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Palliative Care Leads to Better Quality of Life than Standard Care for PDRD Patients, Study Finds

Palliative care

Palliative care — focusing on physical, psychosocial and spiritual treatment — for people with Parkinson’s disease and related disorders (PDRD) led to a significantly better quality of life (QoL) than standard care alone, a study finds.

Easing of both non-motor and motor symptom severity was linked to palliative care intervention — and those with the greatest needs benefited the most, the researchers said.

The study, “Comparison of Integrated Outpatient Palliative Care With Standard Care in Patients With Parkinson Disease and Related Disorders,” was published in the Journal of the American Medical Association, Neurology

Parkinson’s disease and related disorders (PDRD) are a group of disorders that share core features of Parkinson’s but have additional symptoms. People with PDRD do not respond well to standard Parkinson’s medications and have a poor prognosis. 

Given the additional needs of patients with PDRD, an increasing number of medical centers are providing palliative care for these patients. 

While such care is typically associated with hospice and cancer, “recognition of the potential relevance of [palliative care] in other contexts has expanded substantially over the past decade to include earlier deployment, delivery to noncancer populations, delivery in outpatient settings, and delivery by persons not specializing in palliative medicine,” the researchers said.

Palliative care, known as PC, aims to improve quality of life (QoL) and reduce suffering by addressing medical symptoms, psychosocial issues, and care planning. 

Despite the recent advances in patient care, few studies are available that support the effectiveness of palliative care in the PDRD population.

Thus, a team of investigators from the University of Colorado (UC), the University of California, San Francisco (UCSF), and the University of Alberta (UA) in Canada, designed a study (NCT02533921) to examine the effects of this care approach. The team compared outpatient palliative care with standard care alone to assess any differences in participants’ QoL, the burden on the caregiver, and other patient-related outcomes. 

A total of 210 PDRD patients with moderate-to-high care needs were enrolled in the study, with participants randomly divided into a standard care group and a palliative care group. Of those selected, 104 patients and 88 caregivers were part of the standard care group, while 106 patients and 87 caregivers were assigned to the palliative care intervention group.

Standard care was provided by the patient’s primary care physician and a neurologist. 

Outpatient palliative care included standard care plus visits every three months either in person or by telemedicine — two-way videoconferencing and advanced information communication technologies. The PC team consisted of a specialized neurologist with palliative care workshop training, a nurse, a social worker, a chaplain experienced with Parkinson’s patients, and a physician specializing in this type of care. 

The primary outcomes were defined as differences in patient QoL after six months, measured using the Quality of Life in Alzheimer’s Disease (QoL-AD) scale, and by determining caregiver burden, using the 12-item Zarit Burden Interview (ZBI-12). 

Additional patient outcomes also were assessed, including symptom burden and health-related QoL. Patient and caregiver mood, grief, spiritual well-being, and overall impression of change also were reported. The outcomes for both patients and caregivers were recorded at the beginning of the study, and every three months for 12 months.

The results showed that, after six months, those receiving outpatient palliative care had significantly better QoL compared with those receiving standard care. When QoL assessments of patients and caregivers were combined, the impact was even greater. 

While the ZBI-12 difference in caregiver burden at six months was not significant, reassessment at 12 months showed a statistically significant difference. 

The greatest benefit from palliative care intervention was seen among the patients who were assessed, at the beginning of the study, as having greater needs. After 12 months, palliative care had a greater effect on women compared with men. 

In comparison with the standard care group, the PC group had a greater number of patients who experienced a clinically significant benefit in QoL-AD, and a lower number of those who scored worse.

Factors such as age, mood, symptom burden, disease severity, and cognition were not significantly different. However, improvements in non-motor symptoms, motor symptoms severity, and caregiver anxiety were linked to palliative care. 

Standard care alone was not favored for any outcome, the results showed. 

“Outpatient PC is associated with benefits among patients with PDRD compared with standard care alone,” the researchers concluded. “This study supports efforts to integrate [palliative care] into PDRD care.”

