Parkinson’s Disease Dementia Surgery And Gene Therapy
- Great strides have been made in the surgical treatment of Parkinson’s disease. Several different procedures are now available, and they are successful in many patients in relieving movement symptoms. Unfortunately, surgery has no effect on cognitive symptoms. In fact, most people with dementia are not candidates for surgery.
- Gene therapy is in its infancy there are ongoing human and animal trials with various methods to insert genes into neuronal cells to reduce or stop Parkinson’s disease symptoms by causing cells to produce dopamine coded by the newly inserted genes. Early results with the treatment termed ProSavin are encouraging. However, it is not clear if such therapy could prevent or reverse Parkinson’s disease dementia.
What Is The Outlook For Persons With Parkinsons Disease
Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.
Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.
The future is hopeful. Some of the research underway includes:
- Using stem cells to produce new neurons, which would produce dopamine.
- Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
- Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.
Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.
General Anesthesia And Parkinsons Disease
C.-W. CHEN, K.-B. CHEN, Y.-C. KUO
Session Time: 1:45pm-3:15pm
Location: Exhibit Hall C
Objective: Postoperative cognitive dysfunction is common among the elderly. These changes may even be so severe that some elderly people actually become demented after undergoing an operation. There was minimal evidence to support continued postoperative cognitive decline beyond 5 years or more. The aim of this study is to explore whether general anesthesia impact the incidence of Parkinsons disease in nationwide population.
Background: Parkinsons disease is one of the important diseases among older population and leads to disability. The exact mechanism of PD is variant. Whether general anesthesia is a potential risk factor for the development of PD is controversial. Therefore, this study aimed to evaluate the association between previous exposure to different types of GA and the incidence of PD.
Methods: Using claims data of 1,000,000 insured residents covered in the national health insurance, we enrolled 4,931 newly diagnosed dementia cases with age more than 50 years-old in 2005-2009. The control group of 19,720 individuals without PD was matched for age, gender, and index date. GA were categorized as three subtypes, including endotracheal tube intubation general anesthesia , intravenous injection general anesthesia or intramuscular injection general anesthesia , and heavy sedation. Multivariate logistic regression model was used for analyses.
To cite this abstract in AMA style:
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How Does Parkinsons Disease Affect The Body
Recognising the signs
A combination of signs can help a doctor make an early diagnosis. If Parkinsons disease is diagnosed early, the chances of being able to treat and manage the condition are greater. Individual signs may not be an indication of Parkinsons disease. Some signs such as loss of smell could be caused by an infectious illness, or joint stiffness by conditions like arthritis.
Parkinsons is most commonly diagnosed with a very physical examination and assessment of a persons medical history. There are very specific markers for diagnosis which doctors use to assess for possible Parkinsons disease. These markers have a lot to do with a combination of very specific signs and symptoms and if recognised early enough, can be better managed.
1. Primary motor symptoms
2. Secondary motor symptoms
Other motor symptoms include:
Some individuals may also experience the following:
- Hunched over / stooped posture – When standing, the body may begin to slouch or lean inwards, causing a hunched over appearance.
- Impaired gross motor coordination
- Impaired fine motor dexterity and motor coordination
- Difficulties with swallowing or chewing
- Cramping
- Production of excess saliva and drooling
- Sexual dysfunction
- Dystonia
- Akathisia
3. Non-motor symptoms
Symptoms that do not involve physical movement or coordination, and often precede motor problems, can include:
Symptoms are initially mild, even if they develop suddenly, and typically affect one side of the body at first.
Caring For Someone With Parkinsons
Practice patience and understanding when dealing with Parkinsons. You may be very frustrated and challenged as a caregiver, but those with Parkinsons are just as frustrated. Their physical and mental conditions can be debilitating, depressing, and humiliating.
Diet and nutrition can have a huge impact on the health and comfort of a Parkinson patient. Eating well, getting more rest, sleeping well, fresh air, and exercise can make a difference. Getting the right medication and complementary therapies is also important.
As Parkinsons impacts a patients motor skills, modifications to the living environment may have to be made to accommodate wheelchairs and limited mobility issues. Professional in-home assistance for Parkinsons can allow Parkinson patients to remain independent and can enhance quality of life.
Most importantly, seek help and support from family, friends, and caregiving support groups. Take advantage of the resources in your community. Shouldering all the burden can take a toll on a caregiver.
Take care of yourself or you wont be able to take care of your loved one. Follow the preventive advice provided above for yourself as well, and take deep breaths!
