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How To Slow Parkinson’s Disease



Experts Explore Which Of The Existing Strategies To Slow Down Or Stop The Processes Of Parkinsons Disease Are Most Likely To Be Successful Over The Next 20 Years

How To Slow Parkinson’s Disease

Understanding of the processes involved in Parkinson’s disease degeneration has vastly improved over the last 20 years. Published in the Journal of Parkinson’s Disease, authors Tom Foltynie, MBBS, PhD, Department of Clinical and Movement Neurosciences, UCL Institute of Neurology & The National Hospital for Neurology and Neurosurgery, UK, and J. William Langston, MD, Associate Director, Stanford Udall Center, Department of Pathology, Stanford University, USA, explain the progress of research.

New Research Suggests Simple Exercise May Provide Hope For The One Million People Who Suffer From Parkinsons Disease

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New research suggests simple exercise may provide hope for the one million people who suffer from Parkinson’s Disease . This remedy may provide even greater benefits to those who have been, or will be, diagnosed with Young Onset Parkinson’s. Exercise may provide relief for the increasingly debilitating symptoms—such as lack of mobility, tremors, stiffness, speech impairment and mood disorders—and even slow the progression of the disease itself.

Parkinson’s Disease Progression Can Be Slowed With Vigorous Exercise Study Shows

His friends noticed the tremor before he did. It started in his left hand, Geoffrey Rogers said, but before long the trembling affected his right too.

The cause, doctors found, was Parkinson’s disease.

At Rush University Medical Center, where Rogers, then 64, received a second opinion, the father of three learned he could join a new clinical trial for those with the neurodegenerative condition.

A team of researchers at Northwestern Medicine and the University of Colorado School of Medicine wanted to find out whether high- or moderate-intensity exercise was safe for patients with Parkinson’s disease. Would it help with the disease’s symptoms, the progressive loss of muscle control, tremors, stiffness?

Five years later, those scientists have an answer: Yes. Increasing disease severity in early-stage Parkinson’s disease patients can be slowed with a few days of exercise weekly. The results of their trial, published Monday in JAMA Neurology, found vigorous exercise is a safe way to potentially delay the progression of Parkinson’s disease.

“The real question is: Is there any disease or any disorder for which exercise is not good?” said Daniel Corcos, one of the lead authors of the study and a professor of physical therapy and human movement sciences at Northwestern’s Feinberg School of Medicine. “I haven’t found any.”

The onset of symptoms can be distressing for families, especially because the causes of Parkinson’s disease are not fully understood.

eolumhense@chicagotribune.com

New Treatment May Have The Potential To Slow Stop Or Reverse Parkinson Disease Wallace Stephens

Results from a recent study suggest that a revolutionary treatment may have the potential to slow, stop, or even reverse the progression of Parkinson disease.

Results from a February study of a revolutionary treatment suggest that it may be possible to slow, stop, or even reverse the progression of Parkinson disease, according to findings in the Journal of Parkinson’s Disease.

The 3-part, experimental study investigated whether using a novel delivery system to increase levels of glial cell line-derived neurotrophic factor can regenerate dying dopamine brain cells in patients with Parkinson disease and even reverse their condition. GDNF is a naturally occurring protein that promotes the survival of many types of neurons.

“I believe that this approach could be the first neuro-restorative treatment for people living with Parkinson’s, which is, of course, an extremely exciting prospect,” Steven Gill, MB, MS, FRCS, who designed the infusion device used in the study, said in a statement.

Initially, 6 patients enrolled in a pilot study which evaluated the safety of the treatment approach. After the pilot study, 35 additional individuals participated in a subsequent 9-month double-blind trial. Half of the participants were randomly assigned to receive monthly infusions of GDNF while the other half received placebos.

Reference

Discovery Could Help Slow Down Progression Of Parkinson’s Disease

Exercising 2.5 Hours a Week May Slow Parkinson’s ...

Rutgers collaborates with Scripps Research hoping to develop new drug treatment

Peer-Reviewed Publication

Rutgers University

A collaboration between scientists at Rutgers University and Scripps Research led to the discovery of a small molecule that may slow down or stop the progression of Parkinson’s disease.

Parkinson’s, which affects 1 million people in the United States and over 10 million worldwide according to the Parkinson’s Foundation, is a neurodegenerative disorder with no cure. Symptoms develop slowly over time and can be debilitating to patients, who most recognizably develop tremor, slow movements and a shuffling gait.

