December in July

The title refers to the fact that this post was drafted back in December 2016 as an email InfoShare for the Capitol Area Parkinson’s Support (CAPS) group, which is meeting today (July 15 2017) at 2 PM. Never did send it out. So here it is, a few months late, but the news is still timely. Especially the value of early treatment and diagnosis of PD.  So, here it is:
The London School of Economics and Political Science recently released a report on the “Value of Early Diagnosis and Treatment in Parkinson’s Disease”, a literature review of recent studies with recommendations for action. It can be downloaded at http://www.braincouncil.eu/wp-content/uploads/2016/11/Parkinson-report-2016-1.pdf 
On a broader view of PD,  here’s a link to a page that has links to just about everything Parkinson’s – The National Institutes of Health (NIH) U.S. National Library of Medicine (NLM) Medline Plus topic page on Parkinson’s Disease.
OK – you can spend a week going through all of that information. 
So here are the items mentioned in the subject headline:
First, evidence that DBS is helpful in early stages of PDS, not just in later stages. Benefits extend for at least 5 years.
The PDF copy of the research paper referenced in the above news article can be found at this link:
A less drastic approach than brain surgery might be helpful for motor symptoms:
Next, contradictory evidence regarding whether statins used to lower cholesterol levels offer a protective effect for PD – previous analyses said yes, but further massage of the data reveals that the answer is not as simple as it seemed at first.
Here are links to related articles, papers, and abstracts:
Earlier this year, an analysis of ten reports that yielded different conclusions after adjusting for cholesterol levels.
In 2012, the JAMA Neurology journal published a prospective analysis that indicated statins reduced the risk of PD. (PDF of full article is available for free download):
Several years ago, an analysis found publication bias in favor of positive results, and both a protective effect for statin use and no protective effect for long term statin use:
And last year, an analysis of published reports that found that use of statins was not protective for PD, in contrast to the hypothesis that statins are protective.
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Nordic Walking & PD – no decision yet.

Abstract

Background

It is well known that physical exercise is the main therapeutic element of rehabilitation programs for people with Parkinson’s disease (PD). As traditional forms of exercise can guarantee significant health benefits, the emergence of non-conventional physical activities, such as Nordic walking (NW), may add positive effects.

Objective

To appraise the available evidence on the main effects of NW in the rehabilitation programs for people with PD and to propose a design for upcoming research that might improve the uniformity of future trials.

Study Design

Systematic review

Literature Survey.

A literature search of five established databases (PubMed, MEDLINE, Scopus, Web of Science and Cochrane) was conducted.

Method

ology. Any relevant randomized controlled trials (RCTs) pertinent to NW in PD published in English from inception to February 2017, were included. PRISMA guidelines were followed and the methodological quality of each study was assessed by the PEDro scale.

Data Synthesis

Sixty-six studies were retrieved and 6 RCTs (221 subjects) entered the qualitative synthesis. Overall, these studies portrayed NW as feasible and likely to be effective in improving the functional and clinical outcomes of people with PD. When comparing NW with other exercise-based interventions such as treadmill training, free walking, a program of standardized whole-body movements with maximal amplitude (LSVT®BIG training) or a home-based exercise program, the findings proved controversial.

Conclusions

High heterogeneity and methodological discrepancies among the studies prevent from drawing firm conclusions on the effectiveness of NW in comparison with other exercise-based interventions currently employed in people with PD. Further investigations with a common design are necessary to verify whether NW may be included within conventional rehabilitation programs commonly recommended to people with PD.

Autoimmune response may play a role in Parkinson’s

Original of this story at: Medical News Today web site 21 June 2017

The exact causes of Parkinson’s disease are unknown, but an important hallmark is the buildup of damaged alpha-synuclein protein in dopamine-producing cells.

The new study reveals evidence that two fragments of alpha-synuclein can trigger T cells to initiate an attack by the immune system.

The researchers tested blood samples from 67 patients with Parkinson’s disease and control samples from 36 healthy patients.

They exposed the blood samples to fragments of proteins found in brain cells, including fragments of alpha-synuclein. The blood from the controls hardly reacted, but T cells in the blood from the Parkinson’s patients had a strong reaction to defined fragments from alpha-synuclein

The finding suggests that certain variants of MHC – such as those associated with Parkinson’s disease – may cause T cells to mistakenly identify the alpha-synuclein fragments as pathogens and thus trigger an autoimmune response that destroys the offending cells.

