We recently sat down with Andrea Williams from Milwaukee Radio Group. Gary Garland, WPA’s executive director, and Anna Warren, who lives with Parkinson’s, were featured.
Take a listen here:
Stress Linked to Harsher Parkinson’s Symptoms, but Mindfulness May Help
People with Parkinson’s disease experience more stress than those without this disease, and high stress levels associate with a worsening of symptoms, research based on a patient survey reported.
Mindfulness, a practice of maintaining a heightened state of awareness of thoughts and feelings, may help to lower stress in people with Parkinson’s, especially anxiety and depressive feelings, it also reported.
These findings were in the study “Stress and mindfulness in Parkinson’s disease – a survey in 5000 patients,” published in npj Parkinson’s Disease.
A team led by researchers in the Netherlands sent out a survey through The Michael J. Fox Foundation’s Fox Insight program. The survey asked a variety of questions about stress, Parkinson’s, and related factors.
Survey answers were returned by 5,000 patients and by 1,292 controls, mostly relatives, spouses, or friends of patients who did not have Parkinson’s. Patients’ mean age was 67.3, their average disease duration was 5.9 years, and 48.6% were women. Among controls, the mean age was 60.8 years, and 78.0% were women.
Most survey respondents (93%) were white, and most (82.6%) lived in the U.S. Of note, not all survey respondents answered every question; the researchers analyzed data that were available.
Analyses demonstrated that perceived stress was generally higher in people with Parkinson’s than in controls. This effect was also “much larger for men than for women,” the researchers wrote.
Parkinson’s patients also scored higher than controls on measurements of anxiety and depression, and lower on dispositional mindfulness (a trait that allows a person to be aware of the present moment, even during ordinary tasks). These differences were all independent of age or sex.
Among patients, higher stress scores associated with worse symptoms for all symptoms assessed (including sleeping problems, depression, involuntary movement, and slowness of movement.)
The symptom most affected by stress was tremor: 81.8% of patients reported a worsening in tremor during periods of stress.
“It should be noted, however, that PD [Parkinson’s disease] patients may perceive externally observable symptoms such as tremor more easily than slowness of movement or muscle stiffness, which could (partly) explain the difference between tremor and other motor symptoms,” the researchers wrote.
Patients who reported higher stress levels were also found to be more likely to report lower scores related to quality of life, self-compassion, and dispositional mindfulness. Stressed patients were also more likely to show high scores related to rumination (continuously thinking about the same thoughts, which are often sad or dark).
In free-text portions of the survey, patients commonly stated that stress worsened their cognitive and communication difficulties, and heightened emotional symptoms like anxiety.
Physical exercise was the most commonly reported stress-reducing strategy in the survey, mentioned by 83.1% of patients. Other frequent approaches to lessen stress included religion, music, art, reading, taking anti-anxiety or antidepressant medication, and looking for social support (e.g., talking to a friend).
Over a third (38.7%) of Parkinson’s patients reported practicing mindfulness — which involves focusing on the present moment, rather than fixating on the past or worrying about the future.
Of note, patients who were mindfulness users reported significantly higher dispositional mindfulness, and also higher perceptions of stress and anxiety. The researchers noted that it is difficult to tease out cause-and-effect relationships from this data. For example, people who are more stressed might be more likely to seek out mindfulness, or mindfulness practitioners may be more in touch with feelings of stress or anxiety and so recognize them to a greater degree.
Mindfulness also was associated with less severe symptoms across all motor and nonmotor symptoms measured.
“Patients perceived a positive effect of mindfulness on their symptoms,” the researchers wrote.
“Highest effects were seen for depression and anxiety, for which, respectively, 60.2% and 64.7% noticed improvement,” they added.
About half of mindfulness users (53.2%) practiced this technique once a week or more, while over a fifth (21.5%) practiced mindfulness once a month or less. Broadly, individuals who practiced mindfulness more frequently reported a greater easing of their symptoms, but consistent benefits were seen among all mindfulness users regardless of frequency.
The researchers speculated that, even when people aren’t actively practicing mindfulness, they may incorporate it into their lives more informally, through subtle changes to lifestyle or thought patterns.
