COVID-19 Presents Distinct Challenges, and Opportunities, with Parkinson’s

pandemic and Parkinson's

People with Parkinson’s disease can face “hidden sorrows” during the COVID-19 pandemic, like increased stress and limits on physical activity, that could worsen their symptoms. But ways exist to mitigate these “less visible” threats of social distancing and other changes in daily routines.

Indeed, the pandemic may facilitate wider access to helpful online resources, and could open new opportunities for research, two neurologists suggest.

These difficulties and opportunities were discussed in the commentary article, “The Impact of the COVID-19 Pandemic on Parkinson’s Disease: Hidden Sorrows and Emerging Opportunities,” published in the Journal of Parkinson’s Disease.

The COVID-19 pandemic poses many challenges, the most readily apparent being the health-related impact of the disease. This is particularly true for people who are older or have underlying conditions, as they are more likely to have complications if infected. Parkinson’s disease is no exception — people with PD are typically older, and lung problems (most notably pneumonia) are common.

“Although documented reports are thus far lacking, it is conceivable that having a diagnosis of PD is a risk factor for worse respiratory complications or even an unfavorable outcome after a COVID-19 infection,” the researchers wrote.

Yet the pandemic’s impact extends far beyond health alone; it also carries social, cultural, and economic effects. The commentary, by two Parkinson’s experts at Radboud University Medical Centre in the Netherlands, focused on how these might affect patients.

Primarily, the authors point out that the pandemic itself, as well as measures being taken to control it like social distancing, represent a large change to daily life in a short period of time.

While stressful for most, distancing may be a particular burden to people with PD, because the ability to rapidly adapt to new circumstances is largely dependent on brain systems involving the neurotransmitter dopamine. In Parkinson’s patients, these systems are compromised as part of the underlying disease.

“Thus, the pathophysiology of PD puts patients at increased risk of chronic stress, and a further worsening of this may well be one of various hidden sorrows of the COVID-19 pandemic,” the researchers wrote.

Elevated stress, in turn, could have health consequences: previous research suggests that increased stress can worsen motor symptoms, and make levodopa (a mainstay of PD treatment) less effective.

Another “hidden sorrow” of the ongoing pandemic for Parkinson’s patients is reduced physical activity. “Many people are now largely and sometimes completely stuck at home, being unable to go out for a regular walk, let alone to see their physiotherapist or attend a fitness class,” the researchers wrote.

Moderate exercise has been suggested to ease PD symptoms; as such, being unable to exercise could lead to worsening of the disease for some people. Exercise is  also a well-established way to lower stress, so the lack of exercise could compound stress-related problems.

But these obstacles are not insurmountable.

The authors highlight that resources are available online. In particular, they emphasized online courses in mindfulness that could help alleviate feelings of stress, as well as online exercise classes that can help promote physical activity.

“Such interventions are not entirely new, but the current crisis has certainly accelerated their adoption by large groups of patients, paradoxically making the access to these important interventions more accessible than ever before, particularly for those living in loosely populated areas of the world,” they wrote.

The COVID-19 pandemic may also create research opportunities related to Parkinson’s.

For example, it is relatively rare to have many people all experiencing increased stress at the same time. Particularly in existing longitudinal clinical trials, this shared stress could aid studies aiming to better untangle the precise effect of stressful events on PD progression, and in understanding what factors make a person with Parkinson’s more or less vulnerable to the detrimental effects of stress.

“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,” the authors concluded.

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Wives of Parkinson’s Patients are More Impaired in Postural Stability from Caretaking, Study Finds

postural stability, wives of Parkinson's patients

Wives who take care of husbands with Parkinson’s disease have greater impairments in their stability while standing than housewives or more active women of the same age, a study shows.

The research, “Postural stability in Parkinson’s disease patients’ wives and in elderly women leading different lifestyles,” appeared in the journal Health Care for Women International.

Increased impairment of posture and gait that comes with aging results from alterations in the central nervous system — brain and spinal cord — muscle and joint dysfunction, deteriorated physical capability, and other health issues.

