The Hoehn And Yahr Scale: Uses And Setbacks
To quantify disease progression, there is a commonly referenced staging scale. However, the staging of Parkinsons disease does have significant drawbacks. The Hoehn and Yahr scale was developed by Drs. Margaret Hoehn and Melvin Yahr in 1967:
- Stage I: Symptoms involve one side of the body
- Stage 2: Symptoms involve both sides of the body, or the midline
- Stage 3: Symptoms involve both sides of the body, with impairment of balance
- Stage 4: Symptoms have advanced to the point that although the person can stand and walk without the help of another person, he/she has significant disability. People in this stage typically need at least some help to perform their activities of daily living, or self-care activities such as eating, bathing, dressing, and toileting.
- Stage 5: The person cannot stand or walk without the help of another person
Hoehn and Yahr Scale Doesnt Factor in Progression of Non-motor Symptoms
The Hoehn and Yahr scale focuses solely on the progression of motor symptoms and does not consider the psychiatric, cognitive, and autonomic non-motor symptoms that often cause more disability than motor symptoms as PD advances. This is a major limitation of the Hoehn and Yahr scale.
Tips For Living Well With Parkinsons Disease In 2022
This is a self-reported questionnaire, designed for people older than 65, and assesses overall physical activity, including leisure activities such as walking and biking, household activities like gardening, and occupational pursuits, which includes taking care of others. It uses the intensity, frequency, and duration of physical activity over the prior week to calculate the total PASE score, ranging from zero to 793, with higher scores indicating more physical activity.
Motor function was evaluated using part III of the Movement Disorder Society Unified Parkinsons Disease Rating Scale . Each parameter is scored from zero to four, and higher scores indicate more severe impairment. Here, such function was evaluated during patients off times, or periods of time when levodopa medication wears off and motor symptoms re-appear.
Standard cognitive tests were used to assess the participants verbal and memory skills , and the time needed to complete mental tasks .
Participants in the trial were followed for up to six years.
Researchers observed that the Parkinsons patients despite showing significantly greater motor and cognitive impairments compared with the controls at the start of the trial had similar levels of regular physical activity, including of moderate to vigorous exercise, relative to the healthy volunteers.
Best of all, exercise is low cost and has few side effects, he added.
The Modag Anle138b Clinical Trial
Another neuroprotective approach involves enhancing cellular function, and significant preclinical research has shown that boosting the function of mitochondria can help cells survive. Mitochondria are the power stations of cells providing all of the energy requirements. Cure Parkinsons has several clinical trial programs dedicated to mitochondria-targeted approaches. An example of this is the UDCA in Parkinsons UP study. UDCA is a treatment that is used for dissolving gall stones, but recently researchers have found that it also has neuroprotective properties in models of Parkinsons. Cure Parkinsons is co-funding the UP study to determine if UDCA could be a useful neuroprotective treatment for Parkinsons.
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Enhancing Neuronal Survival Processes
An alternative to stopping the spread of pathology, is to try and help neurons continue to function despite the presence of pathological alpha synuclein, i.e., to provide some form of trophic support. There are several classes of drugs being repurposed , which may achieve this.
There has been a lot of publicity surrounding the potential of Glucagon-like peptide 1 receptor agonists in PD . These drugs are licensed for the treatment of Type 2 diabetes and have neuroprotective properties across the whole range of animal models of PD, including 2 alpha synuclein models. There is some evidence that this action may relate to an improvement in brain insulin signaling which enhances Akt activity while additional data indicate these drugs may also act in parallel through a positive effect on neuroinflammation . Indeed, the increased risk of developing PD among T2DM patients may be ameliorated according to the choice of anti-diabetic agent used .
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Symptoms And Warning Signs
Symptoms of Parkinsons fall into two major categories: those related to motor functions, and those related to changes in someones mood. The four most common signs and symptoms of Parkinsons disease include:
- Trembling: This usually presents itself in the arms, jaw, legs and face.
- Rigidity: Most patients experience stiffness of the bodys core as well as their arms and legs.
- Bradykinesia: This is the term for slowness of movement. Some patients pause or freeze when moving without being able to start again, and others begin to shuffle when trying to walk.
- Postural instability : This results in loss of strength, loss of balance and problems with moving muscles or coordinating body parts.
Other symptoms that can also occur, which often impact someones moods and other behaviors, include:
- Sexual dysfunction
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Slowing The Spread Of Alpha Synuclein Pathology
There is a mantra that disease modifying treatments must be initiated early if they are to be of any use in preventing disease progression. This is because post mortem specimens suggest that> 50% of SNc dopaminergic neurons are already lost by the time that patients present with the classical motor features of the disease . Given that there are many effective symptomatic treatments to help the motor, dopaminergic deficits in PD, it can be argued that the important unmet needs in PD relate to cognitive, speech, gait and balance difficulties and autonomic failure. In this case any treatment that prevented onset/worsening of these symptoms, would be highly relevant even in patients with established motor PD, and would be addressing the major challenges that patients face in its long-term management. From another perspective, since many of these non-motor features of PD may precede the onset of motor symptoms, we may have an even earlier window to start therapy, and have an opportunity to slow or stop the development of even the first motor symptoms of PD.
