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Dutch Neurologist Warns of ‘Parkinson’s Pandemic’ Linked to Toxic Chemicals

Bastiaan Bloem, neurologist

As the world frantically battles coronavirus, a leading Dutch neurologist warns of the next global pandemic — and this one, he says, is almost entirely of our own making.

Bastiaan Bloem, MD, a neurologist and professor at Radboud University Nijmegen Medical Center, says that over the next 20 years, the number of people with Parkinson’s disease (PD) will likely double — from the present 6.5 million to more than 13 million.

The main cause of this exponential jump: widespread exposure to herbicides, solvents, and other toxic chemicals used in agriculture and manufacturing.

“A pandemic, as everybody is now painfully aware, is a disease happening worldwide, to which no one is immune. PD fulfills all those criteria,” Bloem told Parkinson’s News Today in a phone interview from the Netherlands.

“Parkinson’s is now the fastest-growing neurological condition on the planet.”

Bloem is co-author of a new book, “Ending Parkinson’s Disease: A Prescription for Action,” along with Ray Dorsey, MD, a neurologist with the University of Rochester, New York; neuroscientist Todd Sherer, PhD, chief executive officer of The Michael J. Fox Foundation; and Michael S. Okun, MD, a neurologist  with the University of Florida.

The 336-page book, published on March 17, has quickly become the bestselling neurology book on Amazon.

“Many neurological conditions such as Alzheimer’s disease are increasingly common because our population is getting older,” Bloem said. “But in a large survey published in The Lancet, after correcting for the aging effect, Alzheimer’s is stabilizing and stroke is actually diminishing thanks to better treatment.

“Literally, the only condition that’s accelerating over and above the aging effect is Parkinson’s disease.”

Bloem, 53, points to the tight link between exposure to herbicides such as paraquat — a weed killer — and the risk of developing Parkinson’s.

“These chemicals were introduced worldwide after World War II, and many are still used today on our fields,” he said. “For this reason, farmers are at a markedly increased risk of developing Parkinson’s. If you feed a mouse paraquat — which is banned in China but not the U.S. — it will kill the dopamine-producing cells in the brain. These chemicals are tremendously toxic to the brain and have even been detected in milk, in supermarkets.”

Paraquat isn’t the only such chemical posing this risk. Trichloroethylene, a solvent used to clean metals and remove stains, has exactly the same effect on human brains. Yet it’s still widely used and is detectable in high concentrations in groundwater, he said.

“Parkinson’s is exploding in numbers, it’s a horribly debilitating disease, and it’s a costly disease that should matter to people and governments. We’re doing this to ourselves,” Bloem said. “But we can do something about it. We need to get rid of these toxic pesticides and move toward organic food. And we should take measures to protect people who work in these toxic environments.”

In the book, he added, parallels are drawn “to HIV and polio, which were once incurable, debilitating diseases. In the 1980s, people with AIDS chained themselves to the front doors of pharmaceutical companies demanding better treatments, and now people no longer die of AIDS.

“We need to raise awareness about this pandemic that’s happening right now.”

ParkinsonNet draws praise

Bloem, who’s published more than 700 scientific papers and book chapters on the subject, is a towering figure in his field — and not only because he’s 6-foot-7.

“Innovative healthcare concepts are now seen as an export product of Holland, not just wooden shoes and tulips — and Parkinson’s is a recognizable disease affecting Muhammad Ali, Michael J. Fox, Alan Alda, Ozzy Osbourne, Linda Ronstadt and other famous people,” said Bloem, who played volleyball on the Dutch national team in his youth.

His 11-minute TEDx talk, “From God to Guide,” was widely praised by viewers on YouTube.

Dr. Bastiaan Bloem, an expert on Parkinson’s disease, leading a lecture at his university. (Photo by Larry Luxner)

“I strongly believe the future of health care is specialized networks, where well-trained specialists treat high caseloads,” he said. “Leaving specialized care merely to the hands of generalists is a thing of the past.”

Bloem and his colleague, Marten Munneke, are the brains behind ParkinsonNet, an acclaimed Dutch health care concept that involves at least 12 disciplines, 70 regional networks, and 3,400 professionals who have all received PD-specific training.

ParkinsonNet is credited with lowering costs associated with Parkinson’s care in their country by at least $439 per patient annually, as well as a 50% reduction in hip fractures and fewer hospital admissions. These cost savings, he said, far outweigh the costs of building and maintaining the network.

