research

Singing Helps Early-stage Parkinson’s Patients Retain Speech, Respiratory Control

Singing may help people with Parkinson’s disease — especially in its earlier stages — because it strengthens muscles involved in swallowing and respiratory control, suggests two studies from researchers at Iowa State University.

One study, “Therapeutic singing as an early intervention for swallowing in persons with Parkinson’s disease,” was published in the journal Complementary Therapies in Medicine. The other, “Effects of singing on voice, respiratory control and quality of life in persons with Parkinson’s disease,” appeared in Disability and Rehabilitation.

Parkinson’s research and current treatments largely focus on symptoms relating to motor skills, and less on those like voice impairment, even though weakness in vocal muscles affects respiration, swallowing abilities and quality of life. Voice impairments in Parkinson’s —  present in 60 to 80 percent of patients, are characterized by reduced vocal intensity and pitch, and breathy voice.

Previous research has suggested that singing can ease voice impairment and improve respiratory control in people with other diseases or conditions, leading researchers to examine if it could also aid those with Parkinson’s, especially in the disease’s early stages.

Results showed that both groups had significant improvement in respiratory pressure, including both breathing in and breathing out. Phonation time, a measure of how long a person can sustain  a vowel sound, also significantly improved. Patients also reported significant improvement in measures of both voice-related and whole health-related quality of life. Lead author Elizabeth Stegemöller conducted two separate pilot studies to determine whether a group of 25 Parkinson’s patients would benefit from light therapy, singing for 60 minutes once a week, or more intensive therapy that involved singing for 60 minutes twice a week. Board-certified music therapies conducted the sessions, which included vocal and articulation exercises as well as group singing. After eight weeks, researchers measured vocal, respiratory and quality-of-life parameters.

“We’re not trying to make people better singers,” Stegemöller said in a press release. “We’re trying to work the muscles involved with swallowing and respiratory control, to make them work better and therefore protect against some of the complications of swallowing.”

Stegemöller, an assistant professor of kinesiology at Iowa State in Ames, runs singing classes there for Parkinson’s patients. She also collaborates with Iowa State Extension and Outreach to pilot an eight-week training session in several counties across northern Iowa, with the goal of creating a DVD to train extension specialists to conduct such classes on their own.

“We do a lot of vocal exercises in classes that focus on those [vocal and respiratory] muscles,” Stegemöller said. “We also talk about proper breath support, posture and how we use the muscles involved with the vocal cords, which requires them to intricately coordinate good, strong muscle activity.”

The goal now is to expand the initiative, she said, adding that “if the DVD is an effective training tool, we’d like to have as many classes as possible across the state.”

 

Article from Parkinson’s News Today.

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First Drug Approved for Dyskinesia in Parkinson’s Disease

Adamas Pharmaceuticals recently announced U.S. Food and Drug Administration (FDA) approval of an extended-release formulation of amantadine (GOCOVRI) to treat dyskinesia in Parkinson’s disease. This is the first drug indicated specifically for dyskinesia — uncontrolled, involuntary movements that can develop with long-term levodopa use.

Extended-release amantadine is intended to be taken once daily at bedtime. In this way it can control dyskinesia during the day, when it typically is most prevalent. The new therapy’s approval is based on data from three placebo-controlled trials that demonstrated safety and efficacy. In addition to easing dyskinesia, the drug also may lessen total daily “off” time, when Parkinson’s symptoms return because medication is not working optimally.

The Michael J. Fox Foundation (MJFF) helped move this drug to market by supporting the creation and authentication of the Unified Dyskinesia Rating Scale, a tool that was used to measure the drug’s impact in trials.

“Dyskinesia can significantly compromise quality of life for people with Parkinson’s,” says Todd Sherer, MJFF CEO. “We are pleased that patients have another option to manage this aspect of the disease and glad the Unified Dyskinesia Rating Scale — a tool our support helped develop and validate — could show clinical efficacy of GOCOVRI for the treatment of dyskinesia.”

Extended-release amantadine is a reformulation of a currently available generic immediate-release version, which is approved to treat Parkinson’s symptoms.

 

Article from Michael J. Fox Foundation for Parkinson’s Research.