The researchers said such efforts are particularly needed for people with more severe symptoms.

“The integration of [palliative care] into PDRD care holds the potential to improve outcomes, particularly for persons who are underserved by current models of care (eg, patients with advanced illness and dementia),” the investigators said.

“Because the PC intervention is time-intensive and resource-intensive, future studies should optimize triage tools and consider alternative models of care delivery, such as telemedicine or care navigators, to provide key aspects of the intervention at lower cost,” they recommended. 

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Here’s Why You Should Consider Getting a Dog

dog

I’m notorious for attempting to convince everyone in my life to get a dog. I love the furry animals, but I often travel or am in places that aren’t particularly dog-friendly. So my latest mission is to convince my dad to get a dog.

Could having a well-trained dog, such as a service dog or an emotional support dog, benefit someone who has Parkinson’s disease? 

Parkinson’s disease and dogs

For someone with Parkinson’s disease, service dogs have been shown to help their owner with challenges like maintaining balance. About 38 percent of people with Parkinson’s disease fall at least once a year, so balance might be one of the disease’s bigger threats. The right service dog could assist its owner in maintaining balance and alerting someone if the owner falls. 

Dogs also can help with freezing episodes by nudging or encouraging their owner to move forward.

While it might not seem intuitive to add another living being to your household, service dogs are trained to perform tasks that their owners might be unable to perform. When properly trained, dogs can turn off the lights, open doors, and carry small items. 

Additionally, many Parkinson’s patients experience depression and anxiety. Dogs can have a positive influence on some of these symptoms. Having a dog around your home can help to combat feelings of isolation while increasing overall health and well-being.

But what type of dog is best for you?

Service dogs

Service dogs are seen as an extension of their human. They are trained to perform tasks that their owner might be unable to perform. 

What you need to know about service dogs:

  • Service dogs can go anywhere their humans go.
  • They aren’t legally obliged to wear a vest, patch, or other identification.
  • They don’t need to be professionally trained to be considered service dogs.
  • Hotels and landlords can’t charge you additional fees for having a service dog.
  • Service dogs come in any shape or breed.

If you’re a dog lover, you might find it useful to know that service dogs don’t always have to be on duty. Sometimes they’re allowed to kick back and be their puppy selves. 

Emotional support dogs

Emotional support dogs essentially are a legal step down from service dogs. They’re intended as therapeutic animals, not to help you perform tasks. You won’t have as much legal flexibility with a support dog as you would with a service dog. For instance, national parks in the U.S. aren’t pet friendly. But because service dogs are seen as an extension of their humans, they are legally allowed. Emotional support dogs wouldn’t be. 

While finding housing, landlords are allowed to ask if you have a disability and if your dog assists with your disability. They’re required to allow you to live with your emotional support dog or another animal regardless of their stance on pet ownership. 

Companionship

I know that dog ownership involves many important factors. They can be expensive. You want them to have a good, active life and a nice yard. Sometimes, the thought of a young dog can feel overwhelming because they require so much attention. 

But adding a reliable companion to your life might make a bigger difference than you realize. (Hi, Dad. Get a dog!) Not only do dogs have a grounding effect on their loved ones, they’re also capable of offering a tremendous amount of support in terms of the tasks they can perform. 

Do you have a service or emotional support dog? What benefits have you encountered? Please share in the comments below.

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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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Weekly Multi-Modal Exercise Program May Benefit Parkinson’s Patients, Study Says

Parkinson's, exercise

A once-a-week multi-modal exercise program can improve and preserve motor function and cognition in Parkinson’s patients, according to a recent study.

Results of the study were presented in a session, “Can a Weekly Multi-Modal Exercise Class Preserve Motor and Non-Motor Function in Parkinson’s?” at The Physiological Society‘s recent early career conference, Future Physiology 2019: Translating Cellular Mechanisms into Lifelong Health Strategies.

