Changes in Specific Brainstem Nerve Cells Linked to Parkinson’s for First Time

brainstem cells

It’s widely accepted that Parkinson’s disease (PD) patients experience neuronal death in the brainstem. Now, for the first time, researchers report that the number of copies of mitochondrial DNA is increased in the surviving nerve cells within this area of the brain.

Interestingly, specific brainstem neurons had more alterations in their mitochondrial DNA.

“This is the only study to date to characterise mitochondrial DNA errors in cholinergic neurons, a neuronal population that is highly vulnerable to cell death in Parkinson’s disease patients,” Joanna Elson, PhD, a mitochondrial geneticist at Newcastle University, said in a press release.

The study resulted from a collaboration between Newcastle University and University of Sussex, both in the United Kingdom.

The team’s work, “Mitochondrial DNA xchanges in pedunculopontine cholinergic neurons in Parkinson disease,” was published in Annals of Neurology.

Mitochondria are our cells’ powerhouses, responsible for maintaining their health. Changes to the genetic composition of the mitochondria compromise its function and can lead to nerve cell death.

Mitochondrial DNA damage has been associated with both normal aging and neurodegeneration.

In a Parkinson’s scenario, studies have demonstrated that a specific brainstem region, known as the pedunculopontine nucleus (PPN), presents altered mitochondrial DNA.

PPN is thought to be involved in the initiation and modulation of gait and other stereotyped movements. As a result of Parkinson’s progression, these “behavioral functions” are affected.

Part of the PPN is made up of cholinergic neurons, meaning these cells produce the brain chemical acetylcholine and use it to communicate with other nerve cells. Cholinergic neuronal loss has been observed in Parkinson’s patients.

In this study, researchers isolated single cholinergic neurons from postmortem PPNs of Parkinson’s patients and aged controls. They then analyzed its mitochondrial DNA content.

Results showed that the number of copies and changes in mitochondrial DNA were significantly higher in the Parkinson’s group, compared to the control samples.

Moreover, the mitochondrial DNA of Parkinson’s patients changed by more than 60 percent, which has been associated with deleterious effects on mitochondria function.

The current results differ from other studies that have focused on other brain regions and cell types.

“Our study is a major step forwards in gaining an enhanced insight into the serious condition. Only by understanding the complexities of what happens in specific cell-types found in specific areas of the brain during this disease can targeted treatments for Parkinson’s disease be produced,” Elson explained.

“At present, treatments are aimed at the whole brain of patients with Parkinson’s disease. We believe that not only would cell-specific targeted treatments be more effective, but they would also be associated with fewer side-effects,” said Ilse Pienaar, PhD, a neuroscientist at Sussex University.

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Adamas Is Getting the Word Out on Its Parkinson’s Muscle Control Therapy

Muscle control therapy

Adamas Pharmaceuticals is making a concerted effort to spread the word on its flagship treatment for the involuntary muscle movements that are a hallmark of Parkinson’s disease.

The U.S. Food and Drug Administration approved Gocovri (amantadine) in August 17. Adamas began making the extended release capsules available in the United States in October 2017.

It has now assembled a 59-person team to acquaint doctors and patients with it. It is calling the deployment of the team its U.S. launch of Gocovri.

Involuntary muscle movements, which disrupt daily activities, affect an estimated 90 percent of Parkinson’s patients.

Gocovri is the first and only treatment the FDA has approved for involuntary muscle movements, or dyskinesia, in Parkinson’s patients who are taking levodopa. The approval covers patients on levodopa by itself or a combination of levodopa and other dopamine-generating agents.

Dopamine is a chemical that is essential to transmitting brain signals to the muscles and controlling movement. Parkinson’s affects nerve cells responsible for producing dopamine. The loss of the neurotransmitter leads to a progressive deterioration in muscle coordination and movement.

One of the first lines of treatment for Parkinson’s is using levodopa to replace dopamine. But its long-term use can disrupt the balance of chemical messengers that control movement, causing dyskinesia.

“The launch of Gocovri, which was demonstrated in clinical studies to reduce both dyskinesia and OFF time, gives physicians a new tool for the treatment of Parkinson’s disease patients with dyskinesia,” Dr. Rajesh Pahwa, who directs the University of Kansas Medical Center’s Parkinson’s Disease Center, said in a press release.