A lot of work still needs to be done,, but it could help to provide a diagnostic test for risk or early stages of PD, which is sorely needed.

I wonder – Could you get allergy shots with alpha synuclein protein fragments to reduce or eliminate the autoimmune response and thus keep T-Cells from attacking the dopaminergic neurons?

 

Visual tests, distorted pictures of cats and dogs, dementia and Parkinson’s…

Medscape reports on new research results from the International Conference on Parkinson’s Disease and Movement Disorders, held in Vancouver, BC, Canada June 4 – 8 2017.

Pictures of Cats and Dogs suggest identification of high risk for Parkinson’s dementia.

When viewing pictures of cats and dogs with no distortion, medium distortion, and strong distortion, Parkinson’s Patients did worse than controls in distinguishing between cats and dogs in the medium distortion condition, pointing to possible improved tests and treatments to prevent dementia in Parkinson’s.

Autopsy studies of patients with PD confirm that this area of the brain — the infero-temporal and parieto-occipital cortex — is affected, she noted. “So we already know that there is some clue that the visual processing part of the brain is important.”

Current visuo-perceptual tests measure only one or two aspects of visual processing and tend to be “too easy,” said Dr Weil. “Everyone does very well on them and by the time they do badly, their disease may have progressed quite a bit. We need trickier tests.”

As well, current tests measure visual processing only in small numbers of patients. Online testing enables access to large numbers of patients.

“People think of PD as a disorder of movement but it’s much more complex and affects much more than just movement.”

A key question then, she said, is how does PD affect the brain? “Whatever it is that causes PD doesn’t just involve the deep part of the brain, but also involves the thinking and memory parts, and the fact that people have trouble with these tests suggests that those bits are involved.”

 

An NIH-Kennedy Center Initiative to Explore Music and the Mind

Link to full article:  http://jamanetwork.com/journals/jama/fullarticle/2630954

(I know how to embed a link inside text – just chose not to do it that way this time, thanks for the advice, folks).  Here’s a couple of quotes from the article:

Music is fundamental to the human species in ways that reach beyond entertainment or pastime. In Musicophilia, Oliver Sacks noted that music can “calm us, animate us, comfort us, thrill us, or serve to organize and synchronize us at work or play, [but] it may be especially powerful and have great therapeutic potential for patients with a variety of neurological conditions.”

. . .

Processing music is one of the most cognitively demanding tasks our brains undertake, and creating and performing music is even more complex. We are just beginning to understand what neural processes underlie the effects of active music making, and a better appreciation of these processes would likely enhance understanding of brain responses to other stimuli and tasks. There is already compelling evidence that in children, music training assists development of language skills, auditory processing, and educational achievement compared with untrained peers,2– 4 and anecdotally, many top professionals across different disciplines have musical training in their background.

The article describes the beginning of this initiative and why it is important – it will be interesting to follow this topic in the future.

Here’s the reference list from the article. More good info there.

References

1.

Schlaug  G.  Musicians and music making as a model for the study of brain plasticity.  Prog Brain Res. 2015;217:37-55. doi:10.1016/bs.pbr.2014.11.020PubMed

2.

Hallam  S.  The power of music: its impact on the intellectual, social and personal development of children and young people.  Int J Music Educ. 2010;28(3):269-289. doi:10.1177/0255761410370658Article

3.

The Arts and Human Development: Learning Across the Lifespan. National Endowment for the Arts in partnership with US Dept of Health and Human Services. https://www.arts.gov/sites/default/files/TheArtsAndHumanDev.pdf. 2011. Accessed April 5, 2017.

4.

Moreno  S, Bialystok  E, Barac  R,  et al.  Short-term music training enhances verbal intelligence and executive function.  Psychol Sci. 2011;22(11):1425-1433.PubMedArticle

5.

Bailey  JA, Zatorre  RJ, Penhune  VB.  Early musical training is linked to gray matter structure in the ventral premotor cortex and auditory-motor rhythm synchronization performance.  J Cogn Neurosci. 2014;26(4):755-767.PubMedArticle

6.

