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Psychotherapy For Parkinson’s Disease

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Current Treatment Options For Parkinsons Disease

Alternative Treatments for Parkinson’s Disease

There are currently no disease-modifying treatments for PD, and management predominantly consists of dopaminergic drugs. The most commonly used of these are preparations of levodopa, the precursor of dopamine, which is administered in combination with a dopa-decarboxylase inhibitor which acts to limit some of the side effects, such as nausea. Dopamine agonists, such as ropinirole or rotigotine, are also used. Monoamine oxidase B inhibitors, such as rasagiline and selegiline, and catechol-O-methyltransferase inhibitors such as entacapone, can be used to reduce the metabolism of endogenous dopamine. These treatments can restore dopaminergic activity in the striatum, heralding improvements in the motor features of PD. However, they do not treat many of the non-motor features, which are particularly disabling for many patients. Indeed, in some cases treatments may exacerbate some of the non-motor symptoms, such as postural hypotension and neuropsychiatric problems .

Other treatment options include deep brain stimulation , which can be very effective in controlling the movement disorder of PD, but like the dopaminergic medications it does not help with most of the non-motor manifestations . Though DBS is a safe treatment approach, there are other potentially problematic adverse effects including speech dysfunction and psychiatric disturbance, as well as the general risks associated with a neurosurgical procedure, and this treatment is only suitable in a minority of PD cases .

Could Light Hold The Key To Help Manage Parkinsons Symptoms Or Even Have A Protective Effect On Brain Cells This Blog Explores The Research Evidence And What The Future Might Hold

Light has a huge impact on life from sustaining the plants we eat to allowing us to see, everyone of us is dependent on the power of light.

The power of light has been investigated in many conditions, and although it is still very much an experimental technique, there is research to suggest that light therapy can have protective and restorative properties. There is also evidence that light can alter our sleep, mood and behaviour.

So why is light relevant to Parkinsons?In Parkinsons it is the loss of dopamine producing brain cells that cause both movement symptoms and other symptoms known as non-motor symptoms such as problems sleeping, depression, and loss of motivation.

Research is being done to look at whether treatment using light could offer protection to struggling brain cells to potentially slow down the progression of Parkinsons. And research is also looking into how light, in various forms, could be used to directly manage the symptoms of Parkinsons.

This is a fascinating topic as researchers try to unpick why cells that sit in the middle of the brain, in complete darkness could be protected, or even healed, by light. How do cells in the eye signal to the deepest parts of the brain? Or is it that light is being absorbed by specific components in cells activating and providing energy for the body to promote brain cell survival, protection or regeneration?

Lets explore some of the ways light is being looked at with regard to Parkinsons research.

Who Can Get It

While anyone can develop Parkinsons disease, age is the greatest factor in receiving a diagnosis. The average age of developing this disease is 60, and men are more likely to receive a diagnosis than women. Having a close relative, like a parent or sibling, who has Parkinsons disease doubles your risk factor.

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Managing Your Symptoms With Medication

Almost all patients with Parkinsons disease eventually need to take medication to help with their motor symptoms. Several classes of medications are available and can be viewed here. Carbidopa/Levodopa remains the most effective symptomatic therapy and is available in many strengths and formulations. It also may be used in combination with other classes of medications including Dopamine Agonists, COMT Inhibitors, MAO Inhibitors, and Anticholinergic agents. Treatment is highly individualized and adjusted over time based on symptoms and side effects.

Why Might Light Therapy Work For Pd

The New Parkinson

Research, primarily in animal models of PD, have investigated potential mechanisms by which light therapy might deliver positive effects on symptoms.

Here are three theories:

  • Light acts directly to reset the bodys master clock. The system of circadian rhythms controls the aspects of human physiology that cycle as a function of time of day chief of which is sleep and wakefulness. Light, sensed by the eyes, is the key regulator of this system. The suprachiasmatic nucleus, which is a brain structure that is located behind the eyes, is the bodys master clock.