A key feature of Parkinson’s disease is a protein named ?-synuclein, which accumulates in an abnormal form in brain cells causing them to degenerate and die. However, it has been difficult to target ?-synuclein because it does not have a fixed structure and keeps changing its shape, making it very difficult for drugs to target. Because higher levels of the protein in the brain speed the degeneration of brain cells, scientists have been looking for ways to decrease the protein production as a form of treatment.

“We found the molecule to be very selective at both the RNA level and the protein level,” Disney says.

“The reach of our study could go beyond people with Parkinson’s disease to many other neurodegenerative diseases. It is a classic example of how interdisciplinary research leads to significant change,” she shares.

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Exercise Can Stop Accumulation Of A Harmful Protein In The Brain

Date:
University of Colorado Anschutz Medical Campus
Summary:
While vigorous exercise on a treadmill has been shown to slow the progression of Parkinson’s disease in patients, the molecular reasons behind it have remained a mystery.

While vigorous exercise on a treadmill has been shown to slow the progression of Parkinson’s disease in patients, the molecular reasons behind it have remained a mystery.

But now scientists at the University of Colorado Anschutz Medical Campus may have an answer.

For the first time in a progressive, age-related mouse model of Parkinson’s, researchers have shown that exercise on a running wheel can stop the accumulation of the neuronal protein alpha-synuclein in brain cells.

The work, published Friday in the journal PLOS ONE, was done by Wenbo Zhou, PhD, research associate professor of medicine and Curt Freed, MD, professor of medicine and division head of the Division of Clinical Pharmacology and Toxicology at the CU School of Medicine.

The researchers said clumps of alpha-synuclein are believed to play a central role in the brain cell death associated with Parkinson’s disease. The mice in the study, like humans, started to get Parkinson’s symptoms in mid-life. At 12 months of age, running wheels were put in their cages.

“After three months,” Zhou said, “the running animals showed much better movement and cognitive function compared to control transgenic animals which had locked running wheels.”

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April 17, 2018

  • liver

Understanding Parkinsons Disease: Getting A Parkinsons Diagnosis

Once you start noticing some changes in your body that impact your daily life or are just simply bothersome, you should begin the process of figuring out if you have Parkinson’s disease. It may seem like a daunting undertaking, but don’t let fear stop you. Once you are diagnosed,  you can start treating your symptoms and learning strategies that will help you feel better.

What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinson’s disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didn’t exercise or didn’t start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinson’s, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments — whether medicines or deep brain stimulation — are optimal; and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

Improve the quality of your sleep.

Why Exercise Can Help Delay The Onset Of Parkinsons Disease

Exercise class helps slow Parkinson

Parkinson’s disease affects more than a million people in the United States alone, and it is the second most common neurodegenerative disorder in the country. It is also the most common of movement disorders, which also include neurological disorders like Dystonia, Huntington’s disease, Tourette’s syndrome, and others. In fact, there are 60,000 new patients diagnosed with PD each year, and men are one and a half times more likely to develop the disease than women.

PD affects both motor and non-motor related faculties and could include symptoms such as tremors, limb rigidity, gait and balance difficulties, slowness of movement, depression, constipation, sleep issues, and cognitive impairment. Though these symptoms may not be readily apparent, they develop and progress as the disease spreads.

Experts remain unsure exactly what causes Parkinson’s — a combination of environmental and genetic factors seems to be at play — but the good news is that there are ways to slow its onset and protect against its development. One helpful method is to maintain good health through a balanced diet high in fiber and antioxidant-rich foods . Other preventative measures include getting proper sleep, minimizing stress, limiting exposure to toxins, and avoiding head injuries.

Research shows that something else is also promising in preventing and delaying the onset of PD: regular exercise.

Parkinsons Disease Natural Treatment & Remedies In 5 Steps

April 17, 2018

Parkinson’s disease is a degenerative illness of the nervous system that results in loss of intentional movement and impaired motor functioning. Parkinson’s disease symptoms affects smooth, natural movements of the body, and can make it hard to perform everyday tasks like speaking properly, walking, swallowing and sleeping.

With Parkinson’s, the area of the brain that controls muscular movements receives less dopamine than usual. Dopamine is an important chemical necessary for not only coordinating proper body movements, but also things like learning, increasing motivation and regulating moods.  This is one reason why depression and other mood changes often affect those with Parkinson’s.

What causes Parkinson’s, and is it curable? There is no specific known cause, but some aggravating factors include exposure to certain chemicals and toxic water, plus inflammation of the brain. While there is no cure for Parkinson’s , there are medications available to boost dopamine in the brain and help manage symptoms.