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Next Stop for PD Research: Outer Space

In an effort to find new treatments for Parkinson’s disease, researchers are sending their experiments to space.

On Monday Aug. 14, researchers launched a key Parkinson’s disease protein, called LRRK2, to the International Space Station (ISS). The microgravity conditions in space should offer a better test environment for their experiments with this protein, the researchers said.

The materials for their experiments will travel aboard the SpaceX Dragon capsule as part of a mission to send supplies and science experiments to the ISS.

The work is a collaboration between The Michael J. Fox Foundation for Parkinson’s Research and the Center for the Advancement of Science in Space (CASIS).

LRRK2 is a type of protein that modifies other proteins. Mutations in the gene that codes for LRRK2 are thought to cause Parkinson’s disease in some people. Researchers have hypothesized that developing drugs to inhibit LRRK2, or block its activity, could help prevent Parkinson’s or slow its progression.

But before scientists can develop a drug to inhibit LRRK2, they need to know the precise structure of this protein. One way to get a detailed view of its structure is by growing crystals of LRRK2 in lab dishes. However, on Earth, gravity can interfere with the growth of these crystals, and keep them small.

“The quality of our crystals is just not good enough [on Earth],” Sebastian Mathea, a researcher at the University of Oxford who is involved in the LRRK2 project, said during a news conference about the project Tuesday (Aug. 8).

This is where the ISS research comes in: Researchers hope that the microgravity conditions in space will allow the crystals to grow bigger with fewer defects. The scientists can then get a sharper view of the crystal structure.

Scientists will grow the LRRK2 crystals for about a month in space. Then, the crystals will be sent back to Earth, where they will be analyzed with high-energy X-rays, Mathea said.

Parkinson’s disease is a progressive neurological disorder that affects people’s movement abilities, and can result in symptoms such as tremors, slowed movements and muscle stiffness. There are currently no treatments to stop or reverse the progression of the disease, according to The Michael J. Fox Foundation.

Article from Live Science.

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Free Water Levels Provide a New Biomarker for PD Progression

According to a recent study, a newly discovered biomarker, free water, can track changes in the brain that are associated with Parkinson’s disease, which ultimately may aid in developing new drugs that could slow disease progression.

“This finding is a potential game changer as it could shift the way Parkinson’s disease clinical trials are designed and conducted,” said Michael S. Okun, MD, a professor and chair of neurology at the University of Florida and medical director for the Parkinson’s Foundation. “Free-water is a validated measurement that will likely decrease the number of patients required to demonstrate the slowing of clinical progression.”

The study titled, “Progression marker of Parkinson’s disease: a 4-year multi-site imaging study,” was published in the journal Brain.

One of the issues in developing disease-modifying therapies for Parkinson’s disease has been a lack of an accurate biomarker that can detect changes in the brain as the disease progresses. Recently, a new imaging technique was developed that can accurately detect the volume of water in brain tissue and separate that measurement from the water outside the brain tissue. The latter type of water is known as free water and has been known to increase in neurodegenerative disorders.

In 2015, researchers demonstrated that free water levels were increased in the posterior substantia nigra (PSN) of patients with Parkinson’s disease. The motor symptoms that accompany a diagnosis of Parkinson’s disease tend to emanate from the area of the brain that includes the nigrostriatal pathway, which is part of PSN.

In another study, researchers discovered that the free water levels in the PSN increased over one year in newly diagnosed Parkinson’s disease patients, but not in control groups. However, no studies have investigated how free water in the PSN changes over an extended period of time.

Therefore, researchers at the University of Florida conducted a multicenter international longitudinal study to determine the pattern of change in free water in patients with Parkinson’s disease over four years.

Results from this study showed that free water levels in PSN increased over one year in newly diagnosed Parkinson’s disease patients. Furthermore, free water levels continuously increased over four years. The research team also showed that sex and baseline free water predicted four-year changes in free water levels. Additionally, researchers showed that free water increasing over one or two years leads to worsening stages on the Hoehn and Yahr scale over a four-year period.

One of the most important things to result from this study has been the discovery of a biomarker that determines the progression of Parkinson’s disease and one that can potentially be used in future clinical trials as an endpoint.

