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Finding the River of Life in Parkinson’s Disease

river

Sherri Journeying Through

I felt different.

With Parkinson’s disease, that can mean many different things. I may be behind on my anti-depressant and can’t decide whether to laugh or cry. Or I’m behind on my Sinemet (carbidopa-levodopa) and feel shakier than usual. There’s no sense in listing all the ways and reasons I might feel different as a person with PD, other than to say I just feel different.

Sometimes I wake up one day and nothing has changed except my mood. I feel dry, or worse, dried up. I am thirsty for something more. Something greater. I am uninspired, emotionless; emotionally and spiritually dehydrated and thirsty for something to fill up the empty spaces and refresh the parched. This can be borderline depression. It is not a place I wish to go. It is not a place I wish to be.

A while ago, I spent two weeks up in Montana visiting my parents. They live right on the banks of the Kootenai River in a little town tucked in the upper northwest corner of the state. While it can be unsafe to get in the local river there, one can sit at the water’s edge and enjoy it any time and for as long as preferred. The peaceful lapping of water against the colorful boulders at the river’s edge is rejuvenating.

I spent several moments of my day at the water’s edge, sitting on a rock and watching the sunset, thinking about different things, or waiting for my dad’s boat to come around the corner. As I sat there, I wondered why I had felt so dry lately. I had been craving to be filled up, drenched with the spirit of God. Then I realized: Sometimes the dry times are when I find more of God. The times when I feel withered and run out of juice. The times when there is absolutely nothing I can do to get filled up, except to rest in Him and trust Him to bring me through that very empty and very lonely place and into a place of spiritual abundance.

It is often suggested that when writers are in the throes of writer’s block, the best thing to do is just to keep writing, regardless of emotional capacity. Get something on paper. Eventually, writers get back in the saddle to write once again. 

Walking through spiritual deserts is similar. I must keep putting one foot in front of the other, knowing that it won’t be an oasis I’ll find in one of my tomorrows, but eventually, I will find the river of life. How much more refreshing is a river or body of water after having just come from the desert? How much more it is appreciated! It is a river where a person can be drenched with cool, dripping water that saturates the dry places and leaves one refreshed.

If in a “dry” place today, for whatever reason, keep walking the path of this journey He has set. A refreshing river may be just around the corner where God is waiting to refresh spirits.

***

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.

The post Finding the River of Life in Parkinson’s Disease appeared first on Parkinson’s News Today.

Taking a Careful Look at Apathy: It Could Be Motor Hesitation

apathy

Depression is often associated with Parkinson’s disease (PD), as is apathy. But there may be a subtle difference between the two. At the risk of oversimplifying, let’s define depression as a state of sadness and loss of interest, and apathy as an apparent lack of motivation. Put sadness and low motivation together and the result looks like someone who has stopped enjoying life. But linking the two together may be a mistake when PD is involved because what looks like a lack of motivation may be the result of motor hesitation and difficulty with set shifting (changing from one motor activity to another). I have seen this motor hesitation in my own life. I feel stuck; not because of a lack of desire but rather an inability to move. It requires a careful examination to recognize the difference.

In a previous column, I talked about scenario looping breakdowns in connection to freezing — a common PD motor symptom. Apathy with PD folks may be linked more to scenario looping breakdowns than to a mood disorder. With PD it speaks to the “unwillingness” to act. But with a breakdown in scenario looping, it may appear as the unwillingness to act when it is actually a form of freezing due to an organic neurological condition. Combine this with the “flat affect face” or facial masking that can come with PD and it can appear to the observer as apathy. A careful look may reveal that often it is not. It is a manifestation of scenario looping breakdowns.

Scenario looping is the brain’s ability to loop through scenarios, exchanging possible actions or responses, until the best course has been determined. This happens with use of language and with motor actions. In every case, the scenario has a starting point. If there is no external cue from the environment to get started, we call that spontaneous initiation; an example is engaging in speech with your partner. You wouldn’t always want to wait until your partner speaks first or provides an external cue. In a normal relationship, each person will often initiate speech spontaneously without external cueing. Patients who have damage to areas of the brain responsible for scenario looping will frequently have problems with spontaneous speech. Does this mean that they are apathetic?