The level of physical activity in the elderly is varied and associated with their lifestyle, responsibilities, and support. While some are able to participate in various forms of physical activity, others spend significant time doing housework or caretaking, and so don’t have opportunities to be physically active.

“This type of activity (housework) certainly is not conducive to the health of the caregivers and some aspects of it can be destructive both physically and mentally,” the study stated.

Parkinson’s patients require permanent care as their movements are unstable and slow. Their caregivers’ own stability may be affected, especially if the patient’s postural balance in impaired, and there’s an increased risk for falls.

“The (Parkinson’s) patient is hunchbacked and leans forward, making rising and sitting difficult,” the researchers wrote.

In the study, Polish researchers compared the postural stability of wives of Parkinson’s patients to that of women doing higher physical activity — students of the University of the Third Age (U3A; adult education movement for retired individuals) — or average physical activity (housewives).

A total of 128 unemployed women were included: 44 were wives of Parkinson’s patients (with a mean age of 66.5 years), 43 were U3A students (68.0 years), and 41 were housewives (65.6 years).

When not housekeeping, the wives of Parkinson’s patients spent their time caring for their husbands and resting. U3A students participated in organized activities twice a week, such as dance, exercises, nordic walking, or swimming. Housewives preferred to spend their time resting passively, which could be watching TV, reading, or chatting with family and friends.

Scientists assessed the women’s balance using a so-called stabilometric platform. Each participant was tested twice for 30 seconds. While one test included complete postural control with eyes open, the second was under conditions that limited postural control, with eyes closed.

The women stood on the platform in a relaxed and upright position, with their upper limbs hanging loosely. They were barefoot and dressed lightly. During the trial with eyes open, the women were asked to focus on a fixed point — a circle with a 15-centimeter diameter and a line through it, which was hanging on the wall three meters away.

No woman had difficulty standing due to neurological, orthopedic, or other issues. An assistant stood behind the participants to prevent falls.

The stability parameters analyzed were the mean velocity of center of pressure (COP) displacement (which measures postural balance); COP velocity in the sagittal plane (the one that divides the body into left and right halves) and frontal plane (front and back); and sway range in sagittal plane — mainly controlled by the ankles — and frontal plane directions, which depends mainly on the control of hip joints. The COP is the point where the sum of all forces on the body act, including gravity.

The wives of Parkinson’s patients were the tallest, and each had a lower body mass index, with none obese, than the other participants. Nearly 30% of housewives and U3A students were overweight.

As for postural balance, the wives of Parkinson’s patients had significantly higher values of mean velocity, displacement velocity, and sway range than housewives and students, which means they had greater impairment in balance. In contrast, U3A students, who engaged in regular organized physical activities, had the slowest velocity and lowest sway.

“It can be thus supposed that engagement in physical activity has positive effect on balance of older adults,” the scientists wrote.

However, the housewives and students showed greater differences in displacement velocity with eyes closed versus open, compared with the wives of patients.

“Surprisingly, compared to the other women, the wives of (Parkinson’s) patients did very well with eyes closed in terms of frontal plane sway,” the researchers said. “This may be the ‘practice effect’ of the long-term strength as well as the motion coordination required for caring for the (Parkinson’s) patients, who are typically characterized by instability.”

“The study results clearly point to the fact that the Parkinson’s disease patients’ wives require support in the form of balance enhancing training,” the team concluded. “Therefore, undertaking any form of physical activity aiming at redressing postural stability deficits would be beneficial for (this) group of women.”

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Physical Activity, Coffee, Moderate Alcohol Consumption Protect Against Disease Progression, Study Reports

coffee, alcohol, lifestyle factors

Physical activity and participation in competitive sports, as well as coffee, caffeinated tea or moderate alcohol consumption before diagnosis, protect against worsening motor and cognitive function in Parkinson’s patients, according to a new population-based study.

In contrast, smoking and heavy alcohol consumption — or never consuming alcohol — correlated with higher risks of mortality and cognitive and motor decline.

The research, “The Association Between Lifestyle Factors and Parkinson’s Disease Progression and Mortality,” was published in the journal Movement Disorders.