“This means if you want to start designing studies to slow the progression of Parkinson’s disease, testing a drug on that measurement in the substantia nigra might be a good way to go,” said David Vaillancourt, PhD, professor of applied physiology and kinesiology at the University of Florida in a press release. “If the measurement in the substantia nigra is increasing year after year after year, and if you can stop that from occurring, you’re likely to slow or possibly stop the progression of the disease. This could change the way studies are conducted for disease-modifying trials in Parkinson’s disease.”

 

Article from Parkinson’s News Today.

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UW Otolaryngology Research Study

Have you been diagnosed with Parkinson’s disease within the last 5 years, and are your motor symptoms mild? Dr. Timothy McCulloch’s research lab at the University of Wisconsin Hospital is recruiting subjects for a study evaluating changes to chewing, swallowing, voice, fine motor, and walking function in the early stages of Parkinson’s disease, as well as healthy controls.

Participation in this study lasts about 2 hours and participants are paid $60. Contact study coordinator Dr. Suzan Abdelhalim at 608-265- 2470 or [email protected] for more information.

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People with Parkinson’s should be monitored for melanoma, study finds

People with the movement disorder Parkinson’s disease have a much higher risk of the skin cancer melanoma, and vice versa, a Mayo Clinic study finds. While further research is needed into the connection, physicians treating one disease should be vigilant for signs of the other and counsel those patients about risk, the authors say. The findings are published in Mayo Clinic Proceedings.

Overall, patients with Parkinson’s were roughly four times likelier to have had a history of melanoma than those without Parkinson’s, and people with melanoma had a fourfold higher risk of developing Parkinson’s, the research found.

Medical experts have speculated about the relationship between Parkinson’s and melanoma for decades, with varying conclusions, the Mayo researchers note. Several studies have suggested levodopa, a drug for Parkinson’s, may be implicated in malignant melanoma, but others have found an association between the two diseases regardless of levodopa treatment, they add.

“Future research should focus on identifying common genes, immune responses and environmental exposures that may link these two diseases,” says first author Lauren Dalvin, M.D., a Mayo Foundation Scholar in Ocular Oncology. “If we can pinpoint the cause of the association between Parkinson’s disease and melanoma, we will be better able to counsel patients and families about their risk of developing one disease in the setting of the other.”

The Mayo study used the Rochester Epidemiology Project medical records database to identify all neurologist-confirmed Parkinson’s cases from January 1976 through December 2013 among Olmsted County, Minn., residents. The study examined the prevalence of melanoma in those 974 patients compared with 2,922 residents without Parkinson’s. They also identified 1,544 cases of melanoma over that period and determined the 35-year risk of Parkinson’s in those patients compared with the risk in the same number of people without melanoma.

The results support an association between Parkinson’s disease and melanoma, but argue against levodopa as the cause, the researchers conclude. It is likelier that common environmental, genetic or immune system abnormalities underlie both conditions in patients who have both, but more research is needed to confirm that and refine screening recommendations, they say.

In the meantime, patients with one of the two diseases should be monitored for the other to help achieve early diagnosis and treatment, and they should be educated about the risk of developing the other illness, the researchers say.

The study’s senior author is Jose Pulido, M.D., an ophthalmologist at Mayo Clinic in Rochester, Minnesota, who treats eye melanoma.

 

Article from Science Daily.

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Substantial Matters: Life and Science of Parkinson’s – podcasts

The Parkinson’s Foundation has produced a series of podcasts, titled ‘Substantial Matters: Life and Science of Parkinson’s’. The free episodes, hosted by Dan Keller, will discuss a wide range of Parkinson’s topics, including early warning signs, treatments, exercise and nutrition.

For more information, visit parkinson.org/podcast.

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Statins may not be used for protection against Parkinson’s disease

Use of statins may speed up the onset of Parkinson’s disease symptoms in people who are susceptible to the disease, according to Penn State College of Medicine researchers.

Some previous research has suggested that statins, used to treat high cholesterol, may protect against Parkinson’s disease. Research findings have been inconsistent, however, with some studies showing a lower risk, some showing no difference and some showing a higher risk of Parkinson’s disease in statin users.