These findings “[support] the idea that mindfulness is effective in reducing PD symptoms,” the researchers wrote, though they again noted they could not determine cause-and-effect from these data. Rather, “people for whom mindfulness is most effective might consequently practice it more.”
The researchers called for further studies, particularly in larger and more diverse groups, to better understand the effects of stress on Parkinson’s patients, as well as the potential benefits of practicing mindfulness.
“The significant beneficial effects that patients experienced from self-management strategies such as mindfulness and physical exercise encourages future trials into the clinical effects and underlying mechanisms of these therapies,” they concluded.
Therapy Fights Depression for People with PD
Cognitive behavioral therapy is a form of psychotherapy that increases awareness of negative thinking and teaches coping skills.
About 50% of people diagnosed with Parkinson’s disease will experience depression, and up to 40% have an anxiety disorder.
“The psychological complications of Parkinson’s disease have a greater impact on the quality of life and overall functioning than the motor symptoms of the disease,” says lead author Roseanne Dobkin, a professor of psychiatry at Rutgers University’s Robert Wood Johnson Medical School.
“Untreated, depression can accelerate physical and cognitive decline, compromise independence, and make it more difficult for individuals to proactively manage their health, like taking medication, exercising, and visiting the physical therapist.”
Depression in Parkinson’s patients is under-recognized and often goes untreated. Among those who receive treatment, antidepressant medication is the most common approach, though many patients continue to struggle with depressive symptoms.
The researchers investigated how adding cognitive behavioral therapy to the care individuals already received would affect their depression.
Cognitive behavioral therapy sessions helped patients re-examine their usual ways of coping with the daily challenges of Parkinson’s. Researchers individually tailored therapy, targeting negative thoughts—such as “I have no control”—and behaviors including social withdrawal or excessive worrying. Treatment also emphasized strategies for managing the disease, such as exercise, medication adherence, and setting realistic daily goals.
The researchers enrolled 72 people diagnosed with both Parkinson’s and depression. All participants continued their standard treatment. In addition, half the participants (37 people) also received cognitive behavioral therapy over the telephone weekly for three months, then monthly for six months.
By the end of treatment, individuals receiving only standard care showed no change in their mental health status, whereas 40% of the patients receiving cognitive behavioral therapy showed their depression, anxiety, and quality of life to be “much improved.”
The convenience of phone treatment reduced barriers to care, allowing patients access to personalized, evidence-based mental health treatment, without having to leave their homes, Dobkin says.
“A notable proportion of people with Parkinson’s do not receive the much needed mental health treatment to facilitate proactive coping with the daily challenges superimposed by their medical condition,” she says.
“This study suggests that the effects of the cognitive behavioral therapy last long beyond when the treatment stopped and can be used alongside standard neurological care to improve global Parkinson’s disease outcomes.”
The study appears in Neurology. Source: Rutgers University. Original Study
Parkinson’s differences in women and men
There is growing evidence that Parkinson’s disease (PD) affects women and men differently. In this insightful review, published in the Journal of Parkinson’s Disease, scientists present the most recent knowledge about these sex-related differences and highlight the significance of estrogens, which play an important role in the sex differences in PD.
PD is a slowly progressive disorder that affects movement, muscle control, and balance. It is the second most common age-related, neurodegenerative disorder, affecting about 3% of the population by the age of 65 and up to 5% of individuals over 85 years of age. The risk of developing PD is twice as high in men than women, but women experience a more rapid disease progression and a lower survival rate.
“It is becoming increasingly evident that PD differs in women and men,” explained lead author Fabio Blandini, MD, Scientific Director of the IRCCS Mondino Foundation, National Institute of Neurology, Pavia, Italy. “Recent research findings suggest that biological sex also impacts on disease risk factors and, potentially, on molecular mechanisms involved in the pathogenesis of PD.”