Lifestyle factors such as coffee and moderate alcohol consumption, physical activity, and cigarette smoking have been linked with lower risk of Parkinson’s disease. Whether they affect disease progression remains undetermined, although small studies have shown that smoking and drinking coffee do not affect motor progression in Parkinson’s.

In turn, nonpaharmacologic approaches such as physical activity may benefit physical functioning, balance and gait, as well as protect against dementia.

Researchers at the UCLA Fielding School of Public Health and the David Geffen School of Medicine, in Los Angeles, California, assessed whether diverse lifestyle factors before a Parkinson’s diagnosis in adults affect motor progression, cognitive decline, and survival.

A total of 360 patients were enrolled within three years of diagnosis (average 2.1 years), as part of the population-based Parkinson’s Environment and Gene study in central California. The patients lived in one of three central California counties — Kern, Fresno or Tulare — and were followed from 2001 to 2016.

From the 252 patients not lost to follow-up (mean follow-up 5.3 years; 64 patients deceased, six were too ill, 17 withdrew, and 21 could not be contacted), 244 individuals — 139 men, mean age at diagnosis 66.9 years, mean duration of disease at baseline 2.1 years — provided data for analysis of disease progression.

The team also included 341 control participants from the same communities for analysis of mortality, who had been living in California for at least five years.

Telephone interviews were conducted to obtain self-reports of history of smoking, caffeinated coffee/tea or alcohol (beer, wine and liquor) consumption, overall physical activity level, and participation in competitive sports.

The participants were asked to report at what age they started and stopped drinking the beverages, as well as their average consumption per day during four age groups: 18-24, 25-44, 45-64, and 65 years or older.

Also, patients were asked about the average number of days per week and hours per day they participated in mild, moderate, or vigorous physical activity at the same age groups. Participation in competitive sports also was addressed, including basketball (20.6% of participants), baseball (18.1%), football (18.1%), track and field (12.5 %), and softball (8.3%).

Physical examinations were performed at each visit to assess motor function — Hoehn & Yahr (H&Y) stages — and cognition, with the Mini-Mental State Exam (MMSE). Cognitive decline was defined as a 4-point decrease from baseline MMSE examination.

In total, 209 patients (58%) and 67 controls (20%) died during follow-up. Fifty of the 244 patients (21%) assessed for progression experienced a 4-point or greater decline on the MMSE, while 77 (32%) progressed to H&Y stage 3 — transition from mild to moderate motor dysfunction, with loss of balance — or worse.

Coffee, caffeinated tea, moderate (below the median drinks per day), beer or liquor consumption, and participation in competitive sports were protective against mortality. In contrast, smoking and never drinking coffee or alcohol correlated with increased risk of mortality. Of note, the higher risk with smoking contrasts with prior studies showing protection against disease onset, the scientists noted.

In controls, alcohol and coffee consumption also were protective, while smoking conferred greater mortality risk.

The data further showed that engaging in competitive sports was associated with a history of head trauma in Parkinson’s patients, but not in controls. Head trauma also was linked with shorter time from diagnosis to death in this subset of patients.

Ever coffee consumption, participating in competitive sports and physical activity were protective against both motor function worsening and cognitive decline. Compared to moderate drinkers, patients who never drank liquor and those who drank more heavily were at greater risk for motor dysfunction. Also, never drinking and current cigarette smoking were associated with increased risk of cognitive decline.

Comparing patients who never drank coffee to those who have ever drank it, the findings also showed that never consuming coffee was associated with younger age at diagnosis (62.6 vs 67.6 years), longer disease duration at baseline (2.7 vs. 1.9 years) and less weekly alcohol consumption at some point (44% vs 69%).

“Although replication is needed,” researchers wrote, “our study suggests that multiple lifestyle factors potentially modify the rate of symptom progression.”

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Adding Physical Exercise to Parkinson’s Therapies Helps to Keep Patients Engaged and Active, Study Says

exercise and Parkinson's

Physical exercise given in addition to standard treatment can improve overall quality of life in Parkinson’s patients, helping to ease physical limitations and allowing for greater engagement in daily activities, a review study suggests.

