Mild Cognitive Impairment in Parkinson’s Linked to Worse Memory, Attention Deficits, Study Reports

mild cognitive impairment

Parkinson’s disease patients with mild cognitive impairment (MCI) have a lower quality of life if their memory is impaired, according to a study that also revealed that MCI is associated with more severe attention and memory dysfunction in people with the disease.

The study, “Mild cognitive impairment in Parkinson’s disease: Characterization and impact on quality of life according to subtype,” appeared in the journal Geriatrics & Gerontology International.

MCI is a major risk factor for dementia and is more prevalent in Parkinson’s patients than in the general population. The prognosis of MCI in Parkinson’s depends on its specific subtypes, which may affect at least five domains: language, memory, attention, visuospatial function, and executive function, the latter of which involves goal-directed actions and ability to adapt to new situations.

Early MCI in Parkinson’s is associated with older age, greater motor impairment, and depression. In addition, research has shown that older age, being male, and motor dysfunction all lead to a greater risk of developing dementia in this patient population. However, a more detailed understanding of MCI in Parkinson’s is needed to improve patient management.

To address this, Brazilian researchers characterized MCI as either amnestic or non-amnestic and assessed its impact on quality of life. For reference, amnestic MCI impairs memory, while non-amnestic MCI affects other domains, namely language, attention, visuospatial skills, and/or executive function.

All participants underwent a neurological examination and were also evaluated using four clinical scales: Modified Hoehn and Yahr scale (which assesses the progression of Parkinson’s symptoms), Unified Parkinson’s Disease Rating Scale (UPDRS), Parkinson’s Disease Quality of Life Scale (PDQ-39), and the Schwab-England Activities of Daily Living Scale.

The study included 149 participants — 60 Parkinson’s patients and 81 individuals used as controls — of whom 52 patients (86%) and 60 controls (74%) had MCI. Overall, patients and controls did not differ in assessments of depression and global cognition, as evaluated with the Mini-Mental State Examination.

Amnestic MCI was diagnosed in 29 patients (mean age 62.1 years, 58.6% men) and 35 controls (61.3 years, 54.3% women), while non-amnestic MCI was found in 23 patients (62.1 years, 58.6% men) and 25 controls (61.3 years, 76% women).

Amnestic and non-amnestic Parkinson’s patients showed no differences in Parkinson’s duration and severity. However, amnestic patients revealed greater impairment in activities of daily living, meaning a lower quality of life.

Impairment in multiple domains was more common than in a single domain in both patients and controls. Regarding the predominant motor sign in Parkinson’s patients, the pure akinetic-rigid form — slow movements and rigidity — was more frequent in non-amnestic (69.65%) than in amnestic (37.9%) patients, but this was not statistically significant.

Neuropsychological evaluations showed that the most useful tests to assess cognition and differentiate amnestic from non-amnestic MCI were the Figure Memory Test, which addresses visual perception, language, attention, recognition, as well as visual short-term, long-term and learning memory; the Rey Auditory Verbal Learning Test; and the Trail Making Test, which analyzes visual attention and task switching.

Parkinson’s patients had worse scores in all three tests than controls. While episodic memory and verbal memory/learning were more significantly impaired in non-amnestic and amnestic patients than in controls, the dysfunction in attention was more pronounced in amnestic Parkinson’s patients.

These findings also revealed that attention was the most significantly impaired domain in both patients and controls, followed by memory.

“These results reveal that the [Parkinson’s] group had worse cognitive performance,” the researchers wrote. A longitudinal analysis of these participants will enable them to determine whether Parkinson’s patients are at a higher risk for dementia and whether this risk is different between amnestic an non-amnestic patients.

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Hydrotherapy Improves Balance, Mobility in Parkinson’s Patients, Study Reports


Hydrotherapy may provide significant balance and mobility benefits in patients with Parkinson’s disease compared to medication and land-based exercises, according to a review study.

The research, “The Effects of Hydrotherapy on Balance, Functional Mobility, Motor Status, and Quality of Life in Patients with Parkinson Disease: A Systematic Review and Meta-analysis,” was published in the journal PM&R.