Abnormalities of the circadian system are becoming an increasingly well-established non-motor symptom of PD. External light can potentially regulate the master clock that is not working properly. Interestingly, several studies have indicated that exposure to blue light is more effective than other wavelengths at resetting the circadian rhythm clock. Therefore, if manipulation of circadian rhythm is the mechanism by the light therapy exerts its effects on PD symptoms, it is possible that blue light might be the optimal one to use. Only one small open label study investigated blue light for PD symptoms. More research is therefore necessary.

A special thank you to Dr. Aleksander Videnovic, Associate Professor of Neurology at Harvard Medical School and Director of the Division of Sleep Medicine at Massachusetts General Hospital, for reviewing this post.

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New Medications For Off Time

A number of new medications approved recently are designed to reduce OFF time. These medications fall into two major categories:

  • Medications that lengthen the effect of a carbidopa/levodopa dose
  • Medications that are used as needed if medication effects wear off

Well give specific examples below. In general, new medications that extend the length of a carbidopa/levodopa dose are used if OFF time is somewhat predictable and occurs prior to next dose. New medications that are used as needed are most beneficial when OFF time is not predictable.

New medications that lengthen the effect of a dose of carbidopa/levodopa

  • Istradefylline is an adenosine A2A receptor antagonist which was approved in the US in 2019 as an add-on therapy to levodopa for treatment of OFF time in PD. Unlike many of the other medications, it has a novel mechanism of action and is the first medication in its class to be approved for PD. It acts on the adenosine receptor, which modulates the dopaminergic system, but is not directly dopaminergic. The drug was developed in Japan and underwent clinical trials both in Japan and in the US.
  • Opicapone is a catechol-O-methyltransferase inhibitor that is taken once a day. It was approved in the US in 2020 as an add-on therapy to levodopa for motor fluctuations.

New formulations of levodopa designed to be used as needed if medication effects wear off

Other medications used as needed if medication effects wear off

When Should I Talk To My Healthcare Provider

Talk to your healthcare providers about your mood at every appointment. Talking about it regularly will prompt you to open up. And it will help your healthcare providers notice symptoms of depression early so they can provide care.

If you start to think about hurting yourself, call a healthcare provider immediately. You can also call the National Suicide Prevention Lifeline at 800.273.8255. This hotline connects you to a national network of local crisis centers for free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, 7 days a week.

In an emergency, call 911.

A note from Cleveland ClinicDepression from Parkinsons disease isnt a sign of weakness or something you have to live with. Its related to chemical changes in your brain, and treatments can help. Talk to your healthcare provider about your mood, especially if you feel down for weeks at a time. Several strategies can help you feel better. You can still take part in things you enjoy and better manage the symptoms of Parkinsons disease.

Last reviewed by a Cleveland Clinic medical professional on 12/20/2020.


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How Are Depression And Parkinsons Disease Related

People with any chronic disease may experience depression. These diseases can trigger strong feelings about symptoms, physical limits and the possibility of death.

People with Parkinsons disease often have similar reactions. But the ties may run even deeper, as Parkinsons disease may directly cause depression. Thats because Parkinsons affects chemicals in your brain. These changes can lead to mood disorders like depression, anxiety and apathy . Depression can also intensify other Parkinsons symptoms speech and movement can slow even further, or forgetfulness can worsen, for example.

Diet For Parkinsons Disease

Alternative Treatments for Parkinson’s Disease

But the diet failed to improve some other measures of cognitive function including visuospatial abilities, short-term memory recall, and orientation to time and place and the study had a high dropout rate, so further studies with more participants are needed to confirm these benefits specific to individuals with Parkinsons.

Constipation can be a problem for people with Parkinson’s, so a fiber-rich diet with plenty of fluids may help. Dietary fiber comes from plant foods fruits, vegetables, whole grains, and legumes all of which are components of the Mediterranean diet.

