Thursday, August 11, 2022

Parkinson’s And Hearing Loss

What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

Peripheral synucleinopathy in a DJ1 patient with Parkinson disease, cataracts, and hearing loss

Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

How Can Hearing Loss Contribute To Cognitive Decline

It makes sense that hearing trouble can impact cognition. People who do not hear well:

  • do not participate in conversation and limit their social and cognitive engagement, which can contribute to cognitive decline.
  • use more cognitive energy to decipher the sounds that they are hearing. This leaves less cognitive power for other tasks.
  • will have a hard time remembering what they hear.

If those around you tell you that your hearing appears to have diminished, get your hearing evaluated with an audiogram. Improving your hearing with hearing aids could have many positive impacts on your well-being, and potentially improve cognitive functioning as well.

Signs Of Parkinsons Disease

In 1817, Dr. James Parkinson published An Essay on the Shaking Palsy describing non-motor, as well as, motor symptoms of the illness that bears his name. Parkinsons is not just a movement disorder, explained Dr. Shprecher. Constipation, impaired sense of smell, and dream enactment can occur years before motor symptoms of Parkinsons. The latter, caused by a condition called REM sleep behavior disorder, is a very strong risk factor for both Parkinsons and dementia . This has prompted us to join a consortium of centers studying REM sleep behavior disorder.

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Foods To Avoid In A Parkinsons Disease Diet

If your goal is to maintain overall health with Parkinsons disease and it should be you should avoid or reduce your intake of some of the same potentially harmful foods as people without the condition.

For example, a diet with lots of sugar can add too many calories and provide your body with too few nutrients. It can also contribute to tooth decay and increase your risk of diabetes.

In addition, foods high in salt and sodium content can increase the risk of high blood pressure, heart attack, and stroke. According to the American Heart Association, some of the saltiest foods in typical diets include:

  • Breads and rolls
  • Cold cuts and cured meats
  • Soup
  • Burritos and tacos

Most of our patients have problems with low blood pressure, due to issues with autonomic nervous system function in Parkinsons disease, Subramanian adds. So in some cases, we recommend a little extra salt in the diet, or even energy drinks, to boost blood pressure.

Either way, you should check with your doctor about taking appropriate dietary steps to manage blood pressure along with Parkinsons disease.

Also limit foods high in calories and fat, particularly saturated and trans fat, which can increase your risk of heart problems as well as certain types of cancer and make it more difficult for you maintain a healthy weight.

Parkinsons Disease Patients Versus Controls

How Parkinsons Disease Affects the Human Body

To compare patients with Parkinsons disease to control subjects, an ANOVA test for repeated measurements was used. The frequency band and the ear were treated as within-subject factors . The between-subjects factor, disease, is a two-level factor, distinguishing patients from controls. Sex was included as a between-subjects two-level factor, and age was included as a covariate factor. A complete factorial model was studied.

In such a comparison between two distinct populations, the sensitivity of the results mainly depends on the testretest and inter-subject fluctuations of the diagnostic technique. At low signal levels, typical of elderly and/or impaired subjects, the advanced DPOAE technique used in this study helps to reduce these uncertainties however, PTA may still prove more sensitive, because the typical change in DPOAE levels due to sensorineural hearing loss is 50% of the audiometric change in cross-section studies .

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Summary: Electrophysiological Measurements In Pd

A summary of study findings regarding electrophysiological measurements in early stage patients with PD can be found in Table 2. Based on various AEPs, neurophysiological alterations in auditory processing have been demonstrated in the clinical stage of PD. Considering early stage PD, a careful selection of electrophysiological paradigms may be suitable to discriminate patients with early stage PD from HCs. Study results particularly suggest a pattern of centrally located ABR abnormalities in PD. However, as ABR studies in early stage PD are limited and rather inconsistent, further research is warranted. Especially because of the potential involvement of the lower brainstem during the early stages of PD pathology . Furthermore, altered long latency AEPs in early stage PD may be evident when ERP paradigms are tailored to evaluate specific and/or more complex auditory processes. Regarding paired-stimulus and intensity dependence paradigms, an increased N1/P2 amplitude in early stage patients with PD has been found. These differences disappeared following initiation with dopaminergic medication in patients with PD. Regarding selective attention and three-stimulus oddball paradigms, studies have shown a decreased Nd amplitude and a decreased or increased P3a amplitude. Regardless of the direction of the P3a amplitude alteration, shifts of the P3a component were most evident when patients with PD were evaluated with dopaminergic medication.

