Understanding What Parkinson’s Progression Means to Each Patient

progression

Every day following the ruin of stagnation, it seems that I have progressed from early Parkinson’s to a moderate stage of the disease. But I can’t be sure. Many other factors, including stress, injuries, medication changes, and aging, could be making it look and feel worse. To appease my quandary, I dove into the internet, searching for elucidation about Parkinson’s progression.

We watched as Michael J. Fox and Muhammad Ali were changed by the disease. Granted, their Parkinson’s symptoms were dramatic: Their body movements gradually became less fluid, the tremors more pronounced. Over time, the movement challenges became more noticeable, signifying progression. The Parkinson’s community uses the terms “early,” “middle,” and “late” stage to describe progression. It mostly makes sense and matches what medical providers identify with patients. But it doesn’t help me in my search for well-being possibilities.

Progression for me is more than “early,” “middle,” or “late.” I accept that the disease will cause changes in me and my life. But it would be helpful for my wellness map if some of the pitfalls could be marked, “Danger ahead!” or, “Here’s a list of supplies,” to get me through the hardest parts of my chronic disease journey. Being well-prepared is an essential part of wellness success. The progression of Parkinson’s is not about stages — except in a general way. Rather, it means having some idea about what can be done to slow the progression, or, failing that, how to recognize when progression is happening. Useful information about progression would help guide us through what is sometimes a tortuous journey. It might make the trip easier.

Chatting with the Parkinson’s community reveals the entrenched idea that progression is unique to each person. It would be helpful if our understanding of progression could provide for each patient more details than, “It’s unique to everyone, and you will know when you get there.” So what’s holding up progress toward understanding disease progression?

Medical professionals determine Parkinson’s progression by a system involving a physical exam, patient report, and sometimes a standardized measurement tool or questionnaire. That system fails when all that we are told about progression is, “You’ll know it when you get there.” We need better information from early Parkinson’s stages to understand progression to middle and beyond. Data from the existing collection system is insufficient to give a clear understanding of what progression means to each patient.

I recently read an article in which the authors discuss the merits of the retropulsion test to evaluate postural instability in Parkinson’s. The three methods are: “(1) the pull test as described in the MDS-UPDRS scale; (2) using an unexpected shoulder pull, without prior warning; and (3) the push-and-release test.” Although the test is considered the gold standard, the authors state that “the outcome can vary considerably due to variability in test execution and interpretation.”

The authors state that the test fails to predict future falls, explaining that falling results from the “complex interplay between gait, balance, cognitive decline and environmental factors, and the retropulsion test captures only part of that.”

It is difficult to spot early symptoms during a short office visit once every three to six months. Increasing the speed of care by reducing the duration of clinic appointments has not improved healthcare for this ailing columnist. It hinders the ability of the healthcare practitioner to get to know the patient better and increases the chance of the latter being categorized as “that patient with Parkinson’s.” The provider can’t see all the effects of the chronic disease, even with a longer visit.

We have good and bad days, on and off periods, and life circumstances — all of which make data collection on Parkinson’s progression from a 15-minute office visit problematic. It makes sense that early diagnosis and proper treatment should make a difference in progression. As far as I can tell, no adequate longitudinal studies exist that describe variation in progression as a result of treatment, or lack thereof. This applies even to exercise, my favorite Parkinson’s treatment to slow progression, and the effects of stress as my “most need to avoid” situation to prevent speeding up the progression.

In the next column, I will offer a possible solution to the Parkinson’s progression research problem. 

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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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Dosing Begins in Phase 2 Trial of CNM-Au8, Potential Therapy for Dopaminergic Neurons

Parkinson's pilot trial

A pilot Phase 2 study evaluating CNM-Au8, an investigational Parkinson’s treatment aiming to protect nerve cells, has started dosing patients, the therapy’s developer, Clene Nanomedicine, announced.

The open-label REPAIR-PD (NCT03815916) clinical trial is enrolling up to 24 people, ages 30 to 80 and diagnosed within the past three years, at its one site at the University of Texas Southwestern Medical Center.

“We are excited to be advancing CNM-Au8 clinically into Parkinson’s patients starting with the REPAIR-PD Phase 2 study” Rob Etherington, president and CEO of Clene, said in a press release.

