Center For Parkinson’s Disease & Other Movement Disorders
The Center for Parkinson’s Disease and Other Movement Disorders at NewYork-Presbyterian Brooklyn Methodist Hospital offers the only comprehensive diagnostic and treatment program for Parkinson’s and other movement disorders in Brooklyn.
Parkinson’s disease is a disorder of the central nervous system, involving the degeneration and loss of nerve cells in the basal ganglia of the brain. The disease occurs in both men and women and, while symptoms may occur as early as age 40, they are usually not apparent until patients are in their 60s or 70s.
Vitamin B12 And Folate
Vitamin B12 is an antioxidant. It helps keep red blood cells and nerve cells healthy and helps produce DNA. Sources of vitamin B12 are typically red meat, chicken, sardines, eggs, fortified cereals and bread, and nutritional yeast.
Researchers discovered that patients with early-onset Parkinson’s disease had lower vitamin B12 levels, which reduced motor and cognitive functions. In some cases, taking a multivitamin that included vitamin B12 slowed the loss of those functions.
Folate is found in organ meats , yeast, and leafy green vegetables. Folate plays several roles in the body and brain.
Both B12 and folate are involved in the metabolism of homocysteine, an amino acid. High levels of homocysteine are seen in various cognitive disorders. Studies show that Parkinson’s disease patients taking levodopa for the condition are also more likely to have elevated homocysteine.
In one meta-data analysis, researchers investigated the correlations between cognitive function , homocysteine, folate, and vitamin B12 levels in patients with Parkinson’s disease. They discovered that patients with cognitive dysfunction had high levels of homocysteine and lower levels of folate and vitamin B12.
The Importance Of Integrative Medicine
Integrative medicine is a particular healthcare approach that treats disease by addressing all imbalances in the body in a holistic manner. Nutrition is a primary component of integrative medicine, as the diet is largely responsible for ensuring our bodies are functioning properly. When considering the fact that nutritional deficiencies impair the way biochemical processes are carried out in the body, its crucial to address any imbalances that may contribute to the onset or outcome of chronic disease.
In recent years, researchers began taking an interest in the relationship between micronutrients and PD. For example, a newly published study assessed whether vitamin B12 deficiency is associated with impaired mobility and cognition among newly diagnosed PD patients.
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Higher B12 Translates To Less Disability
Using patient data and archived blood samples from a prior study, known as DATATOP, the researchers divided three groups of 200-plus patients according to their levels of vitamin B12 at the beginning of the study. They found that over time, symptoms in those from the lower-level group developed more rapidly than in those in the higher bracket. Average annualized changes from preliminary testing for walking capacity were ranked at 1.53 for the group with lowest B12 levels, 0.83 for the middle group and 0.77 for the higher cohort, demonstrating twice the rate of progression between the groups with the lowest and highest B12 levels.
Additionally, researchers tested patients blood levels of homocysteine, an amino acid that may be elevated in people with lower B12, and compared the levels to patients results from the Mini Mental State Examination, a test that measures cognitive skills. The group with higher homocysteine levels, and thus lower B12, was found to decline by an annualized average of 1.96 points, versus a modest improvement in those with lower homocysteine.
Vitamin C And Vitamin E
Vitamin C is found in fruit, vegetables, and the livers of animals. Vitamin E is an antioxidant found in vegetable oils, nuts, seeds, leafy greens, bell peppers, and avocados.
An 18-year study followed 41,058 subjects in Sweden. Within that population, there were 465 cases of Parkinson’s disease. Researchers evaluated vitamin C and E to determine whether antioxidants and total non-enzymatic antioxidant capacity were linked to a lower risk of Parkinsons disease.
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Relationship Of Vitamin B12 Status And Parkinson’s Disease
Objective/Rationale: Vitamin B12 deficiency can cause a number of neurological symptoms, including instability, neuropathy and cognitive defects. Recent studies in Parkinsons disease patients with neuropathy have shown that B12 deficiency is common. Also, we have recently observed that B12 levels decline over the course of PD. These observations have led us to hypothesize that concurrent B12 deficiency may contribute to overall decline in some patients.