Impairments such as muscle rigidity and tremor affect the balance and mobility of people with Parkinson’s. Combined with fear of falling, it promotes a sedentary lifestyle and reduces quality of life.

Water-based exercise is often prescribed to these patients, providing a safe environment that reduces the risk of falling. Prior studies have reported that hydrotherapy improves motor symptoms. However, the evidence about  hydrotherapy as a treatment strategy in Parkinson’s is scarce.

To address this gap, researchers conducted a systematic review of the available scientific literature and a meta-analysis — a type of statistical analysis that combines the results of various studies.

The scientists focused on hydrotherapy’s effectiveness on patients’ balance, mobility, quality of life and motor function.

For this purpose, the investigators searched seven online databases as well as unpublished or ongoing clinical trials from inception through December 2017. Nineteen studies were identified, of which eight were randomized controlled trials (RCTs). Overall, the studies had 484 participants, with a mean age ranging from 54 to 78 years and an average disease duration ranging from three to 10 years.

The studies had different designs, which included comparisons of hydrotherapy with land-based exercises or medications, combinations of hydrotherapy with land-based therapy, and assessments of low-intensity and muscular resistance water-based exercises.

Hydrotherapy could include balance training, stretching, strengthening, trunk mobility, and gait exercises. The sessions ranged from 40 to 60 minutes, one to five days per week, for three to 20 weeks, for a total of eight to 60 sessions. Water temperature was set between 28ºC (82ºF) and 34ºC (93ºF) in the 12 studies that reported this parameter.

All but two studies with available information on levodopa usage evaluated patients’ in the “on” phase, which refers to the period when this medication is effective and has not yet worn off.

The meta-analysis on balance and mobility included five RCTs, which had a total of 133 patients. The results showed that hydrotherapy with or without land-based exercises significantly improved both balance and mobility compared to land-based therapy or usual care with medication alone.

Three other studies not included in the meta-analysis due to lacking a control group also found significant benefits with hydrotherapy in balance. One RCT not included in the statistical comparison did not report differences with hydrotherapy and land-based therapy, while another showed that aquatic obstacles training is more beneficial for balance than traditional water-based exercises.

In turn, two RCTs not included in the respective analysis failed to show mobility improvements with hydrotherapy.

As for quality of life, an analysis of three RCTs with 76 patients showed no benefits with hydrotherapy compared to land-based treatment, which the researchers attributed to the small number of studies included. This also was observed in one RCT not included in the meta-analysis. In contrast, five other studies, including two non-randomized trials, found significant improvements with water-based treatment.

Results of a meta-analysis of five RCTs with 140 patients also did not reveal improvements in motor function in comparison to land-based exercise. This can be explained by patients having types of motor complications not expected to improve with hydrotherapy, the team said.

Of note, two other RCTs and a non-randomized trial also did not find different results with hydrotherapy compared to other approaches in motor function.

Overall, the scientists wrote, “hydrotherapy, combined or not with other therapies, may improve balance and functional mobility of patients with [Parkinson’s] when compared to land-based therapy alone or usual care.”

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Parkinson’s Patients with Poorer Quality of Life May Benefit the Most from Deep Brain Stimulation, Study Finds

dbs oucome quality of life

Individuals with Parkinon’s disease who have worse quality of life due to their disease-related impairments may benefit most from treatment with deep-brain stimulation.

The study with that finding, “Quality of life predicts outcome of deep brain stimulation in early Parkinson disease,” was published by the journal Neurology.

Deep-brain stimulation (DBS) is an invasive surgical technique in which thin wires are implanted in the brain to deliver electric pulses to specific areas, such as the subthalamic nucleus (STN), to ease motor symptoms in patients for whom standard medications are not effective.

Studies have shown that DBS can effectively help manage motor symptoms and reduce the necessary daily dose of medication, improving quality of life in those with advanced or early-stage Parkinson’s.

In a previous Phase 4 clinical trial (NCT00354133) called the EARLYSTIM study, researchers evaluated the long-term impact of STN-DBS as an add-on to best medical treatment regarding quality of life in patients with Parkinson’s disease for a period of more than two years.

The study enrolled patients younger than 61 who had a good response to levodopa therapy, but who still had developed motor complications. Among the participants, 124 were treated with DBS-STN and best medical treatment, while 127 patients received the best medical treatment only.