Protein in the diet can limit the absorption of the drug levodopa, so this medication is best taken without a lot of protein.

Research is ongoing about the possible benefits of antioxidants, caffeine, and supplements in people with Parkinson’s. But there’s no conclusive evidence that any specific dietary factors are helpful in preventing or treating the condition.

Always tell your doctor about any supplements or herbs that you’re taking, as they may interact with medications.

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Box 2 Treatment Strategy For Psychosis In Parkinsons Disease

  • Psychosis in Parkinsons disease is a serious medical condition, and treatment should be directed by an appropriately trained physician who can adapt the suggestions below to the specific situation of the individual patient
  • Confirm the diagnosis
  • pimavanserin is an appropriate first choice in most cases
  • switch to clozapine if an adequate trial of pimavanserin is ineffective
  • If these treatments are ineffective, review diagnosis and medication list and consider quetiapine or other treatment options
  • What Is Nonverbal Communication

    Nonverbal communication, also called augmentative and alternative communication , is a method of communicating without spoken words.

    When communication needs cannot be met through speech, the following techniques can help:

    • Make the best use out of what speaking ability is left.
    • Use expressions and gestures to communicate.

    Non-verbal communication can help people with speech difficulties actually speak better by:

    • Reducing the frustration and stress of being unable to communicate.
    • Alleviating the pressure to speak.
    • Allowing the person to be more relaxed and come across in a more understandable manner.

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    How Home Care Along With Geriatric Care Management And Patient Advocacy Can Make A Difference

    With a seamless connection between Geriatric Care Management or Patient Advocacy and Home Care, our clients receive greater coverage through redundancy. Furthermore, through collaborative communication, there is a deeper connection between what is happening on a daily basis in the home and the higher-level guidance of geriatric care management and patient advocacy. With greater clarity, the decision-making process becomes more informed and with established relationships with a number of high quality geriatric care managers and patient advocates, our collective clients receive the best service possible.

    Brain Connectomic Studies And Improved Precision Of Neuromodulation Targets

    What Is the Best Treatment for Parkinson Disease

    The process of altering brain function through direct manipulation of neural activity has long been used to treat patients with neuropsychiatric disorders and deep brain stimulation has provided clinical benefit to more than 150 000 patients with PD, dystonia and essential tremor . Apart from the conventional application in advanced PD, DBS has also been suggested to exert disease-modifying traits . In multiple preclinical studies on rat models, chronic STN electrical stimulation was shown to result in preservation of SNpc dopaminergic neurons and an increase of brain-derived neurotrophic factors followed by activation of the tropomyosin receptor kinase type B receptor signaling in the nigrostriatal system . Although preclinical experiments suggest potential neuroprotective effects of DBS, results from clinical studies have shown that dopaminergic neuron degeneration remains unaltered , and -syn burden is not reduced in PD patients treated with DBS .

    Focused ultrasound as a newly developed neuromodulation technique

    Repetitive transcranial magnetic stimulation

    Few studies have investigated the effect of rTMS on levodopa-induced dyskinesias, showing only short-lasting or no beneficial effect.

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    If The Person With Pd Is Having Difficulty With Use Of Language:

    • Use short sentences and stress key words
    • Do not ask complex questions.
    • Make sure they can see and hear you.
    • Use body language and facial expression. Note: In some communities and with some I individuals this can be interpreted in different ways, and so may not be appropriate.
    • Vary the tone of your voice.
    • Do not embarrass them by making them join in a group if they do not want to.
    • If verbal communication is becoming overtly challenging, consider using a speech aid to help. A Speech and Language Therapist will advise on this.

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    The Integrated Care Management Model By Seniorbridge

    Home care services vary widely in the services they provide.