Clinical trials have shown that Gocovri can increase the release of dopamine.

Gocovri offers doctors an alternative to managing dyskinesia that can avoid levodopa’s widespread side effects.

In a related development, Adamas has established a program to help patients obtain access to Gocovri. The Gocovri Onboard initiative includes prescription-filling and financial assistance. More information is available on the program’s website.

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5 Benefits of Cannabis Tea for Chronic Illnesses

Medical marijuana is gaining popularity as a complementary medicine to help with many symptoms associated with chronic illnesses. While many people are curious about how marijuana (or cannabis) may help improve their symptoms, they are also reluctant to smoke the substance. However, there are ways that medical marijuana can be administered, including in tea form.

MORE: 11 facts about Parkinson’s disease you may not know

According to thealternativedaily.com, here are five ways that cannabis tea can help relieve some of the symptoms people with chronic diseases live with.

1. Relieves pain
Marijuana has been associated with pain relief for centuries. Researchers have found the cannabinoids in marijuana dampen pain signals by binding to the pain receptors in the central nervous system (CNS).

In contrast to opiates such as morphine or codeine, cannabis is not addictive and poses no withdrawal symptoms to patients. Cannabis-infused tea is delivered to the whole of the body through the digestive system so the effects are longer lasting and more efficient than smoking.

2. Reduces inflammation
Medical marijuana has been found to reduce inflammation associated with many autoimmune diseases such as multiple sclerosisinflammatory bowel disease, and lupus. It also helps to temper the body’s immune system making it less likely to attack itself.

MORE: 16 tips to increase your mobility confidence while living with Parkinson’s disease

3. Protects the brain
Studies of cannabis’s effect on the brain have found that the drug has a neuroprotective effect and appears to slow down or even block the beta-amyloid protein build-ups associated with dementia and Alzheimer’s disease.

4. Promotes digestive health
Many chronic illnesses present symptoms which affect the gastrointestinal system. Cannabis has been found to improve digestion and relieve symptoms such as cramping, stomach pain, diarrhea, nausea, constipation and acid reflux.

5. Mood enhancer
While smoking cannabis may produce mind-altering effects that most people are wary of, drinking cannabis tea can help with stabilizing mood and helping to relieve emotional symptoms associated with chronic illnesses such as depression and anxiety.

MORE: Nine tips for getting rest and sleep with Parkinson’s disease

Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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Measuring Caffeine Levels in Blood Might Help Diagnose Early Parkinson’s, Study Suggests

blood caffeine levels

Low levels of blood caffeine and its metabolites may help identify patients with early Parkinson’s disease, according to new research. The findings are consistent with caffeine’s neuroprotective effects, previously observed in neurodegenerative diseases.

The study, “Serum caffeine and metabolites are reliable biomarkers of early Parkinson disease,” was published in the journal Neurology. The work was conducted by researchers at the Juntendo University School of Medicine in Tokyo, Japan.

A large number of epidemiological studies report a dose-responsive, inverse relationship between coffee/caffeine consumption and the risk of developing Parkinson’s. However, little is known about caffeine metabolism in Parkinson’s patients.

With that in mind, the team recruited 108 Parkinson’s patients without memory problems plus 31 age-matched healthy people as controls, and investigated their blood caffeine (and 11 of its metabolites) levels and whether there were mutations in their caffeine-related genes.

Both groups consumed the same amount of caffeine (about two cups of coffee a day).

Results showed that even early-onset Parkinson’s patients had significantly lower levels of caffeine and nine of its metabolites in their blood, compared to the control group. This was found to be unrelated to total caffeine intake or the severity of the disease.

“If these results can be confirmed, they would point to an easy test for early diagnosis of Parkinson’s, possibly even before symptoms are appearing. This is important because Parkinson’s disease is difficult to diagnose, especially at the early stages,” David G. Munoz, MD, of the University of Toronto in Canada, who wrote an editorial accompanying the study, said in a news release.

A statistical analysis revealed that this simple blood test was able to reliably identify Parkinson’s patients.