In the most recent study researchers reviewed the trial data to understand which factors contributed to the detectable changes in disease-specific quality of life, as measured using the 39-item Parkinson’s Disease Questionnaire summary index (PDQ-39-SI). The self-reported questionnaire assesses Parkinson’s-specific health across eight quality-of-life dimensions.

The analysis revealed that quality of life over the two years of follow-up correlated with the initial value of the PDQ-39-SI in both treatment groups. Still, this association was more pronounced among patients who were treated with STN-DBS.

Patients with very mild impairment due to Parkinson’s, corresponding to PDQ-39-SI values lower than 15, were found not to benefit from STN-DBS as compared to patients treated with standard care alone. In contrast, patients treated with STN-DBS who had PDQ-39-SI sores higher than 15 (worse quality of life) at the beginning of the study experienced better quality of life changes.

“In patients with very low baseline ratings on the PDQ-39-SI, the natural progression of impairment of [quality of life] may outweigh the improvement achieved by STN-DBS,” researchers wrote. “On the other hand, some patients with very modest impairment of their [quality of life] seem to have less to gain from STN-DBS,” they added.

Patients’ cognitive status before the treatment, as determined by the Mattis Dementia Rating Scale (MDRS), was not predictive of change in quality of life in either treatment group. However, higher scores for depression and poorer mood correlated with larger improvements in quality of life among patients in the STN-DBS group.

These findings “may indicate that these patients have a potential for nonmotor improvement to gain from surgery,” researchers suggested.

Changes in quality of life during the two years of follow-up were independent of patient age, disease duration, duration of motor complications, severity of parkinsonian motor manifestation under levopoda therapy, or treatment complications.

Supported by these findings, the team believes that “baseline impairment of quality of life is (…) a reasonable aspect to consider for the decision to treat with STN-DBS.”

“The subjective individual suffering as measured with the PDQ-39-SI should be taken into account as a predictive factor for outcome when selecting patients with early motor complications for STN-DBS,” researchers concluded.

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Finding Words to Describe Parkinson’s Pain


Parkinson’s disease (PD) pain is unique, so finding words to describe it is difficult. Not all those with a diagnosis experience pain. But for some, like me, pain is the major, disabling symptom. It is important to find words that describe the pain experience as clearly as possible. There is no “grin and bear it,” nor is this “a pity party.” Instead, this is a search for accurate articulation of the pain experience to help maintain quality of life.

Pain may be an early symptom of PD, according to a study presented at the 2018 World Congress on Parkinson’s Disease and Related Disorders titled “Pain: A marker of prodromal Parkinsons disease?” The American Parkinson Disease Association published research that supports the connection of pain with Parkinson’s, suggesting that if the pain is relieved with dopaminergic medication and the patient has a pattern of painful sensations that correlate to “off” episodes, more credence can be given to the idea that the pain is PD-related.

PD pain can resemble pain from other disease processes, especially as the patient ages and faces a multitude of other pain-causing conditions such as arthritis, spine degeneration, poor muscular conditioning, and such. In my case, PD pain is distinguished by the following:

  • The progression of body pain correlated with the progression of the disease over time.
  • Levodopa, a dopaminergic therapy, successfully reduces the pain.
  • The pain is worse during “off” periods.

My PD pain also has a particular characteristic: stinging (sometimes knife-jabbing), irritating tingling, burning, and muscle heaviness with increased pain on movement. This pain happens over large regions of the body and varies in severity. At its worst, it can last several days and reach level 7, inducing spontaneous tears.

PD with episodic chronic pain is disabling in several ways. First, high levels of pain obstruct clear thinking. Second, high levels of pain induce the fight-or-flight response, which interferes with emotion management. Third, the amount of energy necessary to manage it is very tiring (even more so in the face of the deep fatigue associated with PD). Chronic PD pain entails much more than body symptoms.

Parkinson’s pain is a total experience that touches thoughts, feelings, and relationships. Even when it’s a struggle, finding the words to describe pain experiences is imperative to maintaining quality of life in the face of a difficult diagnosis. Finding the right words helps one communicate the pain experience to care providers, family, and friends — a network of relationships that help form the foundation for quality of life. By communicating the pain, those close to me are more understanding of why I act the way I do, which helps to maintain those relationships.