The program has now spread to several other countries and serves as a model of successful, scalable innovation.

Bloem said that King Willem-Alexander, whose father had Parkinson’s, is an avid supporter of the ParkinsonNet project; so is the Dutch Health Ministry.

“We have now successfully introduced our ParkinsonNet concept in California, together with Kaiser Permanente, and also in Norway and Luxembourg,” he said. “We are now creating an international network of experts so that a doctor in California can ask a question which will be answered by a therapist somewhere in the Netherlands.”

“When people try to innovate in health care, the insurers always say, ‘prove to me it works, then we’ll reimburse for it.’ This is a Catch-22, because you cannot prove it works unless you first implement and test it,” he said.

“One key message here is, cherish the value of imitation. We value innovation, but let’s stop blindly innovating all the time. Look around, see what’s already good out there and copy it,” he added, nothing that ParkinsonNet “could well be a model for managing many other chronic neurological and even non-neurological conditions.”

Parkinson’s and COVID-19

Bloem is also concerned that the current COVID-19 pandemic could have immediate, detrimental effects on Parkinson’s patients.

As of April 6, the World Health Organization was reporting just under 1.3 million confirmed coronavirus infections and 70,000 deaths — including nearly 10,000 deaths in the United States and close to 1,800 in the Netherlands.

“Parkinson’s patients do not have a higher risk of attracting coronavirus, but we do think they are more at risk of experiencing the severe complications of COVID-19,” Bloem said. “We know, for example, that exercise suppresses the symptoms of Parkinson’s, whereas this crisis forces people to stay at home. And it also leads to chronic stress — and PD patients are particularly susceptible to the negative effects of stress.”

Bloem and a colleague, Rick C. Helmich, MD, outlined those concerns in a commentary article, “The Impact of the COVID-19 Pandemic on Parkinson’s Disease: Hidden Sorrows and Emerging Opportunities,” that appeared in the Journal of Parkinson’s Disease on April 3.

One hidden, but potentially highly disconcerting, consequence of the pandemic is a marked reduction in physical activities, Bloem wrote.

“Many people are now largely … unable to go out for a regular walk, let alone to see their physiotherapist or attend a fitness class,” he said. “A loss of aerobic exercise during the COVID-19 pandemic may well lead to a worsening of motor symptoms in PD.

“Non-motor issues such as insomnia or constipation may also worsen due to a lack of physical activity. Promoting home-based and adequately dosed exercises, such as cycling on a stationary bicycle, is therefore more important than ever before.”

A growth of web-based initiatives, such as online singing, exercise or dancing classes, for Parkinson’s patients is a positive trend — as are sudden new avenues for research this crisis offers.

“The COVID-19 pandemic is an external stressor that is aligned in time for large groups of people, providing a unique opportunity for researchers to test how the pandemic influences the course of PD in existing longitudinal cohorts, e.g., by taking advantage of wearable sensors or biological biomarkers,” he and Helmich wrote in their commentary.

“As such, deleterious as the current crisis may be, it will hopefully also bring some long-term positive outcomes for the many people living with PD worldwide.”

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Stopping the Spread of Loneliness

shelter in place, loneliness

Many symptoms are representative of Parkinson’s disease, the more widely known being external tremors and an unusual gait — or “walking funny,” as some might say. There is one other less visible symptom that can be connected to having the disease: loneliness.

Loneliness can be a shortcut to depression. What makes depression more volatile is to mix it with something like COVID-19. That can be a destructive combination, to say the least.

Quarantine, isolation, and social distance strategies have been used to contain COVID-19. For many, isolation is known as loneliness and loneliness for a person with Parkinson’s is an especially tough struggle.

Loneliness causes a feeling of emptiness, of being alone. Lonely people often yearn for human contact. Fulfilling human contact is somewhat hard to come by when met with an elbow bump, a face mask, a slight bow, or another means by which we greet one another or express farewells during this unsettling time.

The person living with Parkinson’s already feels distanced from others. They can feel ostracized and ashamed. They opt to stay inside because of symptoms and side effects like tremors, cognitive struggles, or speech problems. Staying inside can add fuel to the fire of loneliness and create a deeper pit in which they sit, engulfed by and surrounded in darkness. While some people take isolation as an opportunity to slow down, others fear the worst while sitting alone in their homes, dwelling on the negativity. Focusing on the what-ifs can trigger worsening Parkinson’s symptoms.

