What Treatments Can We Expect In The Near Future
It is crucial that neuroprotective agents are found to slow or halt the progression of Parkinson’s disease. However, fundamental questions remain about the design of neuroprotection trials, particularly delayed start trials and futility studies.
Continuous dopaminergic stimulation throughout 24 hours may reduce motor complications by avoiding pulsatile stimulation of dopamine receptors. The new dopamine agonist rotigotine has been formulated in a transdermal delivery system that provides 24 hour stimulation. Once daily, prolonged release versions of the non-ergot agonists pramipexole and ropinirole are undergoing clinical trials and should be available in the next few years.
Much effort has gone into developing non-dopaminergic agents for parkinsonian symptoms and/or dyskinesias . However, many such agents have proved disappointing in clinical trials, perhaps because animal models do not truly reflect Parkinson’s disease.
Parkinson’s Disease: The Basics
What is Parkinson’s Disease?
Parkinson’s disease is a neurodegenerative disorder in which cells in the brain have difficulty producing dopamine, a chemical messenger that transmits signals which help control movement throughout the body.
What are some symptoms of the disease?
Symptoms can include stiffness rigidity problems with movement including shaking, , and slowness of movement and problems with gait and balance including difficulty walking. Some people with PD also experience . Many scientists now believe that certain symptomssuch as loss of smell, restless behavior during sleep, and constipationcan be very early signs of PD.
What are the current treatments for PD?
Can lifestyle changes make a difference?
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Exercise is generally believed to have a very positive effect on PD patients. “I tell my patients that a mile a day keeps the doctor away,” says Dr. Langston of brisk walking. Many people with PD also find that physical therapy and/or speech therapy can be quite beneficial.
The Danger Of Paraquat Today
The United States banned DDT, Agent Orange, and heptachlor in the 1970s and 1980s. However, the United States has not banned all pesticides linked to Parkinsons. The one with perhaps the strongest link to the disease is still in widespread use: paraquat.
The United States has not banned all pesticides linked to Parkinsons. The one with perhaps the strongest link to the disease is still in widespread use: paraquat.
Paraquat has been used as a pesticide since the 1950s and is marketed as an alternative to the worlds most popular weed killer, glyphosate, more commonly known as Roundup. Paraquat takes care of weeds that not even Roundup can kill. Today, it is used on farm fields across the United States, and its use continues to increase. The pesticides primary uses are for corn, soybeans, wheat, cotton, and grapes.
Portraits of several Parkinsons patients show the many faces of people with the diagnosis. It affects people from all walks of life.
In the laboratory, paraquat reproduces the features of Parkinsons disease. In a 1999 study in Brain Research, A. I. Brooks of the University of Rochester and colleagues gave paraquat to mice, and their activity decreased. Paraquat also killed dopamine-producing nerve cells in the rodents substantia nigras. The greater the amount of paraquat administered, the greater the number of nerve cells lost.
Table adapted from: www.panna.org.
Figure adapted from R. Dorsey et al., 2020.
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Telehealth For People With Pdrds: Clinical Outcomes And Patient Preferences
Neurologists, especially movement disorder specialists, are scarce in certain areas of the country, and travel to these outpatient clinics presents a major burden for patients and caregivers . Even people with PDRDs who are local to their neurologist may choose to be seen using telehealth intermittently if they have motor or non-motor symptoms that make leaving their home difficult at the time of their visit. The flexibility of being able to turn an in-person outpatient visit into a telehealth visit provides reassurance to patients with significant symptom burden that they will continue to have the same access to the neuropalliative care team despite having symptoms that impair mobility and travel. As PDRDs progress, most patients will become homebound, making telehealth an even more important way to provide neurological specialty care for these serious, life-limiting neurodegenerative illnesses . Validation of a modified version of the internationally recognized Unified Parkinsons Disease Rating Scale and the Montreal Cognitive Assessment that can be administered remotely allows for standardized assessments to be used in remote clinical and research visits. Two recently published randomized controlled clinical trials showed that outpatient care for people with PD provided via telemedicine was equivalent to the care provided in-person for people with PD, but telemedicine was significantly preferred to in-person visits, saving a median of 88 minutes and 38 miles per visit .
Exercise May Aid Parkinsons Disease But Make It Intense
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Intense treadmill exercise can be safe for people who have recently been given diagnoses of Parkinsons disease and may substantially slow the progression of their condition, according to an important new study of adults in the early stages of the disease.
But the same studys results also indicate that gentler exercise, while safe for people with Parkinsons, does not seem to delay the diseases advance.
As most of us know, Parkinsons disease is a progressive neurological disorder that involves problems with motor control. Symptoms like weakness, stiffness, loss of balance and falls can make exercise difficult and potentially hazardous. Though Parkinsons is currently incurable, its symptoms can be eased for a time with various drugs.
But most of those drugs lose their effectiveness in people over time.
So some researchers have begun searching for other treatment options, particularly for use in the beginning stages of the disease. If people with early Parkinsons could brake the diseases advance and delay their need to start medications, the researchers have reasoned, they might change the arc of their disease, delaying its most severe effects.