Spontaneously starting a new motor sequence may be difficult for some PD patients. Another example: My partner wants me to put up a new curtain rod. This involves a series of motor tasks: getting the tools and step stool, removing the old curtain rod, and using small screws. These actions involve the use of fine motor skills which are always difficult for those with PD. The curtain rod has been leaning against the wall for a week. Is it apathy that prevents me from engaging in the task? Is it fear? It doesn’t feel that way. It feels like a physical resistance to move my body in the direction of that given sequence of motor actions. PD patients often have motor action hesitancy, and this may be misinterpreted as apathy. In a chapter of “Parkinson’s Disease: Diagnosis and Clinical Management,” Lisa M. Shulman and Mackenzie Carpenter say that great care needs to be taken when ascribing the symptom of apathy to a PD patient, and that more research is necessary.

I need to be taking that careful look, to be clear in my mind that this is motor hesitancy. Doing so will ensure that scenario looping breakdown does not become apathy in my mind, or in the minds of those who care for me. There is a risk of mentally interpreting the motor resistance as “he doesn’t care.” The distinction is very important, and I spend time in mental contemplation making the distinction clear. Muscle hesitancy and difficulty with initiating motor sequences is not apathy. Understanding the difference between apathy and scenario looping breakdown is an opportunity to reframe and enlighten. Taking the time to contemplate on the difference is time well spent.

Write a comment and tell me if you see a difference between apathy and muscle initiation in your own life. Do you have suggestions on how to use this distinction to improve your quality of life?

***

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.

The post Taking a Careful Look at Apathy: It Could Be Motor Hesitation appeared first on Parkinson’s News Today.

Taking a Careful Look at Apathy: It Could Be Motor Hesitation

apathy

Depression is often associated with Parkinson’s disease (PD), as is apathy. But there may be a subtle difference between the two. At the risk of oversimplifying, let’s define depression as a state of sadness and loss of interest, and apathy as an apparent lack of motivation. Put sadness and low motivation together and the result looks like someone who has stopped enjoying life. But linking the two together may be a mistake when PD is involved because what looks like a lack of motivation may be the result of motor hesitation and difficulty with set shifting (changing from one motor activity to another). I have seen this motor hesitation in my own life. I feel stuck; not because of a lack of desire but rather an inability to move. It requires a careful examination to recognize the difference.

In a previous column, I talked about scenario looping breakdowns in connection to freezing — a common PD motor symptom. Apathy with PD folks may be linked more to scenario looping breakdowns than to a mood disorder. With PD it speaks to the “unwillingness” to act. But with a breakdown in scenario looping, it may appear as the unwillingness to act when it is actually a form of freezing due to an organic neurological condition. Combine this with the “flat affect face” or facial masking that can come with PD and it can appear to the observer as apathy. A careful look may reveal that often it is not. It is a manifestation of scenario looping breakdowns.

Scenario looping is the brain’s ability to loop through scenarios, exchanging possible actions or responses, until the best course has been determined. This happens with use of language and with motor actions. In every case, the scenario has a starting point. If there is no external cue from the environment to get started, we call that spontaneous initiation; an example is engaging in speech with your partner. You wouldn’t always want to wait until your partner speaks first or provides an external cue. In a normal relationship, each person will often initiate speech spontaneously without external cueing. Patients who have damage to areas of the brain responsible for scenario looping will frequently have problems with spontaneous speech. Does this mean that they are apathetic?

Spontaneously starting a new motor sequence may be difficult for some PD patients. Another example: My partner wants me to put up a new curtain rod. This involves a series of motor tasks: getting the tools and step stool, removing the old curtain rod, and using small screws. These actions involve the use of fine motor skills which are always difficult for those with PD. The curtain rod has been leaning against the wall for a week. Is it apathy that prevents me from engaging in the task? Is it fear? It doesn’t feel that way. It feels like a physical resistance to move my body in the direction of that given sequence of motor actions. PD patients often have motor action hesitancy, and this may be misinterpreted as apathy. In a chapter of “Parkinson’s Disease: Diagnosis and Clinical Management,” Lisa M. Shulman and Mackenzie Carpenter say that great care needs to be taken when ascribing the symptom of apathy to a PD patient, and that more research is necessary.

I need to be taking that careful look, to be clear in my mind that this is motor hesitancy. Doing so will ensure that scenario looping breakdown does not become apathy in my mind, or in the minds of those who care for me. There is a risk of mentally interpreting the motor resistance as “he doesn’t care.” The distinction is very important, and I spend time in mental contemplation making the distinction clear. Muscle hesitancy and difficulty with initiating motor sequences is not apathy. Understanding the difference between apathy and scenario looping breakdown is an opportunity to reframe and enlighten. Taking the time to contemplate on the difference is time well spent.

