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Anxiety, Drooling May Be Early Signs Of Parkinson's Disease, Study Suggests
Copied from The Northwest Parkinson’s Foundation Weekly News Update
Huffington Post - Before the classic movement problems of Parkinson's disease appear, more benign-seeming symptoms -- such as anxiety and drooling -- may occur, according to a new study in the journal Neurology.
"These results show that Parkinson's affects many systems in the body, even in its earliest stages," study researcher Tien K. Khoo, Ph.D., of the UK's Newcastle University, said in a statement. "Often these symptoms affect people's quality of life just as much if not more than the movement problems that come with the disease. Both doctors and patients need to bring these symptoms up and consider available treatments."
For the study, researchers asked 159 people who had recently been diagnosed with Parkinson's -- as well as 99 age-matched people without Parkinson's -- to report whether they'd experienced any of 30 potential non-motor symptoms. These issues ranged from problems sleeping, to digestive issues, to sexual problems.
Researchers found that the people who had been diagnosed with Parkinson's experience an average of eight of these problems, while those without Parkinson's experienced an average of three problems.
The most common symptoms experienced by the people with Parkinson's included drooling (56 percent of people with Parkinson's, versus 6 percent without the condition), constipation (experienced by 42 percent of people with Parkinson's, compared with 7 percent without the condition), and anxiety (experienced by 43 percent of people with Parkinson's, compared with 10 percent of those without the condition).
Parkinson's disease affects up to 1 million people in the U.S., and about 60,000 people are diagnosed with the condition each year in this country, according to the Parkinson's Disease Foundation. Signs usually include tremors, problems with walking, muscle stiffness, slowed movement, changes in speaking and the loss of the ability to do "automatic movements" (like blinking), the Mayo Clinic reported, though early signs of Parkinson's can be so slight that they go unnoticed.
How Math Could Improve Life for Nearly 6 Million With Parkinson's
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TED TALK
Max Little
Huffington Post - I'm a mathematician and am constantly amazed that the world around us can be described mathematically. All it takes is a combination of a handful of simple mathematical concepts. I'm insatiably curious, and I want to understand how things fit together, so, I get involved in many kinds of scientific problems -- everything from the changing statistics of extreme rainfall, to the behavior of life at the scale of molecules, to analyzing voice and speech recordings for forensics. But there's one project, on Parkinson's disease that has occupied me for the last seven years. I fell into it almost by accident.
It is estimated that between 4 and 6 million people worldwide have Parkinson's. Because the disease is more likely to affect older people than younger, and because the population is aging and growing, that figure is expected to rise. Parkinson's primarily affects movement, the 'classic' symptoms are uncontrollable and unwanted motion in the limbs, which looks like shaking or tremors.
I can only imagine what it is like to suffer from a neurological disease. But like so many of us, I have a friend who is affected: Jan Stripling, who used to be a virtuoso ballet dancer. I thought it particularly cruel for him to suffer from Parkinson's, having lived a life dedicated to the performance of the most elegant, controlled movements. But actually, he tells me that it is the little things we all take for granted -- such as buttoning a shirt -- that frustrate him most now.
What can I do to help? I'm not a health care professional -- so I can't help directly and I found this very frustrating. I was, however, fortunate enough to have met someone who was involved in a medical research project into Parkinson's, which had recorded the voices of around 50 people weekly. As it happens, although I don't know much about neurological disorders, I do know a lot about the voice and sound. In my PhD at Oxford, I had developed mathematical algorithms for detecting voice disorders, and when we tried these algorithms on Parkinson's voices, we were able to detect those with the disease, with around 86 percent accuracy.
So, for me, it was the chance discovery that voice is affected as much by Parkinson's as limb movements, that set me on the path of trying to detect and monitor Parkinson's using voice recordings. In collaboration with one of my students, I worked for several years and now have algorithms that, in the lab, reach around 99 percent accuracy in detecting the disease. We also know how to predict the severity of symptoms to within a few percentage points of clinical judgment.
Current symptom tests are done in a clinic. They are expensive, time-consuming, and logistically difficult. So mostly, these tests are not done outside clinical trials. Our technology could enable some radical breakthroughs, because voice-based tests can be administered remotely, and patients can do the tests themselves. Also, they are high speed, taking less than 30 seconds, and since they don't involve expert staff time, they are ultra low cost. That makes the technology massively scalable.
There are many areas of medical practice and research where we think this could have an impact -- for example, reducing the need to visit the clinic to find out how the disease is progressing. We could do high-frequency monitoring for individualized treatment decisions. This might allow clinicians to optimize drug timing and dosage. For clinical trials, we could do cost-effective mass recruitment for new treatments. By recruiting very large numbers into trials we could help speed up the search for a cure. And finally, this could enable population-scale screening programs, that might allow us to search for 'biomarkers' that show early signs of the disease before the damage done is irreparable.
Recently, we set up the Parkinson's Voice Initiative with the aim of collecting 10,000 voices from across the world, using the standard telephone network. We wanted to test the technology outside the lab. We had a massive public response, quickly reaching the target in just a few months.
This incredible and unique dataset will tell us whether it is possible to use something as ubiquitous as the telephone to detect and monitor the disease. This now becomes a 'big data' analysis problem, and until the analysis is done, we can't know for sure if it will work. But if it does, we would have the technology to check out some 75 percent of the world's population at a negligible cost.
This analysis problem is already raising many new mathematical challenges that require me to design new algorithms. And as always, I'm finding that these algorithms have uses outside Parkinson's and biomedicine. One particularly fascinating application is the detection of extrasolar planets -- that is, planets circling other stars.
One way to detect these planets is to monitor the brightness of the host star: when the planet passes through the line of sight, it dims slightly, and this dimming is very good evidence for the existence of planet. But the brightness signal is extremely noisy, so, removing the noise requires specialized mathematical algorithms. It turns out that these algorithms have a lot in common with those used to analyze voice signals in Parkinson's!
This is the pattern I find in my mathematical research: a particular problem requires a mathematical solution, and I find that I already have a useful algorithm in my 'algorithm toolbox.' The goal of my research, then, is to discover ways to adapt those mathematical tools to help solve new problems. This process has extraordinary depth and is always fascinating.