Parkinson’s is a chronic neurodegenerative disease that can make it difficult for patients to lead an active lifestyle. Previous studies have shown that single modality exercise — which refers to a single type of exercise — can improve and help maintain both cognitive and physical function in those with Parkinson’s.

However, multi-modal exercise — such as circuit training plus cognitive training — may carry more benefits.

To date, a few studies have evaluated the long-term consequences of regular multi-modal exercises in Parkinson’s patients.

In the study, researchers at the University of Kent established a weekly community-based multi-modal exercise regimen for Parkinson’s patients and assessed the effects of this program on physical function, cognition, and well-being over a period of one, two, and three years.

A total of 25 patients participated in the study, which included 20 men and five women (average age of 64 years) with mild-to-moderate Parkinson’s disease. They attended a 60-minute multi-modal group exercise session weekly for over a year.

Results were compared to an aged-matched group of 20 healthy older adults and 20 Parkinson’s patients who did not exercise.

Several health and functional assessments were completed at the beginning of the study and then every four months for three years. Physical function was assessed using four tests: the six-minute walking test, timed up and go, bilateral grip strength, and 1-minute sit-to-stands.

Additionally, researchers assessed the participants’ cognitive function (using the Clock Drawing Test, Trail Making Test A and B, and the Mini-Mental Parkinson’s or MMP test), and quality of life (using the Older People’s Quality of Life Questionnaire).

At baseline, no health-related differences were reported between the groups. For patients who participated in the exercise regimen, the scores for the six-minute walking test (which measures the distance walked over six minutes), timed up and go (which determines fall risk and measures the progress of balance, sit to stand, and walking), and bilateral grip strength (which measures the strength of the hand and forearm muscles) did not significantly decrease over one, two, or three years.

However, the number of 1-minute sit-to-stands (STS) — a method to assess exercise capacity and physical condition — increased during one year between baseline (STS = 21) and after the first four months (STS = 23). This was also true for the MMP scores, which increased between baseline (MMP = 26.67) and after eight months (MMP = 29.38).

While no other significant changes in health, cognition, and physical function were observed, there was also no decline in these parameters, and exercise seemed to reduce the difference in timed up and go, bilateral grip strength, and STS scores between Parkinson’s patients and healthy older adults after one year.

Additionally, patients who did not participate in the exercise regimen had lower scores for the six-minute walking test, timed up and go, and STS compared to healthy older adults.

“A once-a-week multi-modal exercise program for [Parkinson’s disease] showed an improvement in STS and MMP scores and no other significant changes (i.e. no decline) in health, cognition and physical function over 1, 2 and 3 years,” the researchers wrote.

That functional and cognitive performance were slightly increased or maintained is a positive outcome given the progressive nature of Parkinson’s,” they said.

Anna Ferrusola-Pastrana, a researcher involved in the study, said in a press release: “Finding the right set of exercises, both cognitive and physical, to improve Parkinson’s treatment is an important step towards giving Parkinson’s patients a better quality of life. This research is working towards honing this set of exercises, which can then potentially be performed by patients, with or without assistance at home.”

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Mitsubishi Tanabe Pharma Shares Results from Phase 2 Study of ND0612 for Advanced Parkinson’s

ND0612

Continuous delivery of carbidopa/levodopa (CD/LD) with ND0612 under the skin led to quick improvement of clinical status and better quality of life for  patients with advanced Parkinson’s disease, according to patient-reported outcomes from a Phase 2 clinical trial.

Now, a global Phase 3 study named BouNDless (NCT04006210) is recruiting Parkinson’s patients who have motor fluctuations characterized by the reoccurrence of motor symptoms between levodopa doses. The trial will be conducted at approximately 120 sites globally. (More information on contacts and locations is available here.) This study will compare the effectiveness, safety and tolerability of ND0612 to oral immediate-release CD/LD.

