Parkinson’s Disease: Four Unusual Signs You May be At Risk

Patrick Lewis and Alastair Noyce wrote . . . . . . . . .

Do you move around a lot during your sleep? Or have you lost your sense of smell? New insights into Parkinson’s disease suggest that these might be the early signs of changes in the brain that mean you are at greater risk of developing Parkinson’s.

When people talk about Parkinson’s disease, the image that most often comes to mind is of an elderly person who shakes and has trouble moving. And, in the later stages of Parkinson’s, this is often true. Bradykinesia (a medical term for slowed movement) and tremor (the shaking that can be so prominent in Parkinson’s) are two of the most important symptoms of the disease.

But research over the last 15 years has begun to shed light on some of the changes and symptoms that happen much earlier in the disease, sometimes long before the changes in movement that most people associate with Parkinson’s. So what are these early warning signs that you might be at increased risk of developing Parkinson’s? Here are four of the most common ones.

1. Loss of sense of smell

A common recollection by people who are diagnosed with Parkinson’s is that they remember changes in their sense of smell several years before developing any tremor or other movement problems. But many people might not even recognise that their sense of smell is bad. It is only when tested that we see that up to 90% of people living with Parkinson’s have lost their sense of smell.

2. Restless nights

There is a connection between changes in sleep patterns called rapid eye movement (REM) sleep behaviour disorder and the risk of developing Parkinson’s. REM sleep behaviour disorder, or RBD for short, is more than simply experiencing a restless night. People with RBD act out their dreams, sometimes moving violently in their sleep, to the extent that they can even injure themselves, but with often no recollection of their actions.

RBD is rare and can only be diagnosed with a special sleep study, but most people who develop RBD will develop Parkinson’s disease or a similar condition within a decade.

3. Constipation

Problems with digestion and bowel movements are a big problem for people with Parkinson’s, and we now know that these problems can start long before the tremor and problems with movement that lead to someone being referred to a neurologist.

As for most of these early symptoms, people can develop constipation for lots of different reasons, but it is clear that people living with Parkinson’s have problems with bowel movements. Constipation may, in fact, be one of the very earliest features, occurring up to 20 years before Parkinson’s is diagnosed.

4. Anxiety and depression

Feeling anxious or depressed, above and beyond the normal ups and downs of daily life, is one of the biggest problems that people with Parkinson’s report – sometimes noting it as even more of a problem than changes in movement. We think that this is due to changes in the balance of chemical activity in the brain and that these changes start up to ten years before people are diagnosed with Parkinson’s.

It is important to remember that there lots of reasons why any one, or combination, of these changes might happen. And even if you have all of them, it does not mean that you will certainly develop Parkinson’s. But there is good evidence that most people who are diagnosed with Parkinson’s have experienced some or all of these.

If you are interested in joining 10,000 others taking part in research aimed at finding people at risk of Parkinson’s, that might in time lead to prevention or cures, then please go to the Predict PD website.

Source : The Conversation


Today’s Comic

Advertisements

Exercise Can Improve Non-motor Symptoms of Parkinson’s Disease

Exercise has potential to improve non-motor as well as motor symptoms of Parkinson’s disease (PD), including cognitive function, report investigators in a review published in the Journal of Parkinson’s Disease.

PD is a slowly progressive disorder that affects movement, muscle control, and balance. While traditionally regarded as a movement disorder, it is now known to be a heterogeneous multisystem disorder — in recognition of the significant impact that non-motor symptoms have on the quality of life of individuals affected by PD. It is widely acknowledged that physical exercise improves motor symptoms such as tremor, gait disturbances, and postural instability. However, the effect of exercise on non-motor symptoms in PD, especially cognitive function, is less clear.

The number of older people with and without PD that experience cognitive impairment is steadily increasing worldwide. It is associated not only with a substantial rise in healthcare costs, but also affects the quality of life of both patients and relatives or carers. Up to 57% of patients suffering from PD develop mild cognitive impairment within five years of their initial diagnosis, and if they survive more than ten years, the majority will eventually develop dementia. The underlying neurophysiological mechanisms for cognitive decline in PD are not completely understood, but an accumulation of amyloid plaques, mitochondrial dysfunction, and neurotransmitter changes are all suggested to contribute.