Ideas are not set in stone. When exposed to thoughtful people, they morph and adapt into their most potent form. TEDWeekends will highlight some of today's most intriguing ideas and allow them to develop in real time through your voice! Tweet #TEDWeekends to share your perspective or email tedweekends@huffingtonpost.com to learn about future weekend's ideas to contribute as a writer.
http://www.huffingtonpost.com/max-little/parkinsons-diagnosis-test_b_2545128.html?utm_hp_ref=email_share
Early Diagnosis Of Parkinson's May Be Possible With Discovery Of New Antibody
Copied from The Northwest Parkinson’s Foundation Weekly News Update
Petra Rattue
medical news today - Around 15,000 to 16,000 Austrian's suffer from Parkinson's disease, a degenerative condition of the brain, which becomes more prevalent with age. The frequency of Parkinson's disease will become more widespread as society ages.
The neurodegenerative Parkinson's and related diseases occur because of pathogenic changes to proteins. In Parkinson's disease, a disease with no current cure, the alpha-synuclein protein alters, becoming pathological. Demonstrations of changes in alpha-synuclein linked to Parkinson's have so far been not possible as no antibodies have been available. However, a study published in the journal Acta Neuropathologica now reports an international team of experts led by Gabor G. Kovacs from the Clinical Institute of Neurology at the MedUni Vienna has now discovered a new antibody which is able to demonstrate these changes.
Kovacs declares: "It opens up new possibilities for the development of a diagnostic test for Parkinsonism. This new antibody will enable us to find the pathological conformation in bodily fluids such as blood or CSF."
The team is already conducting a clinical study with approximately 200 patients and the first definitive results can be expected at the end of this year. The clinical study is performed in collaboration with research leader Walter Pirker from the University Department of Neurology and aims to determine the extend to which the new antibody can be utilized as an early diagnostic tool to gain a better understanding and to treat the condition more effectively.
The diseased form of alpha-synuclein in people with Parkinson's disease shares the same primary structure as the healthy form, yet the diseased form undergoes an "abnormal fold". Kovacs explains: "Until now, however, it was not possible to distinguish between the two."
Previous immunodiagnostic techniques only allowed confirmation of the general presence of alpha-synuclein, whereas the new, monoclonal antibody can detect a strategic part of the protein, which is responsible for the structural changes. The new antibody has been developed in collaboration between the researchers from MedUni Vienna and the German biotech company Roboscreen.
Kovacs concludes: "It is still not possible to say whether or not we will be able to diagnose Parkinson's from a blood test, but this discovery certainly represents a major step in that direction."
The researchers believe that in theory a diagnosis of Parkinson's disease should be possible five to eight years before the disease develops.
http://www.medicalnewstoday.com/articles/248208.php
Dial-A-Diagnosis? The Parkinson’s Voice Initiative
Copied from The Northwest Parkinson’s Foundation Weekly News Update
www.wftv.com - FLORIDA — BACKGROUND: Parkinson’s disease is a condition of the brain affecting approximately six million people. It is most commonly characterized by slowness of movement, stiffness, shaking, and loss of balance. Parkinson’s often develops after the age of 50. Although Parkinson’s disease is one of the most common nervous system disorders for the elderly, it can affect young people too, usually because a form of the disease runs in their family. Nerve cells use a brain chemical called dopamine to control muscles. When the nerve cells in the brain that produce dopamine are destroyed as a result of Parkinson’s, the nerve cells in that particular part of the brain will not properly send messages. The result is the loss of muscle control. The damage gets worse over time.
SYMPTOMS: Usually symptoms are mild at first. There might be a slight feeling that one foot may be stiff or there might be a small tremor when the disease first makes its appearance. As the disease progresses symptoms can include: slow blinking, difficulty swallowing, constipation, drooling, no expression in the face problems with balance, muscle pains, trouble moving, stiff muscles, shaking (tremors), stooped position, slowed speech or monotone voice, low blood pressure, confusion, anxiety, hallucinations, memory loss, fainting, depression, or dementia. (Source: ncbi.nlm.nih.gov)
TREATMENT: A doctor may be able to diagnose the disease based on symptoms alone, but symptoms can be difficult to access in the elderly. Unfortunately, there is no known cure only a treatment plan to control symptoms. Medicines for Parkinson’s are designed to control symptoms usually by increasing levels of dopamine in the brain. Throughout the day the medications can wear off and symptoms can return. Parkinson’s requires the patient and doctor to work closely with each other to find the right treatment plan that works best. Common medications are Levodopa (L-dopa), Pramipexole (Mirapex), Selegiline (Eldepryl, Deprenyl), Amantadine or anticholinergic medications to reduce early or mild tremors, or Entacapone to help control movement. Other medications include: Memantine for cognitive difficulties, Antidepressants, Gabapentin for pain, Fludrocortisone for autonomic dysfunction, and Armodafinil for sleep disorders. (Source: ncbi.nlm.nih.gov)
NEW TECHNOLOGY: Testing for Parkinson’s can be expensive and time consuming. One of the newest breakthroughs for this disease is the Parkinson’s Voice Initiative. Technology has been developed to test for symptoms using voice recordings. The voice tests are just as accurate as clinical tests with 99 percent accuracy and can be administered over the phone, resulting in reduced costs. The Parkinson’s Voice Initiative believes that the impact of this test will reduce logistical difficulties (no need to do routine checkups), will become a cost-effective mass recruitment for treatment trials (perhaps obtaining a large database for new treatments to speed up the search for a cure), will have a high-frequency monitoring for individualized treatment options, and will result in population-scale screening programs. Calls can be placed based out of your county, including: USA, Brazil, Mexico, UK, France, Spain, Argentina, Canada, and New Zealand. (Source: parkinsonsvoice.org)
Early Thinking Problems May Signal Future Dementia in Parkinson's Patients
Copied from The Northwest Parkinson’s Foundation Weekly News Update
www.ivillage.com - People newly diagnosed with Parkinson's disease who have minor thinking problems may be on the way to early dementia, according to a new Norwegian study.
Some people with Parkinson's go on to develop dementia, but whether it is possible to predict who will fall into this group hasn't been clear. In this new study, researchers wanted to see if early signs of thinking problems would indicate who these patients might be.
