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Impact Of Parkinson’s Disease On Patients

How Does Exercise Affect The Brain

The Impact of Depression in Parkinson’s Disease

Researchers have studied the brains of mice that exercised under conditions similar to a human being on a treadmill. Exercise did not increase the number of neurons or amount of dopamine in mices brains. But it did prompt their brains to use dopamine more efficiently.

Dopamine is a neurotransmitter that helps regulate movement and emotional response. Lack of it is associated with neurodegenerative diseases like Parkinsons.

Some studies have indicated that exercise reduces the chance that dopamine neurons will become damaged.

Note: Parkinsons 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 other 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.

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Management Of Tremor: Levodopa And Deep Brain Stimulation

Medication for tremor in PD is initiated when symptoms become distressing or embarrassing in social settings, and levodopa and dopamine agonists are typically prescribed . Antiparkinsonian medications result in a reduction in the amplitude of tremor but not frequency . Although early PD symptoms are generally considered well-controlled by antiparkinsonian medications, tremor response is less robust compared to other dopaminergic symptoms, such as bradykinesia and rigidity . Parkinson’s disease patients, many of whom had mild on average symptom severity , echoed these limitations of their current medication options through free-text responses to the following question: What kind of assistance might help you cope or solve ?

I look forward to medication to diminish my tremor symptoms and hope to delay progression of the disease.

I try to accomplish things when I know that my medication will be at its peak time.

Although DBS offers robust tremor management for mid- and advanced stage patients, therapies for tremor control in early stage PD are currently limited to pharmacological options, primarily levodopa. Levodopa offers variable relief from symptoms and is associated with significant side-effects that often preclude lifelong use, including irreversible levodopa-induced dyskinesias in most patients . Tremor control remains a source of concern for early stage PD patients, and future studies should explore alternative treatments for tremor in this population.

Eligibility Criteria For Study Characteristics

The participants included healthy human subjects, subjects with PD and animals with experimental PD. Studies were included if their primary intervention was exercise and their primary or secondary outcomes were to assess either behavioral or neurobiological markers of cognitive function. All articles were included where the authors treated the outcome measure as a test of cognition. In some cases, the measure was a surrogate , was a sub-score of cognition from a larger scale, or was influenced by motor capacity. An exercise intervention was defined as any purposeful increase in the subjects physical activity through a single bout of exercise or prolonged exercise over the course of a structured or unstructured program. Cohort and experimental study designs were included, whereas case series, casecontrol, cross-sectional and descriptive studies were excluded. Original research articles were included from 1966 through October 2013. Studies were considered if they were written in the English language and either published or in press.

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Prevalence Of Parkinsons State

Western and Southern states appear to have lower rates of Parkinsons disease, while Northeastern and many Midwestern states have higher rates . Mississippi and Montana have the lowest rates of Parkinsons, at 5.1 per 10,000. Vermont has the highest rate of Parkinsons at 9.9 per 10,000.

Exhibit 2: Prevalence of Parkinsons Disease, by geography

Standard Protocol Approvals Registrations And Patient Consents

Considering the Emotional Impact of Parkinson

Each PPMI participating site received approval from the local ethics committee before study initiation, and written informed consent was obtained from all participants before participation. Our study strictly adheres to the publication policy in the PPMI study, and we have obtained permission for publishing our research by the Data & Publication Committee of the PPMI study.

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Medicines For Parkinsons Disease

Medicines can help treat the symptoms of Parkinsons by:

  • Increasing the level of dopamine in the brain
  • Having an effect on other brain chemicals, such as neurotransmitters, which transfer information between brain cells
  • Helping control non-movement symptoms

The main therapy for Parkinsons is levodopa. Nerve cells use levodopa to make dopamine to replenish the brains dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapy such as nausea, vomiting, low blood pressure, and restlessness and reduces the amount of levodopa needed to improve symptoms.

People living with Parkinsons disease should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, like being unable to move or having difficulty breathing.