Parkinson’s disease is characterized by the death of dopaminergic neurons in two brain regions, the striatum and the substantia nigra. These nerve cells rely on large amounts of energy to function, which is provided by mitochondria, the cell’s powerhouses. Failure to provide the energy that cells need contributes to their death.

Oxidative stress, an imbalance between the production of harmful free radicals and the ability of cells to detoxify them, is another hallmark of Parkinson’s disease. These free radicals, or reactive oxygen species, are produced during certain metabolic reactions that involve mitochondria, and can damage cells.

CNM-Au8 is a suspension of nanocrystalline gold designed to increase the production of energy. Specifically, it works by increasing the speed of conversion between two molecules — nicotinamide adenine dinucleotide (NADH) to its oxidized form (NAD+) — resulting in greater production of energy in the form of ATP (adenosine triphosphate, an energy-carrying molecule of cells).

In addition, CNM-Au8 has antioxidant properties that may help to protect cells against oxidative stress.

Preclinical (in the lab) data showed that CNM-Au8 aided the survival of dopaminergic neurons, and helped prevent the loss of mitochondria.

In a rat model of Parkinson’s disease, treatment with CNM-Au8 improved the animal’s motor activity compared to control (untreated) mice. Of note, rats treated with CNM-Au8 in this test showed better results than did rats given carbidopa/levodopa, a standard Parkinson’s therapy.

“Our preclinical data with CNM-Au8 demonstrated improvements in neuronal bioenergetics, which may improve the survival of dopaminergic neurons in patients with PD [Parkinson’s disease], thereby helping slow the progression of this devastating disease,” Etherington said.

A Phase 1 clinical trial involving healthy volunteers (NCT02755870) found CNM-Au8 to be safe.

In the REPAIR-PD study, patients will first undergo a four-week screening period, after which they will drink two ounces of CNM-Au8 daily each morning for 12 weeks. Treatment will be followed by a four-week follow-up period.

The study’s primary outcome is to determine improvements in oxidative stress in the central nervous system (brain and spinal cord), assessed by the ratio of NAD+/NADH measured using magnetic resonance spectroscopy (MRS).

Additional (secondary) measures include assessing the effects of CNM-Au8 on energy production, and nerve cell metabolism.

“The objective of the REPAIR-PD Phase 2 study is to demonstrate improvements in brain bioenergetic metabolism in Parkinson’s disease patients treated with CNM-Au8. Participants will undergo 31phosphorous magnetic resonance spectroscopy (31P-MRS) imaging to show how treatment with CNM-Au8 results in improvements in brain metabolic and membrane biomarkers,” said Robert Glanzman, MD, chief medical officer of Clene.

Results from the REPAIR-PD trial are expected by mid-2020.

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Deep Brain Stimulation May Impair Swimming Ability and Increase Risk of Drowning, Case Studies Suggest

swim DBS

Patients who undergo deep brain stimulation to treat Parkinson’s disease may lose their ability to swim, even if their motor symptoms improve after the treatment or if they were formerly proficient swimmers, a collection of nine case studies has found.

The study, “Beware of deep water after subthalamic deep brain stimulation,” was published in the journal Neurology.

“Until more research is done to determine why some people with deep brain stimulation can no longer swim, it is crucial that people be told now of the potential risk of drowning and the need for a carefully supervised assessment of their swimming skills before going into deep water,” Daniel Waldvogel, MD, researcher at the University of Zurich in Switzerland and lead author of the study, said in a press release.

Deep-brain stimulation (DBS) is an invasive surgical treatment in which fine wires are inserted into the brain and connected to a device placed under the skin in the upper chest. The device controls electrical impulses to stimulates areas responsible for movement control, such as the subthalamic nucleus.

DBS is usually used on Parkinson’s patients whose motor symptoms do not respond well to standard medications, and studies have shown long-term improvements in motor symptoms, quality of life, ability to perform regular daily activities, and a significant reduction in the need for levodopa.

However, researchers now say that despite a successful surgical procedure and improvement in motor symptoms, some patients can lose their ability to swim.

The nine patients described in the study had received deep brain stimulation of the subthalamic nucleus, and all were highly satisfied with the treatment’s overall outcome. “However, they were frustrated by their lost ability to coordinate limb movements for swimming,” the researchers said.