"Mild thinking problems seem to be an important clinical concept for early detection of patients with Parkinson's disease who are at risk to develop dementia," said lead researcher Dr. Kenn Freddy Pedersen, from the Norwegian Center for Movement Disorders at Stavanger University Hospital.
"Specifically, we found that more than 27 percent of patients with thinking problems at diagnosis progressed to dementia during the first three years of follow-up," he said. "Even more interesting, almost half of the patients with persistent thinking problems one year after diagnosis developed dementia during the next two years."
One result was more encouraging: For some patients, thinking ability returned to normal over the course of the study.
Although there is no immediate clinical implication to the new findings, they may be important for trials of drugs that might slow or reverse the process leading to dementia, and the findings may also help in managing patients, Pedersen said.
The report was published March 25 in the online edition of the journal JAMA Neurology.
Dr. Brian Copeland, a movement disorder fellow at the University of Texas Medical School at Houston and co-author of an accompanying journal editorial, said the study indicates that patients with ongoing evidence of thinking problems are at higher risk of getting dementia.
Although identifying patients with thinking problems is easy to do when Parkinson's disease is diagnosed, there isn't a way to accurately classify patients, so it isn't clear whether early thinking problems really predict dementia, he said.
"[The finding's] value in predicting Parkinson's disease dementia is less clear and needs further research," Copeland said.
To map the course of thinking problems in Parkinson's patients, Pedersen's team followed 182 patients for three years. Participants completed a battery of screening exams, including tests of their memory, verbal fluency and color-naming ability.
During the study, 27 percent of patients who had thinking problems at diagnosis went on to develop dementia, compared with 0.7 percent of those who didn't have thinking problems, the researchers said.
For some patients, however, normal thinking returned. Among those with thinking problems, about 19 percent saw their thinking problems clear up, Pedersen's group found.
The progression to dementia was also dependent on how severe the patient's thinking problems were, the researchers noted.
Among patients with the most severe thinking problems at the start of the study and one year later, 45.5 percent went on to develop dementia while only about 9 percent saw their thinking restored to normal, the researchers said.
Although the study found an association between mild thinking problems in patients newly diagnosed with Parkinson's disease and later dementia, it did not establish a cause-and-effect relationship.
Sun City doctors report progress toward first test for Parkinson’s
Copied from The Northwest Parkinson’s Foundation Weekly News Update
By Kirsten Adams
www.azcentral.com - For Drs. Charles Adler and Thomas Beach, one of the most difficult parts of diagnosing Parkinson’s disease is that they could be wrong.
“There is no test, so we don’t have any way of looking at making a diagnosis while someone is alive,” said Adler, a neurologist with the Mayo Clinic in Scottsdale.
But Adler and Beach, a senior scientist at the Banner Sun Health Research Institute, are reporting strides in developing the first diagnostic test to detect Parkinson’s, a devastating and chronic neurological disorder.
A study they conducted through the Mayo Clinic and Banner Health found that examining a portion of a person’s saliva gland may allow doctors to diagnose the disease.
They will present the study in March at the American Academy of Neurology’s annual meeting.
Should this lead to a diagnostic test, Adler said he is pretty confident it will be able to change the course of the disease.
“Patients often undergo invasive treatment, and people who don’t have Parkinson’s don’t respond well,” Adler said. “Being able to tell people, ‘Yes, you do have Parkinson’s,’ would make it much easier.”
Diagnosis has for years occurred through a sometimes inaccurate examination of symptoms such as tremors, slowness of movement and muscle stiffness. Doctors have only found definitive answers through autopsies.
“That’s a big problem for clinical trials (of treatments or cures),” Beach said. “If you’re testing people with new drugs and only half actually have Parkinson’s disease, then right away you’re up against a problem.”
Adler said only 80 to 85 percent of patients autopsied actually had Parkinson’s, so a tissue test would guarantee diagnosis and lower chances of degeneration.
Beth Lee, 62, started showing symptoms of Parkinson’s almost nine years ago. She said she struggled turning her car keys, drawing circles and performing simple tasks, but having Parkinson’s never crossed her mind until she met with a specialist.
“I looked at him like he had 10 heads and said, ‘I have what?’” Lee said.
If she had the option of a diagnostic test, Lee said she could have saved the three years of degeneration it took to find out she had Parkinson’s.
Adler and Beach’s study tested tissue biopsies of 15 patients who showed symptoms of Parkinson’s for at least five years and responded to medications.
Of the 15 patients, 11 had enough tissue to examine. Of those 11, nine tested positive for the Parkinson’s protein.
Adler isn’t just professionally invested in this study. He has worked for nearly 30 years to improve the treatment and diagnosis of Parkinson’s, from which his grandfather suffered.
Some steps remain before a diagnostic test could be prepared for clinical use. Adler said the recent study and past autopsy results show the test’s success with advanced Parkinson’s patients, or those who have had the disease for at least five years.
But Beach said the team now needs to study the test’s accuracy on early Parkinson’s patients.
Tom Viviano, co-director of the American Parkinson’s Disease Association’s Arizona chapter, said the test could be very helpful if a treatment or cure for the disease is discovered.
“This can become a way to routinely test for Parkinson’s,” he said.
NIH launches collaborative effort to find biomarkers for Parkinson's
Copied from The Northwest Parkinson’s Foundation Weekly Update
New online resource will support data sharing
Daniel Stimson
NIH News - A new initiative aims to accelerate the search for biomarkers — changes in the body that can be used to predict, diagnose or monitor a disease — in Parkinson's disease, in part by improving collaboration among researchers and helping patients get involved in clinical studies.
A lack of biomarkers for Parkinson's has been a major challenge for developing better treatments. The Parkinson’s Disease Biomarkers Program (PDBP) supports efforts to invent new technologies and analysis tools for biomarker discovery, to identify and validate biomarkers in patients, and to share biomarker data and resources across the Parkinson's community. The program is being launched by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.
Biomarkers can include changes in body chemistry or physiology, in genes and how they are regulated, and even subtle changes in a person's behavior. For example, certain antibodies in the blood can be biomarkers for different types of infection. For Parkinson's, there are no proven biomarkers.