“Likewise, caffeine concentrations in patients with [Parkinson’s disease] with motor complications were significantly decreased compared with those without motor complications,” the team wrote.

When looking at the caffeine-associated genes, researchers reported no differences between Parkinson’s patients and healthy subjects.

Despite the promising results, this is a relative small study which needs to be replicated at a larger scale.

As part of the study’s limitations, people with severe Parkinson’s were not included, making it difficult to detect a relationship between disease severity and blood caffeine levels. Also, all Parkinson’s patients were medicated for the disease, which could influence caffeine metabolism, and thus the study results.

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Putting on My Pants

fear, pants

Sherri Journeying Through

I had a shower this morning, then proceeded to get dressed. I pulled on the blue pants I wear when volunteering at the hospital once a week at an adult day care program. The participants have conditions like dementia, Alzheimer’s, multiple sclerosis, stroke recovery, and more. It’s a nice place to volunteer with Parkinson’s disease because I tend to fit in rather nicely.

I can dance the slow two-step because the older folks think my shuffle is actually my dance step. And if my tremor has a mind of its own that day and they notice, they forget quickly. They don’t ask silly questions like, “Do I make you that nervous?” when I do shake. It’s a bit refreshing.

Anyhow, my husband had already left for work and I’m pulling on my pants. I got them up. It was the button that gave me trouble.

I used to lay on my bed years ago to get my zipper up if I ate one too many cookies the night before. Now, don’t tell me that you don’t know what I’m talking about. You’ve more than likely done it yourself a time or two. I’m happy to report, however, that I don’t need to do that now. I found myself some bigger pants. Ha.

This particular situation was different. My brain kept telling my fingers to put the button in the buttonhole, but my fingers had a mind of their own — they did their own thing. Isn’t that just Parkinson’s disease? You decide to go one way and your feet go another. You decide to pen a note and your fingers say, “Not now, dear.” You thought you were in charge, but when Little Monster (aka Parkinson’s disease) came to visit, he not only stayed — he took over.

My fingers decided to do what they felt like doing, and today, they felt like taking the day off. I ended up lying down just to get the fabric to lay flat so I could try to maneuver the button into the hole. It only took six tries, but I did get it in. It was a major accomplishment — I stood on the top of the mountain with my flag of victory.

I had a choice. I could get frustrated and end up in tears, my pants falling off while I felt sorry for myself. Or, I could be determined not to allow this unwanted Little Monster get the best of me, and be thankful I could still try to put on my pants.

I chose to be thankful. But I’ve got to tell you: I did think about those polyester pants with the elastic waistband that used to be the in-thing 40 years ago. They’re actually becoming somewhat appealing. Almost.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s Disease.

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16 Tips to Increase Your Mobility Confidence While Living With Parkinson’s Disease

Parkinson’s disease affects movement, coordination and mobility and as the disease progresses, it can often begin to ebb away at the confidence a person living with the condition has in their own abilities. However, all is not lost and there are ways that you can improve your confidence in movement. Although it may seem counterintuitive, according to the National Parkinson Foundation, in order to increase your mobility confidence you need to move more.

MORE: Six celebrities who lived with Parkinson’s disease

Here are a few of their tips to help you get moving:

  • Try to increase the amount of physical activity you do each day. Tackling chores around the house and garden is a good way to get moving.
  • Attend a local exercise class — yoga, swimming, water aerobics, abd boxing classes are all excellent choices.
  • Try to move around more — get up and walk around the house every hour or get up while the commercials are on while watching TV.
  • Dance. Play some of your favorite music and dance around the house.

If mobility and balance become an issue, mobility aids such as canes and walkers will help you to get around and get some of your independence back.

  • Laser canes and walkers can help those who suffer from gait freezing. The laser can help guide where to place your feet.
  • Straight canes with a rubber tip are best for stability.
  • Ensure the cane is at the correct height for maximum support and has a hand grip that’s comfortable.
  • Tripod or quad canes are more difficult for people living with Parkinson’s disease to use than single tip canes.
  • Walkers with four or more wheels will offer better stability and allow for easier turning.
  • Other features such as swivel casters, larger wheels and hand brakes will offer the best stability.
  • Walkers with added baskets or seats can prove very useful for resting and carrying items.
  • Walkers which need to be lifted into place do not offer stability for anyone with Parkinson’s disease and can make them lose balance.