The researchers described three of the nine cases in their study.

The first case was a 69-year-old man who lived by a lake and was an experienced and proficient swimmer. Due to his good motor outcomes after undergoing DBS, the man was confident enough to jump into the lake, but he would have drowned if not rescued by a family member.

The second case was of a woman, 59, who was a competitive swimmer and continued to swim even after being diagnosed with Parkinson’s. However, after undergoing DBS, she lost her ability to swim, which never came close to her previous level even after regular swimming practice with a physical therapist.

Finally, researchers reported the case of a 61-year-old woman with a lifesaving diploma, who used to swim in competitions crossing Lake Zurich, which is two miles wide. After the surgical procedure, however, she could barely swim two-tenths of a mile and complained of an awkward posture when trying to swim.

“Swimming is a highly coordinated movement that requires complicated arm and leg coordination,” Waldvogel said. “Exactly how deep brain stimulation is interfering with this ability needs to be determined.”

Three of the nine patients turned off their DBS devices and immediately regained their ability to swim. However, this led to worsening of their other motor symptoms, which made them switch on their devices again.

“Even though these reports affected only a few people, we felt this potential risk was serious enough to alert others with Parkinson’s disease, as well as their families and doctors,” Waldvogel said.

More studies are warranted to better understand the real adverse effects of DBS, including its impact on patients’ ability to swim.

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Parkinson’s Changes the Rules: It’s OK to Ask for Help

rules

We all have a fundamental desire to help our loved ones, and this is particularly true of those of us with early-onset Parkinson’s disease. Life moves along, and we try to advance with it. We are used to taking care of our responsibilities. But when we have Parkinson’s, the rules change.

I was trying to accomplish many things and not doing any of them well. I felt defeated in my job, and as a mom, daughter, and wife. I didn’t know how to step back and recognize my limitations. I had been taking care of everything for over 25 years and I loved it.

Now I find myself in unfamiliar territory. It may be a natural part of getting older or my progression, but I am not the same person. I can’t do everything that I could in the past. And accepting my limitations is not easy.

When my doctor suggested that I see a psychologist, my immediate reaction was, “No, I don’t need to.” However, she was right. I did need therapy, at least in the short term. While it is not for everyone, therapy has been beneficial when I find myself struggling. My therapist can make me aware of things that my friends, family, and others who are part of my everyday routine can’t see in me.

Talking with a professional provides a different perspective. And sometimes, having a fresh look at your situation can help you to get to where you want to be. Unfortunately, therapy is not always available, and people often avoid seeking this kind of help because of the stigma attached.

New rules

While my approach is still a work in progress, I have developed some new rules. I am sure that I will add more and you may have some rules of your own. With the busy holiday season approaching, you may want to give these a try:

  • You don’t need to take care of everything.
  • Know when to seek support.
  • It’s OK to ask for assistance.
  • Allow others to help.

Parkinson’s makes us feel helpless at times. However, it’s not just about us. What about the people in our lives? Do they feel the same way? Maybe playing by the new rules and allowing them to help us will make them feel more useful. We can see our acceptance of their help as a gift to them rather than a burden — something as simple as opening a car door can make all the difference.

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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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Exposure to Second-Hand Smoke Linked to Lower Risk of Developing Parkinson’s, Study Suggests

second-hand smoke

Second-hand smoke may have a neuroprotective effect, as exposure to this type of indoor pollutant seems to be associated with a decreased risk of developing Parkinson’s disease, according to a recent study.

Conversely, exposure to certain air pollutants — like nitrogen dioxide and ozone — might contribute to a higher risk of developing the disease.

The study, “The impact of long-term exposure to ambient air pollution and second-hand smoke on the onset of Parkinson disease: a review and meta-analysis,” was published in Public Health.

Air pollution is composed of a variety of particulate air pollutants, volatile organic compounds, gaseous air pollutants, and airborne metals. Exposure to polluted air has been consistently associated with adverse effects in respiratory and cardiovascular diseases, but little is known about the effects of such exposure in neurodegenerative disorders such as Parkinson’s.

Although the exact causes behind Parkinson’s disease are not fully understood, it is thought to be induced by “a complicated interplay of environmental and genetic factors,” according to these researchers.