Parkinson's disease is a movement disorder that affects about 1 million people in the United States. Symptoms of the disease get worse over time, and include uncontrollable shaking, rigidity, slowed movements and impaired balance. Inside the brain, there is a progressive loss of cells in a motor control region called the substantia nigra, and an accumulation of protein-filled structures called Lewy bodies. Lewy bodies and other telltale signs cannot be observed until after death. Biomarkers could be used to detect and monitor the disease much earlier, perhaps even before symptoms appear. This could improve the success of existing therapies and help researchers test new ones in clinical trials.
The range of potential biomarkers for Parkinson's is vast, and there have been promising leads Some researchers are investigating the use of non-invasive imaging to detect changes in brain function or biochemistry. Several studies have tentatively linked the disease with changes in proteins or other molecules in blood, urine, or in the cerebrospinal fluid (CSF) that bathes the brain and spinal cord. PDBP is an initiative to fund and coordinate multiple biomarker studies.
“Our goal is to accelerate progress toward a robust set of biomarkers for Parkinson's disease by supporting researchers who have strong leads or innovative approaches, bringing them together, and making it easier for them to share and analyze data across studies,” said NINDS director Story Landis, Ph.D.
Nine research teams, listed below, have been funded through the program so far. Four of these projects are associated with the NINDS Udall Centers of Excellence for Parkinson’s Disease Research (see projects marked by *).
F. Dubois Bowman, Ph.D., Emory University, Atlanta*
(Grant NS082143)
This group will develop statistical tools to analyze data from brain imaging, genetic, molecular and clinical tests, in order to discover biomarkers which, in combination, can better predict the course of Parkinson’s disease than a single biomarker might be able to do.
Alice Chen-Plotkin, M.D., Ph.D., University of Pennsylvania, Philadelphia*
(Grant NS082134)
This team seeks to confirm several candidate biomarkers they have identified, and search for others by using a novel, broad-ranging approach to measure the levels of more than 400 proteins in blood.
Ted Dawson, M.D., Ph.D., Johns Hopkins University, Baltimore*
(Grant NS082133)
This team seeks to gain a clearer picture of the early clinical features of Parkinson’s – including changes in cognition and sleep – and to correlate those changes with potential biomarkers in blood and CSF.
Dwight German, Ph.D., and Richard Dewey, Ph.D., University of Texas Southwestern Medical Center at Dallas
(Grant NS082148)
Based on evidence that immune responses play a role in Parkinson’s, the researchers will investigate whether disease progression is related to changing levels of antibodies and other proteins in blood and CSF.
Xuemei Huang, M.D., Ph.D., Pennsylvania State University, University Park
(Grant NS082151)
This team will seek to determine whether state-of-the-art magnetic resonance imaging (MRI) scans can reveal subtle structural and chemical changes in the brain, including iron accumulation, during Parkinson’s.
Vladislav Petyuk, Ph.D., Battelle Pacific Northwest Laboratories, Richland, Wash.
(Grant NS082140)
This group will seek to identify new components of the Lewy bodies that accumulate in the brain during Parkinson’s, and then use ultra-sensitive methods to see if any of these proteins have leaked into CSF or blood.
Clemens Scherzer, M.D., Brigham and Women’s Hospital, and Harvard University, Boston
(Grant NS082157)
This team will investigate whether Parkinson’s is associated with changes in the activity of non-coding, “dark matter” genes (which do not make proteins) in brain tissue, blood and CSF. The team also will integrate the PDBP with a Parkinson’s biomarkers study at the Harvard Neurodiscovery Center, which has already enrolled about 2,000 individuals.
Andrew West, Ph.D., University of Alabama at Birmingham
(Grant NS082132)
This team discovered that the Parkinson’s-related protein LRRK2 and many other proteins can be detected in urine, within microscopic structures called exosomes; they will investigate whether exosome-related proteins can serve as biomarkers.
Jing Zhang, M.D., Ph.D., University of Washington, Seattle*
(Grant NS082137)
CSF appears to contain potential biomarkers, but blood is easier to obtain. Therefore, this group’s strategy is to conduct an expanded search for biomarkers in CSF and then search again for the strongest candidates in blood.
To support collaboration across these projects and others, the PDBP is introducing a new online data sharing platform, the Data Management Resource (DMR) (password protected), which was developed by the NIH Center for Information Technology. PDBP investigators are required to share data through the DMR. In the future, this requirement will also apply to investigators funded through the NINDS Udall Centers. Investigators not funded through these programs will be able to access the data and request biological samples, as well as encouraged to submit their own. Biological samples submitted through the PDBP will be banked by the NINDS Human Genetics Repository at the Coriell Institute for Medical Research, Camden, N.J.
“By giving researchers access to data and resources, we hope to stimulate biomarker discovery efforts across the Parkinson’s research community,” said Margaret Sutherland, Ph.D., a program director at NINDS.
The PDBP is committed to enhancing patient involvement and ensuring patient privacy. The DMR is password-protected and will contain only data and biological samples that have been stripped of any identifying information. The DMR will post updates about ongoing research, including notices about actively recruiting studies and results funded through the PDBP.
“This website is not just a database, but a way to communicate with the public and the research community about our progress,” said Katrina Gwinn, M.D., Ph.D., also of NINDS. Drs. Sutherland and Gwinn are the lead scientific officers on several PDBP projects.
For more information about Parkinson’s disease, please visit http://www.ninds.nih.gov/PD.
NINDS (http://www.ninds.nih.gov) is the nation’s leading funder of research on the brain and nervous system. The NINDS mission is to reduce the burden of neurological disease — a burden borne by every age group, by every segment of society, by people all over the world.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.
Promising Saliva Gland Test For Detecting Parkinson's
Copied from the Northwest Parkinson’s Foundation Weekly News Update
Kelly Fitzgerald
Medical News Today - Testing a part of a person's saliva gland may be a way to diagnose Parkinson's disease, according to new research by the Mayo Clinic that will be presented at the American Academy of Neurology's annual meeting in March.
Parkinson's disease is a difficult disease to diagnose. Currently the only way to pinpoint the disease is to do a clinical exam to analyze a person's symptoms. To achieve a definitive answer, an autopsy is performed on the brain after a person has passed away.