If your Parkinson’s disease is more advanced and you require a wheelchair, there are some considerations you should take into account:

  • Speak with your occupational therapist or physical therapist about the best type of wheelchair to suit your needs
  • Check with your insurance company to see if a wheelchair will be covered.
  • Opt for a lighter wheelchair that will be easier to move around.
  • A wheelchair with a reclining back will allow you to rest easier and help if you have elevated blood pressure.

MORE: 12 types of exercise suitable for people with Parkinson’s disease

Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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Nuplazid Review Endorses Treatment, But Pinpoints Additional Study Needs

Nuplazid Review

Even though 60 percent of Parkinson’s Disease patients develop psychotic symptoms, it was only in 2016 that a treatment for the condition was approved.

Nuplazid (pimavanserin) employs an entirely different mechanism to control psychotic symptoms compared to the bulk of antipsychotic medications on the market.

The review, Pimavanserin, a novel antipsychotic for management of Parkinson’s disease psychosis,” took a look at the drug’s specific features, and its potential to early on prevent psychotic symptoms from bringing on more severe disease and premature death among Parkinson’s patients.

Researchers from Feinberg School of Medicine at Northwestern University, published the review in the journal Expert Review of Clinical Pharmacology.

Why not common antipsychotics?

Treatments capable of treating hallucinations and delusions have existed since the 1950s. So, why then do people with Parkinson’s disease require a specific type of medication?

People with Parkinson’s disease suffer neurodegeneration, particularly affecting neurons producing the neurotransmitter dopamine; medications aim to replace lost dopamine signaling by adding more of the substance.

The problem is that the majority of antipsychotic treatments work to block dopamine receptors. Using such drugs, therefore, would worsen motor symptoms. Moreover, some studies show that antipsychotics may increase the risk of death among Parkinson’s patients, although the issue is a topic of debate.

The brain, however, is complex and some newer compounds exist that target other signaling substances to treat psychosis.

Clozapine is considered the most effective antipsychotic on the market. But its widespread use, in Parkinson’s as well as other patients, is prevented by severe and potentially fatal side effects linked to the treatment. Patients need to be closely monitored with blood cell counts because a loss of neutrophil cells can be life-threatening.

Another so-called atypical antipsychotic, quetiapine, is sometimes used in Parkinson’s psychosis. But clinical trials have failed to prove the treatment is more effective than a placebo.

Moreover, both clozapine and quetiapine cause sedation and postural hypotension, which can be difficult to tolerate for someone with Parkinson’s disease, and may increase the risk of falls and worsen cognition, researchers underscored.

The novelty of Nuplazid

Unlike these medications, Nuplazid blocks brain receptors for the neurotransmitter serotonin. The drug has been studied in five Phase 2 or 3 clinical trials, and a sixth is ongoing. So, there is plenty of data showing the safety and effectiveness of this approach.

An analysis of pooled data from four of these trials showed that Nuplazid effectively reduced hallucinations and delusions in patients with Parkinson’s disease psychosis. It also has a good benefit-safety balance, researchers say.

While the side effects of earlier antipsychotics often made doctors delay treating Parkinson’s patients until the hallucinations and delusions became more severe, Nuplazid’s safety profile allows early treatment, the Feinberg researchers underscored.

Studies show that psychotic symptoms in Parkinson’s disease are linked to worsening disease and early death. Moreover, a psychotic Parkinson’s patient is extremely difficult to manage for family caregivers, often making early nursing home placements necessary.

Early treatment, researchers argued, may prevent this development. Since it takes several weeks for the drug to be fully effective, it also is important to start treatment early to prevent a potential exacerbation, they said.

More studies are needed, however, to explore if early treatment really does change the course of negative outcomes linked to psychosis in Parkinson’s disease.

Future directions

Nevertheless, although Nuplazid is approved for use in Parkinson’s disease, it carries a boxed warning that patients with dementia taking antipsychotics are at an increased risk of death.

Many patients with Parkinson’s psychosis also develop dementia, so more information is needed to assess the safety and effectiveness of Nuplazid in this patient group, the reviewers noted.

