Pasadena is home to the Lineage Performing Arts Center, a refuge for people with Parkinson’s disease. Lineage offers a variety of outreach classes where members can train to regain control of their body while learning to dance. Their free class, Dancing with Parkinson’s, is one of the few programs that blurs the line between art and physical therapy, and people of all ages are welcome. Every year, Lineage hosts a dance show where members get to show off their skills.
Even though Parkinson’s disease is a movement disorder that causes uncontrollable tremors, pain, rigidity, and problems with stability, depression is not uncommon. Students of the class insist it improves their lives. 48-year-old Trish Low has had intense pain ever since undergoing an invasive surgery in which a pacemaker that generates electrical impulses was implanted in her brain. She sought the class to “find some joy” and ended up with friends and increased self-confidence. “To know that I can still shake my booty a little bit, it’s good for my soul.” It has become not only a movement for health and physical fitness, but also for well-being, personal fulfillment, and a meaningful aesthetic experience.
Over two years ago, the company was already performing benefit concerts for medical nonprofits across the country, but in 2009 when dance instructor Michelle Kolb saw footage in a documentary about a dance class from the Mark Morris Dance Group (MMDG), she was inspired to bring David Leventhal, program manager of MMDG’s Dance for PD program, to Pasadena for a training workshop. To this day, they now have more than 1,500 students and a lively community.
At the end of the day, dancers and people with Parkinson’s disease have a lot in common. Professionally-trained dancers are experts in strength, balance, and rhythm. They know about the power of dance as a force of meditation on movement, mind, and body. Dance for PD began as a support group and grew into a catalyst in creating other Parkinson’s communities where participants can explore well-being through singing, yoga, and various performance arts. "Although participants from all over the world tell us they find elements of the class therapeutic, the primary goal of our program is for people to enjoy dance for dancing’s sake in a group setting—and to explore the range of physical, artistic and creative possibilities that are still very much open to them,” says Leventhal.
You can take the Lineage Dancing with Parkinson’s class for free at the Lineage Performing Arts Center on Wednesdays at 2:00 pm. They also offer Dancing through Cancer and Dancing with Down Syndrome. Visit LineageDance.org for more information.
Neurologists and movement disorder specialists in Los Angeles will be providing free Parkinson’s presentations and workshops at this one of a kind event. Join us for fair exhibitors, speakers, and demonstrations related to symptoms and treatment options, nutrition and exercise, and more. Food, refreshments and door prizes will be available. Join us, celebrity host Michael Gross, and Mayor Richard J. Ward for this special event!
Lift Stride, a new app by Lift Labs has been designed to help those with gait problems walk more effectively by creating a metronome on a smartphone. It acts as a personal metronome that can help those with Parkinson’s Disease or other movement disorders walk better. Details below:
A lot of our friends and family who have Parkinson’s Disease have a hard time moving, mostly with walking. In many cases they can only take small shuffling steps, and in the most extreme cases, a total loss of motion occurs where they feel like their feet are actually stuck to the ground.
There are several solutions that are in existence for Parkinsonian mobility problems including drugs (L-dopa) and Deep Brain Stimulation (DBS), though they have their limitations. To help with this, other gait improvement strategies have been researched, and it has been found that sound or visual cues happen to make a difference. Floor markers have been shown to increase stride length, as well as gait initiation. Auditory cues generated by a metronome tend to help when they are set slightly above the user’s typical cadence.
The problem, though, is that metronomes are expensive, bulky, and loud. You can easily buy one online, but most don’t like using them. One of our friends told us that his wife quickly became bothered with the incessant ticking coming from his pocket. While metronome units come with headphones, but they don’t have a volume adjustment, and have long obtrusive wires that get tangled. People are also embarrassed with having some machine attached to them.
With almost half of the US owning a smartphone (and quickly growing), we thought there had to be an elegant solution that we could offer. So, we came up with Lift Stride – a free smartphone app for parkinson’s disease (available for iphone and android). Our app is very simple. All you have to do is turn it on, adjust the cadence to just above your walking speed. You can play around with the setting until you find a pace that works right. The app works best with a Bluetooth headset (which is very discreet and does not look like a medical aid). We are keeping the app free (with zero ads). Our hope is that it will help spread awareness of our company, our talent, and our exciting upcoming products. Download the app here:
Lift Labs, part of Lynx Design, is a group of highly talented people
who are working to create new technologies for the social benefit.
LiftLabs recently released a very useful free iPhone app for those with Essential Tremor and Parkinson’s Disease. Here are the details:
We’ve been listening to a lot of patients with Essential Tremor and Parkinson’s Disease these days, and it seems like a lot of people have a desire for a tremor measurement and monitoring app. Since many people have smart phones (and because of the computing power they now have), we thought it would be useful to create an app that can do just that.
Lift Pulse is a highly intuitive, yet powerful app that is calibrated to measure your tremor frequency and amplitude. To get a reading, hold your phone in your hand and press record. The gray bar will begin to fill as the recording begins. Once the bar is full (after about 10 seconds) the app will move to the analysis screen.
There, you can see a frequency spectrum. Your tremor measurement should appear as a peak between 5 and 10 Hz as shown in the figure above. The tremor measurement and monitoring app automatically finds this peak and integrates it to calculate your overall tremor amplitude in centimeters. The app senses tremor in all directions (x,y,z) of the phone and calculates your overall magnitude.
Lift Pulse allows you to compare your tremor to a pre-set baseline. To set your baseline (this could be on an average day for you), take a reading and then tap on the circle showing your amplitude in Cm. Any future tremor measurement and monitoring readings will be compared to this saved baseline and the circle showing your amplitude will change (from blue to red) depending on how much above or below the baseline you are.
The best news is that this tremor measurement and monitoring app is currently free! It is our hope to spread goodwill and generosity in order to support those in need of help. If you have any suggestions, please leave a comment or contact us at firstname.lastname@example.org.
Lift Labs, part of Lynx Design, is a group of highly talented people
who are working to create new technologies for the social benefit.
Parkinson’s clearly affects more than just the person with Parkinson’s. While many people feel its effects, one person usually takes on the role of primary caregiver. When asked what they felt to be the most burdensome tasks, caregivers most commonly answered transportation, followed by housekeeping. Other research suggests difficulties in Parkinson’s disease social dynamics also stem from the change in role a caregiver experiences — e.g., more than just a spouse.
To remember ways to reduce caregiver burden, remember the acronym EARS: Education, Assistants, Resources, and Self-Care. First, as a caregiver it is important to Educate yourself. Knowledge can significantly reduce anxiety and stress. Make sure you understand the medications that your partner is taking; know the proper dosage and what to look for — both the intended benefits and possible side effects. Learn about the common symptoms of the current stage of your partner’s PD, even if you don’t want to know everything about future symptoms. Second, recruit some Assistants. Form a team. You may be the captain, but you do not need to be the lone caregiver. Let family and friends know that they can help with things like transportation and housekeeping if they prefer not to provide direct patient support. Third, research caregiver Resources. Both the PD Association of Los Angeles and local support groups are good places to start. In California, the California Department of Health Services operates eleven caregiver resource centers that provide core services to families and caregivers at little or no cost. Finally, the S in EARS: Self-Care. As a care partner, taking the time to honor, value, and love yourself is not a luxury; it is an absolute necessity. Even though your caregiving responsibilities can seem overwhelming, it’s okay if your loved one’s disease does not always take center stage. At times, it may be necessary for you to ask for help. This will allow you to be in charge of your own life so you can better advocate both for yourself and your loved one. Dedicate a small amount of time each day to your well-being. Eat well, exercise, get rest. These should be priorities along with caregiving. EARS: Education, Assistants, Resources, Self-Care.
This article was provided by PDALA.
People with Parkinson’s disease are at increased risk for developing melanoma, a potentially fatal form of skin cancer, a study found in Neurology shows. The researchers analyzed 12 studies of people with both Parkinson’s disease and melanoma. These studies were conducted from 1965 and 2010, and most had fewer than 10 people with both conditions.
When compared to those without Parkinson’s disease, men with Parkinson’s were twice as likely to develop melanoma. Women with Parkinson’s disease were 1.5 times as likely to be diagnosed with this form of skin cancer. Parkinson’s disease was not associated with an increased risk of other types of skin cancer.
Exactly how the two conditions are linked is not fully understood. Initially, there was some suspicion that a Parkinson’s medication called levodopa may be responsible for this increased risk, but this has not been substantiated. There may be some genetic of environmental risk factor that serves as the common denominator between the two conditions. “Further research is needed to examine the nature and mechanisms of this relationship in order to advance our understanding about the [causes] of both diseases,” conclude researchers who were led by Honglei Chen, MD, PhD, with the National Institute of Environmental Health Sciences in Research Triangle Park, N.C.
Get Annual Skin Exam
This increased risk needs to be placed in its proper perspective, says Roy Alcalay, MD, an assistant professor of neurology at Columbia University Medical Center in New York City and an advisor for the Parkinson’s Disease Foundation.