Beyond this, the companies will have to look carefully at the emerging data to decide whether a strategy of enrichment might be advantageous, and/or whether to risk extending trial eligibility to patients with more established disease than those currently being recruited.
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How Does This Condition Affect My Body
Parkinsons disease causes a specific area of your brain, the basal ganglia, to deteriorate. As this area deteriorates, you lose the abilities those areas once controlled. Researchers have uncovered that Parkinsons disease causes a major shift in your brain chemistry.
Under normal circumstances, your brain uses chemicals known as neurotransmitters to control how your brain cells communicate with each other. When you have Parkinsons disease, you dont have enough dopamine, one of the most important neurotransmitters.
When your brain sends activation signals that tell your muscles to move, it fine-tunes your movements using cells that require dopamine. Thats why lack of dopamine causes the slowed movements and tremors symptoms of Parkinson’s disease.
As Parkinson’s disease progresses, the symptoms expand and intensify. Later stages of the disease often affect how your brain functions, causing dementia-like symptoms and depression.
Reprogramming For Compound Validation
Since their initial work focused on patients skin cells, the team needed to validate their findings in dopaminergic brain cells, which are lost in Parkinsons. This can be particularly challenging because we cant easily take a brain biopsy from a patient, says Dr Mortiboys. The team therefore used a reprogramming technique utilising the patients skin cells to generate induced neuronal progenitor cells. We used a slightly modified protocol, which doesnt take the cells all the way back to being stem cells, explains Dr Mortiboys. Our method takes them to an intermediate, which can only become brain cell types. Crucially for us, it doesnt take them back to the embryonic state. The reason for this is that age is one of the biggest risk factors for Parkinsons and many other neurodegenerative conditions. We didnt want to wipe all the age-associated changes in the cell so, with this reprogramming technique, we retained the changes that had happened throughout the cells lifetime while still producing a high percentage of dopaminergic cells.
Once these cells had been cultured, the team studied their mitochondrial function and observed that they were far more defective in the patients brain cells than in their skin cells. This showed us that it did matter which cells we were looking at it really was a problem with the mitochondria in the dopaminergic brain cells, explained Dr Mortiboys.
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Why Exercise Can Help Delay The Onset Of Parkinsons Disease
Parkinsons disease affects more than a million people in the United States alone, and it is the second most common neurodegenerative disorder in the country. It is also the most common of movement disorders, which also include neurological disorders like Dystonia, Huntingtons disease, Tourettes syndrome, and others. In fact, there are 60,000 new patients diagnosed with PD each year, and men are one and a half times more likely to develop the disease than women.
PD affects both motor and non-motor related faculties and could include symptoms such as tremors, limb rigidity, gait and balance difficulties, slowness of movement, depression, constipation, sleep issues, and cognitive impairment. Though these symptoms may not be readily apparent, they develop and progress as the disease spreads.
Experts remain unsure exactly what causes Parkinsons a combination of environmental and genetic factors seems to be at play but the good news is that there are ways to slow its onset and protect against its development. One helpful method is to maintain good health through a balanced diet high in fiber and antioxidant-rich foods . Other preventative measures include getting proper sleep, minimizing stress, limiting exposure to toxins, and avoiding head injuries.
Research shows that something else is also promising in preventing and delaying the onset of PD: regular exercise.
Sidebar: Ninds Steps Up Pursuit Of Pd Biomarkers
In 2012, the NINDS dramatically accelerated efforts to identify biomarkers by establishing the Parkinsons Disease Biomarkers Program . This unprecedented program unites a range of stakeholders from basic and clinical researchers to healthcare professionals, the NINDS staff, information technology experts, and people living with PD and their families.
PDBP supports research and builds resources aimed at accelerating the discovery of biomarkers to ultimately slow the progression of PD. For example, the program has established a repository of biological specimens and a Data Management Resource system maintained by the NIH Center for Information Technology. The DMR allows researchers to access clinical, imaging, genetic, and biologic data, while a complementary PDBP-supported project develops statistical tools to analyze vast quantities of data so that patterns can be identified across these diverse sources of information.
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Study Limitations And Future Research
The study authors recognize that self-reporting may reduce the accuracy of the figures and that the observational nature of our study makes it impossible to draw a conclusion regarding causality. They accept that these are limitations of the study.