A 2016 study by researchers at the University of Saskatchewan also found a possible way to stop the progression of Parkinson’s. Researchers created caffeine-based chemical compounds — which also contained nicotine, metformin and aminoindan — that prevented the misfolding of alpha-synuclein, a protein necessary for dopamine regulation.

Foods Containing Nutrients That People May Be Deficient In

Some research suggests that people with Parkinson’s often have certain nutrient deficiencies, including deficiencies in iron, vitamin B1, vitamin C, zinc, and vitamin D.

The above study points out that some of these deficiencies may be associated with neuroinflammation and neurodegeneration, which are key factors in Parkinson’s.

Therefore, people with Parkinson’s may wish to consume more of the following foods.

Foods containing iron

The following foods are good sources of iron:

  • liver
  • certain fortified foods

Scientifically Backed Ways To Prevent Parkinsons Disease

Dopamine plays a major role in a variety of mental and physical functions, including:

  • Voluntary movement
  • Memory
  • General behavior

Parkinson’s now afflicts roughly 1.5 million people in the United States alone, with primary symptoms being body tremors, slow movement, rigid limbs, reduced memory, a shuffling gait and speech impairment. So we have to ask:

1.) What causes it?

2.) How do we prevent it?

Currently there isn’t a known cure, and it’s not fully understood what causes the dip in dopamine; however, we know that aging is the single most important risk factor for PD, with inflammation and stress contributing to cell damage. And we now know enough about the disease to understand the preventative measures that counter the aging and death of the neurons under attack.

Because there is no known cure, it’s critical that we prevent the disease before symptoms arise. Granted, thanks to recent advancements in modern surgical procedures, there are some safe surgeries that can mitigate some of the more severe symptoms associated with PD. The most common one now is deep brain stimulation, in which they implant an electrode into the brain that can stop some of the more severe symptoms of Parkinson’s.

But this article will try to keep it from getting to that point. The less drugs and surgery we can have in our lives, the better.

Eat Plenty Of Protein But Not With Levodopa Medications

How To Slow Parkinson’s Disease

If you’re taking a levodopa medication, your doctor may tell you to avoid protein when taking your meds. Both animal and plant protein can interfere with the absorption of levodopa medications.

But you should still eat plenty of protein. Just be strategic with the timing. “Don’t take levodopa medications with meals,” Dr. Gostkowski says. “It’s best to take it on an empty stomach — either 30 minutes before your meal or an hour after eating.”

If you get nauseous from the medication, eat a small amount of starchy food with it, such as crackers. Make sure whatever you eat with your medicine doesn’t have protein. “It’s a misunderstanding that people with Parkinson’s should avoid protein,” Dr. Gostkowski says. “You definitely need protein in your diet. Just don’t eat it when you’re taking your levodopa medication.”

Eat Plenty Of Protein But Not With Levodopa Medications

If you’re taking a levodopa medication, your doctor may tell you to avoid protein when taking your meds. Both animal and plant protein can interfere with the absorption of levodopa medications.

But you should still eat plenty of protein. Just be strategic with the timing. “Don’t take levodopa medications with meals,” Dr. Gostkowski says. “It’s best to take it on an empty stomach — either 30 minutes before your meal or an hour after eating.”

If you get nauseous from the medication, eat a small amount of starchy food with it, such as crackers. Make sure whatever you eat with your medicine doesn’t have protein. “It’s a misunderstanding that people with Parkinson’s should avoid protein,” Dr. Gostkowski says. “You definitely need protein in your diet. Just don’t eat it when you’re taking your levodopa medication.”

Scientifically Backed Ways To Prevent Parkinsons Disease

Dopamine plays a major role in a variety of mental and physical functions, including:

  • Voluntary movement
  • Memory
  • General behavior

Parkinson’s now afflicts roughly 1.5 million people in the United States alone, with primary symptoms being body tremors, slow movement, rigid limbs, reduced memory, a shuffling gait and speech impairment. So we have to ask:

1.) What causes it?

2.) How do we prevent it?

But this article will try to keep it from getting to that point. The less drugs and surgery we can have in our lives, the better.

What Makes Exercise So Helpful In Preventing Parkinsons

What Makes Exercise So Helpful In Preventing Parkinsons

Parkinson’s is characterized by a loss of dopamine neurons in the brain. A majority of PD research thus far has placed a focus on creating neuroprotective drugs to help combat this loss — yet exercise hasshown to be neuroprotective and enhances a participant’s neuroplasticity with few negative side effects.