Instead of succumbing to the what-ifs, fill your mind with positivity. Begin by taking a break from social media, even if only for a day during this crazy time. Eat well, keep up your exercise regiment as much as able, get plenty of sleep, and don’t stop talking with other people, even if it is just a message here and there or a video chat.

What we allow ourselves to become depends on the choices we make. So, get out of the dark and get out into the sunshine for a walk. Turn off the television for an hour and listen to the birds sing. Read an inspiring book and share what you’ve learned with someone over the phone.

Let’s stop the spread of loneliness.

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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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Tips to Stay Fit During Coronavirus Isolation

CBD

If you’re in the same boat as my dad, chances are that your gym is on lockdown. Dad was disappointed to hear that Rock Steady Boxing (RSB) is pausing operations during the global coronavirus pandemic. But he also recognized that it’s the safest move.

This global quarantine is really shaking up our routines, which can feel frustrating. But one of the beautiful consequences of the pandemic is that huge steps are being taken to adapt. In light of current events, fitness instructors are starting to offer free classes for those looking to stay fit at home. It seems as though fitness classes are becoming even more accessible than they were before.

If you’re lucky enough to have an internet connection and a space in your home to work out, there’s no reason to let your fitness go. You can follow along with a number of fitness videos or write down the routine and do it on your own. Some videos are geared specifically toward Parkinson’s patients, while others are general routines that can help you work up a sweat.

Fitness classes for Parkinson’s

Finding fitness classes that target Parkinson’s symptoms can be really helpful. Focusing on strength and mobility can help to keep symptoms at bay. Luckily, a number of organizations recognize this.

Rock Steady Boxing

I recently spoke with Sara Roque, Rock Steady Boxing’s affiliate services director. She noted that affiliate coaches might have access to a series of RSB’s virtual courses. If you usually take RSB classes, it’s possible that your coaches have access to virtual videos that are similar to the classes you’re used to. It might be worth asking them about it.

If you’re unable to gain access to RSB videos, a number of organizations offer virtual boxing courses. Many don’t require equipment. Check out these boxing videos from PopSugar Fitness and Fitness Blender if you want to stay fit until the gyms open again. Many of these workouts are designed to target cardiovascular health, which is an important way to stay strong while in isolation.

The Brian Grant Foundation

The Brian Grant Foundation offers a series of online videos geared specifically toward people with Parkinson’s. If you like what you see, you can donate to show support, but it’s not required. The videos address everything from warmups to aerobic agility and vary in length, making it possible to find a routine that targets Parkinson’s specific challenges without leaving your home.

Power for Parkinson’s

Power for Parkinson’s is another organization that makes exercising from home relatively easy. This organization offers videos that range in length from 30 to 60 minutes. Videos target strength, balance, and vocal strengthening, among other things. Most don’t require equipment.

General fitness classes

If you’re looking for fitness classes that don’t necessarily target Parkinson’s, tons of personal trainers and yoga teachers are adapting to fill the virtual fitness space. YouTube is a wonderful resource for free fitness courses for just about anyone. Chances are you’ll find a fitness class that targets the type of workout you’re looking for.

A couple of them that I know include:

Amy Wansing Yoga

Amy Wansing Yoga will be creating virtual yoga classes on YouTube for use during this pandemic. The Colorado-based yoga instructor specializes in strength and has a background in yoga for climbers. But she also provides meditation sessions and positive mantras.

Kari Sullivan Fitness

Kari Sullivan is a Colorado-based personal trainer. She will be providing at-home workouts during the pandemic. Follow her on Instagram (@karisullivanfitness) to find new workouts during the week. She has a background in CrossFit and specializes in strength training. But her workouts offer a variety of exercises and options for people of any age and ability.

Creating new routines takes a lot of time and effort. But it’s possible. Saying committed to our health and well-being will allow us to overcome barriers associated with frustration and change. And technology is creating new ways to connect with people who can hold us accountable to those routines.

Staying active while in quarantine is entirely possible. Maybe we can even get our loved ones to join us!

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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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Dyskinesia Trial Testing Dipraglurant Postponed Due to COVID-19

dipraglurant trial postponed COVID-19

Phase 2/3 trial (Study 301) testing Addex Therapeutic’s candidate dipraglurant for people with levodopa-induced dyskinesia associated with Parkinson’s disease (PD-LID) has been postponed — until further notice — due to the continued spread of COVID-19 in Europe and the U.S., where the trial was set to occur.