As such, “further investigation of the modifiable risk factors of [Parkinson’s disease] is of imperative significance and expected to have broad implication for the primordial prevention of this disease,” they said.

Second-hand smoke is a type of indoor air pollution. Evidence indicates that active smokers have a 50% lower chance of developing Parkinson’s in comparison with non-smokers. “However, whether this negative correlation is causal and persists among persons regularly exposed to SS [second-hand smoke] remains undetermined,” the researchers said.

To learn more, the scientists searched five medicine-related databases for any observational or epidemiological evidence on the relationship between long-term exposure to air pollution and second-hand smoke and Parkinson’s susceptibility.

The studied air pollutants included: particulate matter with an aerodynamic diameter of less than 2.5 μm (PM2.5), such as combustion particles, organic compounds, and metals; particulate matter with less 10 μm in diameter (PM10), including dust, pollen, and mold; nitrogen dioxides (NO2); ozone (O3); and carbon monoxide.

The researchers combined the results of 21 studies, involving a total 222,051 Parkinson’s patients, and performed a statistical review known as a meta-analysis.

A marginally significant higher risk of developing Parkinson’s disease was observed in those exposed to PM2.5, NO2, and O3. Although carbon monoxide was found to be positively associated with Parkinson’s susceptibility, statistical significance was not attained.

“Second-hand smoke conferred reduced risk of Parkinson disease, regardless of exposure occasions [at home/at work/in children] and timing,” the researchers said. This suggests that second-hand smoke might have a neuroprotective effect in those who are susceptible to developing Parkinson’s at some point in their lives.

Some possible explanations exist as to why cigarette smoke may be associated with a lower risk of Parkinson’s. One theory is that some tobacco smoke compounds contain properties that inhibit monoamine oxidase (MAO), an enzyme that plays a key role in the activation of MPTP, a well-known Parkinson’s-inducing neurotoxin, and that is involved in the degradation process of dopamine released by nerve cells.

“Other hypotheses include the direct neuroprotective effect of nicotine by stimulating dopamine release, upregulating nicotinic receptors, and inhibiting alpha-synuclein fibrillation, thereby suppressing and relieving parkinsonian symptoms,” the researchers said.

Given the many harmful effects of air pollutants, public and environmental health strategies that reduce outdoor air pollution levels could help lower the burden of Parkinson’s disease.

Despite the potential neuroprotective effect of second-hand smoke, caution is advised when interpreting these results, as more large-scale studies are necessary to fully understand such an association.

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Managing the Cost of Chronic Illness

costs

Chronic illness is expensive. It costs money, time, and peace of mind. Whether you’re sifting through your worries or counting the pennies in your pocket, illnesses affect all avenues of life.

Before the symptoms of a disease appear, one may go about daily life unencumbered by thoughts of self-preservation. But disease changes everything. 

According to the U.S. Centers for Disease Control and Prevention, 90 percent of the country’s annual healthcare spending — some $3.5 trillion — is related to chronic illnesses such as diabetes, Alzheimer’s disease, and others. 

With Parkinson’s disease, the same costs apply. While the return is generally worth the investment, Parkinson’s treatments are expensive. And people most often are hit with shocking bills at the same time they’re losing physical independence.

So how do you foot the bill? Where is the balance between finding the appropriate care and saving your pennies? What do you do when financial limitations find you?

Switching from full-time to part-time work

For many PD patients, one big question is: “Will I be able to keep my job as the disease progresses?” Everyone’s situation is different, and there’s no universal answer to this question. It depends on the job and how PD affects you. 

My dad worked as a Realtor for most of his adult life, and he remains invested in that world. He grew up in the same area where he worked, and many of his clients were friends first. So I doubt he’ll ever entirely give up his profession. But he has certainly chosen to change his relationship with work. 

One thing he noticed early on is that stress seems to drastically affect his PD symptoms. So adapting to the disease was never a debate. He just needed to determine how to move forward. His solution was to slow down and reduce the number of homes he sells. This means that his income has changed as well. 

Luckily, my mom is a worker bee. Even when she has a day off, she fills her time with projects and goals. She continues to work full-time and hold down the fort. But the financial side of PD has been fluid and will continue to change. Will my parents have to downsize houses again one day? Sell some assets? What happens when my mom realizes she’s in her 60s and can’t work as much anymore? 