Resources
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Symptoms Of Parkinsons Disease Dementia
Signs and symptoms of Parkinsons disease dementia include:
- Mental inflexibility
- Short-term memory issues and memory loss
- Trouble with decision making
- Executive function difficulty
- Slow processing speed
- Inattention
- Visual processing difficulty
Non-motor symptoms that can be associated with PDD include:
- Psychosis :
- Hallucinations
- Delusions
Learn More About Parkinsons Disease
Parkinsons Disease: The Essentials
If youre new to Parkinsons disease and would like a good overview to help you better understand the disease, please view our Parkinsons Disease: The Essentials presentation. Its a great place to get started with reliable and concise information.
Causes
The exact cause of Parkinsons is still unknown, but there is an enormous amount of research being done to learn more. This research has led scientists to formulate a number of theories on the cause of this disease.
Diagnosing
While there is no definitive test that can be taken to determine whether a person has Parkinsons disease, movement disorder specialists look for symptoms and use brain imaging technology to accurately diagnose Parkinsons.
Symptoms
Even though Parkinsons is classified as a movement disorderand its motor symptoms are the most discussed and well-knownthere are many non-motor symptoms that display in people with Parkinsons as well.
Treatments
As of today, there is no cure for Parkinsons disease. But there are many ways in which the disease can be treated to make symptoms more manageable.
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Hippocampal Subfield Atrophy In Parkinsons Disease
The PD-related changes that occur in different hippocampal subfields can impact the episodic memory impairments experienced by these patients and warrant further study . For example, autopsy studies have shown that dementia-related alpha-synuclein and Lewy-body pathology preferentially affect some subfields more than others. Lewy-body pathology is most prominent in the CA23 subfields but is also found throughout CA1 in PD . A few structural MRI studies have begun to explore these relationships. Foo and colleagues measured hippocampal subfield volumes in PD and correlated the volumes with cognitive and motor decline at two time points over 18 months. At baseline, they found lower volumes in right CA1, right hippocampal-amygdala-transition-area and left fimbria. These were accompanied by lower global cognition scores in PD-MCI as compared to PD-NC. At 18 months, a volume reduction was noted in right CA23 along with significant decline in episodic memory and executive function in PD-converters as opposed to PD-stable .
Background Characteristics And Group Comparisons For Single Measures
The groups were comparable on all demographic characteristics, as well as on motivation and alertness evaluations throughout the test sessions . The age of the PD group ranged from 45 to 72 years and they had an average education of 14.8 years . The mean age at disease onset had been 59.5 years , while the average disease duration had been 5.6 years . The age of the control group ranged from 50 to 73 years and they had an average education of 14.2 years .
There were some differences between the groups in cognitive performance, global cognitive abilities, self-reported everyday cognition, and self-reported affective symptoms . As shown in Table 2, the PD patients performed significantly worse than the healthy controls on SRT , CPT , and the Wordlist recall task . Sentence recall was the only non-WM task that systematically correlated with the WM tasks within the PD group .
Table 2. Group differences for computerized tasks between the PD patients and the healthy controls.
The PD patients exhibited also general cognitive impairment , and reported more everyday cognitive difficulties as well as depressive symptoms as compared to the controls. The PD patients did not, however, differ from the controls on the other global cognitive ability measure or on the self-reported apathy rating .
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What Is Medical Marijuana
Medical marijuana is cannabis that’s prescribed by a physician to treat or provide relief for a medical condition.
There are around 400 chemicals in the cannabis plant, and more than 60 of them are referred to as cannabinoids. The high marijuana users get is primarily due to the most psychoactive cannabinoid in the plant called tetrahydrocannabinol, or THC.
Cannabinol, or CBD, is the other cannabinoid, which is used in medical marijuana. CBD does not cause a high when taken alone and, in fact, moderates the psychoactive effects. Research is being done to determine how medical marijuana can help treat or relieve symptoms of various diseases, including Parkinson’s disease.
Parkinsons Disease Cognitive Impairment
Parkinsons disease is the second most common neurodegenerative disorder of aging. While the diagnosis of PD is based on characteristic motor symptoms, such as bradykinesia , rigidity, and rest tremor, it is well established that most patients eventually experience a wide range of cognitive and neuropsychiatric symptoms . Cognitive impairments in PD patients can include executive, memory, visuospatial, attentional and language function . Studies have shown that in early PD patients who are non-demented, the largest effect sizes of impairment are observed in the memory domain, especially immediate and delayed free recall . PD cognitive impairment, and memory impairment in particular, can have a significant impact on both patient and caregiver quality of life as well as increase the risk of morbidity and mortality . Despite this, there are limited treatments for memory impairment in PD, and none to stop or slow this devastating consequence of disease. In this review we will discuss the types of memory impairment experienced by patients with PD and summarize recent literature on plausible neural correlates.