Living With Parkinsons Disease

Depending on severity, life can look very different for a person coping with Parkinsons Disease. As a loved one, your top priority will be their comfort, peace of mind and safety. Dr. Shprecher offered some advice, regardless of the diseases progression. Besides movement issues Parkinsons Disease can cause a wide variety of symptoms including drooling, constipation, low blood pressure when standing up, voice problems, depression, anxiety, sleep problems, hallucinations and dementia. Therefore, regular visits with a neurologist experienced with Parkinsons are important to make sure the diagnosis is on target, and the symptoms are monitored and addressed. Because changes in your other medications can affect your Parkinsons symptoms, you should remind each member of your healthcare team to send a copy of your clinic note after every appointment.

Dr. Shprecher also added that maintaining a healthy diet and getting regular exercise can help improve quality of life. Physical and speech therapists are welcome additions to any caregiving team.

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Other Symptoms Of Parkinsons

The primary motor symptoms of PD are tremor, rigidity, postural instability , and bradykinesia .

PD also causes many secondary motor symptoms, including micrographia , changes in gait , stooped posture, dystonia , cramping, difficulty swallowing, sexual dysfunction, impaired fine motor dexterity, and akathisia .

In addition to these motor symptoms, PD can cause non-motor symptoms such as depression, difficulty swallowing or chewing, urinary problems, constipation, skin problems, sleep problems, pain, and cognitive problems, such as memory problems or slow thinking.1,7

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Assessments Of Central Auditory Processing

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Speech intelligibility in noise was assessed using the Words in Noise test in which 2 lists of 25 words are presented to each ear in the presence of background masking noise. Participants repeated each word they heard.

Computerized versions of the following tests were administered in which the audio tracks from CDs were triggered by a program written in Matlab and played through a digital-to-analog converter and amplifier connected to the inputs of a GSI-61 clinical audiometer . The sounds were then delivered to the listener via ER3A insert earphones . Playing, pausing, and repeating of test items were controlled from a computer screen interface. Tests were conducted at a minimum of 35dB sensation level .

Responses were indicated by the participant using either a verbal response or computer touchscreen tap. Participant responses were immediately entered by the tester using a graphical version of the appropriate score sheet that was displayed on a computer screen. Scoring and storage of results were performed by the computer program, as was the randomization of the order in which the tests were conducted. Subjects were encouraged to take breaks, and testing was discontinued if fatigue or frustration was evident. This portion of the testing protocol lasted approximately two hours.

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Tinnitus May Warn Of Increased Risk For Alzheimers Parkinsons

Tinnitus, a sensation of sound without any source, appears to precede Parkinsons and Alzheimers diseases and may serve as a sign of increased risk for those conditions, according to a recent study.

Rates of tinnitus increase with age and studies have found that hearing loss, as well as central auditory dysfunction more generally, are associated with higher risks of cognitive dysfunction, particularly dementia, control of attention, and working memory.

Past studies, however, have not examined the relationship between tinnitus, Parkinsons, and Alzheimers in a population-based way.

A team of researchers from various Taiwanese institutions recently examined this association using records from Taiwans National Health Insurance system. The NHI records provide a large and nationally representative patient sample with long follow-up periods, as participation is nationwide and mandatory.

They identified 12,657 tinnitus patients and 25,314 control patients without tinnitus. Over a 10-year follow up period, 398 of those with tinnitus and 501 without developed Alzheimers.

A further 211 tinnitus patients and 249 control patients developed Parkinsons.

Do I Need To See A Doctor About This image from Parkinsons Foundation

Given the importance of preventing falls and associated loss of independence,2 it is imperative that people with PD who suffer from dizziness discuss it with their neurologist. Dizziness can be due to many reasons. It may be due to falling blood pressure when you stand up, a primary brain-related cause or an ear-related issue. Any of these can make you feel unsteady and fall, and almost all of these falls may be preventable. Some of the causes of dizziness are reversible. In addition to falls, loss of hearing can affect your attention and has been associated with cognitive impairment.3 Your neurologist may refer you to an ENT doctor for further assessment.

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Foods Containing Nutrients That People May Be Deficient In

Some research suggests that people with Parkinsons often have certain nutrient deficiencies, including deficiencies in iron, vitamin B1, vitamin C, zinc, and vitamin D.

The above study points out that some of these deficiencies may be associated with neuroinflammation and neurodegeneration, which are key factors in Parkinsons.

Therefore, people with Parkinsons may wish to consume more of the following foods.