Charles Adler, M.D., Ph.D., and main researcher of the study said:
"We have previously shown in autopsies of Parkinson's patients that the abnormal proteins associated with Parkinson's are consistently found in the submandibular saliva glands, found under the lower jaw. This is the first study demonstrating the value of testing a portion of the saliva gland to diagnose a living person with Parkinson's disease. Making a diagnosis in living patients is a big step forward in our effort to understand and better treat patients."
The study consisted of 15 people with a mean age of 68 who had Parkinson's disease for an average of 12 years. The participants chosen had also responded well to Parkinson's medication and did not have any previous saliva gland issues.
Two different saliva glands were biopsied: the minor saliva glands in the lower lip and the submandibular gland. The extracted tissues were then analyzed for evidence of the irregular Parkinson's protein.
Researchers suggest that one of the most important potential advantages this test could have is creating more accurate clinical trials. Parkinson's clinical trial participants currently do not always have Parkinson's disease, making it harder to test new therapies.
In nine of the eleven patients who had an adequate amount of tissue to examine, the irregular Parkinson's protein was found. The rate of positive outcomes in the biopsies of the lower lip glands seemed much lower than for the lower jaw gland.
Dr. Alder explained:
"This study provides the first direct evidence for the use of submandibular gland biopsies as a diagnostic test for living patients with Parkinson's disease. This finding may be of great use when needing definitive proof of Parkinson's disease, especially when considering performing invasive procedures such as deep brain stimulation surgery or gene therapy."
Parkinson's, A Progressive Disease
Parkinson's disease is an accelerating disease of the nervous system that affects movement. It starts slowly, sometimes with an unnoticeable hand tremor. Tremors are the hallmark symptoms of Parkinson's - the disease also comes with stiffness and slowing of motor skills.
Diagnosis is based on medical history, an assessment of symptoms and signs, a physical and neurological analysis, and eliminating possibilities of other disorders. Close to 30 percent of patients may be misdiagnosed early on in the disease.
Even though Parkinson's cannot be cured, medications can greatly reduce symptoms.
Recognize Parkinson’s Symptoms Early
Copied from The Northwest Parkinson’s Foundation Weekly News Update
Shefali Sabharanjak, PhD
brain blogger - Parkinson’s disease (PD) was described almost a century ago but has proven to be intractable in terms of curative therapies. Early detection and interventions for slowing down the progressively debilitating changes are the principal medical approaches to treat this problem. Tremor, loss of motor control and rigidity in limbs are the principal symptoms of Parkinson’s disease.
The paradox is that by the time these overt symptoms develop and a confirmed diagnosis is arrived at based on them, the patient’s motor abilities are already significantly compromised. The loss of motor control results into loss of personal independence altering the quality of life considerably. Therefore the search for early symptoms of Parkinson’s disease which precede loss of motor functions is a vital topic in current neuroscience research.
A long-term research study, known as the Honolulu-Asia Aging Study (HAAS) has helped to shed some light on the development and early signs of Parkinson’s disease. In this study, 8,006 Japanese-American men were examined periodically for 40 years. From 1991, cases of Parkinson’s disease started emerging in this group. Patients were diagnosed as Parkinson’s patients based on the independent diagnoses provided by two neurologists. Brain autopsies have also been performed on deceased patients to ascertain the formation of incidental Lewy bodies — a characteristic cellular feature of Parkinson’s disease.
The study has helped to identify some behavioral patterns in patients that precede the motor symptoms of PD. Excessive day time sleepiness and loss of the sense of smell emerged as two characteristics of patients who developed PD later in life. Constipation was also identified as a feature that indicated greater risk for development of PD in this groups of patients.
Patients who developed PD also showed slower response to a computerized reaction test. In addition to the clinical diagnosis of PD, brain autopsies from people who recorded the slowest reaction times also showed development of incidental Lewy bodies. Since tests like the reaction time to a specific cognitive challenge can be quantified, it may be possible to identify threshold levels in the reaction time to separate the high-risk and low-risk patients. However, a detailed analysis of these results with an aim to identify a quantitative threshold has not been performed in this study.
All these behavioral abnormalities were assessed 7-8 years prior to death which is a sufficient time window to provide therapeutic interventions as well. The incidence of PD in patients was significantly higher when symptoms like constipation (less than one bowel movement a day) and slow reaction time to the computerized test were present simultaneously.
Blood hemoglobin levels may also turn out to be a diagnostic sign for early identification of PD. Normally, hemoglobin levels decline with age. However, in the HAAS study, individuals who had greater than or equal to 16 mg/dl hemoglobin at age 71-75 years were more likely to develop Parkinson’s disease when assessed at age 80 years. Increased levels of iron in blood has been known to be associated with PD.
Are these symptoms definitive? These symptoms are certainly not as black and white as other diagnostic tests which measure specific levels of biochemical markers of a disease. However, these signs and symptoms are of immense predictive value given that they are evident 7-8 years prior to development of motor disabilities and clinically identifiable progression of Parkinson’s disease. Moreover the actual incidence of PD in patients from the HAAS study, which have presented these symptoms, has been confirmed by looking for Lewy bodies in brain sections which is a clear symptom of Parkinson’s disease. These researchers have concluded that presence of a combination of these symptoms — loss of sense of smell, constipation, slower reaction time, high hemoglobin levels and excessive daytime sleepiness — increases the risk for developing PD subsequently.
Even if these symptoms are only indicative and not definitive signs of PD, they can alert physicians to the possibility of incipient PD in geriatric patients and provide a time window for intervention before motor control is lost.
References
Ross GW, Abbott RD, Petrovitch H, Tanner CM, & White LR (2012). Pre-motor features of Parkinson’s disease: the Honolulu-Asia Aging Study experience. Parkinsonism & related disorders, 18 Suppl 1 PMID: 22166434
Abbott RD, Ross GW, Tanner CM, Andersen JK, Masaki KH, Rodriguez BL, White LR, & Petrovitch H (2012). Late-life hemoglobin and the incidence of Parkinson’s disease. Neurobiology of aging, 33 (5), 914-20 PMID: 20709430
Colonic Tissue May be Used to Predict Parkinson's Disease
http://www.rush.edu/rumc/page-1298329896566.html
http://www.rush.edu/rumc/page-1298329896566.html
CSF Markers Aid in Dementia, Parkinson's Dx
Copied from The Northwest Parkinson’s Foundation Weekly News Update
John Gever
Medpagetoday.com - Levels of five proteins in cerebrospinal fluid can distinguish among different types of dementias and also among conditions that resemble Parkinson's disease, researchers said.