“Melanoma is an extremely rare cancer, and Parkinson’s disease doubles the risk of what is still a very rare cancer,” he says. “Get your skin checked by a dermatologist each year.”
This advice is important for everyone — not just people with Parkinson’s disease. Other cancer screening tests are also important for people with Parkinson’s disease. Andrew Feigin, MD, an associate investigator at the Feinstein Institute for Medical Research in Manhasset, N.Y., says the new report stresses the importance of regular skin checks. He conducts studies of Parkinson’s disease, and says that annual dermatologic screening exams are often part of the protocol. “This study doesn’t suggest people with Parkinson’s disease need screening tests more often, but people with Parkinson’s disease should be more careful about sticking to the recommended screening schedule,” he says.
“The message for anyone, especially for those who may have an increased risk for melanoma, is to go and get skin exams,” says Michelle Greene, MD, a dermatologist at Lenox Hill Hospital in New York City.
“Know the signs of melanoma,” she says. Suspicious moles may be asymmetrical, have ragged, notched or blurred borders, and changes in color distribution, size, or shape.
Recent Parkinson’s research has provided compelling and vital evidence that not only everyone, but people with Parkinson’s disease should be active regularly.
Exercise improves the brain’s potential for “neuroplasticity”, that is, the ability for the brain to overcome damaging conditions like stroke, MS or Parkinson’s by redistributing mental real estate and adapting or compensating for lost or malfunctioning neural circuits.
Exercise improves daytime alertness in normal healthy individuals while in those with Parkinson’s it also reduces the troublesome symptoms of daytime fatigue and sleepiness. Regular exercise stabilizes the brain chemicals serotonin and dopamine, both involved in staying awake and alert.
Exercise has also shown to be effective in improving happiness. Depression is common in Parkinson’s, likely because of a dopamine deficiency and its interaction and influence on brain serotonin levels. Since those with depression have lower brain serotonin, they benefit from the chemical stabilization effects of exercise.
Dopamine is the brain chemical that motivates us by making us feel good when we experience exciting or rewarding situations. It has been shown that exercising raises levels of dopamine at active sites in the brain. This decreases the incidence of Parkinson’s symptoms and even makes healthy people feel good. What happens is that at the microscopic level, a key protein grabs on to free dopamine and pulls it back into the cells that produce it. Exercise reduces the activity of that protein thereby making dopamine more available, thus improving symptoms in Parkinson’s disease, and making normal healthy people feel good.
Exercise enhances dopamine’s effect on the brain by increasing the number of dopamine receptors, proteins that bind to dopamine and activate brain cells that use it. This helps people with Parkinson’s disease who have less dopamine around to utilize in activating those brain cells. In all people, increasing the number of the dopamine receptors reduces compulsive and addictive behaviors.
Glutamate, one of the brain chemicals used when brain cells want to signal other brain cells by stimulating them, can cause overstimulation and even cell death. This phenomenon is referred to as “excitotoxicity” and in Parkinson’s disease the dopamine-producing cells are particularly vulnerable to it. Exercise stabilizes glutamate levels in the brain, reducing the chances of stress-induced burnout and the worsening of Parkinson’s symptoms caused by the death of these dopamine cells.
Regular exercise can help prevent the onset of type II diabetes. This is good for everyone and especially good for Parkinson’s patients because there is an association between the genetic factors that worsen the two diseases. Preventing one might theoretically prevent or reduce the severity of the other.
Regular movement trains your body for other types of exercise or physical activities. By exercising, you are in better shape to perform even more beneficial types of exercise and also have improved capacity for more enhanced levels of activity during such exercise.
Exercise improves general coordination and balance. This is especially beneficial to patients with Parkinson’s disease who very often have compromised balance. It makes everyone less likely to suffer common household accidents like falls that kill thousands of otherwise healthy people each year.
Exercise improves the performance of your cardiovascular system and limits atherosclerosis, a disease of the arteries that is characterized by the deposition of plaques on the inner wall. An improved cardiovascular system means improved blood flow capacity to all areas of the body, including the brain. The efficiency by which regions of the brain perform tasks like learning or adapting to damaging situations intimately depends on adequate blood flow.
It is easy to get discouraged about exercising when you haven’t done it in a while, but building on top of small activities and accomplishments will surprise you with how much you can really do! Set small goals you know you can achieve safely and reasonably, and you can be on track to a healthier life before you know it.
NeuroDerm, Ltd. announced that enrollment of healthy subjects is ongoing in its Phase I clinical trial of ND0612, a novel drug formulation for the treatment of Parkinson’s disease. ND0612 is a proprietary levodopa/carbidopa liquid formula administered continuously via a subcutaneous delivery patch device. It is designed to provide steady levodopa blood levels and enhanced bioavailability of oral levodopa for the reduction of motor complications in Parkinson’s disease.
In pre-clinical studies of ND0612, plasma concentrations of levodopa reached straight-line steady state levels. The current Phase I double-blind, dose-escalation trial in young, healthy volunteers will assess ND0612 for safety and tolerability as well as for levodopa and carbidopa steady state plasma levels.
“This first trial of ND0612 in man is a significant step in the development of a new levodopa treatment standard for Parkinson’s disease,” said Oded S. Lieberman, PhD, NeuroDerm’s Chairman and CEO. “For many years, oral levodopa has been the leading Parkinson’s disease drug therapy. However, due to low and erratic oral levodopa bioavailability, advanced Parkinson’s patients suffer from debilitating motor complications even under the best current standard of care. Should ND0612 achieve constant levodopa base blood levels, than low, harmful levodopa trough levels would be prevented, the efficacy of current levodopa therapy could be significantly raised and a new standard of care in our ability to treat and reduce motor complications in Parkinson’s disease patients may be established.”
CSF Panel Analysis for Diagnosis of Dementia and Parkinsonian DisordersA panel of five markers was useful in distinguishing among various dementing and parkinsonian diseases in a clinic-based patient sample.
The differentiation of Alzheimer disease, parkinsonian disorders with dementia, and other forms of dementia has proven difficult. To address this diagnostic dilemma, investigators assessed the value of a panel of cerebrospinal fluid markers (CSF) in distinguishing among diagnoses in 346 patients with various dementing disorders and 107 controls (with no parkinsonian or cognitive disorders). The disorders were Parkinson disease (PD), PD with dementia (PDD), dementia with Lewy bodies (DLB), Alzheimer disease (AD), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD).
Primarily in comparison with controls, the investigators found the following differences:
- Alpha-synuclein was increased in patients with AD but was decreased in patients with PD, PDD, DLB, or MSA.
- Beta-amyloid 1–42 was lowest in patients with AD but was also depressed in DLB patients.
- AD patients showed an expected increase in total tau and phosphorylated tau.
- Neurofilament light chain was increased in PSP, MSA, and CBD patients compared with both controls and the other diagnostic groups. The authors conclude that use of all the biomarkers together (as a panel) could allow AD to be differentiated from DLB and PDD. Light chain analysis predicted atypical parkinsonism without the need for the other elements of the CSF panel.
Comment: Even experienced clinicians have surprising difficulty in differentiating dementia and parkinsonian disorders, being proven wrong at postmortem examination in 15% to 20% of cases. The current study is important in proposing a panel of CSF markers that, when used together, might improve the sensitivity and specificity of diagnosis. One major study limitation was the lack of postmortem diagnostic confirmation, which is difficult to obtain.
Clinicians in practice typically follow dementias and parkinsonisms over many years. The diagnosis of AD, DLB, PD, and parkinsonism all reasonably separate based on the history and clinical, neuropsychiatric, and neuropsychological examinations. Outside of the research setting, a CSF sample would not seem necessary unless early diagnosis could lead to disease-modifying treatment or better symptomatic treatment. A novel finding in this study was that neurofilament light chain alone was helpful in differentiating PD from parkinsonism, but not in differentiating each specific parkinsonian disorder. Neurofilament light chain assessment could be useful clinically, especially when imaging is equivocal and deep brain stimulation is being considered. Neurofilament analysis may also prove important as a marker of the rate of disease progression.
Written by Michael S. Okun, MD, published in Journal Watch Neurology September 18, 2012. Citation: Hall S et al. Accuracy of a panel of 5 cerebrospinal fluid biomarkers in the differential diagnosis of patients with dementia and/or parkinsonian disorders. Arch Neurol 2012 Aug 27
Parkinson’s disease (PD) is a movement disorder that is chronic and slowly progressive, where nerve cells in the brain (substantia nigra pars compacta) start to die well before physical symptoms occurs. These cells produce dopamine, which helps with motor (physical) movement such as walking, speed of movement, and fine motor coordination. The symptoms that occur before physical symptoms are called pre-motor or non-motor symptoms. These are red flags that signal a potential increased risk of Parkinson’s disease.