Write a comment and tell me if you see a difference between apathy and muscle initiation in your own life. Do you have suggestions on how to use this distinction to improve your quality of life?

***

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.

The post Taking a Careful Look at Apathy: It Could Be Motor Hesitation appeared first on Parkinson’s News Today.

Staying Active Versus Exercise

exercise in Parkinson's

Sherri Journeying Through

Whether you ask a group of people with Parkinson’s disease (PD) or your neurologist about the best thing you can do to keep PD at bay or slow down its symptoms, the most common response will likely be “exercise.” Some may say, “Stay active.” But do you realize that staying active and exercising are two different things?

Just about anyone can exercise — jumping jacks, touch your toes, jog around your living room, lift a couple of cans of green beans — but it takes sheer determination to stay active when you are battling a little monster like Parkinson’s disease.

Being active involves more than movement on your part. It includes a state of mind to persevere, to keep putting one foot in front of the other, and to not give up even when you feel like quitting. Being active involves a positive outlook.

It is easy to fall into a state of apathy or depression when fighting a chronic illness, but to try to pull yourself out of one can be downright hard. The gray cloud of despair can last days, weeks, months, even years. Staying active can help sidestep those dark times.

Sitting and watching television can sound relaxing, but when flopping on the couch is your go-to place when you’re feeling down, it may take an act of God to get you back up. Depression feeds depression. Apathy feeds depression. At times you will have to force yourself up off that couch and do something. But force you must. You must stay active. You must not allow yourself to succumb to dark days. Fight and fight hard. Get your friends to join you by coming alongside them. Show them you need them because they do want to be needed at this time in your life.

Exercise is essential for a Parkinson’s patient. Walking, boxing, bicycling, tai chi — these are all terrific forms of exercise as you strive to live healthily with PD. However, to determinedly exercise with PD, you have to “master” staying active. Keep your mind on an even and positive keel. You must tell yourself that you can do this thing; you can battle this little monster. You must say to yourself that as this disease strives to master you, you will fight tooth and nail to push forward and stay active.

Following are some techniques I use in my battle to master PD:

  • Keep your mind active. Do word puzzles, jigsaw puzzles, sudoku games, and more to keep your mind alert.
  • Don’t give in to fear. 
  • Make positive thinking a habit. Carry scripture verses or positive thinking quotes in your pants pocket and read them throughout the day.
  • Don’t give up and don’t give in: mentally, physically, relationally, emotionally, or spiritually.
  • Avoid temptations like empty couches and TV remote controls.
  • Fight the dark days. Don’t let them get the upper hand.
  • Don’t go it alone. Get connected via a support group.

I am in no way an expert in “staying active” but I do make a valiant effort to do so. I have found the above practices to be helpful in dealing with Parkinson’s and hope they are useful to you too.

***

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.

The post Staying Active Versus Exercise appeared first on Parkinson’s News Today.

Benefits of Exercise for Parkinson’s Patients Linked to Increased Dopamine Release, Study Suggests

exercise and Parkinson's

Engaging in regular exercise can help preserve the motor and non-motor function of Parkinson’s disease patients, most likely as a result of an increased release of dopamine in the brain, a small study suggests.

The study, “Habitual Exercisers Versus Sedentary Subjects With Parkinson’s Disease: Multimodal PET and fMRI Study,” was published in the journal Movement Disorders.

Exercise has been shown to ease both motor and non-motor symptoms of Parkinson’s disease, including bradykinesia (slowness of movement) and balance, as well as cognition and mood.

While the mechanisms underlying these benefits are largely unknown, researchers hypothesize that exercise may enhance dopamine release. The progressive degeneration and death of nerve cells in the brain that produce dopamine, called dopaminergic neurons, is one of the underlying causes of Parkinson’s disease.

In this study, researchers investigated how dopamine release and other clinical features of Parkinson’s disease differ between patients who exercise and those who remain sedentary.

A total of 17 patients with mild to moderate Parkinson’s disease were recruited, eight of whom engaged in regular exercise at least three times a week for more than three hours total, while nine were sedentary.

All patients underwent two positron emission tomography (PET) scans, one before and one after exercising on a stationary cycle, to determine whether exercise affects the release of natural dopamine in the dorsal striatum — a region of the brain involved in the control of movement. PET scans were performed after overnight withdrawal from dopaminergic medication.