“One of the reasons that may have explained these prior inconsistent results is that higher cholesterol, the main indication to use statins, has been related to lower occurrence of Parkinson’s disease,” said Xuemei Huang, professor of neurology. “This made it hard to know if the statin protective effect was due to the drug or preexisting cholesterol status.”

Another reason for the inconsistent results is that there are two types of statins. Water-soluble statins cannot get into the brain, while fat-soluble statins, called lipophilic, can. Since people with high cholesterol are treated for both kinds, the interpretation of results as it relates to Parkinson’s disease is not easy.

The researchers analyzed data in a commercially-available database of insurance claims for more than 50 million people. They identified nearly 22,000 people with Parkinson’s disease, and narrowed the number to 2,322 patients with newly diagnosed Parkinson’s disease. They paired each Parkinson’s patient with a person in the database who did not have Parkinson’s — called a control group. Researchers then determined which patients had been taking a statin and for how long before Parkinson’s disease symptoms appeared. Researchers reported their results in the journal Movement Disorders.

After analyzing the data, researchers found that prior statin use was associated with higher risk of Parkinson’s disease and was more noticeable during the start of the drug use.

“Statin use was associated with higher, not lower, Parkinson’s disease risk, and the association was more noticeable for lipophilic statins, an observation inconsistent with the current hypothesis that these statins protect nerve cells,” Huang said. “In addition, this association was most robust for use of statins less than two-and-a-half years, suggesting that statins may facilitate the onset of Parkinson’s disease.”

Guodong Liu, assistant professor of public health sciences, said, “Our analysis also showed that a diagnosis of hyperlipidemia, a marker of high cholesterol, was associated with lower Parkinson’s disease prevalence, consistent with prior research. We made sure to account for this factor in our analysis.”

A recent study reported that people who stopped using statins were more likely to be diagnosed with Parkinson’s disease, a finding interpreted as evidence that statins protect against Parkinson’s disease.

“Our new data suggests a different explanation,” Huang said. “Use of statins may lead to new Parkinson’s disease-related symptoms, thus causing patients to stop using statins.”

Huang stressed that more research needs to be completed and that those on statins should continue to take the medication their health care provider recommends.

“We are not saying that statins cause Parkinson’s disease, but rather that our study suggests that statins should not be used based on the idea that they will protect against Parkinson’s,” Huang said. “People have individual levels of risk for heart problems or Parkinson’s disease. If your mom has Parkinson’s disease and your grandmother has Parkinson’s disease, and you don’t have a family history of heart attacks or strokes, then you might want to ask your physician more questions to understand the reasons and risks of taking statins.”

One limitation of this study was that the MarketScan data did not include Medicare patients, Medicaid patients or the uninsured. Also, because it was a private insurance sample, the patients were all under 65 years old, so the findings cannot be generalized to those who are older.

Other researchers on this study are Lan Kong and Douglas Leslie, Department of Public Health Sciences; Nicholas Sterling, Medical Scientist Training Program student; and Mechelle Lewis and Richard Mailman, Departments of Neurology and Pharmacology, all of Penn State College of Medicine; and Honglei Chen, Michigan State University.

The Center for Applied Studies in Health Economics and Penn State College of Medicine funded this research.

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Microsoft shows off watch that quiets Parkinson’s tremors

SAN FRANCISCO — Tech company developer conferences always feature a wacky demo or three.

But at Build 2017 in Seattle Wednesday, Microsoft went for the waterworks at the conclusion of CEO Satya Nadella’s keynote address: it showcased a prototype watch that temporarily eliminated the arm shaking that often plagues those suffering from the neurological disease Parkinson’s.

After a speech that both heralded and warned about coming leaps in technological power, Nadella screened a video that told the story of two British Microsoft Research employees, Haiyan Zhang and Nicolas Villa, who developed the tremor-interrupting device for a BBC documentary, The Big Life Fix.

Working with graphic designer and Parkinson’s sufferer Emma Lawton, 32, the researchers developed a watch — which they named Emma — that, according to Microsoft, “vibrates in a distinctive pattern to disrupt the feedback loop between brain and hand.”