A comprehensive literature review was conducted by investigators from the Institute of Movement and Neurosciences, German Sport University, Cologne, Germany, and the VasoActive Research Group, School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia. The studies reviewed included investigations of the effects of coordination exercise, resistance exercise, and aerobic exercise on domain-specific cognitive function in patients with PD. “Physical exercise is generally associated with increased cognitive function in older adults, but the effects in individuals suffering from PD are not known,” explained lead investigator Tim Stuckenschneider, MA.

The researchers identified relevant studies published before March 2018. There were 11 studies included with a combined total of over five hundred patients with PD with a disease severity from stages 1 to 4 on the Hoehn & Yahr scale, which is used to describe the symptom progression of PD. In four studies, positive effects of exercise on cognition (memory, executive function, and global cognitive function) were shown with no negative effect of exercise on any cognitive domain. Furthermore, disease severity was generally improved by exercise interventions.

The investigators concluded that all modes of exercise are associated with improved cognitive function in individuals with PD, however, no clear picture of which exercise mode is most effective emerged as they may influence cognitive function differently. Aerobic exercise tended to improve memory best, but different forms of exercises such as treadmill training or stationary bike training may have different effects, although both are considered aerobic exercise. Future studies are needed that directly compare the effects of different exercise modes, as the number of high-quality research projects is still limited.

“The potential of exercise to improve motor and non-motor symptoms is promising and may help to decelerate disease progression in individuals affected by PD,” observed Stuckenschneider. “Exercise therapy needs to be, and often already is, an essential part of therapy in individuals with PD. However, it is mostly used to treat motor symptoms. As part of a holistic therapy, the potential of exercise to maintain or improve non-motor symptoms such as cognitive function in individuals with PD needs to be acknowledged, and the most effective treatment options need to be defined. This will not only help practitioners to recommend specific exercise programs, but also ultimately improve the quality of life of the individual. Our work shows that ‘exercise is medicine’ and should routinely be recommended for people with PD to help combat both the physical and cognitive challenges of the disease.”

Source: Science Daily


Today’s Comic

Diabetes Linked to Risk for Parkinson’s Disease

Alan Mozes wrote . . . . . . . . .

Men and women with type 2 diabetes may face a significantly higher risk of developing Parkinson’s disease later in life, new British research suggests.

The finding of a link followed the tracking of Parkinson’s diagnoses among millions of diabetic and non-diabetic patients who use the National Health Service in England.

Study author Dr. Thomas Warner said that, after accounting for conditions that might mimic Parkinson’s, the research showed that those with type 2 diabetes had a 32 percent greater risk of later developing the progressively debilitating neurological disorder.

Escalated risk was even more dramatic among younger diabetes patients, aged 25 to 44, who were found to face a fourfold greater likelihood of eventually developing Parkinson’s, according to the report.

And adults with diabetes who had already developed diabetes-related health complications — including damage to the retina, kidneys or nerves — faced a 49 percent hike in their Parkinson’s risk.

Nevertheless, Warner stressed, “it is vital to realize that, overall, the majority of diabetic patients do not develop Parkinson’s disease.”

Although the study could not prove a cause-and-effect relationship, Warner cited two possible reasons for a link between the two diseases.

First, he said, there could be “shared genetic predisposition to develop [both] type 2 diabetes and Parkinson’s.”

And then “there may be shared pathways in leading to development of diabetes and Parkinson’s,” he added. While the exact nature of such a connection remains unclear, Warner suggested it might involve the insulin production and glucose control problems that characterize diabetes.

“Unlike most tissues in the body, brain cells are almost totally reliant on glucose as a source of energy,” Warner noted. “So if there is a problem in how insulin controls the use of glucose by cells, this may affect certain groups of brain cells selectively.”