Non-motor symptoms with the highest risk:
- REM behavior sleep disorder (acting our dreams in sleep by talking or moving arms and legs) with an average of 12 years before physical symptoms.
- Decreased or no sense of smell (hyposmia or anosmia) as much as 5 years or more before physical symptoms.
- Constipation (less than one bowel movement/day) with an average of 3 years or more before physical symptoms.
Depression, anxiety, cognitive difficulty (thinking or processing), apathy, and visual disturbances are also non-motor symptoms.
Motor symptoms occur when 50%–70% if the nerve cells in the substantia nigra have died. Two out of three symptoms that are used in diagnosis are:
Usually a decrease in volume of one’s voice, small handwriting, decreased arm swing and shuffling or taking shorter steps are early motor signs as well.
Parkinson’s disease is a clinical diagnosis made by physician. There is no blood test or imaging to diagnosis idiopathic Parkinson’s disease.
Parkinson’s disease is frequently misdiagnosed as essential tremor or mistaken for multiple system atrophy or other atypical Parkinson’s syndromes that don’t respond to medications by general neurologists, neurosurgeons or other physicians. A movement disorder specialist is a neurologist who does an extra one to two years of training (a fellowship). Any neurologist can call themselves a movement disorder specialist, so find out if they have done a fellowship.
Exercise, medications, and deep brain stimulation surgery can help the symptoms of Parkinson’s disease, allowing patients to be more functional. Lack of sleep worsens symptoms. There is no cure for Parkinson’s disease yet, however research is getting closer to understanding Parkinson’s disease and identifying biomarkers that can help in early diagnosis and following progression.
I’m often asked about what kinds or modes of exercise are both appropriate and effective for those wanting to empower themselves and do what they can to improve their condition. There are many exercise disciplines that can help, but essentially an exercise program for individuals with Parkinson’s should be both enjoyable and customized to the individual’s current status. The primary objective is to improve or maintain function by addressing the following physiological aspects through exercise:
- Proprioception (the sense of the relative positioning of your body and limbs in space)
- Hand-eye coordination
- Movement initiation
- Coordination of body and limb movement
Parkinson’s Disease & Exercise: Fighting Back
There is much you can do to make life better, and the process can be enjoyable and fun. Pursuing a coordinated fitness program has proven to be extremely effective in empowering individuals living with Parkinson’s disease to fight back and improve their quality of life. There is currently no cure for Parkinson’s, but a properly designed exercise program has been shown to significantly delay, slow, and even reverse the onset of some Parkinson’s symptoms.
There will be good days and bad days but be courageous and be heartened by the fact that you can improve your quality of life, no matter what your age or level of PD involvement. Every time you complete a workout, you’ve won a battle. So get going and take charge. Medications administered for this disease have made great strides, but daily exercise and physical activity are essential in maximizing their benefits. It can be wonderfully motivating to know that with a comprehensive approach to fitness, you can exercise your right to live life to its fullest!
There are four major components of a properly designed exercise program that you should be aware of to competently address the above physiological aspects:
- Muscle Strength
- Cardiovascular Fitness
- Posture & Flexibility
- Balance & Coordination
Increasing the strength of your muscles is the foundation of your fitness program. This will improve your stability and confidence. Strength training with weight bearing exercises or resistance bands is a wonderful, safe way to build muscle and increase strength. But there are other important adaptations that occur in your body through a progressive strength training program. The connective tissues of our bodies, ligaments, and tendons also adapt and are strengthened as a result of a resistance training program. Bone density is another vitally important element to address as we age. Weight bearing exercises help us avoid conditions such as osteoarthritis, osteopenia or osteoporosis by building strong joints and sturdy bones.
Walking, swimming, running, biking, boxing, dance, and movement disciplines such as tai chi are great and safe ways of conditioning the aerobic system. The function of the cardiovascular system is important in improving circulation, respiration, heart function, muscular endurance, and alertness. The best way to train this energy system is through concentrated, repeated movement that tasks your aerobic system for a specific duration of time. In other words, focus your exercise, get your heart rate up, and keep it up for the length of your workout. Then, the next week, try a small increase to the level of exertion, or the duration. People often ask me what the best activity for aerobic exercise is. The specific activity you choose is not that important, but it should be one that safely raises your heart rate above to which it is accustomed, and an exercise activity that you enjoy. Walking or running, and the stationary bike are wonderful modes of exercise for those with PD. If balance makes walking or running difficult, the bike or elliptical machine are great and safe ways to cause cardiovascular improvement.
￼Your Central Nervous System (CNS) will also benefit from exploring other, unfamiliar modes of aerobic exercise. Forcing the CNS to adapt to a different, repetitive activity is powerful therapy for the individual with Parkinson’s. Anytime you can challenge your brain to reach out to the body through the CNS and perform a new movement, it’s a wonderful, therapeutic reinforcement of the mind-body connection. You could start with a simple 20 minute brisk walk, 3 times a week. The following week, add a fourth walk. The following week, add 2 minutes to each walk, etc.
Posture & Flexibility
Parkinson’s can create stiffness of movement and muscle tone as well as bradykenesia or slowness of movement. A great way to combat this symptom, and even reverse some of its effects, is a comprehensive flexibility program. Range of motion exercises can also help minimize muscle stiffness. Understanding proper posture and practicing good posture every day, is extremely beneficial. Knowing how we maintain correct spinal position, and the mechanics of how we should stand, how we should sit, how we should move, and how we should lift objects is critical to preserving and restoring spinal health. This will also reduce the chance of a dangerous fall. Exercises that create muscle memory or a muscular imprint of proper posture should be practiced every day. Every time you move, change position, or bend down and lift a gallon of milk is an opportunity to reset and practice good posture. Get into the habit!
Balance and Coordination
As Parkinson’s progresses it makes things that were once automatic and easy, challenging. Thus, we must begin to understand the methodology of movement, and practice techniques for everyday mobility. So, we must first intellectually understand what our body must do in order to achieve an action. We must know all of the specific steps that must be executed, and in which order. Being mindful of our movement throughout the day is now important. Strategies such as getting out of a chair, descending a flight of stairs, and getting in and out of a car now have a method and need to be intellectualized, memorized, and practiced. Exercises requiring a proprioceptive skill and stabilization reinforce the brain’s ability to activate muscles and maintain your balance.
How much should I exercise?
That’s easy to remember. You should do something every day! You don’t need to perform a full workout each day, but you should incorporate at least two of the four major components of exercise every day of the week. It’s important to stay active and engaged with life, so empower yourself, challenge yourself, and get up and exercise your right to have a healthy and happy life.
Take charge of your own wellbeing. Empower yourself and improve your quality of life by finding activities you enjoy. Exercise should now be a part of your daily life. It’s never too late to join the fight and see tangible results that make things just a bit better. That’s a battle that you can win.
By Patrick LoSasso, Certified Personal Trainer, CSCS.
Patrick is on the Board of Directors of The American Parkinson’s Disease Association Los Angeles Chapter. Patrick has developed a specialization in working with individuals with Parkinson’s disease (PD) called ReGenerations-PD (Rejuvenating Exercises for the Generations living with Parkinson’s Disease). Above is an excerpt from his exercise manual The BrainBall-FX. If you have any questions you may email him atPatrick@PreventionThruFitness.com.
Parkinson’s is a disease that, in addition to causing neurological challenges, can affect your neuromuscular and skeletal system. So regardless of your stage of the disease, it’s important that you understand its potential effects and where the challenges may manifest themselves. If you’re experiencing some of the symptoms below, it would be helpful for your exercise program to incorporate exercises that will address these conditions. If you’re primarily symptom free, a comprehensive and intensive exercise program will help you postpone or minimize the effects.
Back pain is common in the unaffected population as well as those with PD. I have found much success in both communities with a systematic treatment which combines heat, exercise, stretching, massage, and ice. Consult your doctor and ask if any of these techniques are appropriate for you. Finding the right combination can be extremely pain-relieving as well as physiologically beneficial.
Degradation of Posture
Left alone, the individual with PD may begin to approach what is called the Parkinson’s posture, which is a slumped forward position with protracted shoulders and forward turned hands. This is very difficult on the spine and can cause tightness of muscles in the chest and shoulders as well as tightness in the hip flexors and neck. This contributes to shoulder and low back problems. Here, strengthening the muscles of the upper back and the postural muscles of the spine is key to preventing and correcting this condition. You will also want to stretch the anterior (front) muscles of the upper body: the chest and shoulder musculature (the doorway stretch is excellent for this). You will also want to improve the strength of the posterior muscles of the upper back: rhomboids, scapular stabilizers, trapezius, etc. The ￼￼￼￼stretching of the chest and the strengthening of the back muscles will help pull the shoulders back, the head up, encouraging the body into a more proper posture position.