The intended patient population for this trial is among those with the highest risk for severe illness and death associated with the new coronavirus. As such, Addex is following the guidance of public health authorities that recommend people at high risk stay at home and avoid unnecessary exposure to COVID-19.

“As the situation with COVID-19 has evolved, we have stayed in close communication with study sites, vendors and colleagues and learned of new institutional precautions being put in place for clinical research,” Roger Mills, MD, chief medical officer of Addex Therapeutics, said in a press release.

“Sites are temporarily suspending on-site visits for monitors, vendors, and all other non-patient visitors and several sites have cancelled all non-essential patient visits,” Mills said.

“Priority is now rightly being placed on how to manage regular care for patients in the light of the increasing COVID-19 containment requirements,” he said. “We care about the well-being of all PD patients and do not wish to have them make the additional visits to doctors’ offices that are required in a clinical study, putting them at increased risk of contracting COVID-19.”

One of the gold standards in Parkinson’s treatment has long been therapy with levodopa, or L-DOPA — a precursor to the neurotransmitter dopamine, the increasing loss of which is a hallmark of the disease. However, levodopa therapy can lead to uncontrollable movements, a condition called levodopa-induced dyskinesia, or LID.

Dipraglurant is a new oral small molecule that inhibits the metabotropic glutamate receptor 5 (mGluR5), which has been shown to play a role in LID. The candidate therapy has a pharmacokinetic profile — meaning, its absorption, distribution, metabolism, and excretion in the body — that mimics the profile of levodopa, making it a potential treatment for LID.

The previous Phase 2 ADX48621-201 trial (NCT01336088) assessed the safety and tolerability of dipraglurant in 76 people with Parkinson’s and moderate-to-severe LID. The participants were randomly assigned to receive dipraglurant (from 50 mg once daily to 100 mg three times daily, 52 patients) or a placebo (24 patients).

The results showed that dipraglurant was in general safe. Moreover, it reduced PD-LID clinical symptoms, as measured by the modified Abnormal Involuntary Movement Scale, on day 1 (50 mg) and on day 14 (100 mg), and across a three-hour post-dose period on day 14. Treatment with dipraglurant did not worsen Parkinson’s symptoms.

Addex is continuing to work with the study sites to continue preparations so as to start the study as soon as it is “appropriate to do so.”

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Managing Stress by Expecting the Unexpected

unexpected

Travel beyond our homes is eerie right now with the onslaught of the coronavirus pandemic. We feel as if we’re living a dystopian sci-fi film, with people in masks and gloves waving apocalyptic messages from the World Health Organization and U.S. federal and state governments.

My immune system isn’t like it was when I was younger. I wear gloves for every outing. I wash my hands and apply antibacterial solutions. But you just can’t prepare for every possibility when traveling halfway across the continent. Expect the unexpected and the stress is more manageable.

Sitting for more than two hours is difficult for me. My muscles become rigid and painful. I resemble the Tin Man in “The Wizard of Oz.” Changing positions and making slight movements can ease the discomfort.

The first leg of our flight was great. I had lots of room due to a shortage of passengers. After switching planes for the second leg of the trip, I was in the middle seat. Despite the availability of other seating accommodations, a very large person decided to sit next to me in the aisle seat.

I ended up draping myself over my partner. I focused on a lot of calming breath work. It’s not like I can spend weeks in an airplane cabin simulator learning how to be at peace with a body that makes a lot of noise. Expect the unexpected.

I’m approved for medical marijuana use by my providers at home. I find it useful for pain management as it helps to reduce rigidity and addresses pain receptors. When deciding to relocate, we chose the Illinois side of the St. Louis metropolitan area because marijuana is legal there for both medical and recreational purposes.

Recreational access was important because it will take time to get approved for medical marijuana after I establish residency. Federal law says I can’t transport this medication across state borders — even for medical purposes. So, we had to find a dispensary in Illinois during our house-hunting trip.

Because we had made our plans and reservations two months in advance, we anticipated the weather would be warmer there as it usually is this time of year. We thought the dispensary “experience” would allow access quickly and efficiently, much as we have back home.

Instead, it was a four-hour wait in 40-degree weather with a brisk wind and only two fleece jackets for outerwear. That was my partner handling the unexpected — waiting in line, surrounded by a hundred other folks.