Over the years, I have watched my PD progression. I have taken the warrior stance to do all I can to slow the progression. My hardest battle is with the total experience of chronic PD pain. Large blocks of time disappear into the fog of war. Over time, I have learned the importance of communicating about the pain daily, sometimes multiple times a day. My partner asks, “Where are you today?” I will say, “I’m at level 5,” followed by a quick mention of the most bothersome symptoms. In the past, I kept track of the pain levels throughout several months to create benchmarks. This is all part of finding the words to describe the Parkinson’s pain experience.

I have been a “communicator” most of my life, but it remains a struggle to find words that describe the unique character of PD pain. If you experience PD pain, please share your descriptors in the comments. Together we may find a common dialogue that will help others.


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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Parkinson’s Patients and Caregivers are Active, but Lack Self-management Support, Study Finds

Self-management and PD

Patients with Parkinson’s disease and their caregivers are usually active and ready to adopt strategies to improve their quality of life and disease management, but lack self-management support, a study finds.

The study, “Development of the Integrated Parkinson’s Care Network (IPCN): using co-design to plan collaborative care for people with Parkinson’s disease,” was published in Quality of Life Research.

Parkinson’s disease is a progressive neurological disease characterized by the gradual loss of muscle control, sometimes accompanied by cognitive deficits that can significantly affect patients’ quality of life.

For this reason, “people with [Parkinson’s disease] and their caregivers require a collaborative approach to healthcare to optimize functioning and promote quality of life,” researchers stated.

This collaborative approach requires patients and their caregivers to be active, well-informed, confident and willing to engage and communicate with healthcare providers to manage disease symptoms and improve their overall quality of life.

However, the lack of integrated care programs, including self-management strategies and education, often result in “PD patients [being] underinformed about critical care issues and experience lack of collaboration among members of their healthcare team.” Self-management refers to patients having the skills and confidence necessary to manage day-to-day tasks and live well with a chronic health condition.

In this study, researchers developed and implemented an integrated approach to care in a tertiary Parkinson’s disease clinic in Ottawa, Canada.

The team chose a process of co-design, where the user viewpoint is essential to inform service delivery.  Patients and caregiver input was gathered through surveys and interviews and used to  develop a model that incorporates care integration, self-management support, and technology-enabled care: the Integrated Parkinson’s Care Network (IPCN).

The observational, cross-sectional study involved 108 participants who were asked to complete two questionnaires: one to evaluate perceived self-management support (Patient Assessment of Chronic Illness Care plus); and the other to assess knowledge, skills, and confidence for managing their own health or that of a loved one (Patient or Caregiver Activation Measure).

A total of 57 Parkinson’s patients and 31 caregivers completed the questionnaires. A subset of 13 patients, six caregivers and six healthcare providers also participated in semi-structured interviews, designed to gather information on participant experiences of managing disease, accessing or providing care, information and support; and areas that worked well and areas for improvement.

Findings revealed that 58% of study participants were moderately or highly active at facing and managing Parkinson’s daily challenges. Caregivers tended to be slightly more active than those living with the disease. Additionally, older adults who require a mobility aid or assistance with activities of daily living tend to be less active.

“Knowledge of patient and caregiver levels of activation can be used to tailor interventions to promote adoption of health behaviors,” researchers stated.

Although patients’ and caregivers’ perceptions of self-management support varied, in general they expressed a lack of goal-setting and follow-up support or coordination. Findings also identified the need to provide relevant information and assistance to access “resources and ongoing monitoring of how patients are managing their condition.”

Participants felt better informed and satisfied when healthcare providers “engaged in open communication and shared decision-making.”

There was a positive association between patients’ goal-setting and the level of follow-up and coordination of care they received. “Goal-setting that is led by the patient may facilitate a more focused approach to care that supports shared decision-making and targets individualized needs for follow-up,” researchers stated.

The team noted that although these findings are designed to inform service development at one clinic, “they can sensitize healthcare providers to the individualized needs of people with  [Parkinson’s disease] and their caregivers.”