Foods containing iron

The following foods are good sources of iron:

  • liver

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What Changes Can Occur

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There are several ways PD may affect speech:

  • The voice may get softer, breathy, or hoarse, causing others difficulty hearing what is said.
  • Speech may be slurred.
  • Speech may be mumbled or expressed rapidly.
  • The tone of the voice may become monotone, lacking the normal ups and downs.
  • The person may have difficulty finding the right words, causing speech to be slower.
  • The person may have difficulty participating in fast-paced conversations.1

Some of the medical terms that describe the speech changes that can occur with PD include:

  • Dysarthria, which is a motor speech disorder or impairment in speaking due to PD affecting the muscles required for speech
  • Hypophonia, which means soft speech, is an abnormally weak voice caused by the weakening muscles
  • Tachyphemia, also known as cluttering, is characterized by an excessively fast speed of talking and a rapid stammering that makes it difficult to understand the person speaking2,3

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What Should I Eat Before And After I Exercise

In the same way that theres no one diet for anyone, the timing of your meals before and after exercise will largely depend on you. While its important to limit your protein intake after taking your carb/levodopa, if you want a pre-workout snack, you can choose something light and carbohydrate-based, as this wont interfere with the absorption of your medicine. After you work out, it may be a good time for a protein-rich snack, so long as it is eaten at least 30 minutes before your next dose of medicine. With that framework, the exact type and timing of snacks before and after exercise is something that you can experiment with and talk to your doctor about.

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Age At Disease Onset Results In Distinct Speech Patterns

I made an appointment for Bev at the Audiology Foundation of America Balance & Hearing Institute when she visited me in Arizona last winter. The AFA is part of the Arizona School of Health Sciences at A.T. Still University, a university teaching institution where I was once employed.

I wanted to see if Bev just needed better hearing aids, or if there might be other options to improve her hearing. We learned from the AFA audiologist that Bevs hearing loss was permanent, and that more costly hearing aids wouldnt help, given her Parkinsons progression and her age. However, the audiologist did suggest that we try some assistive technology aids.

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Fewer Accidents And Falls

Although no one knows how many falls are associated with hearing loss per year, researchers at Johns Hopkins Medicine have found that people with hearing loss are three times more likely to fall than those without hearing loss.

Hearing loss is assumed to distract from spatial awareness, which raises the risk of tripping and dropping. Other studies have pointed out the balance issues that can occur when people live with untreated hearing loss.

Who Is The Author Abhimanyu Mahajan Md

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Currently, Dr. Abhimanyu Mahajan is an Assistant Professor at the Rush Parkinsons disease and movement disorders program in Chicago, IL. After medical school, Dr. Abhimanyu Mahajan obtained a Masters in Epidemiology at the Johns Hopkins Bloomberg School of Public Health and a certificate in gerontology from the Johns Hopkins Center of Aging and Health. During this time, he also worked as a graduate research assistant in movement disorders. He completed his Neurology residency at Henry Ford Hospital in Detroit, and Movement disorders fellowship at the University of Cincinnati where he was the 2019 Dystonia Medical Research Foundation clinical fellow. His primary research interests lie in the pathophysiology and clinical manifestations of dystonia. His broader areas of interest lie in aging and the use of epidemiology and imaging in disorders of motor function. He is also interested in graduate medical education. His research has been recognized with the 2018 American Academy of Neurology Young Investigators award, the 2018 he was the Parkinsons Study Group junior investigator award and the 2020 AAN Alliance Award: Founders. One of his research interests is the ear and Parkinsons.

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Cognitive Changes In Pd

Cognitive symptoms in Parkinsons disease are common, though not every person experiences them. In some people with PD, the cognitive changes are mild. In others, however, cognitive deficits may become more severe and impact daily functioning. Similar to slowness of movement , people with Parkinsons disease often report slower thinking and information processing . Attention and working memory, executive function, and visuospatial function are the most frequently affected cognitive domains in PD.

Cognitive deficits that are mild and do not impair ones ability to carry out activities of daily living have been termed mild cognitive impairment. Studies estimate that mild cognitive impairment occurs in about 20-50% of patients with PD. We now recognize that mild cognitive changes may be present at the time of Parkinsons disease diagnosis or even early in the course of PD. They may or may not be noticeable to the person. They may or may not affect work or activities, depending on the demands of specific tasks and work situations.

Short Latency Auditory Evoked Potentials

Regarding early stage PD, two studies have investigated the ABR in early stage patients with PD. Karayanidis et al. administered ABR testing in 16 patients with PD , was not confounded by differences in auditory brainstem processing). All patients had a relatively recent diagnosis and most of them were at H& Y stages I or II. Compared to age-matched HCs, patients with PD exhibited a non-significant prolongation of the IPL between wave I and III. No significant group differences were found for the IPL between wave I and V and wave V latency. In contrast, Yylmaz et al. found significantly prolonged IPLs between wave I and V and wave V latencies in 20 patients with PD at H& Y stage II compared to HCs. However, in their study, patients with PD were on average 6.1 years older compared to the HC group. The result of Yylmaz et al. may indicate a similar pattern of centrally located ABR abnormalities found in more advanced patients with PD. Nonetheless, further research is warranted.

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