ND016 is delivered by subcutaneous (under-the-skin) infusion via a pump system to increase brain levels of dopamine, found in lower levels in people with Parkinson’s. It has been developed by NeuroDerm, which, similar to Mitsubishi Tanabe Pharma America (MTPA), is owned by Mitsubishi Tanabe Pharma Corporation.

The results from a 28-day, open-label study (NCT02577523), “Impact of ND0612 on patient reported outcomes: A blinded rater study of 2 dosing regimens,” were presented at the 23rd International Congress of Parkinson’s Disease and Movement Disorders in Nice, France.

The trial included 38 patients (age 30–80) assigned randomly to 24- or 14-hour infusions of ND0612. Those in the 24-hour group received a daily CD/LD dose of 720/90 mg, while those in the 14-hour group wee given a CD/LD dose of 538/68mg plus a morning oral dose of CD/LD of 150/15 mg.

After one day of standard oral CD/LD, the patients were treated with ND0612 over 27 days. Supplemental oral CD/LD was used if needed.

Patient-reported outcomes were measured using the Unified Parkinson Disease Rating Scale (UPDRS) part II (activities of daily living) at day 28, and the Parkinson’s Disease Questionnaire (PDQ-39, a measure of health status and quality of life) at day 27. The participants also self-rated their impression of improvement at days three and 28.

The results showed that more than 70% of patients reported an improvement in overall clinical status as early as day three. Continuous (24- group) CD/LD delivery led to a significant improvement — a 2.9-point decrease — in the UPDRS ADL score compared to baseline. These scores also trended toward  improvement in the 14-hour group.

Quality of life also was better for patients in the 24-hour group, as the PDQ-39 score reduced by 7.5 points. Again, these scores also trended toward  improvement in the 14-hour group.

Six of the eight PDQ-39 domains were associated with improvements: bodily discomfort, activities of daily living, emotional well-being, mobility, communication, and stigma.

“Many people with Parkinson’s disease take multiple doses of oral CD/LD as their disease progresses, which can cause additional motor fluctuations that may be debilitating and contribute to poor quality of life,” Atsushi Fujimoto, MTPA’s president, said in a press release. “The data presented at MDS add to the body of research on ND0612.”

Sheila Oren, MD, chief medical officer at NeuroDerm, noted the “potential impact of stabilizing CD/LD levels with continuous treatment on a variety of clinical, daily living and quality of life measures.”

In the study “BouNDless: An active-controlled randomized, double-blind double-dummy study of continuous ND0612 infusion in patients with fluctuating Parkinson’s disease ,” the team also presented the design of the BouNDless trial.

The first of approximately 300 patients was enrolled last month. Eligible patients are those not responding to standard treatments, with a minimum of 2.5 hours of motor fluctuations daily and at least two hours per day in the “off” state (no motor control) during waking hours.

The trial’s primary objective is to determine whether ND0612 improves self-reported daily “good on time,” defined as the sum of “on” time without dyskinesia (involuntary movements) and “on” time with non-troublesome dyskinesia.

“We look forward to gaining additional insights on this investigational treatment through the Phase 3 study,” Fujimoto said.

“We are proud of the research behind ND0612 to date and committed to learning more about this investigational treatment for people with fluctuating Parkinson’s disease through the recently initiated Phase 3 study,” Oren said.

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What Not to Say to Someone with Parkinson’s Disease

words

Not all people with Parkinson’s disease experience the same symptoms. For example, I am most affected by bradykinesia, poor fine motor skills, incontinence, and fatigue.

I was inspired to write this column based on my personal experiences after I read Sherri Woodbridge’s column, “What to Say to Someone with Parkinson’s Disease.” Most people don’t know what to say and usually have good intentions. However, poorly chosen words can Be mindful of how you speak to someone with Parkinson’s.

  

 1. ‘You don’t look like you have Parkinson’s.’

This is my least favorite comment. Many of my symptoms are unseen. People have no idea how much I am struggling at times to maintain some semblance of normalcy. Most days, I feel shaky and weak, and I am totally exhausted.