Project Description: The DATATOP study was a large study of patients with early PD conducted more than 20 years ago. As part of this study, standardized measurements of cognitive function and mobility were obtained over the course of the two-year study. Blood samples were also collected and stored. In our study, we will measure blood levels of vitamin B12 and other markers of B12 deficiency in the DATATOP subjects to determine how common B12 deficiency is in early PD and if there is a relationship between low B12 levels and early cognitive or mobility problems. Since a number of patients underwent blood testing nine or more months after study entry, we also will measure B12 levels at study completion to determine whether B12 levels decline.
Vitamin E Vitamin C And Natural Foods
Scientists have also examined Vitamin E, Vitamin C and health foods to evaluate oxidative properties. Vitamin E can fight damage in the brain caused by free radicals and has been suggested to lower the risk of PD. However, researchers conducted an extensive and thorough study more than 10 years ago and failed to find any evidence that Vitamin E slows the progression of PD or manages symptoms.
However, a recent study published in Neurology, revealed that those with high Vitamin E and C consumption might be associated to a lower risk of PD. Additional research is still needed to better understand this association. Vitamin E has few side effects, and many people with PD continue to take it in high doses of 400 IU or more.
Researchers are also examining if health foods, such as fermented papaya and blueberries, play a role in slowing nerve cell death. Scientists are optimistic about the research, but do not have conclusive data at this time to recommend these supplements to treat PD.
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Vitamin B12 Shots Are Very Effective
An untreated vitamin B12 deficiency can lead to neurological problems or pernicious anemia, which occurs when your body doesnt have enough B12 to produce the amount of red blood cells it needs .
Vitamin B12 shots are the most common way to prevent or treat a deficiency. The injections are prescribed by a doctor and given intramuscularly, or into muscle.
Injections are usually given as hydroxocobalamin or cyanocobalamin. These are very effective at raising blood levels of B12 and preventing/reversing a deficiency.
Bottom Line:
If you are deficient in vitamin B12, then the injections are very effective at raising your blood levels.
Benefits Of Vitamins In The Treatment Of Parkinsons Disease
Ying ZhangGuest Editor: Received
Abstract
Parkinsons disease is the second most common neurodegenerative disease in the elderly, which is clinically characterized by bradykinesia, resting tremor, abnormal posture balance, and hypermyotonia. Currently, the pathogenic mechanism of PD remains unclear. Numerous clinical studies as well as animal and cell experiments have found a certain relationship between the vitamin family and PD. The antioxidant properties of vitamins and their biological functions of regulating gene expression may be beneficial for the treatment of PD. Current clinical evidence indicates that proper supplementation of various vitamins can reduce the incidence of PD in the general population and improve the clinical symptoms of patients with PD nevertheless, the safety of regular vitamin supplements still needs to be highlighted. Vitamin supplementation may be an effective adjuvant treatment for PD. In this review, we summarized the biological correlations between vitamins and PD as well as the underlying pathophysiological mechanisms. Additionally, we elaborated the therapeutic potentials of vitamins for PD.
1. Introduction
2. The Pathogenesis of Oxidative Stress in PD
3. Vitamin B and PD
3.1. Vitamin B3
3.2. Possible Neuroprotective Mechanisms of Vitamin B3 in PD
3.3. Clinical Studies regarding Vitamin B3 in PD
4. Vitamin C and PD
4.1. Possible Neuroprotective Mechanisms of Vitamin C in PD
4.2. Clinical Studies regarding Vitamin C in PD
7. Conclusion
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What Is Vitamin B12 And What Does It Do
Vitamin B12 is a water-soluble vitamin, also known as cobalamin.
It plays a vital role in brain function and the production of DNA and red blood cells.