Back in the car, I was battling pain surges — sternocleidomastoid attacks — every five to 10 minutes over those four hours. Then, in the middle of that, I really, really had to find a restroom. I didn’t know where I was, had never been there before, and felt like roadkill.

Looking out the car window across the parking lot, I saw a big sign: “Gateway Convention Center.” Should be a restroom there, I surmised. I found one women’s restroom, then two more women’s restrooms down the hall. I said to myself, “What? Where’s the men’s restroom?”

I’m all for what architects identify as “potty parity” in their design elements. Potty parity is calculating the number of available restrooms by anticipating how many women and men will access public facilities. I know the number of women in most public accommodations greatly outnumber the men. But there is a time when a man needs to do what a man needs to do!

Parkinson’s patients should not postpone their use of the restroom because of the additional discomfort that can happen when one tries to “hold it back for too long.” I was quickly approaching that critical impasse as I found three women’s restrooms and no men’s restrooms. Doubled over and dashing at the same time (quite a sight), I saw a male custodian and thought, “Please, let him know where the men’s room is.” He did.

There is no way to prepare for this sequence of events. The unexpected will happen. The best we can do is embrace the unexpected, as well as the challenges and the opportunities that come with adapting to new situations.

Studies have shown that people who experience anticipated stressors have fewer physiological reactions to those stressors than people who experience unanticipated stressors. For example, receiving electric shocks but not knowing when the shocks will be delivered will increase the stress reactions. The unexpected can ignite our fight-or-flight chemical maelstrom, pushing us close to the threshold.

The unexpected carries with it the unknown, a “cloud of unknowing,” a dissonance that drives demons into our desperation. Embracing the unexpected without a fear-based focus can decrease the effects of stress and shift the balance toward well-being and a positive outcome.

A positive outcome from our cross-country efforts: We found a home we really like. It was stressful but made easier by practicing brain therapy, including embracing the unexpected.

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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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Fighting Giants: Staying Calm During the Coronavirus Panic

fighting fear

I have Parkinson’s disease and I live on a great big orb whose inhabitants have recently taken to biting their nails. They are also purchasing toilet paper, paper towels, water, and soap as if they are going out of style. Eggs are disappearing out of supermarket cold cases. Those suffering from the common cold or allergies will be hard-pressed to find remedies as these have almost completely disappeared as well. 

One thing is driving people to purchase beyond their needs and that is fear, otherwise known as the COVID-19. Though most people hadn’t heard of the coronavirus before this year, it had become an international health concern by January 30. Today, both supermarket shelves and schools are empty. The streets are quiet. People are isolating themselves.

How do we stay calm when facing such a big, invisible giant? How did we stay calm when we first faced Parkinson’s, the other big, invisible, not-so-friendly giant in our lives? Most likely we didn’t. 

Some might have cried. Some might have been seized by fear of the unknown. That’s the problem with diseases that come in various shapes and sizes. You can’t predict their journey. You may have an idea of how it will go but you can’t be certain. Because of the disease’s uncertainties and unknowns, fear can take over and wrap its sharp claws around you, trying to strangle what hope and peace you still cling to. 

When you were told you had Parkinson’s disease, it might have come as a shock. Perhaps it didn’t. Maybe it was a relief to finally know what was waging war within you. Now you can fight against something that isn’t quite so invisible anymore.

You stand in one corner while your opponent stands in the other, baring his sharp teeth and stomping his heavy heels on the mat. It is here you take a stand and decide not to allow this disease to get the best of you. You take the first punch, the second, and the third. You pummel that giant. Exhausted and on your knees, you look at the floor as the tears run down your face and then you feel it. A hard punch to your back followed by a gut punch. Will you ever recover from this — the fight of your life?

You lift your face and then you rise. Now you face your fear. With the last of your strength and unspent anger, you give fear a punch that knocks him off his feet. You know he will never be completely gone, but for now, he is subdued. 

Here comes the next giant: COVID-19. You’ve already faced one giant. You’re not afraid to face another. You adopt a similar strategy to deal with the virus as you do with Parkinson’s disease. You face it head-on and do what you can to stay healthy. You keep exercising. You keep eating well to stay in good health. You keep moving. You isolate. You don’t hide. Hiding is a lonely way to live.

You may get the virus. And yet, it may pass you right on by.

If you find yourself fighting the virus, fight with all you’ve got and don’t give up. You may be isolated but you are never alone.

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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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