That possibility recently led a consortium of researchers from Northwestern University, the University of Colorados Anschutz Medical Campus in Aurora and other institutions to look at exercise as a treatment.
The others were assigned to start exercising.
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The Importance Of Establishing Parkinsons Prevalence Numbers
Parkinsons Prevalence estimates will help the Parkinsons Foundation attract the attention of federal and state government as well as the pharmaceutical industry to the growing need and urgency in addressing PD. This is an important first step to better understanding who develops PD and why.
The next phase of this study will be to determine the rate of PD diagnosis or incidence, how that has changed over time and what is the rate of mortality among those affected by PD. Determining the prevalence and incidence will allow the PD community to effectively advocate for additional money and resources necessary to support Parkinsons research.
Parkinsons Foundation Prevalence Project numbers highlight the growing importance of optimizing expert Parkinsons care and treatment for people with Parkinsons, which would help future caregivers and ease the strain on health and elder care systems.
By supporting this study, the Foundation works to better understand Parkinsons with the goal of solving this disease. Establishing these numbers and using them to educate PD communities and influence legislation will help the foundation provide tailored resources, outreach and advocacy to the underserved PD populations across the nation. The entire published study is available in the Parkinsons Foundation scientific journal, npj Parkinsons Disease.
Vitamins C And E Tied To Lower Risk For Parkinsons Disease
Consuming foods high in vitamins C and E may help protect against the onset of Parkinsons later in life, a Swedish study suggests.
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People who consume a diet rich in vitamins C and E may be at reduced risk for Parkinsons disease.
Researchers followed 41,058 Swedish men and women for an average of 18 years, gathering data on their health and diet. They assessed intake of vitamins C and E as well as beta-carotene and a measure called NEAC, which takes into account all antioxidants from food and their interactions with each other.
Over the course of the study, published in Neurology, there were 465 cases of Parkinsons disease.
After adjusting for age, sex, B.M.I., education, smoking, alcohol consumption and other characteristics, they found that compared with the one-third of people with the lowest intake of vitamin C or E, the one-third with the highest intake had a 32 percent reduced risk for Parkinsons disease. Those in the highest one-third in consumption of both vitamins together had a 38 percent reduced risk. There was no effect for beta-carotene or the NEAC measure.
Still, she said, Implementation of a diet that includes foods rich in vitamins C and E might help protect against the development of Parkinsons later in life. In any case, its never wrong to implement a healthy diet.
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Evelyn Simon 79 San Francisco
Evelyn Simon suspected that a hand tremor that began in early 1998 was an early sign of Parkinsons, but she waited almost a full year to see a doctor.
After speaking with a neurologist, Ms. Simon entered a clinical trial for a new type of Parkinsons drug. It was effective for her and was approved for use soon after.
Nine years later, Ms. Simons symptoms are still under control. Ms. Simon finds that speaking to other people with Parkinsons disease helps her prepare for the future, whether her Parkinsons worsens or not.
Diagnosis Parkinson’s Disease: You Are Not Alone
This 25-minute video was created to provide some comfort and encouragement for a person who has just been diagnosed with Parkinson’s disease. It includes testimonials from people with Parkinson’s on how they learned to cope and live with the diagnosis, scientific and medical information from healthcare experts and helpful tips and resources.
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Surprising Gifts Parkinsons Has Given Me
This short essay was written by a woman with young onset Parkinsons disease, who had DBS. She reflects on how Parkinsons has changed her priorities for the better, and introduced her to wonderful friends. She may be happier now than she would have been without Parkinsons disease. She certainly has more gratitude.
A Portrait Of Parkinsons Disease
Karen Alexander says she is one of the lucky ones. Ten years after learning she has Parkinsons disease, she takes two drugs to control her symptoms and so far has few of them. A tremor on her left side can make it hard to balance a teacup and saucer, but at 74, it doesnt bother me much, she said. Luckily, Ms. Alexander, who lives in a suburb west of Chicago, is right-handed.
Each year more than 50,000 elderly Americans like her are given a diagnosis of Parkinsons disease, typically evidenced by tremors and, eventually, rigid limbs and difficulty moving. It is not an obscure disease, but neurologists often have trouble identifying it in its early stages. A sizable number of cases are misdiagnosed, and many patients receive inappropriate treatments that can have harmful side effects. But that may change later this year when a newly approved brain scan technique becomes widely available.
Parkinsons disease currently does not have definite diagnostic tests, said Todd Sherer, chief program officer at the Michael J. Fox Foundation for Parkinsons Research in New York. Dr. Sherer said the new brain scans would expedite trials seeking new treatments, which researchers hope will slow and one day reverse the progression of Parkinsons.
There has been a resurgence of interest in Parkinson therapies by drug companies, said Joyce Oberdorf, president of the National Parkinson Foundation, based in Miami.
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Through His Eponymous Foundation The Famed Actor
As Marty McFly, he took us Back to the Future. Now, through his work leading The Michael J. Fox Foundation for Parkinson’s Research , actor and activist Michael J. Fox is helping to usher in a new future for people with one filled with hope. “I know without fail that we are getting closerday by day, year by yearto the breakthroughs that will make finding a cure inevitable,” Fox tells Neurology Now. “A lot of work lies ahead of us. But this is a responsibility we have, and we want people to know someone is trying to get this work done.”