A comment like this can minimize the hidden symptoms that are very real to the person with Parkinson’s. Most people do not understand what those of us with the disease deal with daily and sometimes hourly.

2. ‘You are lucky you don’t have tremors.’ Or, ‘Your symptoms could be worse.’

Parkinson’s is progressive and unpredictable. It’s impossible to know where my symptoms might be six months from now, let alone six years from now. Just because I don’t exhibit a particular symptom now does not mean I will never have it. At times, Parkinson’s feels like the sword of Damocles hanging over my head.

3. ‘You look like you are having a good day. Your Parkinson’s must be getting better.’

If I am having a good day with few symptoms, it doesn’t mean that my disease is getting better. There is no cure and no way to heal from Parkinson’s. For me, good days are fleeting and the exception to the rule. A comment like this serves only to remind me that Parkinson’s is progressive.

4. ‘I have the same problem.’

Sometimes, people respond with this statement when I comment about one of my symptoms (choose any of the following):

  • tripping
  • having to sit down when I put on my shoes
  • losing my balance all the time
  • forgetfulness
  • inability to multitask

I think well-meaning people say they have the same issues because they don’t want me to feel alone in experiencing these challenges. After all, they can develop over the natural course of aging. Most people do not understand, however, that I used to be very sharp mentally and was a strong athlete and dancer before I was diagnosed. That makes these symptoms much more glaring for me.

 5. ‘Hurry up!’ Or, ‘What is taking you so long?’ Or, ‘Late, again?’

With Parkinson’s, I have two speeds: slow and slower.

I clearly remember, years ago, watching my Parkinson’s-diagnosed friend putting on her coat or fastening her seat belt. I would think to myself, “Why is she so slow?” Now, I totally understand what she was dealing with.

6. ‘You have to use the bathroom again?’

My late husband always told me my life was ruled by my bladder. No truer words have been spoken, especially now that I have Parkinson’s. I never like to be too far from a bathroom. I found a smartphone app called Flush that displays public restrooms nearby, and I never leave home without it!

7. ‘Please fill out this form and print legibly.’

Doctor’s office staff, please take note of this one. I cringe whenever I see a new doctor and have to fill out reams of paperwork. My handwriting is atrocious; it was the first symptom that sent me to the neurologist. And guess what? I had to fill out a lot of paperwork at his office! Although my typing on a computer is no longer as fast as it used to be, at least I have a spell-checker. E-forms are a greatly appreciated and preferred option.

8. ‘Parkinson’s doesn’t kill you.’

It’s true that people do not die from Parkinson’s, but they typically die from complications of the disease. As an example, Parkinson’s can impair patients’ ability to swallow, putting them at risk for inhaling, or aspirating, food or liquid into their lungs, leading to aspiration pneumonia. Pneumonia is the leading cause of death in patients with this disease.

Still, I fear living with a poor quality of life and loss of my independence more than I fear dying.

In the grand scheme of things, comments made out of ignorance are no big deal considering what people with Parkinson’s deal with every day. Now that you know what not to say, read Sherri’s column on things you can say to someone with Parkinson’s.

Sometimes you don’t have to say anything. Silence speaks it all.”Disha Patani

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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.

The post What Not to Say to Someone with Parkinson’s Disease appeared first on Parkinson’s News Today.

Resistance Training Reduces Depressive Symptoms in Older PD Patients, Trial Shows

Resistance training

Twenty weeks of resistance training significantly decreases depression symptoms and improves quality of life in older people with Parkinson’s disease (PD), a study has found.

The training, consisting of exercises involving the arms and legs and simulating daily activity movements, also improved patients’ flexibility, endurance, and walking performance.

Based on the promising results, researchers are calling for resistance training to be included in exercise programs for patients with Parkinson’s disease.

Their study, “Resistance training reduces depressive symptoms in elderly people with parkinson disease: A controlled randomized study,” was published in the Scandinavian Journal of Medicine and Science in Sports.