Speaking about future research, Dr. Tsukita told MNT: The next step is certainly a with a long-term intervention of exercise. There is a tendency to emphasize high-intensity exercise in the field of PD exercise, but our study strongly indicates that exercise may modify the long-term course of PD even in small amounts if sustained. Therefore, future RCTs should focus on sustained exercise as well, for example, by using motivational apps.
APDA offers free booklets, presentations, and videos to guide those with PD through specifically designed exercises that people can perform safely at home.
Can Parkinsons Disease Be Cured
No, Parkinsons disease is not curable. However, it is treatable, and many treatments are highly effective. It might also be possible to delay the progress and more severe symptoms of the disease.
A note from Cleveland Clinic
Parkinsons disease is a very common condition, and it is more likely to happen to people as they get older. While Parkinsons isnt curable, there are many different ways to treat this condition. They include several different classes of medications, surgery to implant brain-stimulation devices and more. Thanks to advances in treatment and care, many can live for years or even decades with this condition and can adapt to or receive treatment for the effects and symptoms.
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Tips For Daily Living
If you are already living with Parkinsons disease, here are some tips to manage it:
- Exercise your brain. Read, work on crossword puzzle, do Sudoku, or engage in other activities that use your brain.
- Get moving. If you feel comfortable walking, swimming, or riding an exercise bike, go for itand try to do it on a regular basis.
- Try tai chi. We think of tai chi as a mind-body exercise, and it is, but it also has roots as a martial art in China. A 2012 study found that practicing tai chi helped people with moderate Parkinsons disease maintain stability and balance. And a 2014 study found that tai chi can help people reduce their risk of falling. It incorporates a flowing series of coordinated movements to help you maintain flexibility, strength and balance, and it can be easily adapted to meet your abilities.
- Practice yoga. You dont have to perform headstands or other physically challenging poses to get significant benefits from practicing yoga. You can improve your balance, mobility, flexibility, and strength with a form thats adapted for you.
- Find a support group. Whether you prefer an online support group or a group that meets in person, a support group can be an invaluable resource for helping you live with Parkinsons disease.
What You Can Expect
Parkinson does follow a broad pattern. While it moves at different paces for different people, changes tend to come on slowly. Symptoms usually get worse over time, and new ones probably will pop up along the way.
Parkinsonâs doesnât always affect how long you live. But it can change your quality of life in a major way. After about 10 years, most people will have at least one major issue, like dementia or a physical disability.
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More Important To Maintain Exercise Than To Be Active Before Disease Starts Study Shows
byJudy George, Senior Staff Writer, MedPage Today January 13, 2022
People with early Parkinson’s disease who exercised regularly over 5 years performed better on cognitive testing and had slower disease progression in several domains, an observational cohort study showed.
Regular overall physical activity levels over time were significantly associated with slower deterioration of postural instability and gait scores , activities of daily living scores , and processing speed scores , reported Kazuto Tsukita, MD, of Kyoto University in Japan, and colleagues.
Moderate-to-vigorous exercise was linked with slower decline in postural and gait stability, while work-related physical activity was tied to slower deterioration in processing speed, they wrote in Neurology. Baseline activity level, however, was not tied to Parkinson’s progression.
“We found that to slow progression of the disease, it was more important for people with Parkinson’s to maintain an exercise program than it was to be active at the beginning of the disease,” Tsukita said in a statement.
“Although medications can provide people with Parkinson’s some symptom relief, they haven’t been shown to slow the progression of the disease,” Tsukita added. “We found that regular physical activity, including household tasks and moderate exercise, may actually improve the course of the disease over the long run.”
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Rutgers Collaborates With Scripps Research Hoping To Develop New Drug Treatment
A collaboration between scientists at Rutgers University and Scripps Research led to the discovery of a small molecule that may slow down or stop the progression of Parkinsons disease.
Parkinsons, which affects 1 million people in the United States and over 10 million worldwide according to the Parkinsons Foundation, is a neurodegenerative disorder with no cure. Symptoms develop slowly over time and can be debilitating to patients, who most recognizably develop tremor, slow movements and a shuffling gait.
A key feature of Parkinsons disease is a protein named -synuclein, which accumulates in an abnormal form in brain cells causing them to degenerate and die. However, it has been difficult to target -synuclein because it does not have a fixed structure and keeps changing its shape, making it very difficult for drugs to target. Because higher levels of the protein in the brain speed the degeneration of brain cells, scientists have been looking for ways to decrease the protein production as a form of treatment.
In 2014, Parkinsons disease expert and scientist M. Maral Mouradian, William Dow Lovett Professor of Neurology and director of the Rutgers Robert Wood Johnson Medical School Institute for Neurological Therapeutics, contacted Matthew D. Disney, chemistry professor at Scripps Research in Florida, to explore a novel idea for treating Parkinsons disease using a new technology developed by Disney.
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