“While participants perceived varying levels and types of self-management support, a lack of goal-setting, follow-up, and coordination of care and access to services were highlighted as gaps. Adapting service provision to address these gaps is critical for collaborative care,” they concluded.

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Focused-ultrasound Lesion Surgery Can Treat Tremors and Improve Life Quality, Study Says

tremors and surgery

Treating tremor in Parkinson’s patients using non-invasive and focused-ultrasound lesion surgery is associated with better quality of life when compared to deep brain stimulation, although both approaches are equally effective in easing this disease symptom, a review study reports.

The study, “Outcomes in Lesion Surgery versus Deep Brain Stimulation in Patients with Tremor: A Systematic Review and Meta-analysis,” was published in the journal World Neurosurgery.

At least 50 percent of people with Parkinson’s, essential tremor (ET) or multiple sclerosis (MS) given oral medications as a first-line treatment for tremor — defined as an involuntary, uncontrollable muscle contraction; most commonly in the hands — do not tolerate these medications over the long term.

Current alternatives include deep brain stimulation (DBS) and lesion surgery (LS), which induces lesions on targeted areas using a heated electrode or focused ultrasound. Prior comparisons have shown that while the two techniques are equally effective in suppressing tremor, DBS led to a greater improvement in function.

But LS with focused ultrasound is gaining in popularity, and one study suggested that it may significantly improve tremor and quality of life.

Researchers at Harvard Medical School conduced a systematic review and a meta-analysis — a type of statistical study that combines the results of various studies — to determine which strategy is most effective in diminishing tremor severity and improving life quality and function in people with Parkinson’s, ET, or MS.

Three online databases were searched for results of randomized clinical trials published up to Jan. 1, 2018, and that included adults treated with either LS or DBS, or serving as controls. Both DBS and LS studies targeted unilateral or bilateral thalamus, pallidum or subthalamic nucleus, all of which are implicated in motor function.

Thirteen Parkinson’s trials were among the 15 included in this study, and the primary outcome for all but one was change in upper limb tremor severity, as assessed with the unified Parkinson’s disease rating scale (UPDRS) part III. Changes in quality of life, cognitive function and neuropsychiatric function were also assessed with variable measures.

A total of 1, 508 patients (mean age range, 48.4 to 70.8) were included, and in addition to the 13 studies involving only Parkinson’s patients, one study looked at people with Parkinson’s, ET and MS, while the remaining study was in people with severe ET.

Four of the 15 trials — involving 125 patients — directly compared DBS to LS. The others compared either LS or DBS with controls.

Results showed that DBS and LS were not significantly different across all analyzed outcomes, which is in line with current guidelines, the researchers noted. All but one trial showed both these types of surgery eased tremor severity. Quality of life findings showed variability in outcomes, which was driven by disease duration. Specifically, longer disease duration correlated with a greater likelihood of surgery and better quality of life.

A subgroup analysis that looked specifically at LS using focused ultrasound revealed that this approach was associated with a significant improvement in quality of life compared to DNS, although changes in tremor severity were similar.

“Policy makers, healthcare providers, and patients could therefore consider focused-ultrasound [LS] as a potential choice for tremor control, based on currently available evidence,” the researchers wrote.

However, results from more studies directly comparing DBS with focused-ultrasound LS are needed, they advised.

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Most Untreated Parkinson’s Patients Have Non-Motor Symptoms, Study Shows

non-motor symptoms

Non-motor symptoms are common among patients with Parkinson’s disease who have not yet received any treatment, and the type of symptoms differs between men and women and onset age groups, a study shows.

The study, “Gender and onset age related-differences of non-motor symptoms and quality of life in drug-naïve Parkinson’s disease,” was published in the journal Clinical Neurology and Neurosurgery.

Parkinson’s disease is mostly recognized by its motor symptoms, such as tremor and postural instability. Several non-motor symptoms, including sleep disorders, neuropsychiatric disturbances, and sensory deficits, have also been reported in Parkinson’s patients at both the early and late stages of the disease.

Increasing evidence suggests that these non-motor symptoms can precede the onset of Parkinson’s motor manifestations and have a significant impact on patients’ quality of life.