Loss of muscle strength and function predisposes Parkinson’s patients to sedentary behavior and social isolation, with consequent increase in depressive symptoms, affecting up to 40% of patients.

But studies suggest that those who have a more active lifestyle and exercise are less prone to depression.

Some researchers contend that exercise works at least as well as antidepressants. The effect of exercise as natural antidepressant is thought to be mediated either by stimulating the growth of new nerve cells — as antidepressant medications might — or releasing substances from muscles and fat cells (adipocytes) that can travel to the brain and work as antidepressants.

Up to now, known effective physical therapies against depression in Parkinson’s are based mostly on  aerobic exercises.

Here, Brazilian researchers conducted a trial to evaluate the benefits of another exercise modality — resistance training — in reducing depression and improving quality of life in elderly patients with PD.

Considering its potential physical benefits, researchers investigated how much this type of training improved patients’ movement and resistance capacity as well. The trial was sponsored by Pará State University, in Brazil.

Resistance training is a form of exercise designed to improve muscular fitness by exercising a muscle or a group of muscles against any object that poses an external resistance. This causes muscles to contract, which can help improve strength, power, muscle growth, and endurance.

The trial involved 33 patients, age 60 or older, who were randomly assigned to resistance training (17 patients) or a control group (16 patients) for 20 weeks. All were on stable medication and had Parkinson’s stage 1-3 on the Hoehn and Yahr scale.

Those in the resistance training group spent the first two weeks getting used to the exercises, under supervision. After that, they started having training sessions twice a week, on non-consecutive days.

Each session (30–40 minutes each) consisted of two series of of 8–12 repetitions of these exercises: bench press, deadlift, unilateral rowing, standing calf raise and abdominal reverse crunch. Such exercises involve the major muscle groups in the arms and legs and mimic the basic movements of daily activities.

Training loads were increased when the patient had a high performance, with full range of motion.

Unlike the control group, at the end of the 20 weeks, patients performing resistance training had fewer depressive symptoms. Clinician-rated HAM-D17 scores dropped from 17.9 to 10.3.

Patients in this group also reported improvements in their quality of life (as measured by the Parkinson’s disease Questionnaire, PDQ-39) and had better UPDRS scores, which rate Parkinson’s motor and non-motor symptoms.

Concerning motor capacity, resistance training also improved patients’ physical performance as seen in several tests — Timed Up and Go (pre-training, 33.2 seconds versus post training, 26.4 seconds), flexibility on the sit and reach test (pre, 20.7 cm versus post, 28.8 cm), aerobic endurance measured by the two-minute step test (pre, 79.2 steps versus post, 99.1 steps) and maximum walking speed (pre, 1 meter per second versus post, 1.3 meters per second).

In contrast, no significant changes were seen in the control group, either regarding depressive symptoms, quality of life, or motor skills.

“In addition to improving functional capacity and quality of life, resistance training reduces depressive symptoms of elderly with Parkinson’s disease,” the researchers said.

“To our knowledge, the present study is the first to show that 20 weeks of isolated resistance training reduced depressive symptoms in elderly people presenting PD. We suggest that resistance training should be a central component of exercise programs for patients with Parkinson’s disease,” they concluded.

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TNM Device for Thermal Brain Stimulation Eases Motor and Other Symptoms of Parkinson’s, Small Trial Reports

TNM device study

Twice daily treatment with ThermoNeuroModulation (TNM), a non-invasive device for at-home use, provided sustained motor and non-motor benefits and was associated with high satisfaction in a small group of Parkinson’s patients on standard medications, a clinical trial reports.

The study based on its findings,“Caloric vestibular stimulation for the management of motor and non-motor symptoms in Parkinson’s disease,” was published in the journal Parkinsonism and Related Disorders.

Results of a previous study in a 70-year-old man with Parkinson’s found that daily use of caloric vestibular stimulation (CVS) eased both disease motor and non-motor symptoms by nearly 50%.