This review meticulously examines the most recent knowledge concerning differences between women and men with PD including:
- Motor and non-motor symptoms
- Quality of life
- Genetic and environmental risk factors
- Pharmacological therapy of motor and non-motor symptoms
- Surgical procedures
- PD and steroids
- Impact of biological sex on pathophysiology
Recent research has shown that women and men have distinctive motor and non-motor symptoms as their PD progresses. Motor symptoms emerge later in women: tremor is a common first presenting symptom associated with recurrent falls and more severe pain syndromes with specific characteristics such as reduced rigidity, a higher propensity to develop postural instability, and elevated risk for levodopa-related motor complications. Conversely, male PD patients show more serious postural problems and have worse general cognitive abilities: freezing of gait—the most disabling motor complication of PD—develops later in men; however, men have a higher risk of developing camptocormia (abnormal severe forward flexion of the trunk when standing or walking). An ongoing clinical trial is evaluating the prevalence in PD and the biological sex impact on other postural abnormalities, such as Pisa syndrome (a reversible lateral bending of the trunk with a tendency to lean to one side), antecollis (dystonia of the neck resulting in excessive forward flexion), scoliosis (a sideways curvature of the spine), and deformities related to hands and/or toes.
Non-motor symptoms have been the subject of a study of over 950 PD patients, which concluded that symptoms such as fatigue, depression, restless legs, constipation, pain, loss of taste or smell, weight change and excessive sweating are more common and severe in women. Other studies have demonstrated that male PD patients have worse general cognitive abilities and male sex is the primary predictive factor for mild cognitive impairment and its more rapid progression in the severe stage of the disease. A diagnosis of PD with dementia has a greater impact on life expectancy of women than men; in addition, women show distinctive symptoms as well as differences in the response to pharmacological therapies and deep brain stimulation, and in their personal evaluation of the quality of life compared to men.
The authors note that the distinctive clinical features as well as the contribution of different risk factors support the idea that PD development might involve distinct pathogenetic mechanisms (or the same mechanism but in a different way) in women and men. They highlight the significance of estrogens, which play an important role in the sex differences in PD, providing disease protection as demonstrated by the similar incidence of the disease in men and post-menopausal women.
“Sex hormones act throughout the entire brain of both males and females and sex differences are now highlighted in brain regions and functions not previously considered as subjected to such differences, opening the way to a better understanding of sex-related behavior and functions,” added Silvia Cerri, Ph.D., head of the Laboratory of Cellular and Molecular Neurobiology of the IRCCS Mondino Foundation and first author of the article. She commented: “Neuroinflammation is an important piece of the pathogenic puzzle of PD. Current evidence suggests that the physiological role exerted by microglial and astrocytic cells could become compromised during aging, thus contributing to PD onset and progression. Since estrogens have anti-inflammatory properties, their actions throughout the lifespan could partially account for sex-related risk and manifestation of PD.”
By drawing attention to sex-related differences and disparities in PD, Dr. Blandini and colleagues hope this will further encourage the scientific community and policy makers to foster the development of tailored interventions and the design of innovative programs—for example in care practices—that meet the distinct requirements of women and men with PD. “Women diagnosed with PD are a sizable portion of the PD population, but their specific needs are still partially overlooked. The differences between women and men strongly suggest the need for a personalized (sex-related) therapy in PD,” concluded Dr. Blandini and Dr. Cerri.
Parkinson’s and depression: it’s not all in your mind
Depression is a very real and debilitating condition that many Parkinson’s disease sufferers experience. ParkinsonsLife guest writer Dr Nicola Davies explores the causes of and treatments for depression and Parkinson’s.
It’s well-documented that people who have been diagnosed with a chronic illness such as Parkinson’s are at higher risk of developing depression as well. Indeed, it’s estimated that 50% of people diagnosed with Parkinson’s will experience depression.
As Suma Surendranath, professional engagement and education manager at Parkinson’s UK, says: “Parkinson’s is a long-term progressive condition for which there is currently no cure, therefore a diagnosis can be a psychological blow for a person and those around them as they may well be concerned about what the future might hold.”
The following scenario is a common experience among many newly diagnosed Parkinson’s sufferers. First there is confusion: ‘What does this mean?’, ‘What can I do?’, ‘How will this impact me?’ Then the shock comes as the reality of the disease sets in and the impact that it will have on the rest of your life is realised. The shock gives way to grief and depression. The feeling that your life has ended and your hopes and aspirations have been shattered is less time than it takes to make a cup of tea. As one person with Parkinson’s told us, “When I was diagnosed, I came home and cried. I thought it was the end of my life.”
“There is evidence that suggests depression is an early symptom of Parkinson’s”
However, receiving a diagnosis for Parkinson’s isn’t the only factor that can cause depression in people with this condition – the very course of the disease changes the brain chemistry that usually keeps depression at bay.