Patel  AD.  Why would musical training benefit the neural encoding of speech? the OPERA hypothesis.  Front Psychol. 2011;2:142. doi:10.3389/fpsyg.2011.00142PubMedArticle

7.

Norman-Haignere  S, Kanwisher  NG, McDermott  JH.  Distinct cortical pathways for music and speech revealed by hypothesis-free voxel decomposition.  Neuron. 2015;88(6):1281-1296.PubMedArticle

8.

Limb  CJ, Braun  AR.  Neural substrates of spontaneous musical performance: an FMRI study of jazz improvisation.  PLoS One. 2008;3(2):e1679.PubMedArticle

9.

Salimpoor  VN, Benovoy  M, Larcher  K, Dagher  A, Zatorre  RJ.  Anatomically distinct dopamine release during anticipation and experience of peak emotion to music.  Nat Neurosci. 2011;14(2):257-262.PubMedArticle

I’ve got a (gut) feeling…

Here’s a sample of links to Gut Microbiota For Health’s website and some of the research articles they’ve published, mostly in the last year. One talks about the linkage between certain bacteria and motor system disorders, another about relief for constipation for Parkinson’s patients, Another is a compilation of several articles, and finally, an article that explores the gut to brain relation regarding Parkinson’s, and to top it all off, the relationship of the bacteria in your stomach to the chemicals in your brain, and how the various microbial communities communicate. Life goes on within you and without you, it would seem.

Genetic risk for Early Onslaught Parkinson’s upped by PINK1 variation

Single mutation in recessive gene increases risk of earlier onset Parkinson’s disease

“A collaboration of 32 researchers in seven countries, led by scientists at Mayo Clinic’s campus in Florida, has found a genetic mutation they say confers a risk for development of Parkinson’s disease earlier than usual.

The major study, published in Brain, is important because the risk comes from a single mutation in the PTEN-induced putative kinase 1 (PINK1) gene. Investigators had believed that this rare form of Parkinson’s developed only when a person inherited mutations in both PINK1 alleles (one from each parent).”

 You can download a copy of the original research article at this link: Heterozygous PINK1 p.G411S increases risk of Parkinson’s disease via a dominant-negative mechanism

 

Standing up can reveal cognitive difficulties.

Unmasking cognitive deficits by standing up

Published at the end of November 2016, the linked article found that folks with orthostatic hypotension revealed more cognitive deficits on standing up than when measured sitting down or lying down.

Since most cognitive tests are administered while the subject is sitting or lying down,  cognitive difficulties faced in day to day living might be underestimated.

Participants with PD and OH were far more susceptible to posture-related impairment on several tests, including those that measured math skills, the ability to produce words easily, keeping information in mind while working on it, paying sufficient attention so that later memory is efficient and searching for items quickly and accurately.

Will Parkinson’s be diagnosed by a simple sample of blood in the near future?

A step towards more accurate diagnoses of Parkinson’s and other similar neurological diseases was recently reported in Nature. And by CNN which picked up the story: Parkinsons disease blood test study

Up until now, many diseases have been diagnosed based on symptoms, with patients asking, “How do you know I have this?” Meanwhile, doctors are not always correct, Wright said. This is true even of Parkinson’s, which is diagnosed based on symptoms, a patient’s history, neurological exams, a patient’s response to medicine and, in some cases, brain imaging tests.

As a person with Parkinson’s among other conditions, related or unrelated, this would be a big deal. When a diagnosis is based on having a specific array of symptoms, some of which might not be present in all cases (tremors, for instance), one wonders whether medications for reducing certain symptoms might not prevent the presentation of all the symptoms required for a diagnosis of Parkinson’s.

It does me little good to play “what if” since one doesn’t know how one would have reacted to an earlier diagnosis at an earlier age. One can only refer to Victor Frankl’s work on the search for meaning in our lives, and approach the present as though one has already been at this decision point and are being given a second chance to make a decision just as wrong as the original decision. At least that’s how I remember that particular quote.  Here’s another quote from Frankl:

the meaning of life always changes, but that it never ceases to be. According to logotherapy, we can discover this meaning in life in three different
ways: (1) by creating a work or doing a deed; (2) by experiencing something or
encountering someone; and (3) by the attitude we take toward unavoidable
suffering. The first, the way of achievement or accomplishment, is quite obvious.