CVS, which stimulates the vestibular system, is self-administered via the portable TNM device, delivering thermal waveforms through ear pieces in a headset (37° C–42°C to one ear and 37 °C–17 °C to the other, over about 19 minutes). Ears given the slow warming and cooling waveforms are switched every two days.

The vestibular system is a sensory network with diffuse pathways throughout the brain, and responsible for providing the brain with information about motion, head position, and spatial orientation.

Researchers in the U.K. and U.S. conducted a double-blind and randomized trial (NCT02703844) with 33 Parkinson’s patients to determine whether the TNM device, developed by Scion, could provide sustained and clinically relevant motor and non-motor benefits.

All were on standard anti-parkinsonian therapies, most frequently oral levodopa-based treatments. The median age of the 16 patients undergoing TNM stimulation (10 men, median 10 years since diagnosis) was 68. The remaining 17 patients received a sham (placebo) treatment.

Use of the TNM device for two months followed a four-week baseline period. Participants were further evaluated at five and 24 weeks after treatment. At each visit, the patients were assessed during “on” states – which refer to periods when anti-parkinsonian medications are effective — to judge changes in motor and non-motor symptoms, activities of daily living, and quality of life.

Compared to those on placebo, the 16 patients undergoing TNM showed significantly improved scores in the MDS-UPDRS Part I scale, which refers to non-Motor Aspects of Experiences of Daily Living. “Therapeutic gains for this assessment were greatest 5 weeks after the cessation of treatment although change scores at both time-points surpassed a previously established minimal clinically important difference,” the researchers wrote.

Similar benefits were observed in the Montreal Cognitive Assessment of cognitive impairment, MDS-UPDRS Part II — motor aspects of daily life activities — and Part III (motor exam), the Modified Schwab & England Activities of Daily Living scale, the 10-meter test of walking speed, the Timed Up and Go test of mobility and balance, and the MDS-UPDRS Part IV (motor complications).

Most of these benefits were attributed to lesser dyskinesia, or involuntary and jerky movements, and most levels returned to baseline (those at the study’s start) after six months.

Patients given TNM treatment were unable to correctly guess their study group, which the team partly attributed to difficulty perceiving the gradual improvements.

A total of 34 adverse events (AEs) were reported, 24 in the group undergoing TNM stimulation. The three serious AEs were deemed unrelated to the device. Four AEs — ear discomfort, dizziness/motion sickness and migraine — were considered possibly related to the device, and all resolved after the end of treatment. All other AEs were minor and thought most likely due to the disease.

Most, 25 people, found the device easy to use at home, while six had the opposite opinion but continued its use anyway. All but three found the time spent in treatment as “enjoyable” or “acceptable.” Twelve patients on TNM and 16 on placebo rated their overall experience with the device as “very positive” or “somewhat positive.”

“The results provide evidence that repeated CVS can provide safe and enduring adjuvant relief for motor and non-motor symptoms associated with [Parkinson’s],” the scientists wrote.

“One typically doesn’t see such consistency in study results when evaluating a new therapy,” Hubert Fernandez, director of the Cleveland Clinic’s Neurological Institute, who reviewed the data, said in a press release. “The fact that the gains observed were on top of the standard therapies is quite promising.”

Kallol Ray Chaudhuri, the medical director of the Centre of Excellence in Parkinson’s and Movement Disorders at King’s College, also considered the results “very encouraging.” Chaudhuri added that achieving benefits in non-motor symptoms “would be especially notable.”  Such symptoms, he said, “are often untreated or poorly treated and have a particularly detrimental impact on quality of life, and their treatment is a key unmet need.”

“I am intrigued and want to see where this device technology might go,” Chaudhuri added.

The TNM Device 3.2 was cleared for marketing in the U.S. (ages 12 and older) and the E.U. (adults) for the prevention of episodic migraine. Parkinson’s patients may currently only use the device (TNM Device 4.0) in clinical trials.