Surendranath says: “Depression may occur amongst people with Parkinson’s as a result of the condition as dopamine, the neurotransmitter that becomes depleted with Parkinson’s, is [also] involved in motivation and a sense of reward.”
Experiencing depression after receiving a diagnosis of Parkinson’s isn’t a sign of emotional weakness or a flaw in character. Depression is caused by an imbalance of chemicals in the brain, which is what Parkinson’s is all about: low levels of chemicals in the brain.
There is evidence that suggests depression is an early symptom of Parkinson’s. Despite this, people with Parkinson’s aren’t routinely tested for depression and therefore might not receive treatment for the condition.
It remains unclear whether the medications prescribed to reduce the physical symptoms of Parkinson’s contribute or worsen symptoms of depression. It is also unclear how Parkinson’s affects pre-existing depression or how medication prescribed for Parkinson’s impacts pre-existing depression.
Surendranath says: “While medication, in the form of anti-depressants, can be beneficial to people with Parkinson’s it is still important to ensure that there are no adverse effects from medications interacting with each other.”
Words of hope
Depression is treatable even if it co-exists with other conditions. Depression is also limited in duration. Often, finding the right mixture and combination of drug therapy can improve both the physical symptoms of Parkinson’s and the symptoms of depression. However, it is important to know that the treatment of Parkinson’s must be comprehensive and include both the physical as well as the emotional symptoms.
Reaching out can also ease the depressive symptoms associated with Parkinson’s. As one patient told us, “I started meeting other people with Parkinson’s and it helped all of us to talk to someone who had the same condition.” There are many physical and online communities where other people with Parkinson’s can meet up virtually, or in person, and share their experiences with others who are feeling the same and suffering from similar symptoms.
Most importantly, you have to set a goal in for your life. Unless you have something to aim for, or something that drives you to get up every morning and face the day fighting, you will find yourself drifting through life. It is best to accept that you have Parkinson’s and move on.
Dr Nicola Davies holds a Master’s and a PhD in Health Psychology. She is a member of the British Psychological Society and the Division of Health Psychology. Article from ParkinsonsLife.
IBM unveils fingernail sensor that can monitor PD
Recently IBM unveiled its latest innovation that could change the way how we monitor health. It’s prototype AI-powered fingernail sensor will let its users place the sensor over their fingernail to detect symptoms and track disease progression.
According to IBM, the innovation can help track cognitive functions in schizophrenics, check the effectiveness of medication in a person with Parkinson’s disease and even individuals’ cardiovascular health.
Although there are skin sensors that can monitor body activities, it is hard to place them on people with Parkinson’s disease as a majority of them are older patients with brittle skin and might lead to infection.
But by shifting the sensors to the nail, not only did they avoid the problem of skin rash that could arise from skin sensors, they were able to track the activities of hand for throughout the day which is a key factor in diagnosing degenerative neurological diseases such as in the case of Parkinson’s disease.
“Our fingernails deform — bend and move — in stereotypic ways when we use them for gripping, grasping, and even flexing and extending our fingers. This deformation is usually on the order of single digit microns and not visible to the naked eye,” said Katsuyuki Sakuma, from IBM’s Thomas J. Watson Research Center in New York.
The system consists of strain gauges attached to the fingernail and a small computer that collects data and communicates with a smart watch, which is equipped with machine learning models to rate bradykinesia, tremor, and dyskinesia which are all symptoms of Parkinson’s disease.
The AI-powered sensor monitors the bending and movement of a patient’s nail to calculate their grip strength. It then transmits the information which includes matters like nail wrap, motions, gestures, finger-writing, grip strength, and activation time from the wearable sensors to an off-finger device for interpretation and draws meaningful insight.
With this invention, IBM says that it is one step closer to materialising their longtime challenge of using AI to help clinicians monitor individuals in their natural environments. “By pushing computation to the end of our fingers, we’ve found a new use for our nails by detecting and characterising their subtle movements,” Sakuma said in closing.
Manganese and Parkinson’s: Mechanism may explain link
In the human body, manganese aids blood sugar regulation, bone formation, and immunity.