Additionally, participants underwent functional magnetic resonance imaging (MRI) of the brain during a monetary reward task that required randomly selecting one of four cards.

“Subjects were explicitly informed about the probability of obtaining a monetary reward ($0.50) for selecting a winning card during each block. Subjects were also instructed that the task was purely chance (analogous to a slot machine), and there was no pattern to learn that could improve odds,” the researchers wrote.

However, for each selected card, subjects were provided visual (happy or sad face) and auditory (cheers or sighs) feedback, which could alter the card selection process, even though the success of each trial was by chance.

This test allowed researchers to evaluate possible behavioral differences in card selection between groups. Specifically, researchers measured the response of the brain’s ventral striatum, a region involved in the evaluation of rewards.

Participants also completed other tests to evaluate motor and non-motor function, including the Beck Depression Inventory to assess depression and the Starkstein Apathy Scale to measure apathy.

Results showed that habitual exercisers had an increased release of dopamine compared with sedentary patients. They also had greater activation of ventral striatum during the MRI reward task. Their apathy and bradykinesia scores were also lower than sedentary patients.

These results suggest that exercise is associated with improved motor and non-motor functions in Parkinson’s patients, which is likely linked to exercise-enhanced dopamine release.

“Although it appears that exercise plays a role in the clinical outcome of subjects with PD, future randomized control trials are needed to determine the cause-effect relationship between exercise and enhanced DA [dopamine] release, response to anticipation of reward, and clinical outcomes,” the researchers wrote.

“Future studies should also investigate other potential mechanisms of benefit from exercise,” they added.

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Exercise Can Raise BDNF Levels, Alleviate Depression in Parkinson’s Patients, Review Shows

BDNF levels

Levels of brain-derived neurotrophic factor (BDNF) — a protein important in promoting the survival of dopaminergic neurons — are abnormally low in patients with Parkinson’s disease, regardless of whether these patients also have depression, a common non-motor symptom associated with the disease, a systematic review study reveals.

The study also revealed that exercise can increase BDNF levels in Parkinson’s patients, highlighting exercise’s potential not only to treat depression, but also motor symptoms typically associated with Parkinson’s disease.

The systematic review, “Plasma levels of brain-derived neurotrophic factor in patients with Parkinson disease: A systematic review and meta-analysis,” was published in Brain Research.

BDNF is an abundant protein whose main function is to protect dopaminergic neurons located in the substantia nigra — a region of the brain responsible for movement control — that are gradually lost in the course of Parkinson’s disease.

Although no literature consensus exists, some studies have shown that blood serum BDNF levels decrease in patients with depression and increase after intense exercise in healthy adults.

In this systematic review, the authors focused on gathering and discussing data from previous studies assessing blood serum levels of BDNF in Parkinson’s patients.

After a thorough screening in three different databases (MEDLINE, EMBASE and SCOPUS), 12 eligible studies were selected, including five comparing serum BDNF levels of Parkinson’s patients to those of healthy control subjects and three comparing serum BDNF levels of depressed and non-depressed Parkinson’s patients.

Data revealed that Parkinson’s patients tend to have lower levels of BDNF in their serum, compared to healthy control individuals (mean difference of 2.99 ng/mL). Parkinson’s patients who also had depression had even lower levels of BDNF compared to healthy control subjects (mean difference of 4.83 ng/mL).

No differences in BDNF levels were found between depressed and non-depressed Parkinson’s patients.

There was also a positive correlation between serum BDNF levels and patients’ male gender, disease duration and Hoehn and Yahr motor score — a commonly used system to describe the progression of Parkinson’s symptoms.

There is “a direct relationship between [Parkinson’s disease] progression and worsening of motor symptoms and higher serum BDNF. We believe that this could be a result of a compensatory mechanism in response to progressive loss of dopaminergic neurons of the substantia nigra and progressive [reduction] of neurotrophin expression in the remaining neurons. This could also reflect a possible effect of medications, namely antidepressants and dopamine replacement therapy,” researchers said.

Four studies also analyzed the effects of exercise on serum BDNF levels, while two others focused on the relationship between Parkinson’s disease severity and patients’ physical capacity and serum BDNF levels.

While there was no relationship between patients’ physical capacity and serum BDNF levels, a significant increase in BDNF levels was seen in patients with mild to moderate Parkinson’s after four or eight weeks of physical training, which was accompanied by an improvement of UPDRS motor scores and patients’ performance on the 6-minute walking test, used to assess aerobic capacity and endurance.