Chemically, vitamin B12 can exist in a number of different forms, but all of them contain the mineral cobalt.
The vitamin can be stored in the liver for a long time, so it may take a few years for a deficiency to develop .
Bottom Line:
Vitamin B12 is a water-soluble vitamin that plays an important role in brain function and red blood cell production.
Findings Could Help Inform Development Of New Lrrk2
The basic micronutrient vitamin B12 inhibits the activity of a protein implicated in LRRK2-associated Parkinsons disease the most common inherited form of the condition, according to research conducted at the Icahn School of Medicine at Mount Sinai and published March 11 in the journal Cell Research. The study findings suggest that vitamin B12 may hold promise as a PD therapy.
Parkinsons disease, the most common chronic neurodegenerative disorder, affects one percent of the world population over the age of 60 by disabling the brain and disrupting both motor and cognitive function. Missense mutations in the gene leucine-rich repeat kinase 2 are the greatest known genetic contributor to PD and are linked to the incidence of both familial and sporadic forms of the disease. These mutations lead to a hyperactive form of the protein kinase that promotes neurotoxicity. Over time, increases in LRRK2 kinase activity lead to a reduction in the activity of dopamine in the brain, which manifests in the muscle rigidity and tremors that are hallmark symptoms of PD. Over the past several years, drug companies have developed LRRK2 kinase inhibitors that target the adenosine triphosphate binding pocketessentially, the energy storein the biological system of LRRK2, which is required for LRRK2 signaling.
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A New Era For Parkinsons Disease Treatment
March 2, 2022 | By
A non-invasive ultrasound treatment for Parkinsons disease that was tested in a pivotal trial led by University of Maryland School of Medicine researchers is now broadly available at the University of Maryland Medical Center .
Howard Eisenberg, MD, Dheeraj Gandhi, MD, MBBS, Paul Fishman, MD, PhD, Bert W. OMalley, MD.
The device, called Exablate Neuro, was approved in November by the U.S. Food and Drug Administration to treat advanced Parkinsons disease on one side of the brain. The approval was based on findings from the UMSOM clinical trial and effectively expands access to focused ultrasound beyond clinical trial participation.
Rapid Reversal of Symptoms
Focused ultrasound is an incisionless procedure, performed without the need for anesthesia or an in-patient stay in the hospital. Patients, who are fully alert, lie in a magnetic resonance imaging scanner, wearing a transducer helmet. Ultrasonic energy is targeted through the skull to the globus pallidus, a structure deep in the brain that helps control regular voluntary movement. MRI images provide doctors with a real-time temperature map of the area being treated. During the procedure, the patient is awake and providing feedback, which allows doctors to monitor the immediate effects of the tissue ablation and make adjustments as needed.
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A New Era for Parkinsons Disease Treatment
Symptoms Of A Vitamin B12 Deficiency
Fatigue, mood change and memory loss are some of the possible neurological symptoms associated with low levels of B12. Physical manifestations may include muscle weakness, sore tongue, shortness of breath, diarrhea, numbness, and difficulty walking. Severe deficiency can cause deep depression, paranoia, delusions, incontinence, loss of taste and smell, and other neurological damage. Any of these symptoms can also signify other medical issues, so it is important to determine the cause through a blood test.
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Vitamin B12 Inhibits Key Enzyme In Parkinsons Disease
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Vitamins For Parkinson’s Disease
Verywell / Michela Buttignol
Apart from traditional pharmaceutical treatments, if you have Parkinsons disease, your doctor may recommend vitamins with antioxidant properties. While it is best to get these from food sources as part of a healthy, balanced diet, some people need to take supplements. These vitamins include:
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Not Ready To Recommend
Commenting for Medscape Medical News, Michael S. Okun, MD, medical advisor at the Parkinson’s Foundation and professor and director of the Norman Fixel Institute for Neurological Diseases at the University of Florida, Gainesville, noted that other recent studies have suggested high-dose B12 may be preventive and a possible treatment in PD.