The doctor may prescribe other medicines to treat Parkinsons symptoms, including:

  • Dopamine agonists to stimulate the production of dopamine in the brain
  • Enzyme inhibitors to increase the amount of dopamine by slowing down the enzymes that break down dopamine in the brain
  • Amantadine to help reduce involuntary movements
  • Anticholinergic drugs to reduce tremors and muscle rigidity

What Medications And Treatments Are Used

Medication treatments for Parkinsons disease fall into two categories: Direct treatments and symptom treatments. Direct treatments target Parkinsons itself. Symptom treatments only treat certain effects of the disease.

Medications

Medications that treat Parkinsons disease do so in multiple ways. Because of that, drugs that do one or more of the following are most likely:

Several medications treat specific symptoms of Parkinsons disease. Symptoms treated often include the following:

  • Erectile and sexual dysfunction.
  • Hallucinations and other psychosis symptoms.

Deep brain stimulation

In years past, surgery was an option to intentionally damage and scar a part of your brain that was malfunctioning because of Parkinsons disease. Today, that same effect is possible using deep-brain stimulation, which uses an implanted device to deliver a mild electrical current to those same areas.

The major advantage is that deep-brain stimulation is reversible, while intentional scarring damage is not. This treatment approach is almost always an option in later stages of Parkinsons disease when levodopa therapy becomes less effective, and in people who have tremor that doesnt seem to respond to the usual medications.

Experimental treatments

Researchers are exploring other possible treatments that could help with Parkinsons disease. While these arent widely available, they do offer hope to people with this condition. Some of the experimental treatment approaches include:

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Effect Of Exercise On Motor And Nonmotor Symptoms Of Parkinsons Disease

Khashayar Dashtipour

1Department of Neurology, School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA

2Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA 92354, USA

3Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, Loma Linda, CA 92354, USA

4Department of Pharmacy Practice, College of Pharmacy, Marshal B. Ketchum University, Fullerton, CA 92831, USA

Academic Editor:

Abstract

1. Introduction

LSVT BIG therapy incorporates large trunk and extremity functional motions and should only be administered by an LSVT BIG certified therapist. In contrast to other conventional training methods that use various techniques to facilitate movements, the LSVT BIG therapy uses amplitude as the main focus of the exercise and engages the patient in functional activities with the promise of sustainability after completion of the therapy .

2. Materials and Methods

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Changes In Social And Role Functioning

Impact of Falls and Parkinson’s Disease

PD inevitably results in significant changes in the relationship between patients and caregivers. Both groups commented extensively on the category of social and role functioning, particularly on the debilitating toll that PD has on many social aspects. There appeared to be a variation between early and typical onset patients, which suggests that early onset patients may experience more difficulty accepting and coping with the social and role changes as a result of PD a similar variation appeared across caregivers and patients .

Shifting roles

Some patients voiced their sense of a progressive alienation from the world around them, lamenting either the gradual erosion or complete loss of some relationships. One patient recognized the accumulation of losses not only in physical activities, but also in emotional wellbeing and in a close relationship, such as marriage: Losses, yeah. I lost a job. I lost a marriage, too. Thats the painful part. And a loss of activity time. A loss of motivation … A loss of inspiration … So its all an accumulation of losses. Moreover, one of the most compelling commonalities among patients was the sense of loss and sadness over not having the same social role they once had in relation to their family members . One patient, for example, disclosed a sense of feeling obsolete in his former familial role as the provider:

Social networks and communication

Career

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Obstacles To Exercise And Limitations In Current Literature

Although there have been a number of studies showing the benefits of various forms of exercise, most do not address long-term follow-up and adherence to exercise regimens. Reported reasons for failure to participate in training sessions include scheduling issues, commuting challenges, medical comorbidities, hospitalizations, motor vehicle accidents, musculoskeletal injury, and family demands.28 Depression, difficulty initiating movement, and decreased motivation are nonmotor symptoms of PD that also impede patients from initiating exercise.