    SeniorBridge offers an integrated care management practice model that involves two components:

  • Clinical care supported by a Social Worker and a team of caregivers, based on patients needs and
  • A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.
  • NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

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    Clinical Trials Of White Light:

    Bright vs dim light

    Bright light therapy is being compared to dim red-light therapy delivered twice daily. Outcome measures include an assessment of excessive daytime sleepiness and a general scale of non-motor symptoms in PD.

    SunRay light boxes

    This trial will also compare bright white vs. dim red light stimulation, with light to be administered via the SunRay light box. Outcome measures include assessment of sleep and fatigue.

    DayVia lamp

    This trial will compare bright light vs control light. The outcome measures will be United Parkinson Disease Rating Scale scores.

    Within the DB RCT for Specialized Phototherapy trial, double-blinded and randomized comparing the Celeste device to a control light. PDQ 39, a measurement of quality of life, will be the primary outcome measure. Other endpoints will be UPDRS scores of motor and non-motor symptoms. This trial has not started yet.

    Search Is On For New Treatments

    Parkinson Disease: Treatment by a Physical Therapist

    There is an energetic effort right now to find treatments that slow the progression of Parkinsons, Matthew Menza, M.D., chair of psychiatry at the Robert Wood Johnson Medical School and a Parkinsons expert, said during an interview. The effort is focused on neuroprotective treatments such as nonsteroidal inflammatory drugs, since there is substantial evidence that inflammation is involved in the Parkinsons disease process.

    Many of the disorders that we deal with in psychiatry start early in lifein childhood or adolescenceand some of them appear to get worse over the years, he said. So if we had a treatment that was neuroprotective, it might have application in psychiatric disorders. True, nothing is ready for prime time right now. But it is certainly something that people are thinking about.

    Parkinsons disease is in many ways the prototypical neuropsychiatric disorder in that it causes clear damage to the brain, but also has many psychiatric aspects to it, Menza observed. The hope of those of us who work in this interface between psychiatry and neurology is that if we understand more about Parkinsons, its going to lead to a better understanding of many other diseases that we believe are based in the brain, such as attention-deficit/hyperactivity disorder, bipolar depression, and schizophrenia. if we understood Parkinsons better, we might have better insights into how to treat these other purely psychiatric disorders.

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    What Are Some Integrative Therapies To Consider For Parkinsons

    More info on this topic

    Parkinsons is a complex disease that manifests in different ways for everyone and includes both motor and non-motor symptoms, from tremors and dyskinesia to depression and cognitive difficulties. Because the spectrum of experiences is broad, many people seek a variety of treatments and practices to manage symptoms. These approaches include holistic, or integrative therapies, in addition to standard pharmacological and surgical treatments.

    Depending on which survey you read, anywhere from 40-85% of people with PD try some form of holistic therapy and most who try them find them to be effective.

    Integrative or holistic therapies should not be considered cures for Parkinsons rather, they can address the wellbeing of the whole person body, mind, spirit and work in tandem with conventional approaches recommended by your healthcare provider. Because of this, you should always let your provider know what integrative therapies you are considering using.

    Limitations And Future Perspectives

    The limitations of this review article are directly related to the limitations of the selected articles. Most articles used a small sample, so the results are not sufficiently reliable, and thus the authors propose that larger samples should be recruited for future studies . Another limitation is the patients knowledge of the applied therapy, so in many cases, the effect could have been due to the placebo effect and not to the technique itself.

    In order to mitigate some of the effects or limitations of this review, we employed comprehensive search strategies to avoid biases in the information gathering process, making a critical assessment and synthesis of the studies. In addition, the data obtained were extremely heterogeneous because of the differences between the designs and therapies or rehabilitation interventions applied in the reviewed studies.

    As research on this topic becomes more rigorous, further revisions will be required on interventions that have changed or improved over time. As dysphagia rehabilitation is a central aspect of the working of a speech-language therapist in many countries, this term speech-language therapy could be considered in future reviews and more articles can be retrieved in the search.

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