Parkinson’s disease is a central nervous system disorder in which the brain has difficulty controlling the movements of the body. In people with PD, the brain cells that make dopamine don’t function normally, which causes trouble with body movement. Some of the classic symptoms of the disease are “rigidity, stiffness, stooped or forward-leaning posture, and shuffling gait,” says J. William Langston, M.D., the founder, chief executive officer , and scientific director of The Parkinson’s Institute in Sunnyvale, CA. Like over one million Americans, Michael J. Fox has PD.
Called “the most credible voice on Parkinson’s disease research in the world” by The New York Times, MJFF is the world’s largest private funder of PD research, having contributed more than $270 million toward their goal of finding a cure. Along the way, the organization has helped improve the way research is funded and conducted.
Fox Trial Finder
Slowing Down the Disease
Parkinsons: A Progressive Incurable Disease
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By Denise Grady
Muhammad Ali, who died on Friday after a long struggle with Parkinsons disease, was given the diagnosis in 1984 when he was 42. The world witnessed his gradual decline over the decades as tremors and stiffness set in, replacing his athletic stride with a shuffle, silencing his exuberant voice and freezing his face into an expressionless mask.
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Scott Giffney 46 Homewood Ill
Scott Giffney, a stay-at-home dad, first found out he had Parkinsons disease at age 37, after experiencing minor symptoms for six months.
Mr. Giffney used to own a scrap iron yard but had to leave his job as weakness on one side of his body and other symptoms progressed. Often, Mr. Giffney has a hard time completing simple tasks like tying his shoes. He is now at home full time with his daughters, Alex and Jordan.
As Parkinsons progresses, Mr. Giffney sees his world getting smaller. He is less able to travel and is sometimes dependent on outside help. But he prefers to keep a positive outlook about his condition. Somebody always has it worse, he says.
Patient Voices is an audio-visual series that tells the stories of people living with chronic illness. Patient Voices: Parkinsons Disease was originally published in August 2008.
Designed by Christian Swinehart and Rumsey Taylor
What Parkinsons Teaches Us About The Brain
Scientific discoveries can be serendipitous, and so it was when Jay L. Alberts, then a Parkinsons disease researcher at Emory University in Atlanta, mounted a tandem bike with Cathy Frazier, a Parkinsons patient. The two were riding the 2003 RAGBRAI bicycle tour across Iowa, hoping to raise awareness of the neurodegenerative disease and show people with Parkinsons that you dont have to sit back and let the disease take over your life, Dr. Alberts said.
But something unexpected happened after the first days riding. One of Ms. Fraziers symptoms was micrographia, a condition in which her handwriting, legible at first, would quickly become smaller, more spidery and unreadable as she continued to write. After a day of pedaling, though, she signed a birthday card with no difficulty, her signature beautifully written, Dr. Alberts said. She also told him that she felt as if she didnt have Parkinsons.
Impressed, Dr. Alberts, who now holds an endowed research chair at the Cleveland Clinic in Ohio, embarked on a series of experiments in which he had people with Parkinsons disease ride tandem bicycles. The preliminary results are raising fascinating questions not only about whether exercise can help to combat the disease but also and of broader import whether intense, essentially forced workouts affect brains differently than gentler activity does, even in those of us who are healthy.
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The Rise Of Parkinson’s Disease
Neurological disorders are the worlds leading cause of disability. And the fastest growing of these conditions is not Alzheimers but Parkinsons disease.
- The number of people with Parkinsons disease more than doubled from 1990 to 2015 and could double again by 2040. An aging population alone does not account for this rise.
- Air pollution, metal production, certain industrial chemicals, and some synthetic pesticides are linked to Parkinsons. Yet we are doing little to manage known risk factors.
- The authors contend that the United States should ban trichloroethylene, paraquat, and other chemicals linked to Parkinsons, which many other countries have already done.
From 1990 to 2015, the number of people living with Parkinsons more than doubled from 2.6 million to 6.3 million, according to a 2015 study in Lancet Neurology. By 2040, the number is projected to double again to at least 12.9 million, a stunning rise .
The number of people with Parkinsons disease more than doubled between 1990 and 2015 and is projected to double again by 2040.
Figure adapted from E. R. Dorsey and B. R. Bloem, 2018.
Figure adapted from R. Dorsey et al., 2020.
The number of people who succumb to Parkinsons each year has been increasing steadily.
Data from: U.S. National Center for Health Statistics, National Vital Statistics System, Mortality Data.
Christophe Vander Eecken / Reporters / Science Source
Box 1 Common Causes Of Tremor
A parkinsonian or akinetic-rigid syndrome consists of rigidity, bradykinesia, and hypokinesia. Some patients may have tremoraround 80% in Parkinson’s disease. A parkinsonian syndrome is not diagnostic of Parkinson’s disease many older patients have one or two features of parkinsonism as a result of ageing, making differential diagnosis difficult.
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