Warner is a professor of clinical neurology with the University College London Institute of Neurology, as well as the Queen Square Brain Bank for Neurological Disorder, both in London.

He and his colleagues published their findings online in the journal Neurology.

For their study, the investigators used data from the English “Hospital Episode Statistics” database to identify 2 million British patients newly diagnosed with diabetes from 1999 through 2011.

This group was then stacked up against 6 million British patients who had initially sought care during the same time frame for non-diabetes related issues, such as sprains, varicose veins, appendectomies or hip replacements.

The researchers found that just over 14,000 of the 2 million in the diabetes group were later diagnosed with Parkinson’s, compared with about 21,000 of the 6 million others. That translated into a more than 30 percent greater risk for Parkinson’s among those with diabetes, the researchers said.

Among diabetic patients 25 to 44 years old, 58 of over 130,700 people developed Parkinson’s, compared with 280 out of nearly 2.6 million similarly aged non-diabetics. That translated into a fourfold greater Parkinson’s risk among those with diabetes, the researchers said.

Drug regimens and smoking histories were not considered in the current analysis; nor were patients seeking diabetes care outside a hospital setting.

Dr. Michael Okun, medical director of the National Parkinson’s Foundation, called the findings “not surprising, as the collective evidence from multiple studies has been converging on the idea of some link or association between Parkinson’s and diabetes.”

According to Okun, “There are many potential explanations for a link between the two diseases, but in younger patients, genetics likely plays a key role. In older patients, the degenerative process itself may disrupt brain-driven endocrine pathways, including those related to insulin and to sugar management.”

Okun, who also serves as the chair of neurology at the University of Florida in Gainesville, said, “At this point the mechanisms are unknown, and will require careful research.”

He said it’s “important to stress that although diabetes drugs are currently candidates to treat or prevent Parkinson’s disease, we are not recommending this approach until more compelling data is available.”

Source: HealthDay


Today’s Comic

Smartphones Could Help Measure Parkinson’s Disease Symptoms

Carolyn Crist wrote . . . . . . . .

An experimental smartphone application could monitor changes in Parkinson’s disease symptoms throughout the day, sending data to doctors to help them treat patients, U.S. researchers say.

“Like diabetes, Parkinson’s has variability and symptom fluctuations, which can also vary the treatment. We can’t measure these fluctuations at home, and you can only do so many measurements in the clinic,” said senior study author Suchi Saria of Johns Hopkins University in Baltimore.

The app developed by Saria and her colleagues asks patients to complete five tasks that assess speech, finger tapping, gait, balance and reaction time. From that, it generates a “mobile Parkinson’s Disease score,” which doctors can use to assess symptom severity and adjust medication, the team writes in JAMA Neurology.

Parkinson’s disease is a neurodegenerative disorder that affects dopamine-producing nerve cells in the brain. Symptoms include tremors, body stiffness, slow movement and difficulty walking.

“This new development is very exciting because this wasn’t feasible even a few years ago,” Saria said in a telephone interview. “Patients seem eager, willing and curious to do this with their phones.”

The researchers developed their app, HopkinsPD, for Android smartphones to assess performance on the five tasks as often as patients want to use the app. The mobile score is based on the types of assessments usually done in doctor’s offices.

To test the app and the scoring system, the researchers recruited 129 patients who completed more than 6,000 smartphone assessments. Scores ranged from 0 to 100, with higher numbers indicating more severe symptoms. Participants completed the tasks before and after their first daily dose of dopamine medication. They also completed standard assessments in the clinic.

Symptoms varied by an average of 14 points through the day, information that could help doctors understand the highs and lows for their Parkinson’s patients.

The team also found a strong correlation between the mobile app score and the in-office rating scales. On average, the mobile app score also decreased more than the official scales when dopamine medication was taken, which could highlight its sensitivity and accuracy in monitoring real-time symptoms, the authors note.

“The data from the phone aligns beautifully with what we found with classic instruments in the clinic,” Saria said. “It gives us a sense of patients’ motion and movement, like breadcrumbs along the way to understanding their symptoms.”