Dyskenesia or involuntary movement can occur in the PD individual. This can be as subtle as a quiver of the lip to an extremely disrupting and frustrating shaking of a limb. Studies have shown that intense cardiovascular exercise performed on a consistent schedule can reduce the intensity of the symptom. The stationary bike is a wonderful and safe option, as is swimming, jogging, power walking, boxing, elliptical, water aerobics, and others. So dedicate yourself to 30–50 minutes of this exercise 3 to 5 times a week.
You may experience muscle stiffness with PD. You need to focus on getting oxygen to the muscles through exercise and implementing stretch and massage as much as possible. Dedicating 20–30 minutes a few times a week just to stretching and massage will make a difference. But always, always, always, begin this with a 10 minute warm up. There is no point in stretching a cold muscle. This puts undue stress not only on the muscle, but on the tendon that attaches the muscle to the bone. The type of stretch most of us have been taught is what is called a static stretch. This involves holding a stretch of the muscle from attachment point to insertion point. Another very useful type of stretching called myo facial release. Myo facial release stretching involves applying pressure to the belly of a muscle, while it is being stretched statically, or from end to end. This can be a great way of loosening up the soft tissues.
Reduction in Range of Motion
Joint stiffness and reduced activity will cause losses in functionality and reduction in range of motion. The best approach to improve this is through a combination of strength training, flexibility, and movement. You’ll want to improve the suppleness of the joints by keeping the ligaments, tendons and muscles soft and pliable. And you’ll want to improve the strength of the musculature around the joint so that the limbs can lift and rotate through the proper ranges of motion. Muscle stiffness and reduction in oxygen to the muscles of the core and postural musculature can create difficulty in trunk or torso rotation and contribute to poor posture. Chair rotation exercises involving hip stabilization and trunk rotations while attempting to maintain proper spinal alignment can be a wonderful way to open up the body and drive nutrients and oxygen to the muscles and soft tissues.
The ability to maintain balance requires muscle strength and proprioceptive awareness. When balance is lost, the individual must be able to react, correct, and stabilize. The components to work on to improve balance are muscle strength, proprioceptive awareness, and stepping drills that imitate common lower extremity movement patterns that will help correct and improve stability. PD can cause slowness of movement or problems with initiation of movement. Speed drills and exercises involving exaggerated movement can help. If you’re taking small and slow steps, push yourself to both exaggerate your movements and move quicker than you feel you’re able. You may be uncomfortable at first, but most likely, you’ll be moving at a safer and more appropriate speed.
Freezing often is a symptom that can affect an individual with PD. There are tricks you can find that will get you beyond this point. Everyone is different and you must find the technique that works best for you. The first thing you should do is to stop, and reset. Take a ￼￼￼moment to reset your posture. Take a deep breath and get a clean slate. Your feet may feel glued to the ground. If this is the case, one of the tricks is to focus your sight on a point beyond your destination and make that your target destination. Then begin shifting your weight from side to side, back and forth, as you gradually begin to lift your feet. When you feel you’re ready, take a big step forward and initiate your walk. Make it a big first step and stride forward with exaggerated movements. But always move with a focus on balance and safety.
Loss of Proprioceptive Awareness
As PD progresses there is a tendency to lose your awareness of where your limbs and body are positioned (1). In studies, the medications associated with PD such as Levodopa have shown to also interfere with this sense. Exercises such as open and closed eye balancing exercises have been shown to improve this awareness. A useful tool for improving this is the balance board or the Bosu ball or a foam pad. Always practice balance with a stabilizing object near by for safety because to improve this awareness, you must encounter moments of instability.
Difficulty with Eye Tracking
Testing of PD individuals has shown that there is a progressive difficulty of hand-eye coordination as well as a loss of the ability to track an object with the ocular muscles (the muscles that control the eyes). Training ocular muscles can be as simple as holding a thumb up and following it from left to right. Incorporate activities that involve hand eye coordination challenges into your exercise program. This can be both effective and fun.
- Sponsor of study: Department of Veteran Affairs, Collaborator University of Iowa. Title: Effects of Aerobic Exercise in Parkinson’s Disease. (1) J Neurol Neurosurg Psychiatry 2001; 71:607–610
- Journal of Neurology, Neurosurgery & Psychiatry “Proprioception in Parkinson’s disease is acutely depressed by dopaminergic medications.
By Patrick LoSasso, Certified Personal Trainer, CSCS.
Patrick is on the Board of Directors of The American Parkinson’s Disease Association Los Angeles Chapter. Patrick has developed a specialization in working with individuals with Parkinson’s disease (PD) called ReGenerations-PD (Rejuvenating Exercises for the Generations living with Parkinson’s Disease). Above is an excerpt from his exercise manual The BrainBall-FX. If you have any questions you may email him atPatrick@PreventionThruFitness.com.
This article is based of a presentation given by Ben Mishico, president of Hello! Home Care.
Making getting around and eating easier
- Use an adjustable cane with a comfortable handgrip.
- Hiking poles can also be useful and can promote better posture if adjusted correctly. Your forearms should be roughly horizontal or 90 degrees to your body.
- Don’t use a cane with three or four point bases. People living with PD often have trouble keeping all points on the floor.
- Avoid using a wooden cane if it is not sized correctly. The cane height should be as high as the break in your wrist when standing straight with arms at your side. Using an adjustable cane makes getting this just right an easy task.
- Use a four-wheeled walker. Essential features are large swivel wheels and handbrakes. Walkers that come with a basket and a seat are most helpful.
- The standard walker is not recommended. People living with PD may lose balance when picking up the walker to move.
- Stretching, balance and posture exercises help prevent falls. Ask your physician to send you to physical therapy. Doing home exercises to help reduce fall risk is important.
- Try and schedule meals around times when the medication is working best your “on-times”.
- Sit up as straight as possible during meals. Continue to sit up straight for an extended period after finishing your meal.
- If you have difficulty swallowing try using a straw with thin liquids. This helps control the volume of water entering your mouth.
- Cut up your food into very small pieces. Don’t try and force yourself to swallow the entire bite or sip. Swallow a few times per bite or sip to make swallowing easier.
- Use eating aids. Special utensils, plates and cups can make eating easier and more enjoyable.
Some useful utensils
- Angled Utensils: Makes picking up food easier.
- Nosey Cups: Makes drinking easier. It allows you to drink without tipping the head back.
- Rocker Knife: Makes cutting food easier with a rocking motion.
- The Hi-lo Scoop Plate: Helps keep food on the plate. Non-slip matting can also be used to keep the plate in place. Dycem is the name of one company that makes these products.
Making toileting, bathing, and grooming easier
- Limit caffeine intake. Caffeine in very high doses can act as a diuretic and therefore increase the frequency of urination.
- Decrease fluids either two hours before bedtime, after dinner or earlier to reduce waking up at night to use the bathroom. Sleep deprivation worsens symptoms of Parkinson’s Disease.
- Put your bathroom trips on a regular schedule. Try going to the bathroom every couple of hours.
- Put a bell in the bathroom so that friends and care providers can be alerted if you need help.
- Use a bidet. A good quality bidet has both a warm water spray and dryer, which can make cleaning much easier.
- At night use a portable urinal and or bedpan if you find getting out of bed to make trips to the bathroom is too difficult.
- Incontinence products such as briefs and pads can also be helpful if you find it difficult to make it to the bathroom. Using washable pads in lieu of disposable plastic pads that go over the bed sheets can help keep the bed dry and also saves money.
- It is essential to use a non-skid rubber bath mat to prevent slipping.
- Using a shower stall is much easier and much safer than a shower/tub combination. If you must use a shower/tub combination, it is advisable to use a transfer bench. This is a seat that you sit on which allows you to scoot from the outside to the inside of the tub.
- Installing handrails is essential. The showering area should have at least two handrails installed. Do not use the towel rack, soap dishes, etc. for support.
- Use soap on a rope or tie one leg of a pair of nylons to the handrail and drop a piece of soap into the nylon leg. Then lather up through the nylon.
- Bring a cordless phone into the bathroom so that you can call for help in the case of a fall.
- Using an electric toothbrush and razor can make brushing your teeth and shaving easier.
- Use a hair dryer stand so that hair drying can be performed hands-free.
- Sit down when grooming to reduce the risk of falling and to conserve energy. When you are seated you can prop your elbows on the sink counter to reduce the tension on your shoulders.
Source: National Parkinson Foundation Activities of Daily Living
The survey was conducted by Harris Interactive® on behalf of the Advancing Parkinson’s Trials campaign, sponsored by major Parkinson’s disease and movement disorders groups, including WE MOVE. The survey was funded by The Michael J. Fox Foundation, and was conducted in the United States between January 17, 2005 and March 2, 2005. Five hundred physicians who treat patients with Parkinson’s disease, including 250 neurologists and 250 primary care physicians/gerontologists, responded online, while 518 patients responded via mail. Sampling errors were 5–9%, and samples were not necessarily representative of patients or physicians as a whole.