Diagnostic accuracy of the five markers in terms of the area under the receiver-operating characteristic curve was 0.90 for distinguishing Alzheimer's disease from two other common forms of dementia and 0.93 for Parkinson's disease versus other neurodegenerative conditions with similar symptoms, according to Oskar Hansson, MD, PhD, of Skane University Hospital in Malmo, Sweden, and colleagues.
The five proteins are alpha synuclein, the 42-amino acid form of beta amyloid protein (AB42), total tau protein (T-tau), hyperphosphorylated tau protein (P-tau), and neurofilament light chain (NF-L), the researchers explained online in Archives of Neurology.
"Together with earlier published data, our results indicate that these five CSF biomarkers might have clinical value in the differential diagnosis of dementia and/or parkinsonism," they wrote.
In fact, for the latter purpose, one of the markers -- NF-L -- was as accurate when used alone as all five combined. The area under the curve for NF-L in distinguishing Parkinson's disease from "atypical parkinsonian disorders," including progressive supranuclear palsy, corticobasal degeneration, and multiple system atrophy, was 0.93.
An accompanying editorial by Richard J. Perrin, MD, PhD, of Washington University in St. Louis, noted that such biomarkers would not only be useful for routine patient care, but also as research tools.
"Useful biomarkers will guide enrollment into trials by ensuring accurate early symptomatic or presymptomatic diagnosis, uniform pathological staging, and selection of individuals at increased risk of a progressive course," Perrin wrote.
"Ideally, trials will also include biomarkers that can assess pharmacological 'target engagement' by the therapeutic agent to verify delivery, efficacy, and appropriate dosage," he added.
For the study, Hansson and colleagues analyzed CSF samples from a total of 346 patients with Parkinson's disease with or without dementia, Alzheimer's disease, progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration, or dementia with Lewy bodies as well as 107 healthy controls.
Four of the five markers tested in the study (alpha synuclein, AB42, and T- and P-tau) were part of a commercial multiplex assay; NF-L was measured with a separate quantitative diagnostic.
Among the key findings for individual markers:
Alpha synuclein was elevated, relative to controls, in patients with Alzheimer's disease and lower in those with Parkinson's disease (with or without dementia), dementia with Lewy bodies, and multiple system atrophy.
AB42 levels were decreased in dementia with Lewy bodies and extremely decreased in Alzheimer's disease.
Both types of tau protein were elevated in Alzheimer's disease.
NF-L was increased in patients with the atypical parkinsonian disorders.
In dementia patients, according to Hansson and colleagues, T- and P-tau and alpha synuclein were each relatively accurate as standalone markers in distinguishing Alzheimer's disease from the Parkinson's and Lewy body forms, with areas under the receiver-operating characteristic curve of 0.83 to 0.86.
However, using all five markers together boosted the area under the curve to 0.90 -- "high enough to be of clear value in the clinical setting," the researchers wrote.
For the differential diagnosis of Parkinson's disease versus other conditions that may resemble it clinically, on the other hand, the five-marker panel was no more accurate than NF-L by itself.
In his editorial, Perrin cautioned that the markers need testing in more challenging situations -- "clinically ambiguous or seemingly straightforward cases that involve more than one proteinopathy," he wrote, such as patients who have excesses of both tau and alpha synuclein proteins.
"The cases included in this study -- by necessity and by design -- represent relatively ideal clinical examples," he added. "It remains unclear whether the biomarker changes of the entire panel observed at these stages will also be detectable and diagnostic during the early symptomatic or presymptomatic stages that will be targeted in clinical trials."
He noted as well that patients in the sample were diagnosed clinically, with neuropathological confirmation lacking.
Still, Perrin indicated, the work "represents a significant step forward."
The study was supported by Swedish government agencies and private foundations, with no industry funding.
Study authors and Perrin declared they had no relevant financial interests.
Primary source: Archives of Neurology
Source reference:
Hall S, et al "Accuracy of a panel of 5 cerebrospinal fluid biomarkers in the differential diagnosis of patients with dementia and/or parkinsonian disorders" Arch Neurol 2012; DOI: 10.1001/archneurol.2012.1654.
Additional source: Archives of Neurology
Source reference:
Perrin R, "Cerebrospinal fluid biomarkers for clinical trials: why markers for differential diagnosis are important" Arch Neurol 2012; DOI: 10.1001/archneurol.2012.2353.
http://www.medpagetoday.com/Neurology/Dementia/34444
Eye Movement Research Could Help Diagnose Neurological Disorders
Copied from The Northwest Parkinson’s Foundation Weekly News Update
USC-led team has designed a low-cost, easily-deployed method for detecting ADHD, Parkinson’s, and Fetal Alcohol Spectrum Disorder
red Orbit - Researchers at the University of Southern California have devised a method for detecting certain neurological disorders through the study of eye movements.
In a study published today in the Journal of Neurology, researchers claim that because Attention Deficit Hyperactivity Disorder (ADHD), Fetal Alcohol Spectrum Disorder (FASD) and Parkinson’s Disease (PD) each involve ocular control and attention dysfunctions, they can be easily identified through an evaluation of how patients move their eyes while they watch television.
“Natural attention and eye movement behavior – like a drop of saliva – contains a biometric signature of an individual and her/his state of brain function or dysfunction,” the article states. “Such individual signatures, and especially potential biomarkers of particular neurological disorders which they may contain, however, have not yet been successfully decoded.”
Typical methods of detection — clinical evaluation, structured behavioral tasks and neuroimaging — are costly, labor-intensive and limited by a patient’s ability to understand and comply with instructions. To solve this problem, doctoral student Po-He Tseng and Professor Laurent Itti of the Department of Computer Science at the USC Viterbi School of Engineering, along with collaborators at Queen’s University in Canada, have devised a new screening method.
Participants in the study were simply instructed to “watch and enjoy” television clips for 20 minutes while their eye movements were recorded. Eye-tracking data was then combined with normative eye-tracking data and a computational model of visual attention to extract 224 quantitative features, allowing the team to use new machine learning techniques to identify critical features that differentiated patients from control subjects.