Another study reported similar findings in depressed Parkinson’s patients who participated in a 12-week exercise program.

“Our results proved that PD is of equal potential to [decrease] BDNF expression as depression, which is a common co-morbid condition in PD. The potential for exercise to induce BDNF expression in PD patients justifies that physical training might prove useful to treat depressive symptoms as well as motor complications of PD patients,” researchers concluded.

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Depression May Aggravate Motor, Cognitive Symptoms in Newly Diagnosed Parkinson’s Patients, Study Reports

Depression in newly diagnosed Parkinson’s patients is associated with initial motor deficits and worse cognitive function, unrelated to dopamine loss, a study suggests.
These patients also require higher doses of medications at follow-up.
The study, “The presence of depression in de novo Parkinson’s disease reflects poor motor compensation,” was published in the journal PLOS ONE.
Early burden of non-motor symptoms, such as depression, is considered a relevant prognostic marker indicative of poor motor outcomes in Parkinson’s disease. Because motor symptoms only appear after marked degeneration of dopamine-producing neurons, scientists believe that significant motor system compensation occurs in these patients, providing a way to overcome dopamine loss.
Patients with de novo Parkinson’s — newly diagnosed and still untreated — with either olfactory dysfunction (loss of sense of smell) or rapid eye movement sleep behavior disorder have greater motor deficits than those without these symptoms, but they both have the same levels of dopamine, suggesting that the early presence of non-motor symptoms correlates with less compensatory ability.
The early occurrence of depression in de novo Parkinson’s indicates widespread involvement of pathological lesions, which may limit motor compensatory ability and lead to greater physical impairment. However, the link between depression and dopamine depletion in early Parkinson’s is still unclear.
Aiming to address this gap and to explore whether early occurrence of depression is associated with reduced motor compensation, researchers from Yonsei University College of Medicine in South Korea analyzed 474 patients, at a mean age of 64.6 years, including 242 men, with de novo Parkinson’s without dementia. The mean duration of their symptoms was 18.3 months.
The patients underwent positron emission tomography (PET) scans for the dopamine transporter (DAT) — responsible for the uptake of dopamine into neurons from the synapse, where neurons communicate — in the striatum, a key brain region involved in movement and cognition.
Depression was assessed using the Beck Depression Inventory, a 21-question multiple-choice self-report inventory composed of items related to symptoms of depression. Motor symptom severity was evaluated with Part III of the Unified Parkinson’s Disease Rating Scale, and the Mini-Mental State Examination was used to measure cognitive function.
Depression scores were divided into three levels: 157 patients, 55.4% of whom were women, were in the highest (worse) level (a score of 15 or greater, assumed to include only depressed patients); 159 patients, of whom 49.7% were women, were in the middle level (a score of 8-14); and 158, of whom 41.8% were women, were in the lowest level (7 or less, non-depressed patients only).
Patients in the highest level had more severe motor impairment and worse cognitive function than those in the lowest levels, even after taking DAT scan results into account.
Of note, no differences were found in DAT scores across the three groups, suggesting that “depression in de novo [Parkinson’s] does not require striatal dopamine depletion,” the researchers wrote.
Over a median follow-up of 47 months — ranging between four and 107 months — two movement disorder specialists adjusted the doses of Parkinson’s medications at three-to-six-month intervals.
Depressed patients required higher levodopa-equivalent doses — the amount of levodopa that has a similar effect as the medication taken — than non-depressed individuals after taking age, gender, and initial

Source: Parkinson's News Today

Chronic Pain Common in Parkinson’s Patients and Weighs Heavily on Quality of Life, Study Reports

