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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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New Collaboration Will Focus on Developing Parkinson’s Screening Software

hand writing software

Startup company Jesse Medical and researchers from the Royal Melbourne Institute of Technology (RMIT) have agreed to collaborate on the further development and commercialization of new software to enable early detection and improved monitoring of Parkinson’s disease.

The screening technology analyzes the results of seven specific drawing and writing tasks, including simple writing and drawing a spiral by joining dots, performed on an interactive tablet, allowing the identification of a patient-specific pattern of motor response.

Dexterity information collected through this software provides clinicians with real-time data on fine motor skills that can be used to differentiate between people who do not have Parkinson’s and those who may have the disease but still do not show its most common and visible motor symptoms.

“It’s long been known that Parkinson’s disease affects muscle control and habitual activities, so it affects how patients write and draw. Our technology translates that insight into a reliable assessment tool,” Dinesh Kumar, PhD,  a professor at RMIT and lead investigator of the team that developed the software, said in a news story from the institute.

Using only a pen, paper, and a drawing tablet, the software can evaluate speed and applied pen-pressure while a person performs specific writing and drawing tasks.

Results from a study that evaluated an initial version of the software demonstrated that the new tool had the potential to distinguish not only Parkinson’s patients from controls, but also patients with differing disease severity with an accuracy of 93%. The assessment tool has since been refined and can now also be used to monitor response to treatment.

“As our population ages, the number of people living with Parkinson’s is expected to increase dramatically, so knowing more precisely how the disease is progressing and understanding the effect of different treatments will be crucial in helping them manage their condition,” Kumar said. “Our technology is completely objective and it’s highly sensitive for both improvements and deterioration in dexterity.”

RMIT’s biomedical engineering team has granted Jesse Medical exclusive rights to conduct clinical trials and commercialize this innovative technology with the newly established agreement.

The startup company anticipates the launch of clinical studies to evaluate the potential of this diagnostic and monitoring tool in Australia and China in mid-2020. These trials are expected to support the anticipated approval of the software for commercialization by 2022.

“The agreement with Jesse Medical is an exciting step in bringing this much-needed technology into the hands of clinicians, to benefit the many people around the world affected by this condition,” Kumar said.

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No Link Between Drinking Alcohol and Increased Parkinson’s Risk in Women, Large UK Study Finds

alcohol, parkinson's risk

Drinking alcohol does not increase the risk of developing Parkinson’s disease in women in the United Kingdom, nor are there increased risks linked to the consumption of different types of alcohol, a large study has concluded

The study, “Alcohol intake and Parkinson’s disease risk in the million women study,” was published in the journal Movement Disorders.

Several studies have investigated the link between alcohol intake and the risk of Parkinson’s disease, albeit with contradictory results: While some reports suggest people who drink alcohol have a lower risk of developing Parkinson’s disease, other studies show no effect. 

Some studies have suggested that different types of alcohol (beer, wine, and liquor) can influence Parkinson’s risk differently, with low beer consumption linked to a lower Parkinson’s risk and liquor associated with a higher Parkinson’s risk. 

However, most of these studies have been retrospective — based on information collected about the past — which rely on people accurately remembering details about their lives, and many studies did not properly control for other influential lifestyle factors such as diet, exercise, and smoking (confounding factors), which can affect the conclusions. 

Moreover, many of these associations between alcohol and Parkinson’s were found in men but not women. 

Therefore, a team of researchers based at the University of Oxford in the United Kingdom conducted a prospective study — following individuals over time — of a large group of women in the U.K. to examine the association between Parkinson’s and alcohol intake. 

Participants were recruited from The Million Women Study — a U.K. initiative that collected information on the lifestyle and medical histories of more than 1.3 million women, ages 50 to 64, to investigate how reproductive and lifestyle factors affect women’s long-term health. 

At the beginning of the study, a total of 1,309,267 women without Parkinson’s completed a questionnaire on weekly alcohol consumption. They were asked to identify different alcohol types they consumed that each contained approximately 10 grams of pure alcohol (glass of wine, half-pint of beer/cider, or a shot of liquor) and reported a number of drinks per week ranging from no alcohol to 21 or more drinks. 

After 14 years, 44,524 participants completed an additional 24-hour diet recall questionnaire to measure their alcohol intake. 

Women who went on to develop Parkinson’s were identified through hospital or death records. After an average follow-up time of 17.6 years, a total of 11,009 women developed the disease. 

Data analysis found that, compared with drinkers, non-drinkers with an alcohol intake between zero and one drink per week had an increased risk of developing Parkinson’s. However, because some women in the early stages of Parkinson’s can change their drinking habits, the team excluded data from the first 10 years and found the risk for non-drinkers was lower.  

The higher Parkinson’s risk in non-drinkers may reflect that in the early stages of the disease, parts of the brain associated with alcohol drinking behavior may be damaged, making a person that goes on to develop Parkinson’s less likely to drink. 

For women who consumed more than 14 drinks per week, the risk of developing Parkinson’s was the same as women who drank one to two drinks per week, in both the first 10 years and after more than 10 years of follow-up. 

No increased risks were found between women who drank only one type of alcohol and those who drank more than one type. 

The research team also found no association between alcohol consumption and Parkinson’s in those who never smoked cigarettes, and these results remained whether women had cardiovascular disease, drank coffee and tea, or had a family history of Parkinson’s.

“In this analysis of a large, prospective cohort of women in the UK, we found little evidence for an association between usual alcohol intake and [Parkinson’s] risk,” the authors reported. “Nor was there any evidence of an association between intake of specific types of beverages and [Parkinson’s] risk.

“The results suggest that alcohol intake does not materially influence the risk of [Parkinson’s] in UK women,” they concluded. 