However, exposure to excessive levels of manganese may trigger Parkinson’s-like neurological symptoms. Manganese builds up in the basal ganglia area of the brain.
Researchers have known about these links between manganese and Parkinson’s for decades, but new research helps elucidate the mechanisms behind these associations.
Anumantha Kanthasamy, the Linda Lloyd Endowed Chair of Neurotoxicology at Iowa State University in Ames, led the new research.
Manganese helps transfer a faulty protein
Parkinson’s disease is characterized by clumps formed by misfolded alpha-synuclein protein. These protein aggregates are toxic to neurons.
Kanthasamy and colleagues set out to investigate how these misfolding proteins might interact with manganese to trigger the progression of Parkinson’s.
To do so, they examined data from mice and blood serum samples collected from eight welders. As a group, welders have a higher risk of prolonged manganese exposure. The research also examined a control group of 10 people.
The analyses revealed that welders with exposure to manganese had higher levels of misfolded alpha-synuclein, which puts them at a higher risk of Parkinson’s.
Additional cell culture tests showed that misfolded alpha-synuclein was secreted through small vesicles called exosomes into the extracellular space. In other words, the vesicles enabled the proteins to travel from cell to cell and further spread the misfolded protein.
The scientists also isolated alpha-synuclein-containing exosomes from alpha-synuclein-expressing cells that had exposure to manganese and delivered them to a brain area in the mice called the corpus striatum. This induced Parkinson’s-like symptoms in the mice.
Manganese seemed to accelerate the “cell-to-cell transmission” of alpha-synuclein, which, in turn, led to neurotoxicity. Kanthasamy and colleagues explain:
“Together, these results indicate that [manganese] exposure promotes [alpha-synuclein] secretion in exosomal vesicles, which subsequently evokes proinflammatory and neurodegenerative responses in both cell culture and animal models.”
“[W]e identified a possible mechanism involving the exosome-mediated, cell-to-cell transmission of [alpha-synuclein] during exposure to the environmental neurotoxicant,” write the authors.
Findings may lead to earlier detection
According to the National Institutes of Health (NIH), around 50,000 individuals in the United States receive a diagnosis of Parkinson’s each year, and 500,000 people currently live with the condition.
Though the condition does not yet have a cure, diagnosing it earlier may prevent irreversible brain damage and help accelerate human clinical trials of new drugs.
The results that Kanthasamy and colleagues have just published may help scientists devise a new diagnostic test for Parkinson’s that could detect the disease much earlier on. The results may also help scientists test how effective new Parkinson’s drugs are.
“As the disease advances, it’s harder to slow it down with treatments,” Kanthasamy says. He adds: “Earlier detection, perhaps by testing for misfolded alpha-synuclein, can lead to better outcomes for patients. Such a test might also indicate whether someone is at risk before the onset of the disease.”
However, the study authors also caution that their findings are still experimental, and that such a diagnostic test may not be available for years.
Study examines links of age, smoking, and physical activity with Parkinson’s
A new study published in the European Journal of Preventive Cardiology examines the links of age, smoking and physical activity as factors associated with Parkinson’s.
Previous studies have examined the link between physical activity and Parkinson’s, but the findings were inconclusive because of difficulties interpreting the results.
Researchers from the Technical University of Munich, Germany, and the Stanford University School of Medicine, US, assessed how physical activity and lifestyle factors impact the development of Parkinson’s.
They invited 7347 male veterans from the Veterans Exercise Testing Study (VETS) – an ongoing physical evaluation program – to take part in the study. The average age of those who took part was 59.
During the period of the study – which was 12 years on average – 94 participants or 1.3% of those studied had developed Parkinson’s.
Researchers found that high physical fitness, current smoking and younger age were associated with a lower incidence of Parkinson’s disease.
Commenting on the study, researchers said: “These findings parallel those of several epidemiological studies focusing on physical activity and the onset of Parkinson’s disease. Together, these observations provide strong support for recommending physical activity to diminish the risk of Parkinson’s disease.”
View the full study from the European Journal of Preventive Cardiology here.
Characterization of Parkinson Disease With Restlessness
Highlights
- A study was conducted of restless leg syndrome, leg motor restlessness, and their variants in Parkinson disease and related disorders.
- A total of 49.2% of PD patients had any restlessness, including RLS and LMR.