Medical care and travel expenses

Medical care is a complicated subject. If you’re lucky enough to live in or near a city, the options allow you the privilege of choice. But what if you have to commute an hour each way and you’re not comfortable with your driving abilities anymore? What if you live in a remote area of the country and medical care is limited? The greatest cost in this situation seems to be time — your time and the time of a loved one.

Since undergoing deep brain stimulation, an expensive surgery, Dad continues to see his neurologist to tune the hardware. He always has a companion for these visits, which increase his quality of life. But he gives up time to travel and money for gas, and he probably pays something for each doctor visit. Sometimes he’ll also see an herbalist (the “witch doctor,” as he says) and a chiropractor. And even with insurance, he spends a lot of money on medication. 

My mom’s thoughts on the cost of Parkinson’s

My mom was kind enough to share some thoughts about the cost of Parkinson’s disease. She said that while they’re doing fine, it seems that “fun money” inevitably turns into bill money. Yet she remains positive. She, like my dad, continuously adapts to the changes that come with chronic illness. 

She ended a recent email on a positive note: “NONETHELESS, we are doing alright!”

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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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I’ve Made BIG Improvements with Parkinson’s Therapy Program

BIG

I have been seeing a physical therapist four times a week for the last month. I hadn’t injured myself, though I experience aches and pains with Parkinson’s disease.

My neurologist referred me to a physical therapist who teaches the BIG program. The LSVT BIG program is designed for people with Parkinson’s to bring their movements to a more “normal” state, as they tend to become slower and smaller over time.

My first session

My first appointment consisted of small “tests,” like those performed during a Parkinson’s diagnostic exam but less extensive. The therapist examines and times your walking and tests your balance, among other abilities.

BIG is customized for people with Parkinson’s. Perhaps you struggle with getting out of bed. Though this specific activity isn’t included in the standard routine of the BIG program, it can be worked into your tailored activities. The therapy can help you no matter what stage of the disease you are at and it’s recommended that you start treatment as early as possible.

What improved?

The BIG treatment improved my walking in general, and I gained confidence with “stair-stepping.” I no longer take each stair sideways, with extreme caution, and slower than molasses. The program helped me to be more intentional in my activities and how I carry them out.

At my therapy sessions, we started with the exercises that are specific to the BIG program. I completed two exercises while sitting in a chair, stretching down, up, and back, and ending with a “BIG” finish. The rest of the exercises — except for the last — are performed while standing and are aimed at balance and coordination, and also end with a “BIG” finish. The program strives to teach the person with Parkinson’s to emulate the bigger movements of those around them who walk and interact “normally.”

After the “regular” exercises, we practiced tasks tailored to my needs. These included cutting up food, buttoning/unbuttoning and zipping/unzipping my coat or sweater, and other tasks. After those exercises, we walked around the neighborhood for a half-hour, practicing arm swings and balance.

Was it worth it?

My sessions are over, and as my movements have improved, my outlook has, too. While the exercises are not difficult to do, they must be practiced daily for continuous improvement. I noticed that if I skipped even one day, it made a difference to my ease of movement. I realize that if I want to live BIG, I need to exercise BIG, and that means I must think BIG.

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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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Brain Cells Will be Studied in Space to Better Understand Parkinson’s and MS

Space Station research

An ongoing study onboard the International Space Station (ISS) is investigating how microgravity affects the development of immune cells in the brain, with the goal of understanding the cellular processes behind the neurodegeneration seen in Parkinson’s disease and primary progressive multiple sclerosis (PPMS).

Scientists hope that the results of the study will provide new disease biomarkers and accelerate the search for new therapy options for patients.

Earlier this year, the same group — from the New York Stem Cell Foundation (NYSCF) Research Institute and Aspen Neuroscience — launched a preliminary experiment to test their systems and methods. Custom flight hardware systems, onboard cell culture technology, and post-flight analytical methods tested in that run all contribute to this next experiment.