Results from the survey showed:
96% of physicians and 95% of patients agree that clinical trials are necessary to find better treatments for the disease.
65% of neurologists and 54% of PCPs/gerontologists have discussed clinical trials with 10% or fewer of their patients with Parkinson’s disease.
53% of neurologists and 83% of PCPs/gerontologists have never referred a patient to a clinical trial.
11% of patients report that their doctor ever suggested that they participate in a trial.
Patient awareness of clinical trials comes primarily from support groups (40%) and other people with Parkinson’s disease (27%), rather than their doctors (11%).
14% of primary care physicians, 21% of neurologists and 18% of patients surveyed indicated that they are somewhat or very satisfied with the amount of information available about clinical trials for Parkinson’s disease.
52% of physicians would not recommend that a patient enroll in a trial if their disease is well-controlled.
72% of patients expressed concern about continued access to medication once the trial has stopped.
To learn more about clinical trials visit The Micheal J. Fox website and read Clinical Trials 101. Learn about the facts of clinical trials and how it can help you and others that share medical condition you or your family might have.
If you’re interested in clinical trials going on in your area click on the following links:
Most medications for Parkinson’s disease address the hallmark issue of dopamine deficiency–most specifically the drugs levodopa and carbidopa. However, because treatments do not consistently control PD symptoms, “off time” occurs when the beneficial effects of the drug wear off and symptoms begin to return. While off time in Parkinson’s patients can be difficult to manage, there are improvements in the works. A trial found that levodopa-carbidopa intestinal gel (LCIG) reduced off time by an average of two hours per day when compared to standard oral levodopa-carbidopa.
A key element of the positive results is the mechanism by which this treatment works. “’Off’ time was reduced because the infusion of levodopa-carbidopa intestinal gel (LCIG) helps to deliver levodopa-carbidopa continuously, thereby avoiding the fluctuating levels that occur with standard oral levodopa-carbidopa therapy and that are thought to contribute to the development of wearing off,” said study author C. Warren Olanow, MD, Professor of Neurology and Neuroscience at the Mount Sinai School of Medicine in New York and a Fellow of the American Academy of Neurology.
Recently presented at the American Academy of Neurology’s 64th Annual Meeting in New Orleans, this study offers progress towards improving the quality of life for many PD patients. To read more about it, read the full press release at the American Academy of Neurology.
There are always new treatments for Parkinson’s disease on the horizon and with so many minds working on this, developments are inevitable. A particular drug, dipraglurant, has shown promising results when tested for the treatment of levodopa-induced dyskinesia (PD-LID). The approach is to block a specific glutamate receptor that has previously been linked to excess glutamate activity in those with Parkinson’s disease. A recent trial of 72 patients studied aspects such as safety and the results were reportedly positive. According to a recent press release, “dipraglurant appears to reduce dystonia severity in addition to chorea, the two major LID components.”
Since no drug has yet been approved by the FDA to treat dyskinesia, progress here is welcomed. For more details, see a summary at Addex Therapeutics.
ProteoTech, Inc., a privately held biotechnology company, has entered into a drug development agreement with GlaxoSmithKline R&D Company Limited to collaborate on ProteoTech’s small molecule technology platform against misfolded proteins to specifically advance work on its alpha-synuclein therapeutic program for the treatment of Parkinson’s disease and other synucleinopathies.
Steve Runnels, CEO of ProteoTech, stated “We are pleased to be working with GlaxoSmithKline on the identification and optimization of new therapeutic compounds for Parkinson’s and other synucleinopathies, such as Lewy Body Dementia and Multiple System Atrophy. We are excited to be working with this leading pharmaceutical company on this important project which further validates ProteoTech’s small molecule approach for developing therapies against diseases caused by misfolded proteins.”
Initial support for ProteoTech’s alpha-synuclein therapeutic research program was funded over a four- year period by the Michael J. Fox Foundation for Parkinson’s Research (MJFF). Todd Sherer, PhD, the Chief Executive Officer of the MJFF commented, “We have followed ProteoTech’s success on this therapeutic development program over the years and are extremely pleased to see this collaboration between them and GlaxoSmithKline to accelerate the development of a potential disease modifying treatment for this debilitating disease. This is what we all hoped to see when ProteoTech was initially granted the LEAPS award from our Foundation.”
About ProteoTech: ProteoTech is a private drug development company located in the Seattle, WA area (Kirkland, WA), and is focused on targeting amyloid diseases caused by protein misfolding. Besides the Company’s SynuclereTM program, in late pre-clinical development for the treatment of Parkinson’s disease, ProteoTech is developing Exebryl–1® for the treatment of diseases caused by beta-amyloid protein and tau protein aggregates and fibrils; and is in early human clinical studies with SystebrylTM for the treatment of Systemic AA Amyloidosis. The Company is also in late pre-clinical development for a novel small peptide (PepticlereTM) for the treatment of Alzheimer’s disease beta-amyloid protein aggregates. For more information please see the Company web site at Proteotech.com.
There are few medical diagnoses more life changing than Parkinson’s disease. This neurodegenerative disorder is detected in some 70,000 people in the U.S. each year; Michael J. Fox and Muhammad Ali are best known for having Parkinson’s disease.
As a neurologist, I find it particularly tragic that most of these patients are referred late and do not find out they have Parkinson’s until they are already suffering from severe tremors, walking difficulties, loss of smell and other physical manifestations of the disease.
Parkinson’s occurs when dopamine-producing cells, which control aspects of movement, diminish in the brain. We know that the disease starts working its damage long before physical symptoms show up. Parkinson’s can take as long as 12 years or more to develop, and the first mild symptoms are often mistaken as part of the normal aging process.
Because there are no simple tests to detect Parkinson’s in its early stages, it can take up to two to three years to accurately diagnose the disease. By the time someone has their first physical sign—tremor, rigidity or shuffling gait—50 percent to 70 percent of the brain cells that produce dopamine, which controls movement, have already died. Unfortunately, there is little that we physicians can offer patients at that point other than damage control. If we could intervene earlier on, we might be able to stave off or delay the progression of disease through neuroprotection. In Pasadena, we have the first FDA-approved radiopharmaceutical imaging agent that can help physicians evaluate patients with suspected parkinsonian syndromes (PS) and related diseases. It is called DaTscan. Despite the unavailability of a simple blood test, tools like DaTscan can offer evidence that may help lessen diagnostic uncertainty and confusion for early-stage Parkinson’s patients and their families.
When DaTscan is combined with a single photon emission computed tomography (SPECT) brain scanner, it produces visual evidence of the amount of dopamine transporter cells, allowing physicians to determine whether occasional tremors are the result of Parkinson’s or some other cause.
DaTscan has been in available in Europe for more than 10 years. The FDA approved the imaging agent for use in the U.S. in January 2011. I scanned the first patient in Pasadena with it on September 6. I believe that DaTscan will revolutionize both neuroimaging and the treatment of Parkinson’s as more and more hospitals and physicians learn about this method.
DaTscan can also detect Parkinson’s disease by detecting early risk factors (red flags) alone or in combination, that may appear more than a decade before physical symptoms, such as decreased or lost sense of smell or certain sleep disorders, but these uses are not yet FDA-approved.
Just think how much we could slow down this difficult disease and improve lives of patients and their caregivers if we are able to act before the symptoms of Parkinson’s become debilitating and ensure that treatment recommendations are appropriate. I am certain that early detection is the future for Parkinson’s disease. Dr. Jerome Lisk is a physician at Southern California Movement Disorder Specialists, 65 N. Madison Ave. Suite 410, Pasadena. 626-792-6683. www.socalmds.com
Parkinson’s disease, a neurodegenerative disorder effecting 0.3% of the world population and growing, could have a new effective treatment. Parkinson’s disease is classically characterized by muscle rigidity, tremors, and slowed physical movement, but a new treatment named Cogane could could directly fight it with less side effects
Parkinson’s disease, a neurodegenerative disorder effecting 0.3% of the world population and growing, could have a new effective treatment. Parkinson’s disease is classically characterized by muscle rigidity, tremors, and slowed physical movement, but a new treatment named Cogane could reduce the amount of damaged nerves in the brain, which could directly fight it.
How does Cogane work?
Cogane helps your brain release glial cell-derived neurotrophic factor and brain derived neurotrophic factor, both naturally occurring proteins in the brain that regrow damaged nerves, which Parkinson’s disease hinders. The latest study shows increased an outgrowth of neurites, the extended part of the neuron cell, while reversing some of the effects of Parkinson’s disease in the striatum decreasing both motor and non-motor symptoms. Also, Cogane has been shown to reduce the side effects of L DOPA, a popular Parkinson’s disease treatment.
Cogane is currently being testing by 400 patients in a randomized, double blind and placebo controlled study. You can read more about Cogane on Phytopharm.com. You can also get updates on the current cynical trial on PDtrials.org and ClinicalTrials.gov.