The long-term effects of exercise in patients with PD are limited, as most prospective interventional studies are short, ranging from 1 to 6 months.26 Most studies lack adequate control groups and have small sample sizes and poor follow-up regarding long-term outcomes and adherence to the studied interventions. Most of the studied interventions utilized some form of supervision. Practically, the cost of physical therapy and personal trainers may prohibit patients from participating in supervised exercise. Adherence to and benefits from self-initiated independent exercise that is typically encouraged by clinicians remains unknown.

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Is Telehealth Available If I Don’t Feel Comfortable Going Into The Office

This is a question best answered by your Parkinsons disease care team, but for many people, telehealth visits are now available. Though some visits may best be done in person, telehealth offers many benefits and may be an appropriate choice for visits such as those needed for medication refills.

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Scoring And Statistical Analysis

Summary scores as well as the subdimensions of the PDQ-39 were calculated according to the scoring algorithm. The akinesia score of the UPDRS was calculated as the sum of item 19 and 23 to 26 of the UPDRS for both sides, the score of axial features from items 27 to 30, and the tremor score from items 20 and 21 for both sides. The tremor dominant subtype of Parkinson’s disease was defined as patients with a ratio of tremor to bradykinesia score of 0.5 or more, and the akinetic rigid subtype as patients with a ratio of< 0.5. Socioeconomic groups were determined according to the classification of occupations and coding index with socioeconomic group 1 representing the highest and group 5 the lowest socioeconomic class.

Mean values were compared by the Mann-Whitney test, and Spearman rank correlation coefficients were calculated to assess the direction and magnitude of association between variables. Stepwise multiple regression analysis was used to determine the factors that best accounted for variance in QoL scores. Due to the number of different comparisons, statistical significance was only accepted at p< 0.005.

Be Active & Beyond: A Guide To Exercise And Wellness For People With Parkinsons Disease

Long

This 34-page booklet outlines the importance of exercising for those with PD, discusses barriers to exercise and how to overcome them, distills exercise guidelines from several organizations into a quick reference chart for those with PD, provides information on exercise basics and how to get started along with specific exercises to increase endurance, strength, flexibility, and balance.

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So What Relationship Do The Health Effects Of Parkinsons Have With Death

The adverse health effects of Parkinsons are serious, and you should work with your doctor to explore the many ways to manage your Parkinsons symptoms. However, Parkinsonian symptoms do not directly cause death, but they do increase your risk for other factors that can lead to death. For instance, one of the symptoms of Parkinsons is postural instability which leads to an increased risk of falls. Postural instability by itself will not cause death but falls can lead to serious injuries that can result in death. So, Parkinsons symptoms can increase the risk for death but will not cause death in and of itself.

This is an important distinction to make because instead of seeing Parkinsons as a death sentence we should look at it as a manageable risk factor the same way we look at dieting. A poor diet will not kill you, but it will increase your risk for developing diseases that can. We should think of Parkinsons in the same way, that if we manage our symptoms of Parkinsons through exercise, medication, etc. we decrease the likelihood of risk factors that lead to death.

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The Impact Of Living With Parkinsons Disease: Balancing Within A Web Of Needs And Demands

Catharina Sjödahl Hammarlund

Abstract

This study explores the impact of living with Parkinsons disease . Nineteen persons aged 5584 diagnosed with PD 327 years ago participated. Data were collected through semistructured interviews, which were recorded, transcribed verbatim, and analysed by qualitative content analysis. Four categories represented the impact of living with PD: Changed prerequisites for managing day-to-day demands, Loss of identity and dignity, Compromised social participation, and The use of practical and psychological strategies. There was a shift from an internal to an external locus of control in managing, control, competence, relatedness, and autonomy. According to self-determination theory, a shift towards extrinsically motivated behaviours may occur when these basic needs are thwarted, leading to compensatory strategies or needs substitutes with negative consequences on health and well-being. We suggest a needs-based approach as an important starting point to better understand the consequences of living with PD and to explore the means for people with PD to acquire an improved quality of life on their own terms. In conclusion, our findings suggest for a shift in focus, from a biomedical to a needs-based approach to understand the impact of living with PD and facilitate more person-centred care and person-centred outcome measurement.