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Sexually Active Life Linked to ‘Milder’ Disease Progression in Men with Early Stage Parkinson’s, Study Finds

sexual life and disease

An active sexual life is associated with less severe motor and non-motor disability and a better quality of life in men with early Parkinson’s disease, a study reports.

Its findings are “in line with data showing a close relationship between sexual health and general health both in healthy individuals and in patients with chronic disease,” its researchers wrote, calling on doctors to be watchful of their patients’ sexual life.

The study, “The PRIAMO study: active sexual life is associated with better motor and non‐motor outcomes in men with early Parkinson’s disease,” was published in the European Journal of Neurology.

Because people with Parkinson’s disease have to deal with important changes in sexual function, “achieving a satisfying intimate and sexual relationship is often a challenge.”

Data from previous studies indicate that patients’ sexual performance is affected by their illness, and men with erectile dysfunction, particularly, have worse disease progression.

It is important to stress, however, that an active sexual life — rather than a person’s sexual function — can serve as a general indicator of good health. But little is known about how sexual activity influences the course of Parkinson’s disease.

A team of researchers with the Center for Neurodegenerative Diseases (CEMAND) at the University of Salerno, Italy, analyzed data from a group of 355 people (238 men and 117 women) with early stage Parkinson’s disease who were enrolled in the PRIAMO (PaRkinson dIseAse non MOtor symptoms) study and followed for two years.

Researchers wanted to understand if an active sexual life associates with better outcomes, and how prevalent sexual dysfunction is among sexually active Parkinson’s patients.

Individuals were asked whether they had been sexually active in the past 12 months. Those who responded positively were then questioned about specific issues that arose in the last month, including reduced sexual desire, impotence, loss of erection, or inability to reach an orgasm.

Motor disability, cognitive abilities, and quality of life were measured using validated scales: respectively, the  UPDRS‐III, MMSE, PDQ‐39 and EQ-VAS scales. Depression and other non-motor symptoms were also evaluated.

Early stage Parkinson’s was defined as a score of 2 or lower in the Hoehn and Yahr (H&Y) scale, a five-stage measure of disease progression and disability level, at the study’s start.

Data showed that patients’ sexual activity progressively dropped over time, with 56.3% of patients reporting to be sexually active at the study’s start and 50.8% reporting the same two years later. Men were twice as likely to be active as women.

Nearly half of sexually active men complained about erectile dysfunction (difficulties with erection and impotence) and orgasmic disorders at every time point.

Sexually active men tended to be younger and to have had an earlier onset of symptoms than non-active male patients.

Noticeably, sexually active men were less likely to have gastrointestinal problems and less likely to be affected by apathy (a general lack of motivation and interest) than those not sexually active. The odds of lower chances of these non-motor symptoms were 44% (gastrointestinal problems) and 58% (apathy).

Male patients with an active sexual life were associated with less severe motor disability, better quality of life, and lower depression scores. At two years, they were taking levodopa less frequently and had lesser fatigue as well as attention or memory problems, “reflecting a milder motor impairment and disease progression,” the researchers wrote.

No association between sexual activity and disease symptoms were shown for women, which researchers suggested might be because of gender differences in symptoms and attitudes toward open discussion of sexual drive and difficulties, and the smaller group of female patients in the study.

“The most novel finding of our analysis was that, irrespective of disease severity as evaluated by the H&Y, sexually active men displayed distinctive demographic and clinical features,” the researchers wrote, adding that the findings suggest “that sexual activity might be associated with reduced motor and non‐motor burden and milder disease progression in men with early [Parkinson’s disease].”

They added that, from a “clinician’s perspective, examination of a patient’s sexual life is often neglected during the clinical interview.”

While further studies are needed to confirm such data, they “should prompt movement disorders specialists to periodically inquiry about their patients’ sexual life,” the team concluded.

It is important to note that all correlations between sexual activity and patient outcomes were controlled for patients’ age and disease duration.

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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

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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