Impax, the Hayward and technology-based generic pharmaceuticals company, in collaboration with GlaxoSmithKline, announced their new treatment for idiopathic Parkinson’s disease on December 21st, 2011. It is currently being reviewed by the U.S. Food and Drug Administration (FDA). Titled “IPX066,” this extended release capsule “is intended to maintain consistent plasma concentration of levodopa for a longer duration versus immediate release levodopa, which may have an impact on fluctuations in clinical response.”
IPX066 has been researched for three and a half years “through multiple clinical studies of efficacy and safety.” IPX066 has been studied in early and advanced U.S. and European Parkinson’s patients.
Caribdopa/levodopa, also known as Sinemet, was one of the first major drugs used to treat Parkinson’s disease and is currently widely used. This drug is converted to dopamine voa a natural enzyme to reduce the symptoms of Parkinson’s disease with less side-effects.
Read this press release at ImpaxLabs.com.
Facing any major chronic illness means dealing with a host of challenges that span far beyond the initial diagnosis. Parkinson’s disease is no different, as patients with this disease face not only the effects of their fine motor loss but in many cases must also deal with chronic pain problems.
Traditional descriptions of Parkinson’s disease do not include pain. However, when carefully questioned, more than half of all people with Parkinson’s disease say that they have experienced painful symptoms and various forms of physical discomfort according to Blair Ford MD at Columbia University Medical Center in NY. The type of pain most reported by Parkinson’s patients was “dystonia” or pain from involuntary muscle contractions, particularly in the leg, foot, neck, and shoulders.
Pain syndromes and discomfort in Parkinson’s usually arise from one of five causes: (1) a musculoskeletal problem related to poor posture, awkward mechanical function or physical wear and tear; (2) nerve or root pain, often related to neck or back arthritis; (3) pain from dystonia, the sustained twisting or posturing of a muscle group or body part; (4) discomfort due to extreme restlessness; and (5) a rare pain syndrome known as “primary” or “central” pain, arising from the brain.
Treatment is usually symptomatic and includes muscle relaxants initially and even utilization of botulinum toxin for persistent cases of dystonia. I always recommend that patients work with their neurologist as a first line approach. However, by the nature of their specialized diagnostic training, neurologists will often collaborate with pain management specialists for additional treatment options. The goal is to find the most painless manner for seeking a proper assessment and treatment of your pain with an emphasis on movement and function. And while Parkinson’s disease is a chronic condition, there can be relief for the painful effects of this ravaging disease.
Both Essential Tremor and Parkinson's Disease are common movement disorders that affect many people around the world. Tremor can occur at rest (resting tremor), while holding objects (postural tremor) or during movement (action/intention tremor). Tremor can also effect the head (usually essential tremor) and/or the vocal cords (when isolated spasmodic dysphonia). Neither of these movement disorders can be diagnosed with blood tests or MRI/CT brain imaging technologies. However, brain scans can help rule out structural causes of some movement disorders.
Essential Tremor is the most common movement disorder in the world and is 25x more prevalent than Parkinson’s Disease. Since both Essential Tremor and Parkinson’s Disease patients have symptoms of tremor, it is extremely difficult to self diagnose. Both of these movement disorders can worsen with fatigue, mental or physical stress, anxiety, and too much caffeine (stimulants).
Both movement disorders can be caused by genetics. More than 60% of patients with Essential Tremor have had some sort of family history with the disorder. The ties between Parkinson’s Disease and genetics are much more subtle; only 2-5% of Parkinson’s Disease patients report strong family history. Scientists have recently begun researching the genes that cause both of these movement disorders with the intent of finding the best way to prevent and cure them.
Tremor disorders are difficult to diagnose even for neurologists who have several years treating patients with Essential Tremor and Parkinson’s Disease. Unfortunately, most patients are not referred to neurologists with fellowship training in movement disorders from an accredited neurology residency program — there are many patients who are only referred to fellowship trained movement disorder neurologists when their symptoms worsen significantly. Also there are many neurologists that call say they are movement disorder specialists but who have never done any specialized training. Medical boards and the American Academy of Neurology have not yet prevented neurologists in from falsely advertising their training qualifications to the public. Those neurologists that haven't done a fellowship and are at academic institutions in the movement disorder department have the equivalent of having done a fellowship. An accurate and early diagnoses is very important for correct treatment. If a patient isn’t diagnosed correctly, they can end up taking the wrong medications and go through unnecessary surgeries. For example, Deep Brain Stimulation (DBS) treats both Parkinson's Disease, Essential Tremor, but the surgery is performed in different locations in the brain.
TremorA “tremor” is defined as an involuntary and often rhythmic movement of an isolated body part. Essential Tremor is also known as a familiar or benign tremor. Tremors often start in the arms and move to different parts of the body. Essential Tremor can start at any age. The involuntary movements that happen with ET are more obvious during action and in good posture. In most cases, ET affects the hands and also commonly effects the head, face, vocal cords, legs, and torso. Alcohol is known to temporarily reduce the strength of muscle tremors. Patients with ET can normally walk without problems, but some feel unsteady during movement at times.
Parkinson’s Disease and Essential Tremor Pearls of DiagnosisParkinson’s Disease patients tend to have a shuffling gait, a bent posture, shorter strides, and a hard time turning quickly. Parkinson’s Disease is usually occurs after the age of 65, however, young onset Parkinson's can occur between age 21-40. PD also characterized by muscle rigidity, tremor, and Hypokinesia (slower movement). Parkinson’s Disease is known to have it’s tremors start in one arm and move to the other. Parkinson’s Disease tremors are usually more obvious when in a relaxed (resting) position.
The tremor in Parkinson's Disease is 4-6 Hz (cycles per second) and the tremor in Essential Tremor is faster 8-13 Hz.
Parkinson’s Disease patients never have isolated vocal cord or head tremors.
The slowing of physical movement (bradykinesia), rigidity and a masked or poker face occur in PD but not in ET.
In Essential Tremor walking is normal and most of the patients only have difficulty with heel to toe walking. Patients with ET do not develop any other physical signs except for progressive worsening of their tremor.
Also up to 70% of Essential Tremor patients report their tremor improved with alcohol and is not effective in Parkinson's Disease unless the alcohol is treating anxiety worsening the tremor.
Non-physical signs (3-15 years prior) of Parkinson’s Disease include:
- Decreased or complete lose of ones sense of smell
- High risk: REM Behavior Sleep Disorder (RBD)
The more well known Secondary Parkinson's Diseases are Multiple System Atrophy (Striatonigral Degeneration, Shy Drager, Olivopontocerebellar Atrophy), Progressive Supranuclear Palsy, Corticobasal Ganglionic Degeneration, Diffuse Lewy Body Disease (Lewy Body Dementia).
Red Flags for Secondary Parkinson's Disease that indicate one does not have idopathic (typical) Parkinson's Disease are:
1. Early Dementia
2. Early Onset of Postural Instability
3. Early Onset of Hallucinations or Psychosis with low doses of Carbidopa/Levodopa (Sinemet) or Dopamine Agonists (Mirapex or Requip).
4. Paralysis or restricted eye movements in the up or down direction
5. Early Urinary Incontinence or more than a 20 point drop in the systolic blood pressure or pulse when going from a laying, sitting to standing position (orthostatic hypotension). This indicates early involvement in the autonomic nervous system.
Secondary Parkinson’s Disease can be also caused by, among other things:
- Medications- Depakote, Reglan, Haldol, Zyprexa, Abilify, Geodon, Risperdal, Phenergan, Amiodarone and other medications.
- Head trauma
- Normal Pressure Hydrocephalus
There has recently been extensive study regarding nitrates and how they relate to living a healthy live. I’ve always recommended that my patients stay away from foods that contain nitrates in them and now the latest research has found a correlation between nitrates, movement disorder, and cancer. I also warn my patients that “nitrate free” products can also contain nitrates in them, so I courage them to do further research. Here are some of our blog posts on nitrates:
ScienceDaily has reported on new evidence finding a link between an increased level of nitrates in the environment and higher movement disorder rates. The evidence suggests that Alzheimer’s, Diabetes, and Parkinson’s Disease all directly link to nitrates. The findings indicate that the American population consumes 230% more nitrates now than they did in 2005. This article includes interviews with experts on the subject and explains how nitrates might be causing the increase in movement disorders.
This FAQ written by PrevenCancer dives into detail about how hot dogs and similar meat products can cause cancer. Not only is there evidence connecting nitrates to movement and neurological disorders, but there is also plenty of evidence showing it’s a carcinogen. This article answers specific concerns such as:
- What’s wrong with hot dogs?
- How could hot dogs cause cancer?
- Some vegetables contain nitrites, do they cause cancer too?
- Do other food products contain nitrites?
- Are all hot dogs a risk for childhood cancer?