In the preliminary experiment, the researchers loaded patient-derived induced pluripotent stem cells (iPSC) and cells from healthy donors into CubeLabs, shoebox-sized labs-in-a-box, developed by Space Tango. Automated systems fed and cultured the cells inside the CubeLabs. At the end of the experiment, the cells were frozen for analysis in earthbound labs.

Of note, iPSCs are derived from either skin or blood cells that have been reprogrammed back into a stem cell-like state, which allows for the development of an unlimited source of any type of human cell needed for therapeutic purposes.

The current experiment will be the first study of long-term cell culture in microgravity. Onboard the ISS, patient-derived and control iPSC will be grown into three-dimensional neural organoids — simplified versions of an organ. These organoids will include microglia, which are immune cells of the brain whose dysfunction is thought to drive neurodegenerative diseases such as Parkinson’s and PPMS.

“Microglia are constantly scanning the brain for danger, and it’s starting to look like they overreact in neurodegenerative illnesses, contributing to the death of neurons,” Valentina Fossati, PhD, one of the lead investigators from the NYSCF, said in a press release. “Physical forces affect how these cells behave, and microgravity is a unique circumstance in which to tease apart these healthy and diseased behaviors.”

Microglia make challenging research targets. They cannot be safely harvested from patients’ brains, and mouse models of Parkinson’s and PPMS do not mimic all the features of these diseases in humans. Fossati and her colleague, Andres Bratt-Leal, PhD, of Aspen Neuroscience, believe the ISS provides a better environment for building models of these diseases.

The group hopes that by understanding how microgravity — known to increase proliferation and delay differentiation of stem cells — affects the development and dysfunction of microglia, they will learn how these cells function while migrating throughout the brain and interacting with neurons. This, in turn, can teach us how these processes change during disease progression.

Because microgravity affects even healthy nervous tissue, the results of this experiment may prove useful for astronauts. NASA points out that “exposure to microgravity and radiation, as occurs in the International Space Station, causes significant mechanical unloading of mammalian tissues, resulting in rapid physiological alterations.” This can lead to a number of risks. Understanding the mechanisms by which this occurs will help to guard against them.

“There is significant potential to advance our understanding of MS and [Parkinson’s] as we initiate these long-term studies of patient cells in microgravity now that we have completed our preliminary tests,” Fossati said in another press release. “We look forward to leveraging the unique capabilities of spaceflight research to better understand the role of microglia in multiple sclerosis and Parkinson’s disease, as well as how dysfunction in these cells can be targeted therapeutically.”

The experiment is scheduled to launch into space on Dec. 4, on the 19th SpaceX Commercial Resupply Services mission. The National Stem Cell Foundation provided funding for the study.

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RightEye’s Vision System for Early Diagnosis Named ‘Breakthrough Device’ by FDA

RightEye system

RightEye’s Vision System, an advanced eye-tracking device that measures eye tremors to help diagnose Parkinson’s disease at early stages, has been designated a breakthrough device by the U.S. Food and Drug Administration.

This FDA designation is given select medical devices or products that aim to more effectively treat or diagnose ” life-threatening or irreversibly debilitating diseases.” It streamlines processes to speed these devices’ development, testing, and agency review for approval, possibly allowing them to reach the market more quickly.

Currently, a Parkinson’s diagnosis relies on the outcomes of several neurological tests, and delays are common before a correct decision is reached.

“When assessing Parkinson’s disease, 60% of patients are misdiagnosed at least once, with one third of patients misdiagnosed twice. That is a terrifying and unacceptable statistic in the age of modern medicine,” George Gitchel, PhD, director of clinical research at the Southeast Parkinson’s Disease Research, Education, and Clinical Center (PADRECC), at the Richmond Veterans Affairs Medical Center, said in a press release.

“In my experience Parkinson’s patients often struggle for years, going from doctor to doctor trying to get a correct diagnosis,” Gitchel added.

Previous research has found tremors that prevent the eyes from fixing with stability are “pervasive” in people with Parkinson’s, and researchers have suggested that eye tremor be considered in diagnosing the disease.

The RightEye Vision System uses advanced eye-tracking technology to measure eye tremors, which usually develop in patients before other symptoms arise. This means that the device may help to detect Parkinson’s at early stages.

The size of a laptop, the system provides objective and accurate visual screening, generating reports that reflect hundreds of collected metrics.