Studies addressing the prevalence and nature of Parkinson’s non-motor symptoms have been widely discussed in the general Parkinson’s population, mainly in patients receiving anti-parkinsonian therapy. However, the presence of non-motor symptoms may be confounded by the fact that many of these symptoms arise as part of therapy-related side effects.

In this study, a team of researchers evaluated the prevalence of non-motor symptoms in 569 Chinese patients with Parkinson’s disease who had not yet been treated with any approved therapy.

“Untreated PD [Parkinson’s disease] patients represent a suitable model, which is good for exploring the clinical expression of NMS [non-motor symptoms] as well as motor symptoms,” the researchers wrote.

The team wanted to explore the gender and onset age-related non-motor symptom profiles and investigate the determinants of quality of life in these patients.

Participants were between the ages of 45 and 70 and had a mean disease duration of two years. Approximately 51.7% were women, 18.6% had early-onset disease, and overall patients showed bilateral disease without impairment of balance, as determined by a score of 1.9 on the modified Hoehn and Yahr (H&Y) staging scale.

The mean score on the Unified Parkinson’s Disease Rating Scale (UPDRS III), which assesses the motor signs of Parkinson’s disease, was 21.7, with men exhibiting significantly higher (worse) scores than females.

A total of 552 patients had at least one Parkinson’s non-motor symptom, with 74% reporting sleep disorder or fatigue and 62.7% attention or memory impairments. The rarest manifestation was perceptual problems or hallucinations, which affected 3.7% of patients.

Men showed a higher incidence of urinary and sexual dysfunction, and a significantly lower incidence of sleep issues or fatigue, mood changes or apathy, and attention or memory impairments than women.

The team also found that patients with late-onset disease had a significantly higher incidence of perceptual problems or hallucinations, attention or memory deficits, as well as gastrointestinal, urinary, and sexual dysfunctions than early-onset Parkinson’s patients.

Overall, patients who were depressed and those who had worse non-motor symptoms, in particular sleep problems or fatigue, mood alterations or apathy, attention or memory impairments, or gastrointestinal symptoms, were found to have a poorer quality of life.

“Our study suggests that NMS is common in drug-naïve PD patients,” the researchers wrote.

“NMS, especially sleep/ fatigue, mood/apathy, attention/memory, and gastrointestinal symptoms, are dramatic determinants on decreased QoL [quality of life] in PD patients,” they added. “Management of non-motor symptoms is of great importance to improve the quality of life of early stage Parkinson’s disease patients.”

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Spectramax Light Therapy Shows Promise in Easing Parkinson’s Non-motor Symptoms


PhotoPharmics’s Spectramax light therapy reduces disease severity, lessens non-motor symptoms, and improves the quality of life of Parkinson’s patients, according to recent results of a controlled clinical study.

The study,“Double-blind controlled trial of Spectramax™ light therapy for the treatment of Parkinson’s disease patients on stable dopaminergic therapy” was presented at the International Congress of Parkinson’s Disease and Movement Disorders (MDS), held Oct. 5-9, in Hong Kong, China.

Besides the well-known motor symptoms, Parkinson’s disease also is characterized by non-motor symptoms, such as cognitive impairment, sleep disturbances, depression, and pain.

These non-motor symptoms may occur years before Parkinson’s hallmark loss of dopamine-producing nerve cells and motor symptoms’ onset and usually are resistant to dopaminergic medications.

Parkinson’s patients also have a dysregulated circadian rhythm — the natural “body-clock” that regulates essential functions such as sleep, rest-activity rhythm, and metabolism — which has been increasingly associated with the development of the disease’s motor and non-motor symptoms.

Previous preclinical studies have suggested that light therapy improves the circadian rhythm and may be an effective therapy for both motor and non-motor features of Parkinson’s disease.

“Therapeutic light is the most powerful tool for circadian regulation, and based on our experience in treating circadian-related disorders with specific bandwidth phototherapy, we believe we can make a major difference in treating PD,” Dan Adams, PhotoPharmics’s science officer, said in a press release.

In the randomized, double-blind, clinical study (NCT02175472), PhotoPharmics evaluated the safety and effectiveness of Spectramax light therapy in Parkinson’s patients on stable dopaminergic therapy.