The video showed Lawton trying to draw a square with her shaky right hand, and then again, wearing Emma. Watson erupts in tears as she calls her mother to say this is the first time she’s been able to write her name in ages.

When the lights went up, Nadella welcomed both Lawton and engineer Zhang on stage, thanking them for showing that thanks “developers can have impact.”

Emma Watch remains a prototype, Microsoft says, but the developers are working with a neuroscience research team to undertake trials with a small group of Parkinson’s sufferers.

The watch works through a combination of sensors and AI (artificial intelligence) techniques to potentially detect and monitor symptoms like tremors, stiffness and instability, among others, according to Microsoft. “Once these symptoms can be identified and measured, it’s possible to develop technology and devices that help humans manage their symptoms. AI is used to classify the sensor information and elicit real-time responses on small devices like wearables.”

Microsoft stresses that Emma Watch is not a cure for the disease, which afflicts 10 million people. “Rather, its technology has the potential to help Parkinson’s patients manage symptoms that impede regular functions. The goal of further research is to determine whether Emma Watch could help other people with similar Parkinson’s symptoms.”

https://www.usatoday.com/story/tech/talkingtech/2017/05/10/microsoft-shows-off-watch-quiets-parkinsons-tremors/101517718/

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Could Parkinson’s Disease Start in the Gut?

Parkinson’s disease may start in the gut and spread to the brain via the vagus nerve, according to a study published in the April 26, 2017, online issue of Neurology®, the medical journal of the American Academy of Neurology. The vagus nerve extends from the brainstem to the abdomen and controls unconscious body processes like heart rate and food digestion.

The preliminary study examined people who had resection surgery, removing the main trunk or branches of the vagus nerve. The surgery, called vagotomy, is used for people with ulcers. Researchers used national registers in Sweden to compare 9,430 people who had a vagotomy over a 40-year period to 377,200 people from the general population. During that time, 101 people who had a vagotomy developed Parkinson’s disease, or 1.07 percent, compared to 4,829 people in the control group, or 1.28 percent. This difference was not significant.

But when researchers analyzed the results for the two different types of vagotomy surgery, they found that people who had a truncal vagotomy at least five years earlier were less likely to develop Parkinson’s disease than those who had not had the surgery and had been followed for at least five years. In a truncal vagotomy, the nerve trunk is fully resected. In a selective vagotomy, only some branches of the nerve are resected.

A total of 19 people who had truncal vagotomy at least five years earlier developed the disease, or 0.78 percent, compared to 3,932 people who had no surgery and had been followed for at least five years, at 1.15 percent. By contrast, 60 people who had selective vagotomy five years earlier developed Parkinson’s disease, or 1.08 percent. After adjusting for factors such as chronic obstructive pulmonary disease, diabetes, arthritis and other conditions, researchers found that people who had a truncal vagotomy at least five years before were 40 percent less likely to develop Parkinson’s disease than those who had not had the surgery and had been followed for at least five years.

“These results provide preliminary evidence that Parkinson’s disease may start in the gut,” said study author Bojing Liu, MSc, of the Karolinska Instituet in Stockholm, Sweden. “Other evidence for this hypothesis is that people with Parkinson’s disease often have gastrointestinal problems such as constipation, that can start decades before they develop the disease. In addition, other studies have shown that people who will later develop Parkinson’s disease have a protein believed to play a key role in Parkinson’s disease in their gut.”

The theory is that these proteins can fold in the wrong way and spread that mistake from cell to cell.

“Much more research is needed to test this theory and to help us understand the role this may play in the development of Parkinson’s,” Liu said. Additionally, since Parkinson’s is a syndrome, there may be multiple causes and pathways.

Even though the study was large, Liu said one limitation was small numbers in certain subgroups. Also, the researchers could not control for all potential factors that could affect the risk of Parkinson’s disease, such as smoking, coffee drinking or genetics.

The study was supported by the Swedish Research Council for Health, Working Life and Welfare, the Parkinson Research Foundation in Sweden, and the U.S. National Institutes of Health.

To learn more about Parkinson’s disease, visit www.aan.com/patients.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with 32,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+, LinkedIn and YouTube.

http://www.newswise.com/articles/could-parkinson-s-disease-start-in-the-gut

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