- LMR variants and RLS variants are rare in PD and related disorders.
- PD with restlessness was related to autonomic, sleep and depressive symptoms.
Objective
The objective of this study was to investigate the prevalence of restless leg syndrome (RLS), leg motor restlessness (LMR) and RLS/LMR variants and their relationship with clinical factors in patients with Parkinson’s disease (PD) and related disorders.
Methods
Sixty-three PD patients, 17 multiple system atrophy (MSA) patients and 11 progressive supranuclear palsy (PSP) patients were included in this study. Through face-to-face interviews, the patients were diagnosed with RLS/LMR, or with RLS/LMR variants in which the symptoms occur predominantly in body parts other than the legs.
Results
The frequency of RLS, LMR, RLS variants and LMR variants was as follows: PD (12.7%, 11.1%, 0% and 1.6%); MSA (5.9%, 11.8%, 0% and 0%); and PSP (0%, 9.1%, 0% and 0%). Restlessness without the urge to move was observed in 25.4% of the PD patients, 11.8% of the MSA patients and 0% of the PSP patients. The PD patients with restlessness exhibited higher Hoehn and Yahr stages and higher scores on the Scales for Outcomes in PD-Autonomic, PD sleep scale-2 and Beck Depression Inventory-II. The olfactory functioning, 123I-MIBG myocardial scintigraphy uptake and dopamine transporter single photon emission computed tomography findings did not differ between the PD patients with restlessness and those without. The severity of RLS was correlated with the autonomic symptoms among the PD patients with restlessness.
Conclusion
PD with restlessness was characterized by increased autonomic, sleep and depressive symptoms. Further studies including a large sample are warranted to characterize restlessness in PD and related disorders.
The eyes may have it, an early sign of Parkinson’s disease
The eyes may be a window to the brain for people with early Parkinson’s disease. People with the disease gradually lose brain cells that produce dopamine, a substance that helps control movement. Now a new study has found that the thinning of the retina, the lining of nerve cells in the back of the eye, is linked to the loss of such brain cells. The study is published in the August 15, 2018, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“Our study is the first to show a link between the thinning of the retina and a known sign of the progression of the disease – the loss of brain cells that produce dopamine,” said study author Jee-Young Lee, MD, PhD, of the Seoul Metropolitan Government – Seoul National University Boramae Medical Center in South Korea. “We also found the thinner the retina, the greater the severity of disease. These discoveries may mean that neurologists may eventually be able to use a simple eye scan to detect Parkinson’s disease in its earliest stages, before problems with movement begin.”
The study involved 49 people with an average age of 69 who were diagnosed with Parkinson’s disease an average of two years earlier but who had not yet started medication. They were compared to 54 people without the disease who were matched for age.
Researchers evaluated each study participant with a complete eye exam as well as high-resolution eye scans that use light waves to take pictures of each layer of the retina. In addition, 28 of the participants with Parkinson’s disease also had dopamine transporter positron emission tomography (PET) imaging to measure the density of dopamine-producing cells in the brain.
Researchers found retina thinning, most notably in the two inner layers of the five layers of the retina, in those with Parkinson’s disease. For example, for those with Parkinson’s disease, the inner most layer of the retina in one section of the eye had an average thickness of 35 micrometers (?m) compared to an average thickness of 37 ?m for those without the disease.
In addition, the thinning of the retina corresponded with the loss of brain cells that produce dopamine. It also corresponded with the severity of disease. When disability from the disease is measured on a scale of one to five, the people with the most thinning of the retina, or thickness of less than 30 ?m, had average scores of slightly over two, while people with the least thinning, or thickness of about 47 ?m, had average scores of about 1.5.
“Larger studies are needed to confirm our findings and to determine just why retina thinning and the loss of dopamine-producing cells are linked,” said Lee. “If confirmed, retina scans may not only allow earlier treatment of Parkinson’s disease but more precise monitoring of treatments that could slow progression of the disease as well.”
A limitation of the study was that the retina scans focused only on a limited area of the retina. The study was also a snapshot in time and did not follow participants over a long period of time.
The study was supported by the Seoul Metropolitan Government – Seoul National University Boramae Medical Center and the Korean Ministry of Education, Science and Technology.
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