The trial enrolled 92 Parkinson’s patients 45 years or older at three centers in the U.S. and Europe. Participants were randomized to receive one hour of either light therapy (45 patients) or a placebo light (47 patients) every evening over six months. The placebo was a light therapy with a bandwidth that was not thought to be biologically active.

Patient’s disease severity (including motor and non-motor symptoms), sleep disturbances, anxiety, depression, and quality of life were assessed before and after six months of treatment through several validated methods.

According to PhotoPharmics’ website, the company’s Spectramax device, which provides strong but harmless doses of light in specific wavelengths, was mainly set on a table or desk at the participants’ home. This way, patients were able to do several activities — such as read, watch TV, and eat a meal — while receiving the light therapy.

After six months of light therapy, patients showed a clinically meaningful improvement on disease severity — assessed through the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) — compared with patients in the placebo group.

Treated patients also showed a significant reduction in non-motor symptoms (measured through Part 1 of the MDS-UPDRS), a significant improvement in their quality of life (assessed using the Parkinson’s Disease Questionnaire (PDQ-39)), and an almost statistically significant reduction in daytime sleepiness (measured through the Epworth Sleepiness Scale), compared with those receiving only standard dopaminergic treatment.

Spectramax light therapy was well-tolerated, with dry eye, teary eye, and eye strain being the most common side effects.

These results are a “significant milestone for patients with Parkinson’s disease and showcases what may be the only adjunctive therapy to improve Parkinson’s disease symptoms on top of the dopaminergic medications that patients are likely already taking,” said Kent Savage, PhotoPharmics’ CEO.

PhotoPharmics noted that larger double-blind studies are required to confirm these results, and that the company plans to conduct additional clinical trials to further investigate light therapy in neurodegenerative diseases.

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Non-Motor Symptoms During Wearing-off Periods Associated with Worse Quality of Life in Parkinson’s Patients

Parkinson’s patients with non-motor symptoms during “wearing-off” periods — when symptoms return as their medication wears off — have a significantly worse quality of life compared to patients who only experience the return of motor symptoms, a new study shows.
The study, “Motor and non-motor wearing-off and its impact in the quality of life of patients with Parkinson’s disease,” was published in the journal Arquivos de Neuro-Psiquiatria.
Motor fluctuations refer to the alterations between periods of being “on,” during which a Parkinson’s patient experiences a positive response to medication (generally levodopa), and being “off,” during which the medication wears off and symptoms return.
“Off” periods are more common as the disease progresses and people take medication for a longer period of time.
Motor fluctuations in patients with Parkinson’s disease have been studied extensively. But little is known about non-motor symptoms during “on” and “off” periods.
Motor wearing-off includes the re-emergence of motor symptoms such as tremor, rigidity, and bradykinesia (slowness of movement). Non-motor symptoms include anxiety, fatigue, and depression.
Non-motor symptoms have a significant impact on a patient’s quality of life, as the burden can often be more disabling compared to motor symptoms.
Researchers have developed tools to assess wearing-off in Parkinson’s patients. In particular, the wearing-off questionnaire (WOQ-19) has been used in studies as a screening tool to identify which patients experience the wearing-off phenomena.
The team conducted a cross-sectional study to assess the impact of motor and non-motor wearing-off on daily activities and quality of life in Parkinson’s patients. All patients were evaluated using the movement disorders society unified Parkinson’s disease rating scale (MDS-UPDRS, to follow disease progression), the WOQ-19, and the Parkinson’s disease questionnaire-8 (PDQ-8) to assess quality of life.
Among the 271 patients included, 73.4% had wearing-off. Researchers then classified those patients according to the type: 63.8% had mixed wearing-off (motor and non-motor), 32.7% motor, and 3.5% non-motor.
As expected, the MDS-UPDRS part I total score — which assesses non-motor aspects of daily living — was higher (worse) in the non-motor wearing-off group. Interestingly, there were no differences in MDS-UPDRS part I score between patients in the mixed wearing-off group and those who did not experience wearing off.
“This finding suggests that patients with motor wearing-off may have a lower overall burden of non-motor symptoms, while patients with mixed or no wearing-off have similar burdens,” researchers said. “Conversely, patients with non-motor fluctuations also have a higher burden of non-motor symptoms.”
Parkinson’s patients in the non-motor wearing-off group also had the worst score in the PDQ-8, followed by patients in the mixed wearing-off group. On the other hand, patients with no wearing-off and those with only motor wearing-off had a better quality of life.
“[T]he present study shows that both motor and non-motor fluctuations have an impact on activities of daily living and quality of life. However, the presence of non-motor fluctuations did significantly worsen the quality of life,” the authors wrote.
“The identification and assessment of non-motor fluctuations in the day-to-day clinical practice could result in the improvement of the quality of life of patients with [Parkinson’s disease],” the team concluded.
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Rock Steady Boxing: In the Beginning