Exercise offers numerous physical and psychological benefits for all people; but for PD patients, exercise helps maintain balance, improve mobility, enhance mood, and protect the brain. Exercise also remains a powerful long-term solution when compared to PD medications, which are considered short-term because they become less effective over time.

Exercise also functions as a type of targeted PD therapy to improve a patient’s gait, balance, flexibility, grip strength, and motor coordination. Walking exercises target gait issues, while dancing lessons improve balance and coordination. Participating in resistance training improves strength and helps maintain muscle mass, which decreases with age.

For many seniors, physical activity also offers opportunities to have fun and socialize, which may alleviate symptoms of depression caused by PD. Fitness programs are an easy way to meet new people and connect with a wider community.

Other studies have shown that exercise is similarly beneficial for Alzheimer’s and dementia, two other progressive neurodegenerative disorders.

What Are The Surgical Treatments For Parkinsons Disease

Most patients with Parkinson’s disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable – reducing symptoms during “on” periods and no longer controlling symptoms during “off” periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they can’t. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.

What Is The Outlook For Persons With Parkinsons Disease

Can Exercise Slow Down Parkinson

Although there is no cure or absolute evidence of ways to prevent Parkinson’s 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 team’s 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 Parkinson’s 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.

How Patients Are Using Cycling To Slow Down Parkinson’s

Parkinson’s symptoms include tremor, rigid muscles and problems with movement. While early treatment can delay the worst symptoms, people almost always get worse. About 60,000 Americans are diagnosed with Parkinson’s disease each year and about a million Americans have Parkinson’s now.

No medical therapy can cure Parkinson’s and while exercise was always shown to help people feel better, it was not generally accepted as a true therapy until recently.

Now teams are trying to find out how much exercise helps and just which symptoms it affects. Doctors say they’d be thrilled just to slow the inevitable worsening of the disease and if they can freeze progression or reverse symptoms, that would be a home run.

Corcos and colleagues say the most intense exercise appears to have at least temporarily frozen symptoms in many of their volunteers.

“The earlier in the disease you intervene, the more likely it is you can prevent the progression of the disease,” Corcos said in a statement.

“We delayed worsening of symptoms for six months,” he added. “Whether we can prevent progression any longer than six months will require further study.”

Related: Walking Helps Parkinson’s

They worked with 128 patients with early stage Parkinson’s. They randomly assigned them to either moderate exercise four days a week, intense exercise four days a week, or no additional exercise.

“This is not mild stretching. This is high intensity,” Corcos said.

Related: Gut germs affect Parkinson’s

Conditions That May Be Mistaken For Parkinsons Disease

There are a few conditions that may be confused with Parkinson’s disease. These conditions can cause similar symptoms, and because there is no definitive test that proves you have Parkinson’s disease or any of these “similar” conditions. As you might imagine, this can make it challenging at times for doctors to figure out which condition you have. A few of the most common conditions that might look like Parkinson’s are:

What Medications Are Used To Treat Parkinsons Disease

Medications are the main treatment method for patients with Parkinson’s 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 Parkinson’s 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 Parkinson’s disease.

Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinson’s disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinson’s 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 .

What Are The Different Stages Of Parkinsons Disease

BIG therapy is making a big difference for people with ...

Each person with Parkinson’s disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinson’s disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms; others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.

In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:

Early stage

Early symptoms of Parkinson’s disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.

Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.

Mid stage

Mid-late stage

Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.

Advanced stage

Slowing Down The Progression Of Parkinsons Disease

We have all heard that keeping active is good for you and has immediate benefits for your health both short-term and long-term. Regular activity reduces the risk of developing some cancers, cardiovascular disease, as well as obesity and the health issues associated with this. What you may not have heard is regular exercise has also shown to slow the progression of Parkinson’s disease.

Parkinson’s disease is a neurodegenerative disease which targets and progressively damages nerve cells in a particular area of the brain over a long period of time. These nerve cells are very important for their role in producing a chemical called Dopamine. Without this chemical, the brain is not able to control normal bodily movement and the typical presentation of Parkinson’s beings to show in the individual. This can range from balance issues, difficulty with memory and smell, as well as the well-known involuntary shaking. The cause of Parkinson’s is still unclear, however, there is thought to be a combination of both genetic and environmental factors.

The link between exercise and reducing Parkinson’s progression is believed to be focused on a particular protein known as the DJ-1 gene. As we all become more and more sedentary in our day-to-day lives, scientists have noticed an increase of a normal neural protein alpha-synuclein, which is important for relaying messages and normal brain function. However, in excessive “clumps” this could potentially be an issue.