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Brain MRIs Can Be Used to Detect Early Signs of Parkinson’s Cognitive Impairment, Study Suggests

brain MRI

Brain magnetic resonance imaging (MRI) scans could be used to detect early and subtle markers of cognitive impairment in people with Parkinson’s, which may help predict patients’ prognoses and disease progression, a recent study suggests.

Such early detection also allows people with the neurodegenerative disease to start appropriate care strategies earlier, the researchers say.

The results of the study, “Texture features of magnetic resonance images: A marker of slight cognitive deficits in Parkinson’s disease,” were published in the journal Movement Disorders.

Cognitive impairment is a common non-motor symptom of Parkinson’s disease and a cause of significant disability for patients and a burden for caregivers. The extent and progression of cognitive deficits vary, with about 20.3% to 60.5% of individuals experiencing mild cognitive impairments (MCI). In more severe cases, such impairment can result in dementia.
Those at-risk can benefit from early detection of cognitive alterations, which allows them to initiate appropriate care strategies such as cognitive stimulation therapy. Such therapy can result in a marked improvement in cognition and quality of life, according to researchers. However, standard neuropsychological assessments are time-consuming and not easy to do in routine clinical practice. Moreover, such evaluations can be influenced by medication, pain, anxiety, and other factors.
Therefore, additional markers of cognitive deficits are needed for Parkinson’s patients, the researchers say. One potential option is the use of magnetic resonance imaging (MRI), an imaging exam that uses a powerful magnetic field, radio waves, and a computer to produce detailed pictures of the body’s internal structures.
“Texture features” — a well-known method of MRI image processing used for medical purposes — could offer insights on subtle brain changes.  These features could be used to detect the damage to brain cells, long before any symptoms of cognitive impairment develop.
Recognizing the potential of this method, a team of French researchers now tested whether such signals could be used as early markers of Parkinson’s cognitive impairments — “potentially even before the atrophy [loss of brain volume, a usual sign of cognitive decline] becomes manifest,” they said.

The team investigated if MRI texture analysis is sensitive enough to be an early marker of cognitive alterations, specifically of cognitive slowing, in Parkinson’s patients.

They analyzed brain MRI scans of 102 people with Parkinson’s from centers in Lille, France, and Maastricht, the Netherlands, who were involved in a previous study.

Based on tests of attention, memory, executive function, language, and visuospatial functions, three groups of patients were considered for the study. These groups were cognitively intact patients (PDCN); cognitively intact patients with slight cognitive slowing (PDCN-S); and patients with mild cognitive deficits, particularly in executive functioning (PD-EXE).

A group of 17 age‐matched healthy people (controls) was included for comparison. All participants were examined on a 3T whole-body scanner and T1‐weighted images were acquired.

Six regions of the brain previously reported to suffer from atrophy (volume loss) in Parkinson’s patients with cognitive impairments were specifically chosen by the researchers for analysis. These regions were the thalamus, the hippocampus, the puramen, the pallidum, the caudate nucleus, and the amygdala.

The researchers found that values for two texture features — skewness and entropy — could distinguish individuals who had normal cognition from those with slight cognitive slowing, and from those with mild impairments. Skewness is a parameter that quantifies the asymmetry of the intensity of MRI signals. Entropy represents the degree of uncertainty of the texture intensity.

These texture features were at three specific regions in the brain: the hippocampus, the thalamus, and the amygdala.

The values for these features gradually decreased in those patients with worse cognitive function, suggesting it is possible to detect early cognition deficits in people with Parkinson’s using MRIs. The researchers noted that the best performances regarding sensitivity and specificity were obtained by measuring skewness in the hippocampus. In fact, skewness in the hippocampus was a significant marker of slight cognitive slowing.
“Our results suggest that hippocampal neurons could be affected very early in PD patients, even before atrophy can be detected with commonly used methods, and this could cause a general slowing of information processing,” the researchers said.
“These results support the assumption that signal alterations associated with Parkinson’s disease–related cognitive decline can be captured very early by texture analysis,” they added.
The researchers believe that brain MRI imaging could be combined with other methods, such as cognitive assessments and electroencephalograms. That would allow scientists to build a combined model “not only for the profiling but also for the prognosis and the prediction of evolution” of cognitive impairment, they said.

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I’m Learning that Life Doesn’t Always Need to Be Lived ‘My Way’

my way, courage

I saw a musical movie with my daughter a while back. We were the only people in the theater and we had a great time. The only problem is that these types of movies awaken my repressed desire to sing and dance, much to my family’s despair. 

I left the theater singing, adding a few little dance moves to the words I could remember (which were few) in my song of choice. (Yes, the attendant behind the snack bar delighted in laughing at me.)

Pain in pleasure

And then, in one of my graceful moves, I threw out my back. The pain seared through the entire middle section. Fortunately, it didn’t last too long.

What was unfortunate, however, was coming face to face with Parkinson’s disease once again. I know that no matter what my heart desires, this thieving disease will determine whether I can do what I’d like to do. Ultimately, it isn’t my decision to make. Not really, anyhow.

My way would be a different way

If I had my way, I’d join a dance class and learn to waltz.

If I had my way, I’d go skiing just one more time.

If I had my way, I’d play softball and hit a home run.

If I had my way, I’d put on my own socks and shoes.

If I had my way, I’d insist that I can do it all myself.

If I had my way, I’d do many things I once could do but can no longer do.

But today is different

I can’t have my way. Parkinson’s has seen to that.

I’ve had to learn to receive and accept that I am not always able to give.

I’ve had to learn that dancing will have to wait, at least for right now.

I’ve had to learn that skiing is not for me anymore.

I’ve had to learn that others are able and willing to do what I cannot.

I’ve learned, unlike Frank Sinatra, that I don’t always have to have it — or do it — my way.

And I’m learning … that’s all OK.

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