Chronic pain is prevalent in Parkinson’s disease patients and its severity considerably impacts their daily life, work, and social relationships, a  study aiming to guide physicians in better managing this symptom reports. It also links chronic pain to such psychological ills as depression, low self-esteem, frustration and sleep deprivation.
The study, “Negative impact of severity of pain on mood, social life and general activity in Parkinson’s disease,” was published in the journal Neurological Research.
Parkinson’s non-motor symptoms are often reported prior to a definitive diagnosis, and become more frequent and severe with disease progression.
Several studies have shown that many Parkinson’s patients have abnormal pain processing that could be affected by levodopa treatment. Pain is also believed to be associated with the reappearance of motor symptoms when the effects of levodopa wear off. However, the characteristics of pain associated with Parkinson’s disease, its causes and underlying mechanisms, and its psychological impact have not been thoroughly analyzed.
Previous research revealed that neurons involved in pain processing, mood, and motor functions may be connected, suggesting a higher prevalence of fibromyalgia — a chronic rheumatic condition that causes widespread pain — and chronic pain in Parkinson’s patients.
Researchers in Canada and Pakistan conducted a case control study to assess patients’ perception of pain, as well as its impact on their quality of life, measures in terms that included daily activities, mood, and social relationships.
The study included 100 Parkinson’s patients (mean age, 70.4) and 100 healthy age- and gender-matched controls (mean age, 69.4) visiting a community-based movement disorders clinic between June 2011 to June 2012. Patients with dementia and/or atypical Parkinson’s were excluded.
Chronic pain between the two groups was assessed using the Brief Pain Inventory (BPI), which measures pain severity (pain right now, pain at its worst and least since the last week), pain interference (disrupting  general activities, mood, walking ability, normal work environment, relationships with others, sleep and enjoyment of life) and pain frequency. A qualitative description of pain was also conducted.
Patients described pain as “exhausting,” “tiring,” “penetrating,” “miserable” and “unbearable” significantly more often than controls.
Among patients, those with depressive symptoms — as evidenced by a score of eight or higher in the Hospital Anxiety and Depression Scale (HADS) — reported pain as tender more frequently than those without depression. Controls with depressive symptoms were more likely to report pain as stabbing, tender and tiring compared to those without evidence of depression.
“These descriptions indicate a significant impact of pain on the psychological well-being of the patient,” the researchers wrote.
Subsequent analysis showed that patients overall scored higher than controls in “worst pain felt since last week” and in global pain severity. Among all participants with depressive symptoms, those with Parkinson’s had higher scores of worst pain felt and average pain felt since last week, as well as higher reported pain levels at the time of assessment and global pain severity than those in the control group.
Pain among Parkinson’s patients also interfered most with life quality, showing a greater impact that among controls on general activity, mood, walking ability, work, sleep, social relationships, and enjoyment. In agreement, these

Source: Parkinson's News Today

Flee or Fight: Which Do You Choose?

heart on your sleeve, fighting

Sherri Journeying Through

As a young parent, it is often hard to realize how fast time slips away. You’re too busy changing diapers, refilling milk bottles, wiping dirty faces, and running bath water. You’re doing tubs of laundry daily and wiping up spills hourly. You’re consumed with the next activity, whether it be a school baseball game or homework assistance.

Through all of the busyness, you lose sight of the reality this could be one of the “lasts.” The last rocking chair moment. The last bottle feeding while you hold your not-so-little-one-anymore. The last Boy Scout camp out.

As my grandkids grow, there have been times I’ve wondered if it was the last day for opportunities to rock them because they won’t fit on my lap any longer. Will today be the last day for my granddaughter to be excited to see me as she runs into my arms when I pick her up from her preschool? Will today be the last day my grandson will be enamored with a hummingbird and wave “bye-bye” as it flies away? Will this be the last day my youngest grandson tries to roll over because tomorrow he won’t need to try anymore, having another life moment for which he can claim victory?

Sometimes “growing up” in life can bring us down. The important thing for me to remember is it’s dangerous to stay down. When dealing with a chronic disease on a daily basis (constant pain, loss of mobility, confusion, whatever comes with whatever you have), we can easily find ourselves dying in our spirit. We lose the desire to be a part of the fleeting days. We want to “fleet” right along with them. Life is sometimes unbearable.

The fleeting days, the hard days, are partly why I watch my grandkids. Life is so very precious, and tomorrow isn’t promised. We aren’t promised endless opportunities to spend time with those who mean the most to us. We might choke on an olive at supper, and that will be it. We may get another tomorrow, but we don’t know we’ll have energy or strength or a clear mind.

Knowing PD’s path and the road it could choose for me, I may avoid the olive choking incident but still be left with the inability to do much of anything in the years to come with my husband, my kids, and my grandkids.

And so, I must make a choice. In lieu of the pain, loss of movement, lack of energy, strength, and everything else that can come into play with a chronic disease: Do I say forget it and give in to that dying spirit? Or do I endure through the pain, the frustration of losing control of my body and mind, and keep fighting this thing?

I choose to fight.