How Often Do Patients Need To Exercise To Benefit

Patients need to engage in at least 150 minutes of exercise each week to see an impact. In a paper published in JAMA Neurology, researchers were able to delay the progression of PD for six months through exercise alone, splitting exercise into three sessions per week, with each session increasing the participant’s heart rate to a maximum of 80-85%.

How Cycling Helps To Slow Down Parkinsons Disease

In the summer of 2003, Dr Jay Alberts, a neuroscientist at the Cleveland Clinic Lerner Research Institute, took a bike

In the summer of 2003, Dr Jay Alberts, a neuroscientist at the Cleveland Clinic Lerner Research Institute, took a bike ride that would change medical history. He rode a tandem bike in the week-long Des Moines Register’s Annual Great Bike Race . His partner on the bike was a woman affected with Parkinson’s Disease, a long-term degenerative illness afflicting the central nervous system.

Symptoms of the disorder include shaking, rigidity, difficulty in walking as well as cerebral and behavioural problems and eventually dementia, and total incapacitation after perhaps 15 years. There is no cure. Treatment is generally carried out with medication that attempts to alleviate the symptoms and slow the progress of physical degeneration.

After riding a few days, Alberts noticed that his biking partner was showing signs of physical improvement, especially in her handwriting, which had become more legible and controlled.

https://www.youtube.com/watch?v=VM-DBsdajTM

In 2006, Alberts rode a tandem bike with another patient, also a doctor, who used a deep brain stimulation implant to control his Parkinson’s symptoms. As an experiment, the patient turned the device off for the ride.

Not surprisingly, the researchers also found that it improves “overall wellness.” In other words, cycling is good for everyone.

What Parkinsons Diagnosis Criteria Do Doctors Use

6 Rules for Exercising with Parkinson’s Disease

Until the 1980s, there was no formal diagnostic criteria for Parkinson’s disease. Beginning with James Parkinson’s 1817 article, “An Essay on the Shaking Palsy,” and Margaret Hoehn and Melvin Yahr’s description of the five stages of motor progression in 1967, scientists focused on the unique ways Parkinson’s disease affects movement. A few scientists also noted non-motor symptoms like issues with automatic body functions, such as heart rate and blood pressure.

With the discovery in the 1950s of levodopa, a drug that gets turned into dopamine in your brain and thus replaces some of the dopamine that is lost due to PD, and the discovery of how dramatically levodopa improves motor symptoms, the medical community continued to focus more of their efforts on defining and treating Parkinson’s as a motor condition.7

Other Challenges Of Diagnosing Parkinsons Disease

Parkinson’s disease progresses slowly, often with non-motor symptoms appearing months or years before motor symptoms. This can make it challenging for doctors to diagnose you in the early stages, especially since the diagnostic criteria is based mostly on motor symptoms. You may have to wait until your symptoms progress for you and your doctor to confirm your diagnosis.14

Age and gender can be another issue. Since Parkinson’s is associated more with older men, doctors may not think their younger or female patients have Parkinson’s.5 On the other hand, since the disease is associated with aging, your symptoms may be blamed on “getting older.”

Remember that movement disorder specialists are extremely knowledgeable about Parkinson’s disease and can help put the pieces together where other more generalized doctors may not. Never hesitate to fight for the care you deserve.

Related: Here’s what’s important to remember if you were just diagnosed with Parkinson’s disease. 

Slowing The Spread Of Alpha Synuclein Pathology

There is a mantra that disease modifying treatments must be initiated early if they are to be of any use in preventing disease progression. This is because post mortem specimens suggest that>50% of SNc dopaminergic neurons are already lost by the time that patients present with the classical motor features of the disease . Given that there are many effective symptomatic treatments to help the motor, dopaminergic deficits in PD, it can be argued that the important unmet needs in PD relate to cognitive, speech, gait and balance difficulties and autonomic failure. In this case any treatment that prevented onset/worsening of these symptoms, would be highly relevant even in patients with established motor PD, and would be addressing the major challenges that patients face in its long-term management. From another perspective, since many of these “non-motor” features of PD may precede the onset of motor symptoms, we may have an even earlier window to start therapy, and have an opportunity to slow or stop the development of even the first motor symptoms of PD.

Beyond this, the companies will have to look carefully at the emerging data to decide whether a strategy of enrichment might be advantageous, and/or whether to risk extending trial eligibility to patients with more established disease than those currently being recruited.


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