The review, “The Effect of Physical Activity in Parkinson’s Disease: A Mini-Review,” was published in Cureus.

Parkinson’s disease, the most prevalent neurodegenerative disorder of the elderly, affecting 7 to 10 million people worldwide, is characterized by the gradual loss of muscle control, sometimes accompanied by cognitive deficits.

Current treatments include medications (levodopa, catechol-O-methyl transferase inhibitors, dopaminergic and non-dopaminergic drugs), non-pharmacological therapies, and neurosurgery (deep brain stimulation). Mostly, these focus on treating disease symptoms and delaying progression.

Researchers summarized and discussed findings in their review of studies suggesting that physical activity can significant benefit Parkinson’s patients, and could be used in combination with other treatment approaches to help minimize physical and cognitive effects of the disease.

Physical activity has been shown to not only improve patients’ motor symptoms — including gait, balance and strength — but also to slow disease progression, decrease pain, and improve sleep, mood, memory, and overall quality of life, the review reported.

Exercise has also shown a potential to improve non-motor symptoms, like depression, apathy, fatigue and constipation, as well as complications caused by patients’ lack of mobility, such as cardiovascular disease and osteoporosis.

Studies in animal models support these findings, and suggest that the benefits of physical exercise on cognition could be due to an increase in nerve cell proliferation, preservation (neuroprotection), and de novo formation (neurogenesis) in the brain.

The review emphasizes that these benefits were reported in long-term studies performed in Parkinson’s patients undergoing different types of exercises.

One study, published in 2013, enrolled 70 patients who took part in 60-minute, twice-weekly, rehabilitation exercises aimed at increasing range of movement, and improving balance, movement agility and walking. Results showed a “reduction of the severity of motor symptoms in patients with PD when enhancing their daily activities,” its authors stated.

Other studies tested specific types of physical activities to evaluate differences in benefit.

A randomized clinical trial studied three types of exercises in 67 Parkinson patients with gait difficulties, testing the impact of treadmill (high and low intensity), resistance, and stretching exercises on gait speed, strength and, fitness. Results, also published in 2013, revealed that combining treadmill (low-intensity) and resistance exercises may offer greater benefits, although all three types “improved gait and mobility.”

Physical exercise also seems to help keep pain under control — a disease symptom prevalent in 85% of patients and usually managed by conventional analgesics and dopaminergic agents. Exercise is thought to enhance neuronal restoration in the brain and improve metabolism and the immune response.

Based on this evidence, the reviewers suggested that physical exercise be used in combination with other therapies to improve the patients’ overall quality of life.

“The motor and nonmotor symptoms remain difficult to manage with current clinical therapies, but exercise has been identified as a possible adjuvant treatment and can be considered to help improve a person’s limitations and improve the daily activities. It is important that physicians keep this treatment in mind while treating patients with Parkinson’s disease,” they concluded.

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British Crew Rowing the Distance to Improve Understanding of Parkinson’s Disease

rowing Indian Ocean

A four-man crew from Britain is hoping to increase understanding of Parkinson’s disease by rowing across the Indian Ocean in an attempt to break a world record.

Robin Buttery, Barry Hayes, James Plumley, and skipper Billy Taylor are planning to row for 1,920 hours non-stop, for 65 days straight, all the way from West Australia to Mauritius, with the goal of becoming the fastest four-man crew to row the Indian Ocean.

The effort is an attempt to raise awareness of the disease and raise funds to support research — all while serving as subjects of scientific research aimed at studying the relationship between physical exercise and Parkinson’s.

Buttery, 46, was diagnosed with young-onset Parkinson’s disease two years ago, just before his 44th birthday. He lives in Leicester with his wife, Nicola, and son Rory, and works as a technical instructor at De Montfort University in Leicester.

Determined to show that life does not end with a Parkinson’s diagnosis, he challenged three friends to join him in his attempt to break a world record and serve as an inspiration to the community. The crew members will row non-stop, taking shifts of two hours on, two hours off, for 12 weeks.