“By providing quantitative, objective data to assist clinicians, I truly believe that RightEye will play a key role addressing this issue, while its FDA Breakthrough Designation will accelerate availability,” Gitchel said.  

The system received FDA clearance  for recording, viewing, and analyzing eye movements to help identify patients with troubled visual tracking in October 2018.

“With this FDA Breakthrough Device Designation, RightEye has an opportunity to address a critical unmet need in the fight against Parkinson’s disease,” said Adam Gross, co-founder and CEO at RightEye.

“The annual cost of Parkinson’s disease in America is estimated at approximately $52 billion. Earlier assessment, intervention, and more accurate diagnoses is anticipated to reduce these costs, while also improving patient outcomes and quality of life,” he added.

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Plant-based Diets: What About Dairy?

plant-based diets

Plant-based diets might aid in the prevention and reversal of disease. People with Parkinson’s disease can benefit from plant-based diets.

Plant-based, vegetarian, and vegan diets

I became a vegetarian over 10 years ago. I chose not to eat red meat, chicken, or fish for animal welfare reasons. After my Parkinson’s diagnosis, I eliminated dairy products and became vegan.

Consumption of dairy, particularly milk, is linked to a greater risk of Parkinson’s. However, many vegan foods may be unhealthy. For example, a nondairy diet consisting of junk food could be labeled vegan despite the artificial ingredients.

A plant-based diet, on the other hand, consists of minimally processed fruits, vegetables, whole grains, legumes, nuts, seeds, herbs, and spices. Plant-based diets exclude all animal products, including red meat, poultry, fish, eggs, and dairy, so they are both vegetarian and vegan. Forks Over Knives breaks down vegan, vegetarian, and plant-based diets in this resource.

Plant-based diets and legislation

The state of New York recently passed a bill (pending the governor’s signature) that requires hospitals to offer plant-based meals to patients. I believe the emphasis on plant-based diets is here to stay and will become the norm over time.

My challenges with a plant-based diet

I miss Parmesan cheese (I used to put Parmesan on everything, from soup to salad to pasta), creamer for my cappuccino, yogurt, burgers, cheddar cheese for my veggie burgers, and chocolate mousse. But after much trial and error, I can finally say that I can live without them. Luckily, I can purchase nondairy substitutes at my local health food store or supermarket.

Where’s the beef?

Your supermarket may sell frozen veggie burgers. However, many veggie burgers are made with cheese or contain processed ingredients that I can’t pronounce. I have found one especially delightful burger that contains healthy ingredients and no dairy!

Cheese alternatives

Violife’s Parmesan cheese consists of potato and rice starch and coconut oil. Violife is the tastiest substitute for Parmesan that I have found. It even smells like Parmesan!

I make this delicious, dairy-free cheese dip to top my veggie burgers and bean tacos. The main ingredients are raw cashews, raw almonds, almond milk, crushed red pepper, and nutritional yeast. A blender or food processor works just as well as a Vitamix.

Milk/cream substitutes

Almond milk, coconut milk, and oat milk work well with cereal. For cappuccinos, both Trader Joe’s coconut creamer and So Delicious’ coconut milk creamer foam well and taste great.

What’s for dessert?

Tofu-based chocolate mousse is my favorite dessert now. This recipe calls for soft tofu, but I use firm tofu instead. You can tweak the maple syrup and cocoa to your liking. For a nondairy topping, Coyo makes a vanilla bean or original flavor coconut yogurt alternative.

I prefer dark chocolate, but I have found a dairy-free milk chocolate bar that I enjoy. If you like a little crunch, the company also makes a delicious quinoa crunch version.

For a really guilty pleasure, Ben & Jerry’s offers delicious, nondairy frozen desserts. They have too much sugar and too many processed ingredients for my taste, but I will eat them as a special treat once in a while. I have served Ben & Jerry’s to people on unrestricted diets, and they loved it. They thought they were eating ice cream!

Plant-based diets are the way to go, whether you’re making the change for the planet, animal welfare, or your health. You can find good dairy alternatives through trial and error.

“You can’t be an environmentalist, you can’t be an ocean steward, without truly walking the walk. And you can’t walk the walk in the world of the future, the world ahead of us, the world of our children, not eating a plant-based diet.” –James Cameron

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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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