“Although only a secondary aim of the current study, there was a reported potential benefit” in this new study, too, said Okun, who was not involved with the research.
However, the evidence is still not strong enough to change prescribing habits, he noted. “We do not recommend high-dose B12 either for those at genetic risk of Parkinson’s or those already with the disease,” Okun said.
He added that because multiple recent studies have questioned the beneficial effects for multivitamin combinations used to prevent neurologic diseases, “it wasn’t surprising to see results showing a lack of protection against later-onset Parkinson’s disease with folate, B6, and B12 intake” in the current study.
The study was supported by the NIH. Flores and Okun have reported no relevant financial relationships.
Medications For Parkinson’s Disease
After youve received a diagnosis of Parkinsons disease, your doctor will develop a treatment plan based on the diseases progression at the time you were diagnosed. Current pharmaceutical treatments include:
- Levodopa is a primary treatment for movement, tremors, and stiffness. Levodopa helps nerve cells make dopamine. This medication is also taken with carbidopa so that levodopa can reach the brain and stop or reduce side effects from the drug, such as vomiting, nausea, and low blood pressure.
- Dopamine agonists mimic dopamine in the brain but are not as effective as levodopa in controlling symptoms like muscle movement and rigidity.
- Catechol O-methyltransferase inhibitors block an enzyme that breaks down dopamine. They are taken with levodopa and slow the bodys ability to get rid of levodopa.
- MAO B inhibitors block monoamine oxidase B , a brain enzyme that breaks down dopamine. This allows dopamine to have longer-lasting effects.
- Anticholinergics aid in reducing tremors and muscle stiffness.
- Amantadine was first developed as an antiviral agent and can reduce involuntary movements caused by levodopa.
- Istradefylline is an adenosine A2A receptor antagonist. It is used for people taking carbidopa and levodopa but who experience off symptoms.
These drugs can have a variety of side effects. Be sure to discuss your medications with your doctor so you understand how and when to take them, what side effects may occur, and when to report any concerning side effects.
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Safety And Side Effects
Vitamin B12 injections are generally considered to be very safe. They have no major side effects.
However, in very rare cases, some people can experience side effects caused by allergic reactions or sensitivity (
If you experience any side effects, speak with your doctor.
Bottom Line:
Vitamin B12 injections are very safe. In rare cases, the injections may cause allergic reactions.
Supplement Intake Parkinsons Meds Ruled Out Eligibility
Patients were eligible for the study if they had not started treatment for Parkinsons and if they had not been taking a vitamin supplement of greater strength than a standard daily multivitamin , in the month before the start of the study. The study endpoint was disease progression to a degree indicating readiness for levodopa, standard Parkinsons therapy that over time becomes less effective.
After preliminary testing, patients were offered the option of taking a daily multivitamin. Close to 50 percent of participants were found to have higher B12 on subsequent testing, suggesting that many took the supplement or improved their diets. For those patients who remained in a lower B12 level suggesting they may not have started supplements their annualized average increase of disability was 14.4 on the Unified Parkinsons Disease Rating Scale , a test that assesses activities of daily life, motor skills, behavior and mood. In contrast, for the group whose B12 levels began low but improved during the study, their average increase in the UPDRS score was 10, showing less disability.
The study was supported by funding from the Michael J. Fox Foundation and from gifts from the Ko and Tsu family, and William and Mary Ann S. Margaretten.
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What Are Vitamin B12 Injections
A vitamin B12 supplement, just like vitamin C or vitamin D, is administered by pill or injection. According to Harvard Medical School, vitamin B12 is naturally ingested through the food we eat, and cannot be made by the human body. B12 is responsible for the uptake of iron and the production of red blood cells, nerves, DNA, and an amino acid that affects mood and the immune system. The recommended dosage for adults is 2.4 micrograms per day.