Acadia Pharmaceuticals, Nuplazid’s developer, recently launched a Phase 3 trial (NCT03325556) testing the drug in patients with dementia-related psychosis. The study enrolls patients with Parkinson’s disease, among others.

The review, however, pointed out that further studies examining the drug are necessary. For instance, the treatment is available in one dose only. Studies should explore other doses, and assess the safety of combining Nuplazid with atypical antipsychotics for people who fail to respond to Nuplazid alone.

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Deep Brain Stimulation May Help Parkinson’s Patients Live Longer, Study Shows

Deep brain stimulation

Deep brain stimulation (DBS) may help extend the survival of patients with Parkinson’s disease, according to a new study by researchers at the Edward Hines, Jr. VA Hospital in Hines, Illinois.

“Overall, DBS surgery has been viewed quite positively by both patients and providers,” Dr. Frances Weaver, the study’s lead author, said in a press release.

“There is an immediate effect on patients who have DBS on their motor function — the dyskinesia [involuntary muscle movements] is either gone or greatly reduced. The patient can move around and do things they hadn’t been able to,” Weaver said.

The research, “Survival in patients with Parkinson’s disease after deep brain stimulation or medical management,” appeared in the journal Movement Disorders.

Deep brain stimulation is a treatment that uses a medical implant, similar to a pacemaker, that sends electrical impulses via electrodes to specific areas of the brain. The implant is placed under the collarbone or in the abdomen.

Previous studies showed that this treatment led to a significant long-term improvement in motor function. But whether it improves survival remained largely unknown.

To answer this question, researchers compared data from two groups of veterans with Parkinson’s disease — those who received DBS vs. those who did not. In total, researchers analyzed each group’s data, which was retrieved from the VA and Medicare from 2007 to 2013.

The results showed that those treated with DBS survived longer, on average, than those without the device – 6.3 years after the surgery versus 5.7 years, respectively.

The analysis compared patients who submitted to deep brain stimulation to matched controls (those who did not have the DBS surgery) for age and symptom severity. Researchers then measured patients’ survival from the date of surgery in both groups.

Besides the modest increase in survival, the quality of life also improved after deep brain stimulation, mainly because the Parkinson’s patients were better able to control their disease symptoms, like tremors and rigidity.

Other confounding factors could also contribute to the observed phenotype, researchers said. Patients who had DBS surgery are closely monitored and any additional conditions are likely identified and treated in a timely fashion, while the same conditions may remain unnoticed in patients without the surgery.

Researchers also noted that most of the patients in the study were men, so the findings are not immediately extended to female patients with Parkinson’s disease.

DBS is usually employed when other forms of therapy, primarily medication, stops working.

“The surgery may get patients back to where they were when the medication was effective. That is, DBS is typically as effective as the medication — if the medication was still working,” Weaver said.

Additional studies are needed to confirm if indeed deep brain stimulation extends Parkinson’s disease patients’ life expectancy. If so, another question that remains is how: Does it halt disease progression or does it have indirect effects, improving only Parkinson’s disease-related conditions or diseases?

More research will shed light on the mechanisms of deep brain stimulation and how it may modulate brain function.

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Lifestyle Changes That Can Improve Quality of Life for Parkinson’s Patients

In this video from Panorama Patient Network LLC, neurologist Susan Fox talks about some of the lifestyle changes people living with Parkinson’s disease can make to improve their quality of life.

MORE: How does Parkinson’s disease affect the brain?

Fox begins by explaining that exercise is one of the most important things a person with Parkinson’s disease can do to improve their life. There isn’t any particular exercise that’s better for Parkinson’s patients, but she advises people pick something they enjoy so they’ll be more likely to do it regularly.

Diet is also something Fox recommends people living with the condition look into. Eating a healthy balanced diet and drinking lots of water will help patients avoid gastrointestinal issues often associated with Parkinson’s, such as constipation, and will help medication work to its full potential.

Sleep is the final issue Fox addresses. Getting regular quality sleep where you feel refreshed upon waking can help the brain produce dopamine. And if you feel fatigued during the day, having a short nap can help restore energy.

MORE: Using exercise to help combat Parkinson’s disease symptoms.

Parkinsons’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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