1. Introduction

2. Materials and Methods

2.1. Participants and Recruitment
2.2. Data Collection

3. Results

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Association Between Tzd Use And Pd Incidence

A total of 674 incident cases of PD were observed during follow-up in the primary analysis, of them 571 were AGI users and 103 were TZD users, with an incidence of 203 and 135 per 100,000 person-years, respectively. Compared with users of AGIs, the crude analysis indicated a significant inverse association between use of TZDs and incidence of PD, with a hazard ratio of 0.67 . After adjusting for potential confounders using stabilized inverse probability of treatment weighting , users of TZDs still showed a significant 26% decrease in incidence of PD . The mean of the IPTW was 1.00 , and the median was 0.97 . Multivariate regression model presented consistent result, with a HR of 0.76 . Figure gives the IPTW-weighted survival curves of the users of AGIs and TZDs. Moreover, subgroup analyses found similar inverse association between use of TZDs and incidence of PD in different subpopulations of T2DM patients except that in smokers TZD use showed an insignificant increase of risk of PD . No significant interaction was indicated in all subgroup analyses . In addition, the IPTW adjusted HRs for the cumulative duration of TZD use of 0.5 years, 0.514.0 years, and > 4 years were 0.80 , 0.69 , and 0.73 , respectively .

Table 2 Results of the primary and subgroup analyses.Fig. 2: IPTW-weighted survival curves of TZD users and AGI users.

AGIs alpha glucosidase inhibitors, TZDs thiazolidinediones.

Pharmacological Treatment Of Parkinsons Disease

How Parkinson’s Disease Affects the Body — The Doctors

Pharmacological treatment of PD is based on the replacement of dopamine levels in the brain, which generally promotes the temporary improvement of physical disability and control of some of the symptoms. The medication considered gold standard in the treatment of PD motor symptoms is Levodopa , a metabolic precursor of dopamine that crosses the blood-brain barrier easily. Once in the Central Nervous System, L-Dopa is metabolized basally by DOPA decarboxylase, leading to dopamine. L-Dopa is marketed in association with a decarboxylase inhibitor drug , preventing the peripheral synthesis of dopamine and ensuring the drugs arrival in the brain . Other drugs are available, in most cases in association with L-dopa, and are divided according to the mechanism of action in order to increase the concentration of dopamine levels such as Monoamine Oxidase-B , Catechol-O-Methyl Transferase inhibitors, or dopaminergic agonists such as Pramipexole . However, pharmacological treatment for PD has limitations ranging from possible drug interactions and side effects , to decrease in its efficacy with years of use and the appearance of secondary symptoms such as dyskinesias and fluctuations , due to the lack of effectiveness of the treatment of non-motor symptoms of the disease . The choice of drug or association that will be administered to the patient depends on factors such as age, stage of the disease, type of activity performed by the patient, and their mental state.

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What Is Parkinson’s Disease

Parkinsons disease is a degenerative, progressive disorder that affects nerve cells in deep parts of the brain called the basal ganglia and the substantia nigra. Nerve cells in the substantia nigra produce the neurotransmitter dopamine and are responsible for relaying messages that plan and control body movement. For reasons not yet understood, the dopamine-producing nerve cells of the substantia nigra begin to die off in some individuals. When 80 percent of dopamine is lost, PD symptoms such as tremor, slowness of movement, stiffness, and balance problems occur.

Body movement is controlled by a complex chain of decisions involving inter-connected groups of nerve cells called ganglia. Information comes to a central area of the brain called the striatum, which works with the substantia nigra to send impulses back and forth from the spinal cord to the brain. The basal ganglia and cerebellum are responsible for ensuring that movement is carried out in a smooth, fluid manner .

The action of dopamine is opposed by another neurotransmitter called acetylcholine. In PD the nerve cells that produce dopamine are dying. The PD symptoms of tremor and stiffness occur when the nerve cells fire and there isn’t enough dopamine to transmit messages. High levels of glutamate, another neurotransmitter, also appear in PD as the body tries to compensate for the lack of dopamine.

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