With eye movement data from 108 subjects, the team was able to identify older adults with Parkinson’s Disease with 89.6% accuracy, and children with either ADHD or FASD with 77.3% accuracy.
Providing new insights into which aspects of attention and gaze control are affected by specific disorders, the team’s method provides considerable promise as an easily-deployed, low-cost, high-throughput screening tool, especially for young children and elderly populations who may be less compliant to traditional tests.
“For the first time, we can actually decode a person’s neurological state from their everyday behavior, without having to subject them to difficult or time-consuming tests,” Itti said.
—
http://www.redorbit.com/news/health/1112685382/eye-movement-research-could-help-diagnose-neurological-disorders/
Speech test may help diagnose Parkinson's
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Using professional recording equipment and computer algorithms, researchers have had success detecting tiny changes in speech patterns that may point to the disease in its early stages.
Robin Erb
www.usa.today.com - - DETROIT -- Identifying Parkinson's disease one day might be as easy as a speech test -- a non-invasive, inexpensive tool that in early experiments has shown surprisingly accurate results, a Michigan State University researcher said Wednesday.
The key: Tiny changes in speech that occur early in Parkinson's development and can be detected by professional recording equipment and computer algorithms -- perhaps even before loved ones notice slurred or slow speech or other symptoms, said Rahul Shrivastav, professor and chairman of Michigan State University's Department of Communicative Sciences and Disorders.
The method detected those with Parkinson's and those without nine out of 10 times.
Changes in speech patterns are noticeable in late-stage Parkinson's, Shrivastav said. But in early stages, "the changes are small … they are not necessary big enough to notice."
Parkinson's affects nerve cells that use the brain chemical dopamine to help control muscle movement. Over time, the dopamine levels fall and nerve cells no longer properly send messages, leading to loss of muscle function, tremors and even dementia, Shrivastav said.
That can affect speech because muscle movements in the jaw and tongue become slow and have a reduced range, he said.
Over several years, Shrivastav and colleagues at the University of Florida's Department of Speech, Language and Hearing Sciences tested 76 men and women ranging in age from their 40s to their 80s, half of whom had been diagnosed with Parkinson's.
They asked the participants to recite 10 sentences that covered different sounds, including: "The beer drinkers raised their mugs" and "The boat sailed along the coast."
Special software developed by the team then dissected the speech sentence by sentence and in pieces that were just 1/50th of a second long.
Using thousands of readings, the software this year correctly differentiated the speech between patients with Parkinson's and those without Parkinson's most of the time. It was so sensitive, in fact, that it could make a determination with just two seconds of speech.
"We anticipated good results, but getting two seconds and 90 percent -- that was a surprise," Shrivastav said.
Parkinson's is one of the most common nervous system disorders of the elderly, and about 50,000 new cases are reported annually, according to the National Institutes of Health.
Researchers have tried for years to understand the disease, but the cause and cure remain evasive, said Maureen Gartner, information and referral nurse for the Cincinnati-based Tri-State Parkinson's Wellness Chapter, a chapter of the American Parkinson Disease Association that covers Michigan.
"We don't know where it starts, so any new twist that could help us diagnose it earlier would be great," she said.
Voice Recognition Software Can Diagnose Parkinson’s
Copied from The Northwest Parkinson’s Foundation Weekly News Update
Jamie Condliffe
gizmodo.com - "Siri, do I have Parkinson's?" That might sound flippant, but actually new research shows that it's possible to detect Parkinson's symptoms simply by using algorithms to detect changes in voice recordings.
Parkinson's, a degenerative disorder of the central nervous system, is usually diagnosed through analysis of symptoms along with expensive medical imaging to rule out other conditions—though there is currently no concrete method for detecting it.
Max Little, from the University of Oxford, has different ideas. He's been developing software that learns to detect differences in voice patterns, in order to spot distinctive clues associated with Parkinson's. Little explains to the BBC:
"This is machine learning. We are collecting a large amount of data when we know if someone has the disease or not and we train the database to learn how to separate out the true symptoms of the disease from other factors."
Using data from 50 patients with Parkinson's, who had their voices recorded once a week for six months, Little was able to develop an algorithm to detect changes in voice purely associated with Parkinson's. In recent tests, the software accurately picked out Parkinson's patients from a random population with 86 percent accuracy.
Now, Little is taking things further. Today, he is announcing at TEDGlobal that the project is extending, by inviting members of the general public to phone in and leave voice recordings to help him improve the software. The aim is to collect up to 10,000 voices, and people from around the world are encouraged to contribute.
If all goes well, Little hopes to roll out the technology for use by doctors in two years, and is adamant that it will help in the diagnosis of the disease. Again speaking to the BBC, he explained:
"We're not intending this to be a replacement for clinical experts, rather, it can very cheaply help identify people who might be at high risk of having the disease and for those with the disease, it can augment treatment decisions by providing data about how symptoms are changing in-between check-ups with the neurologist."
It's an impressive achievement to take a relatively young technology and turn it into a system capable of detecting a disease like Parkinson's. Now, if you excuse me, I have an important phone call to make. [Parkinson's Voice Initiative via BBC]
http://gizmodo.com/5921035/voice-recognition-software-can-diagnose-parkinson’s
Parkinson's Disease - Smelling Test For Early Detection
Copied from The Northwest Parkinson’s Fouindation Weekly News Update
Petra Rattue
Medical News Today - Even though Parkinson's disease is incurable, nowadays doctors are able to favorably influence the course of the disease, so that patients are able to enjoy a high quality of life for many years. In order to fight against the destruction of brain cells in Parkinson's it is necessary for doctors to detect the disease early, but unfortunately only very few adequate early detection methods are available.
Researchers have now discovered that the sense of smell provides valuable indications. Hyposmia, i.e. losing the ability to smell for no known cause could be a markers for the non-motor signs of Parkinson's disease. Dr Ulrich Liebetrau, chief physician for Parkinson's consultations at the Neurological Department of Kliniken der Stadt Köln, declared at the 22nd Meeting of the European Neurological Society (ENS) in Prague: "Smelling tests in doctors' offices are suitable for detecting hyposmia but so too are tests conducted in public places such as pedestrian zones."