There may be some reading this today who are not so sure. Some who have been fighting much longer, much harder, than I have. That is what prompted this post. Someone may feel like giving up, like giving in. 

Please don’t. 

If you don’t have the strength to fight emotionally, write me, leave a comment, or message me on Facebook. Something. You are not in this alone. I will fight with you. I will fight for you. I’ve been there in the dark places, and fighting is so much better because even in pain, in the unknown, life is precious. And if we fight together, we may just beat this thing.

***

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.

The post Flee or Fight: Which Do You Choose? appeared first on Parkinson’s News Today.

Source: Parkinson's News Today

Apathy Most Evident in Patients’ Behavioral and Social Habits and Linked to Depression, Study Says

apathy and Parkinson's

Apathy is prevalent problem in Parkinson’s disease, but it is more evident in patients’ behavioral and social habits than in their emotional or cognitive ones, researchers in the U.K. report.

Their study, Differential impact of behavioral, social, and emotional apathy on Parkinson’s disease,” also linked behavioral and social apathy to a likelihood of depression in these people. The research was published in the journal Annals of Clinical and Translational Neurology.

Apathy is a well-recognized Parkinson’s non-motor symptom, although research rarely looks into the specific domains – behavioral, cognitive, executive, social, and emotional – it affects, or how exactly this symptom relates to depression and anhedonia (the inability to feel pleasure) seen in Parkinson’s patients.

University of Oxford researchers used the Apathy Motivation Index (AMI), a self-report measure of apathy validated in healthy individuals, to examine the multidimensional profile of apathy in Parkinson’s disease.

AMI categorizes apathy according to behavioral (the tendency to self-initiate goal-directed behavior), social (the level of engagement in social interactions), and emotional (ability to express feelings or affective responses) domains.

The team first evaluated AMI’s reliability and validity in Parkinson’s by comparing it with the Lille Apathy Rating Scale (LARS), a well-validated interview approach to assessing apathy in Parkinson’s and used in the development of AMI. Next, they evaluated if Parkinson’s patients exhibited differences in apathy domains compared to healthy controls, and if these domains associated with depression and anhedonia.

The study included 102 Parkinson’s patients (mean age 67.7; 79 men) and 147 healthy volunteers (mean age 66.1; 104 men). Mean disease duration was 6.6 years and Unified Parkinson’s Disease rating scale score was 27.0 (on a 0-199 scale, with 0 meaning no disability and 199 total disability). Neither patients nor controls had other neurological or psychiatric conditions.

Eighty-seven patients completed LARS, 84 (and 67 controls) completed the 14-item Snaith–Hamilton Pleasure Scale (SHAPS, a 14 item scale that measures anhedonia), and 80 (87 controls) completed the Geriatric Depression Scale–Short Form (GDS-15, a 15-item form to screen for depression in a variety of settings).

Results showed that AMI’s total score correlated positively with LARS’ overall score, demonstrating good construct validity, the researchers said. AMI also showed diagnostic accuracy in identifying 36 Parkinson’s patients with apathy. According to the authors, this means that AMI enables them to explore the various dimensions of apathy, while achieving an apathy prevalence rate consistent with existing studies.

Parkinson’s patients showed a higher total AMI score than healthy controls, indicating greater apathy overall. This result, as well as individual subscale scores, was not dependent on age, sex, cognition, years of education, disease duration, and levodopa doses.

Subsequent analyses revealed that patients had higher levels of behavioral and social apathy relative to controls, but not of emotional apathy. However, six patients showed deficits in emotional sensitivity and no deficits in the other domains.

Patients who were more behaviorally and socially apathetic were more likely to be depressed, a co-existing condition not observed in emotional apathy scales among patients. In healthy controls, higher the level of emotional apathy associated with lower the evidence of depression.

“This result suggests that different clinical approaches toward apathy in patients with PD compared to the general population might be needed,” the scientists wrote.

Patients with higher behavioral and social apathy also showed more evidence of anhedonia. Again, this was not found in emotional apathy. In the controls, only social apathy correlated with a reduced capacity to feel pleasure. No differences were found between patients and controls regarding anhedonia levels.

“Together our findings may help in guiding the development of more effective, selective treatments for apathy in [Parkinson’s] — including nonpharmacological ones aimed at different aspects of motivation — as well as assisting in our understanding of how apathy, anhedonia, and depression are related,” the researchers concluded.

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Source: Parkinson's News Today