Livestrong.com, a popular health blog, published an article about common foods that contain nitrates. It’s a superb overview of the products I recommend my patients stay away from. The list they provide includes cured products, some vegetables, and tap water. Visit the bottom of the article for references and further reading.
There has been a stream of new information on vitamin D and how it affects the body. New evidence suggests that minimum recommended intake is 2000 IU/day. The bigger you are the more you have to take. You can safely take no more than 10,000 IU/week. Your physician will prescribe 50,000 IU/Week which is a standard dose. Vitamin D in the body is not well understood and is known to be involved in the cell cycle and other cellular functions. Vitamin D deficiency increases the risk of Parkinson’s Disease and may be involved in many other diseases such as multiple sclerosis and cancer. The blood level on the lab form will say that the vitamin D low-normal level is 30 but newer scientific evidence suggests the number should be 40. Vitamin D levels should be monitored to ensure it does not increase past 100 but rather 40–75.
Overview of the latest vitamin D science
Vitamin D deficiency-related diseases and complications have been rising over the past decade. Physicians have been testing their patients' blood to monitor their vitamin levels and have been prescribing large doses of vitamins. Despite many physicians recommending their patients take vitamins, the effectiveness of popular dosages have been called into question with the latest scientific evidence. Many medical institutions and recommending children and adults triple their daily intake of Vitamin D, but a controversy lingers.
A quick glance and the medical literature shows that there are a wide range of opinions regarding how much Vitamin D one should take in order to stay healthy. Vitamin D has a pivotal role in maintaining the immune and skeletal system. Many of the scientific studies researching vitamin D have been conducted with rodents since human studies are difficult and expensive. Most of our knowledge of vitamin D was provided by epidemiological data.
Despite all the studying of vitamin D, we are still not sure what the optimal amount is for humans. Many factors determine which is the ideal amount for someone: body size, latitude, time spent outside, age, state of health, plasma levels, and more. Since there hasn’t been enough research on vitamin D levels in humans, most estimates are educated guesses or opinions. Generally, we can infer that city dwellers don’t get enough vitamin D levels since they aren’t outside much, nor do they consume enough dairy products, generally.
Some of the recent, popular, and well-researched scientific papers favor an increased vitamin D supplementation. The papers found that an intake of 40–60 ng/ml (100–150 nM) of vitamin D a day could reduce cancer risks. Taking this much vitamin D is only recommended for those with healthy diets and lifestyles, due to the possibility of vitamin D toxicity. A prominent proponent of increasing vitamin D intake is Dr. Michael Holick, an endocrinologist at Boston University Medical Center. Here is an excerpt of Dr. Michael Holick’s opinions:
“Vitamin D deficiency and insufficiency have been defined as a 25-hydroxyvitamin D 20 ng/ml and 21-29 ng/ml respectively. For every 100 IU of vitamin D ingested the blood level of 25-hydroxyvitamin D, the measure vitamin D status, increases by 1 ng/ml. It is estimated that children need at least 400-1000 IU of vitamin D a day while teenagers and adults need at least 2000 IU of vitamin D a day to satisfy their body's vitamin D requirement.“
Endocrinology Clinics of North America recently published many thorough articles by researchers who study specific the aspects of vitamin D metabolism in action. In general, these authors recommend “maintenance of plasma levels of 25-OH-D ≥ 30 ng/mL, requiring a daily intake of ≥1000 IU for most children and adults, and twice that for pregnant and lactating women.” These recommendations of the Institute of Medicine advise higher overall daily intake than previously indicated for both calcium and vitamin D.
Summary of IOM findings
This scientific research found compelling evidence in favor of the role for calcium and vitamin D in promoting skeletal health. A vitamin D overdose requires excess of 4,0000 UIs per day while a calcium overdose requires over 2,000 milligrams per day. Side effects of an overdose include hypercalcemia and hypercalciuria.
The studies found that vitamin D supplementation can help prevent bone fractures, but the IOM investigation failed to find evidence indicating a significant reduction in risk of falls that are directly related to vitamin D intake. Surprisingly, the role of supplemental calcium in supporting skeletal strength is still controversial.
Gender, age, diet, and overall health change the requirements for calcium and Vitamin D intake. Dairy products such as milk, yogurt, cheese, and juices fortified with calcium and vitamin D remain the best (food) sources of calcium and vitamin D. A cup serving of most dairy products contains 200–300 mg of calcium. Vitamin D can easily be acquired by being in the sun as well.
riedman, PA and Brunton LL. Updated Vitamin D and Calcium Recommendations. Goodman and Gilman’s Online, March 1, 2011. http://www.accessmedicine.comRelated to Chapter 61 Agents Affecting Mineral Ion Homeostasis and Bone Turnover, in Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 11th edition, Laurence L. Brunton, John S. Lazo, and Keith L. Parker, Eds. McGraw-Hill, New York, 2006.
An BS, Tavera-Mendoza LE, Dimitrov V, et al. Stimulation of Sirt1-regulated FoxO protein function by the ligand-bound vitamin D receptor. Mol Cell Biol 2010;30:4890–4900. [PubMed abstract]Bikle DD. Vitamin D: newly discovered actions require reconsideration of physiologic requirements. Trends Endocrinol Metab 2010;21:375–384. [PubMed abstract]Cauley JA, Lacroix AZ, Wu L, et al. Serum 25-hydroxyvitamin D concentrations and risk for hip fractures. Ann Intern Med 2008; 149:242–250. [PubMed abstract]Chung M, Balk EM, Brendel M, et al. Vitamin D and calcium: a systematic review of health outcomes. Evid Rep Technol Assess (Full Rep) 2009:1–420. [PubMed abstract]Cranney A, Horsley T, O’Donnell S, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007:1–235. [PubMed abstract]Cranney A, Weiler HA, O’Donnell S, et al. Summary of evidence-based review on vitamin D efficacy and safety in relation to bone health. Am J Clin Nutr 2008;88:513S–519S. [PubMed abstract]Egan, JB, Thompson PA, Vitanov MV, et al. Vitamin D receptor ligands, adenomatous polyposis coli, and the vitamin D receptor FokI polymorphism collectively modulate beta-catenin activity in colon cancer cells. Mol Carcinog 2010;49:337–352. [PubMed abstract]Garland CF, Gorham ED, Mohr SB, et al. Vitamin D for cancer prevention: global perspective. Ann Epidemiol 2009;19:468–483. [PubMed abstract]Higdon J, Drake VJ. Vitamin D. Linus Pauling Institute. 2010. http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD/.
Holick MF. The vitamin D solution: a 3-step strategy to cure our most common health problem. New York: Hudson Street Press; 2010, p. 336.
Holick MF. Vitamin D: evolutionary, physiological and health perspectives. Curr Drug Targets 2011;12:4–18. [PubMed abstract]Hollis BW. Vitamin D requirement during pregnancy and lactation. J Bone Miner Res 2007;22 Suppl 2:V39–44. [PubMed abstract]Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington, DC: The National Academies Press; 2011, p. 1015. Full Report: http://books.nap.edu/openbook.php?record_id=13050. Brief
Report: http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Report-Brief.aspx. Lanham-New SA, Buttriss JL, Miles LM, et al. Proceedings of the Rank Forum on Vitamin D. Br J Nutr 2011;105(1):144–56. Epub 2010 Dec 7. [PubMed abstract]Multiple Authors. Vitamin D. Endocrinol Metab Clin North Am 2010;39:243–479.
Vieth R. Vitamin D and cancer mini-symposium: the risk of additional vitamin D. Ann Epidemiol 2009;19:441–445. [PubMed abstract]Copyright © The McGraw-Hill Companies. All rights reserved.
The above message comes from McGraw-Hill/Access Medicine, who is solely responsible for its content.
This news is a bit outdated, but it’s always great to see Michael J. Fox and several large companies putting their minds together to help those with Movement Disorders. You may know Michael J. Fox from the Back To The Future movies. This famous movie from 1985 featured some custom futuristic shoes that the character Marty McFly (played by Michael J. Fox) wore.
Michael J. Fox was diagnosed with Parkinson’s Disease in 1990 and established The Michael J. Fox Foundation in 2000. The organization has invested nearly $179 million in research for Movement Disorders. The Michael J. Fox Foundation has been very successful because of their unique ventures such as this recent auction of movie memorabilia.
DATScan - New Tool to Aid in the Differentiation Between Essential Tremor and Parkinsonian Syndromes
GE Healthcare recently announced DATScan, ioflupane iodine–123 injection, a contrast agent for use with single-photon emission computed tomography (SPECT) for detecting dopamine transporters (DaT) in suspected parkinsonian syndromes.
The DaT visualization was created to help differentiate essential tremor and drug induced parkinsonism from tremor due to parkinsonian syndromes (including idiopathic Parkinson’s disease, multiple-system atrophy, and progressive supranuclear palsy, as an adjunct to other diagnostic modalities). These new SPECT scans show abnormal distribution of DaT in parkinsonian syndromes but are normal in other conditions, such as essential tremor and Alzheimer’s disease.