A limitation of the study is that only five tasks are used to measure behaviors and symptoms, the authors acknowledge. Additional studies will evaluate whether changes in the app score represent a significant difference experienced by patients.

“We physicians may measure phenomena we think are highly relevant, but patients may disagree,” said Dr. Alberto Espay, director of the James J. and Joan A. Gardner Center for Parkinson’s Disease and Movement Disorders at University of Cincinnati in Ohio, who wasn’t involved in the study.

“Also, it will be important to determine if the machine-learning component will require less active entry of data by patients, rendering it easier to use long-term,” Espay said in an email. “Long-term adherence will be important to ascertain if this application . . . can capture data for patients in their home settings.”

Researchers want to know whether elderly patients and those in developing countries can use similar apps, said Ye Wang of the National University of Singapore, who wasn’t involved in the current study.

“These ubiquitous technologies can and should be used to help doctors with their diagnosis,” Wang told Reuters Health by email.

“They are diagnostic aids and are not supposed to replace doctors,” he said. “But perhaps they can be part of the screening process.”

Source: Reuters


Today’s Comic

Vigorous Exercise May Help Slow Parkinson’s Disease

People with early stage Parkinson’s may be able to delay a worsening of the disease through a regimen of intense exercise, new research found.

“If you have Parkinson’s disease and you want to delay the progression of your symptoms, you should exercise three times a week with your heart rate between 80 to 85 percent maximum. It is that simple,” said study co-lead author Daniel Corcos. He’s professor of physical therapy and human movement sciences at Northwestern University’s Feinberg School of Medicine in Chicago.

However, a more “moderate” exercise level — under the heart rate threshold outlined in the study — was not effective in slowing the disease, the researchers said.

As Corcos’ team explained, medications for Parkinson’s cause harmful side effects and their effectiveness declines over time, so new treatments are needed.

“The earlier in the disease you intervene [with intensive exercise], the more likely it is you can prevent the progression of the disease,” Corcos said in a university news release.

The exact magnitude of the effect remains unknown, however.

“We delayed worsening of symptoms for six months; whether we can prevent progression any longer than six months will require further study,” Corcos said.

But the findings do challenge the long-held belief that intense exercise is too physically stressful for people with Parkinson’s disease, he added.

The new study included 128 patients, ages 40 to 80, who had early stage Parkinson’s and were not yet taking medications for the disease.

Some of the patients did high-intensity workouts three times a week for six months, others did moderate-intensity workouts, and a control group did no exercise.

The results showed that intense exercise was safe and delayed worsening of Parkinson’s symptoms such as loss of muscle control, trembling, stiffness, slowness and impaired balance.

“Several lines of evidence point to a beneficial effect of exercise in Parkinson’s disease,” Dr. Codrin Lungu, program director of the U.S. National Institute of Neurological Disorders and Stroke, said in the news release.

“Nevertheless, it’s not clear which kind of exercise is most effective. [This] trial tries to rigorously address this issue. The results are interesting and warrant further exploration of the optimal exercise regimes for Parkinson’s,” Lungu said.

Two other experts agreed that physical activity could be what the doctor ordered for Parkinson’s patients.

“As a neurologist who cares for many patients with Parkinson’s, this study offers the potential for additional non-pharmacological strategies in aiding our patients,” said Dr. Yasir El-Sherif of Staten Island University Hospital in New York City. He said he “looks forward” to further studies that might tell doctors just how long the benefits last.

Dr. Souhel Najjar directs neurology at Northwell Health in New Hyde Park, N.Y. He agreed that longer-term studies are needed, but the new findings help confirm that when dealing with Parkinson’s, intense exercise “can be very effective in halting its short-term progression.”

Parkinson’s affects about 1 million people in the United States. Incidence increases with age, and men are 1.5 times more likely than women to have the disorder, according to the Parkinson’s Foundation.

The study was published in the journal JAMA Neurology.

Source: HealthDay


Today’s Comic