rock steady boxing

In September 2017, I started to take Rock Steady Boxing (RSB) classes. RSB has truly made a remarkable impact on improving the quality of my life.

What’s it all about?

The RSB classes I attend twice a week average about 10 to 16 people per class. The ages of the participants vary, and we are all at various stages of the disease. Many participants deal with obvious symptoms like tremors. Some are like me, in the earlier stages of PD with no glaring symptoms.

My late husband was a well-known triathlon swim coach. Steve and I were together for over 33 years, and I was immersed in his world with athletes of all levels. However, I’ve found that the drive, dedication, and commitment of the RSB participants equals or exceeds that of most of the athletes I have known. Everyone I have met in RSB classes is determined to fight this cruel and insidious disease of countless losses. None will let PD get the best of them.

In 75 minutes, we work on our stamina, strength, speed, cognitive skills, and balance. We are encouraged to count loudly and also perform fine motor skill exercises. It is like a group physical therapy session, with the bonus of mental therapy. We celebrate each other’s triumphs, no matter how insignificant they may seem to the casual observer. As an example, if a participant succeeds for the first time to perform a “skip,” we will all loudly cheer him or her on. When we literally stumble or fail at a particular drill, there are more than enough sympathetic shoulders to lean on.

Laughter is the best medicine!

We will laugh at ourselves when the sometimes absurdity of our disease symptoms threaten to dampen our spirits. During our heavy bag punching drills, our coach will sometimes tell us to go faster. I think this is hilarious since “fast” is a foreign concept to me now. Every time she asks us to increase our speed, I break out into belly laughs.

But the tears do flow

However, at some point or another during a class, many of us will experience highly-charged emotional moments. It took only a month of taking RSB classes for me to have my first meltdown.

My emotions got the best of me as I was doing a footwork drill. This was a move I had once done with grace, rhythm, and fluidity, back when I used to dance. Now when I do this step, I feel like I have lead legs, and it takes every bit of my willpower to recreate just the mechanics (forget about the grace of a ballerina) of a once-simple step for me.

Another time, we “shoveled snow.” Using a spoon with our non-dominant hand, we were challenged to fill a bowl with as many cotton balls as we could in 30 seconds. I am right-handed, and my left side is most affected by PD. It was a huge struggle for me even to get nine cotton balls in the bowl using my left hand. My eyes started to well up with tears as I was doing the exercise. I felt so uncoordinated and helpless, trying to will my body to quickly perform such a simple task. The 30 seconds seemed like an eternity, but I was finally able to finish without crying mainly due to the support and kind encouragement from other participants. Seeing the beaming smiles on some of my fellow boxers’ faces bolstered my spirits. It is ironic how failing at one small mindless task can bring a person to tears, yet, if performed well it can be so satisfying, and such a joy.

While it may seem inconsequential, performing a fine motor skill task like “shoveling snow” can become monumental and overwhelming. This is just one small example of the simple movements I had always taken for granted that PD has robbed from me. I suspect that most of my fellow boxers in class that day truly empathized with me. Although their PD challenges may be different and unique to them, I believe they, too, have their moments of despair when they are reminded of what they have lost to this disease. PD affects everyone so differently, and while one class member may perform a drill well, another may struggle tremendously with it. There seems to be no rhyme or reason as to what any one person loses as a result of this disease. One thing we are all cognizant of is that PD does not discriminate. We also realize that what we can easily do today may be robbed from us tomorrow.

To be continued …

Since there is so much to share about my RSB journey, next month, I will continue talking about my boxing experiences.


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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Source: Parkinson's News Today