disease: A systematic review and meta-analysis. PLoS ONE 15(8): e0236820. https://doi.org/10.1371/journal.pone.0236820

I have come to the conclusion that every study or review has to include the phrase “more research is needed.” And it is true.

You can read the article in its entirety at the URL in the citation, or download it directly from this link:

The efficacy of dance for improving motor impairments, non-motor symptoms, and quality of life in Parkinson’s disease: A systematic review and meta-analysis

 

Music, Research , , , Leave a comment

Say what?

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Not specifically related to Parkinson’s, this study looked into whether providing musical training to older non-musicians would have an effect on the experimental task.

Experienced musicians outperform non-musicians in understanding speech-in-noise (SPIN). The benefits of lifelong musicianship endure into older age, where musicians experience smaller declines in their ability to understand speech in noisy environments…  results suggest that short-term musical training in older adults may enhance neural encoding of speech, with the potential to reduce age-related decline in speech perception. [emphasis added]

The effects of short-term musical training on the neural processing of speech-in-noise in older adults

… these findings suggest that music training enhances neural responses to speech in speech-motor and control regions.The absence of training-related interactions with noise level suggests that the benefit of music training is related to processing speech in general, and not separating it from background noise;

– BUT analysis of functional Magnetic Resonance Imaging showed electrical activities in a couple of areas of the brain related to speech perception for those who were in the musical training group.

Obviously, “further research is needed,” as the saying goes, and perhaps for longer periods of time.

Whatever type of musical training one chooses, singing, keyboard, string, or wind instruments, there’s another saying that applies to that as well: “It may not help, but it can’t hurt.”

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Music on the brain

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Why do we like some kinds of music but not others?

Back in college, Jerry Coker (who taught jazz improvisation, said that we tended to like music that was not entirely predictable, but that a certain level of surprise increased our enjoyment of jazz. Music that was too unpredictable led to diminished enjoyment. Now, a study has been done that mathematically analyzed people’s enjoyment of musical snippets, and basically confirmed what Jerry taught us. Surprise us every now and then, but don’t make us feel like we’re stupid and can’t guess the next note that’s coming along.

Here’s the article with a reference and link to the original research (if you can afford it): The brain’s favorite type of music

Dopamine’s role in music enjoyment.

In this study, researchers looked at people’s responses to music under three separate conditions. One group received levodopa, another received risperidone, a dopamine antagonist, and a third group received a placebo. Folks in the levodopa group reported and were recorded as having higher levels of enjoyment, and those taking the antagonist, lower levels of enjoyment. Each group[ went through all the conditions, separated by a week in between sessions. The results clearly indicate that dopamine is the brain is related to musical pleasure. Now, if  playing and singing music promote an increase of dopamine in the brain, we have a prescription for Parkinson’s Disease (and depression) that can’t be beat (although it can be counted off).

Dopamine role in musical pleasure    

the actual research article which appears to be available in its entirety online: Dopamine modulates the reward experiences elicited by music

 

 

 

Exercise, Parkinson's, Research, Reviews , , , Leave a comment

A review of non-traditional treatments for PD

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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).

 

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Art, Dance, Medicine, Parkinson’s, Genetics, Oh My!

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Arts and Medicine research – my only wish is that they would look into the possibility of physical changes in the brains of people involved, and not just on co-creating knowledge:

Co-creating knowledge…

Next:

Dance therapy demonstrates a highly appropriate choice of intervention to stimulate plasticity processes, improve age-related deterioration, and thus contribute to successful aging. Health care professionals involved in the care of elderly individuals should whenever possible consider the feasibility of associating dance therapy as a stimulating and therapeutic activity.

Dance therapy in aging: A systematic review

“There were 2,334 studies, out of which 6 were chosen.” This review limited itself to dance as therapy for healthy aging adults, and excluded those studies that looked at Parkinson’s or Alzheimer’s people. Again, I would hope that future studies look at changes in brain activity and structure, as well as observable differences in movement, etc.

Next, an open access article reviewing genetic risks involving Parkinson’s: “This study provides evidence that alleles associated with Parkinson disease risk, in particular GBA variants, also contribute to the heterogeneity of multiple motor and nonmotor aspects. Accounting for genetic variability will be a useful factor in understanding disease course and in minimizing heterogeneity in clinical trials.”

Genetic risk of Parkinson disease and progression: An analysis of 13 longitudinal cohorts

(Will have to read it in order to see what it says,  and compare it with my genome files to see what it means for me).

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Kazoos are good for youse

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

I used to write for this student newspaper:

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

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

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

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

Finger Kazoo: spectrographic acoustic modifications and vocal self-assessment

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

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

Vocal warmups for the individual: Vocal warmups

Vocal warmups for the group: Anatomy of a choral warmup

 

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Old drugs in new bottles

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

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

Felodipine induces autophagy in mouse brains with pharmacokinetics amenable to repurposing

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

Nortriptyline inhibits aggregation and neurotoxicity of alpha-synuclein

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

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