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Brain Boost: A Conversation On Thinking
In this 1-hour webinar a panel of experts and a person with Lewy Body Dementia answered moderator questions about cognitive changes typical in those with Parkinson’s Disease and Lewy Body Dementia . They discussed what’s normal and what’s not, the impact cognitive changes have on everyday life, what you can do to preserve brain health, strategies for both the person with PD and care partners to cope with cognitive changes, and what researchers know about predicting who is likely to suffer significant cognitive change with PD.
How Parkinsons Disease Affects The Brain
The Parkinsons disease brain stops producing dopamine cells, which in turn causes problems with movement and coordination known as motor symptoms. We all have a basic understanding of how Parkinsons disease affects the brain, but what really happens when someone has Parkinsons disease? Lets explore the facts surrounding the Parkinsons disease brain and how it differs from a normal, healthy brain.
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How Is Parkinsons Disease Managed
Your doctors will tailor your treatment based on your individual circumstances. You will manage your condition best if you have the support of a team, which may include a general practitioner, neurologist, physiotherapist, occupational therapist, psychologist, specialist nurse and dietitian.
While there is no cure for Parkinsons disease, symptoms can be treated with a combination of the following.
What Cognitive Changes Should You Expect
Between 20% and 50% of people with Parkinsons have mild cognitive changes at some point, even early on. You may not even notice them if they dont get in the way of with your daily life.
Mild cognitive changes with Parkinsons may crop up as problems with:
- Memory or recall
Cognitive screening tests. The doctor can give you questionnaires to measure your cognitive function, like:
- Mini-Mental State Examination
- Montreal Cognitive Assessment
These screening tests only take 10 minutes or less to complete. The doctor will ask you questions and assess your memory, speech habits, awareness, concentration, problem-solving skills, and movements.
Referrals to specialists. A clinical neuropsychologist can give you more formal tests to figure out if you have mild cognitive changes due to Parkinsons, or if your symptoms result from another condition like a stroke or Alzheimers disease.
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What Other Things Help
There are various ways to help a person with PDD. Speech therapy may help improve communication between people with PDD and others. Physical therapy may help strengthen and stretch stiff muscles and help to prevent falls.
Research has shown that physical exercise helps to enhance brain health and improves mood and general fitness. A balanced diet, enough sleep and limited alcohol intake are other important ways to promote good brain health. Other illnesses that affect the brain, such as diabetes, high blood pressure and high cholesterol, should also be treated if present.
Living With Parkinson Disease
These measures can help you live well with Parkinson disease:
- An exercise routine can help keep muscles flexible and mobile. Exercise also releases natural brain chemicals that can improve emotional well-being.
- High protein meals can benefit your brain chemistry
- Physical, occupational, and speech therapy can help your ability to care for yourself and communicate with others
- If you or your family has questions about Parkinson disease, want information about treatment, or need to find support, you can contact the American Parkinson Disease Association.
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What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
Does Parkinsons Affect Voice
The voice is affected too, because the voice box is ultimately controlled by the basal ganglia as well. Thus the voice becomes soft, slurred and hushed. Others may comment that the patient is mumbling. The mumbling goes away temporarily once the patient becomes aware of it but soon returns to the soft, slurred state.
This temporary improvement when attention is paid is true of many of the motor symptoms of PD because the condition primarily affects subconscious movements, and does not directly affect nerve or muscle control at the most basic level. Thus, conscious awareness can override the slowness to a certain extent. This fact is one reason why physical therapy and physical activity are so useful and necessary in treating PD.
- Slowness of walking and other movements
- Trouble with dexterity
Imbalance, loss of balance reflexes
- May fall backwards
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Cognition And Mood And How To Manage Them
In this 50-minute webinar Greg Pontone, MD, distinguishes the cognitive changes commonly seen in those with dementia from the cognitive changes seen in Parkinson’s disease . He shares medications used to treat dementia and highlights those that are more effective for the cognitive changes in Parkinson’s. Dr. Pontone also talks about depression and anxiety specifically, the impact depression has on quality of life, and meditations to treat it, and how increased feelings of anxiety can be directly related to the wearing-off of medications.
How Does Medical Marijuana Affect The Body
Marijuana affects the body through neurotransmitters, which are the chemical messengers of the nervous system.
Various factors can stimulate neurotransmitter activity, initiating a set of physiological responses. In cannabis, it is mainly THC or CBD binding to endocannabinoid receptors that produce new physiological reactions in the body.
The endocannabinoid system is one of the most important neurotransmitter systems in the body. It utilizes cannabinoid receptors located throughout the central nervous system and peripheral nervous system . Cannabis works to turn on endocannabinoid neurotransmitters through activity at these receptors.
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