New Diagnostic Adjunct
Currently, movement disorders are diagnosed with clinical and laboratory tests as well as neuropsychological evaluations, "which are not conclusive and may lead to misdiagnosis.
FDA Advisory Panel
"This might make a real difference in 5% of patients seen by movement disorders specialists and 15% of patients seen by general practitioners, and that's an important number of patients," committee member Nathan Fountain, MD, associate professor of neurology at the University of Virginia, Charlottesville.
"There are many circumstances I can think of and imagine where this could be a benefit, and the risks are very low," said Karl Kierburtz, MD, MPH, committee member and professor of neurology and community and preventive medicine at the University of Rochester, New York.
Dr. Kierburtz noted that in many instances DaTscan could help improve the diagnostic accuracy by clinicians and decrease some of the problems associated with other means of differential diagnosis — such as medication challenges, which often work poorly in the elderly or patients with dementia.
Committee members emphasized that DaTscan was not suitable for screening or prognosis on its own. "We don't want to make this the gold standard for diagnosing Parkinson's disease.
Safety Concerns and Practical Issues
Joel Perlmutter, MD, professor of neurology at Washington University School of Medicine, St. Louis, Missouri, said that after reviewing the scientific literature, he did not think that DaTscan was cost-effective. Between the cost of DaTscan ($1500 per scan) and a month’s trial of carbidopa or levodopa for a patient with possible PD ($150), the price can easily become unbearable. Joel said “it wouldn’t change how I would treat a patient.”
There are always issues with scans that require an active substance, such as iodine, into the body since some individuals have known sensitivities. GE Healthcare gave the following warning in their release notes: “To decrease thyroid accumulation of I–123, block the thyroid gland at least 1 hour before administration of DaTscan; failure to do so may increase the long term risk for thyroid neoplasia.”
GE has also stated that in clinical trials, adverse reactions such as headache, nausea, vertigo, dry mouth, and mild to moderate dizziness were reported. Hypersensitive and painful reactions in the injection site have also been documented.
Overall, the DATScan machine is promising. It’s new technology, but I believe it will soon be a valuable tool for diagnosing Parkinson’s Disease and Essential Tremor.
Learn more about DATscans at Medscape
Visit GE Healthcare to read/view DATScan promotional material
New evidence has been released finding Goteng, a Chinese herb, has healing effects on Parkinson’s Disease patients. The study is strong, and this new evidence could potentially lead to safer and more effective treatments for Parkinson’s Disease. The research team is currently looking for individuals with Parkinson’s Disease who want to participate in future studies.
A pilot clinical study in Hong Kong has found the Chinese herbal medicine Uncaria rhynchophylla (Gouteng), or prescriptions containing Gouteng, to be effective in treating Parkinson’s disease.
Researchers at the Hong Kong Baptist University (HKBU) School of Chinese Medicine, led by Associate Professor Dr. Li Min, have applied for a US patent for this research result, and will soon start the second phase of the clinical study with a US $70,000 research grant from the Food and Health Bureau of the Hong Kong SAR Government.
The researchers identified an active compound Isorhynchophylline (IsoRhy) in the Chinese herb Uncaria rhynchophylla as a potential neuronal autophagy inducer which promoted the clearance of the pathogenic protein alpha-synuclein in the neurons of Parkinson's patients. This unique property of IsoRhy could contribute to the therapeutic action of Uncaria rhynchophylla.
From 2007 to 2009, researchers observed the therapeutic efficacy on 47 patients aged from 50 to 74 years old, who had been suffering from the disease for 18 months to 11 years, and who had been taking the same type of Western medicine. The study revealed that patients who had received the Chinese medicine treatment showed improved communication skills and reduced non-motor symptoms such as depression, anxiety, sleeping difficulties, constipation and poor appetite. In addition, no obvious side effects were found in both groups during the study period.
The department has already begun inviting Parkinson’s disease patients aged between 18 and 80 to participate in a 40-week, second phase clinical research trial.
Pesticides have been proven to cause Parksinson’s Disease. Some also cause dysfunction in cells by poisoning the Mitochondria in the cell. Pesticides can also effect cell protein systems, such as Ubiquitin. Rotenone is in the commercial product round up. If you are buying pesticides or herbicides, they may contain synthetic chemicals — Ziram, Rotenone, Paraquat, Maneb, DETC (Diethyldithiocarbamate), Dieldrin, Endosulfan, and Benomyl — which are harmful to the human body.
Learn about the early warning signs and symptoms or Parkinson's Disease at:
Pasadena Senior Center
84 Easy Holly Street
Wednesday, September 21 2011
10:00am — 4:00pm
To RSVP, email or call Email Barnard (see PDF flyer below for contact information - click to enlarge).
New scientific papers on Parkinson’s Disease were recently released. They gives Neurologists solid ways of predicting whether or not someone will have Parkinson’s Disease in the future:
Constipation in PD
Constipation (less than three bowel movements per week) is the most commonly reported (50–80%) gastrointestinal symptom in PD. It can occur during both preclinical and clinical stages of the disease and worsens with disease progression. Barium studies have shown that prolonged colon content transit time is the physiological basis of both symptomatic and asymptomatic constipation. Most patients experience only mild discomfort and distension, but the risk of life-threatening complications, such as megacolon and pseudo or true obstruction resulting in bowel perforation should be taken into account and prevented. Dysmotility may be related to poor fiber and fluid intake or reduced physical activity. Some authors point out that the neurodegenerative process in the enteric nervous system may be a potential target for future therapies.
They reported a preserved or mildly impaired olfactory function to be more likely for atypical parkinsonism such as multiple system atrophy, progressive supranuclear palsy, or corticobasal degeneration whereas markedly pronounced olfactory loss appeared to suggest PD. Similar to the results of Wenning et al., in a study on 50 Parkinsonian patients, we also found evidence for olfactory loss in MSA, but little or no olfactory loss in (the few investigated) patients with PSP and CBD.
REM Behavioral Sleep Disorder
RBD consists of recurrent episodes of sudden, abnormally vigorous body, head or limb movements that appear during REM sleep, often associated with dreams in which the patient defends against a threat or aggression. In its most severe form, patients may injure themselves or their bed partner but, in milder forms of RBD, patients may not be aware of the parasomnia, particularly if they sleep alone
Parkinson's Disease (PD) affects 1 million people in the United States and this number will increase with the aging population. Parkinson's Disease is a neurodegenerative disease of the central nervous system that occurs as a result of a loss of dopamine-producing cells in the brain. The cardinal features of Parkinson's Disease are Slowness of movement (bradykinesia), Rigidity annd Tremor. Non-Motor Symptoms begin 3-15 years before motor symptoms and patients usually have 50-70% loss of the cells that produce dopamine. However the accuracy of diagnosis is 70% with general neurologist and 90% with Movement Disorder Neurologists. Most neurologists have not completed formal fellowships for movement disorder specialization. We have come to find out that experience does not make up for formal training.
History of Parkinson's Disease(1:00)
- James Parkinson wrote an essay on this disease he witnessed. Doctors later diagnosed it and established it as a disease, then named it after James Parkinson.
- 1875 — 2 year old child with Parkinson's disease, took 7 years to diagnose
The brain of Parkinson's disease patients(4:00)
- Non-motor symptoms: decreased sense of smell, gastrointestinal issues, urinary issues, sexual disfunction, sleepiness, depression, anxiety, impaired color discrimination, contrast sensitivity, and restless leg syndrome
REM behavior sleep disorder
- Patients are able to act out their dreams when their brain is supposed to paralyze their body. These patients can move around during sleep and cause harm to others or themselves.
Patients often don't visit doctors for small signs of Parkinson's Disease (loss of smell, constipation, etc.). Patients visit their doctors after the first tremor or obvious neurological misfire five to seven years later. At this point, they have lost 50-70% of cells in the Substantia nigra (part of the brain). (8:00)
- About 1 million people in the United States have Parkinson's Disease.
- You are 1.5x more likely to get Parkinson's Disease if you are a female.
Rates of Parkinson's Disease in different cultures
- The Amish community has the highest promenence of Parkinson's Disease.
- Italy, India, and Nebraska (United States) also have a high ratio of Parkinson's Disease.
- Ethiopia and Korea have the lowest ratio.
- High agricultural areas and communities generally have higher rate of Parkinson's Disease. Studies show a link between pesticides and Parkinson's Disease. (11:00)
Pathology of Parkinson's Disease
- Starts effecting the Olfactory bulb (smell) and the brain stem that controls the GI tract (causing constipation). (12:00)
- Identifying Patients at Risk: (15:00)
- Watching the movement of dopamine
- Smell identification test (scratch and sniff)
- Cardiac imaging
Neurologists don't have good tools to diagnose Parkinson's Disease yet (18:30).
Neurologists look through patient history, use tests, and employ their expertise to diagnose the disease.