They will start their journey in Exmouth, Western Australia, and row 3,600 nautical miles in a 29-foot-long ocean rowing boat until they reach their destination in Port Louis, Mauritius.

Cameras on the boat will film the crew 24/7, gathering footage that will be processed by computers after the journey is complete. Researchers will then analyze the video to study the effects of exercise on Parkinson’s.

Although physicians often prescribe physical exercise for Parkinson’s patients and anecdotal evidence shows that common motor symptoms such as tremors, cramps, and gait issues are improved with exercise, very little is really known about how exactly physical activity affects Parkinson’s patients.

By studying Buttery and his crew mates, professors Helen Dawes, Fabio Cuzzolin, and Johnny Collett of Oxford Brookes University in the U.K. hope to answer questions such as whether endurance exercise is always better than other types of exercise and if endurance exercise affects Parkinson’s patients differently than non-patients.

They will compare the changes in Buttery’s movements with those of his crew mates to investigate how endurance exercise affects the motor skills of Parkinson’s disease patients. They can also enlarge the video to look at any changes in their heart and lung regulation.

By analyzing the progression of Buttery’s motor skills and other Parkinson’s symptoms while exercising, the researchers hope to learn more about how physical activity really affects this disease.

Other researchers will also use this venture as a case study. Oxford Brookes research fellow Shelly Coe, a qualified nutritionist, for example, will monitor how diet impacts the management of Buttery’s symptoms.

All of the information these researchers gather could potentially help with the development of new treatments for Parkinson’s disease.

In addition to serving as subjects of scientific observations and attempting to break a world record, the team is also raising funds for charity. They are hoping to raise a minimum of $350,000 to support the Restoration of Appearance and Function TrustClear Trust and the European Parkinson’s Disease Association.

Anyone can support the crew and their goal by buying a mile or by making a donation. Once they depart, a livestream of their journey will be available on their website.

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Obesity, Sedentary Behavior Not Linked to Parkinson’s Disease Risk, Study Shows

Obesity and Parkinson's

Increased body mass and sedentary behavior do not increase the risk of having Parkinson’s disease, a study shows.

To date it is still not fully understood what causes Parkinson’s disease, but several environmental and lifestyle factors have been suggested as contributors to this disease.

In the study, “Body mass index, sitting time, and risk of Parkinson disease,” which was published in the journal Neurology, researchers from the Karolinska Institutet in Sweden focused on the potential of body mass index (BMI) — a measure indicative of obesity — and sitting time to contribute for Parkinson’s disease development and progression.

The team already had reported that more physical activity around the house and commuting lowered Parkinson’s risk. “Regardless of time spent on physical activity, sedentary behavior characterized by sitting extended periods of time has been associated with increased general morbidity and mortality,” the researchers wrote. “Thus, sedentary behavior may affect PD pathogenesis through mechanisms other than physical activity.”

Clinical records of 41,638 individuals who completed a comprehensive questionnaire with extensive assessment of lifestyle factors at a national fund-raising event in September 1997 (The Swedish National March Cohort) were analyzed.

During the study period (13 years) 286 participants were diagnosed with Parkinson’s disease.

Participants who spent six or more hours seated per day had a 6 percent higher risk. Also, those with body max index of 30 or higher had a 13 percent increased risk compared to leaner patients. These results were not found to be influenced by age, sex, or smoking status.

Although some differences were found, these data do not show a significant correlation between baseline body mass and sitting time with the risk of developing Parkinson’s, which is in accordance with previous studies.

However, researchers highlighted that all the analysis was based in data collected at the beginning of the study, and some measures could have changed during follow-up. “If such changes are related to the outcome, this could lead to misclassification and an over- or underestimation of any true association,” they wrote.

Still, it is widely accepted that the underlying mechanisms of Parkinson’s start many years before symptom onset. So, any factor that might contribute to development of this disease may occur in an “exposure window of interest closer to the baseline exposure assessment,” they said.

“Future studies should focus on environmental factors other than obesity and sedentary time in efforts to disentangle the complex causation of Parkinson’s disease,” the authors suggested.

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Source: Parkinson's News Today