Parkinson's is a very common neurological slowly progressive disease that usually affects individuals aged between 50 and 60 years. In Germany alone there are about 300,000 people diagnosed with Parkinson's. Scientists still remain uncertain for the reasons of cell death occurring in the substantia nigra in the basal ganglia of the brain of Parkinson's patients, but suspect that genetic factors may be involved. The cell death causes a shortage of dopamine, a neurotransmitter, which leads to loss of control over voluntary and involuntary movements. German neurologists from Cologne have now tested a new early detection method for subtle signs of Parkinson's which focuses on the partial loss of the sense of smell, which they based on previous studies that demonstrated that one in ten people with hyposmia develop Parkinson's in later years.
Dr Liebetrau explained: "Our objective was to reach as many people with hyposmia as we possibly could."
The team used an unusual method for their trial. They performed a public smelling test on a Saturday in a banqueting hall in Cologne's pedestrian district that is well known. Liebetrau described the requirements the venue needed to fulfill, saying:
"For people to accept the test we were offering, the location had to be central and familiar to everyone. Another important factor was having private places to withdraw. But tents would have detracted from the seriousness of the endeavor."
They asked 187 participants to smell vanilla, lemon, cloves and lavender to smell. Overall, 46 participants were identified as having hyposmia, who were all offered a follow-up at the City of Cologne Clinics (Kliniken der Stadt Köln). Dr Liebetrau explained: "The test was to be followed up by a professional examination done by neurologists and ENT specialists at a separate time and place. After all, hyposmia can be a sign of any number of diseases."
The result revealed that three of the 46 individuals with hyposmia were diagnosed with Parkinson's, even though they had no former knowledge prior to the test that they were affected by the disease.
One of the key advantages of low-threshold tests is that diseases that would otherwise go undetected are identified early, which also prevents these diseases from becoming chronic. Early diagnosis is advantageous, even if they involve severe neurological disorders like Parkinson's.
Dr Liebetrau declared: "There is no cure for Parkinson's but new drugs such as Rasagilin can have a demonstrably positive effect on the course of the disease, especially if treatment is started early. Further research is needed to determine whether that also applies to early stages of the disease."
The researchers conclude that olfactory dysfunctions are not just irritating; they also provide an opportunity to detect Parkinson's in the early stages of the disease and recommend to use hyposmia as an early indicator of Parkinson's. Liebetrau concludes: "Physicians should ask more frequently about olfactory dysfunctions and conduct simple tests, for instance with coffee or spices. If hyposmia is suspected, a confirmation test must be carried out." He added that public smelling tests are especially suitable for raising awareness of hyposmia.
http://www.medicalnewstoday.com/articles/246678.php
Parkinson's: doctors missing early warning signs
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Doctors are failing to diagnose thousands of people with early stage Parkinson's disease because they do not know the early warning signs, a charity warns today
Stepen Adams
The Telegraph - Loss of smell, fatigue, problems sleeping, mood changes, constipation and unexplained pain can all be early indications of the disease, best known for the tremors it can cause.
Although a well known disease, GPs only see patients with it rarely, according to The Cure Parkinson's Trust.
As a result they tend to be unaware that more than 90 per cent of people with Parkinson's experience such "non-motor symptoms".
Professor Ray Chaudhuri, a consultant neurologist at Kings College London, said: "Generally speaking most GPs will only see one or two people with Parkinson's in many years of work.
"Their general knowledge of the condition tends to be very poor, and it's very unlikely they would know the fine details.
This meant most people were only diagnosed late in the course of the disease, when the brain had already deteriorated considerably, he said.
About 1 in 500 people in Britain - some 127,000 -suffer from Parkison's, mostly over 50.
It is caused by nerve cell loss in the brain that result in low levels of a neurotransmitter called dopamine.
Those with advanced disease are often unable to walk unaided, have stiff muscles, and can have considerable trouble eating and speaking.
The neurological condition is progressive and their is no cure, although drugs do exist that can control some of the symptoms.
Prof Chaudhuri said that, while individually problems like loss of smell or sleep disturbance were highly unlikely to be signs of Parkinson's, if they occurred together as a "constellation of symptoms" they could be indicative.
He said that even in those already diagnosed with Parkinson's, non-motor symptoms were not identified in about 60 per cent of neurology consultations.
The Cure Parkinson's Trust has helped develop a 'personal wellbeing map' to help sufferers and doctors understand the complex condition better.
Meanwhile, another charity is announcing a landmark study to come up with a blood test to identify the disease early.
Parkinson's UK wants to enroll 3,000 volunteers in its £1.6 million 'Tracking Parkinson's' project, that hopes to tease out the genetic and environmental factors that trigger the disease.
They want to enroll 2,000 diagnosed in the last three years, 500 early developers - diagnosed before their 50th birthdays - and 500 siblings of Parkinson's patients.
Dr Kieran Breen, director of research and innovation at Parkinson's UK, said: "By the time a person is diagnosed with Parkinson's they've usually lost a lot of capacity.
"What we want to be able to do is identify them at the earliest possible stage, so we can get in and treat the underlying cause of the disease, rather than just the symptoms."
He explained the volunteers would all have their genomes sequenced, to look for responsible genes, blood samples taken and followed for three to five years to see how they changed.
Enrolling brothers and sisters, who he said had an "almost identical genetic makeup" would enable them to examine what lifestyle factors were important.
He said the "ideal conclusion" of the project would be to identify a series of "biomarkers" capable of spotting very early Parkinson's with a high degree of accuracy.
He said: "By the time we have got accurate biomarkers, we will probably have drugs that can halt the progress of the condition."
But it was "impossible to say" how long it might take to reach a suitable set of biomarkers capable of forming the basis of a reliable, accurate screening programme.
Potential biomarkers, known to be raised in those already diagnosed, will be the first candidates, he said, but these might not show in those with very early disease.
He said it was also likely a number would be needed, not just one, because Parkinson's appeared to be a range of closely-related conditions.
http://www.telegraph.co.uk/health/healthnews/9205363/Parkinsons-doctors-missing-early-warning-signs.html
Note by John Pepper
This is not news! In my book, written ten years ago, I had been aware that all the symptoms outlined and described in the book, were recognised symptoms of Parkinson’s disease.
Why are the medical profession only waking up to this realisation at this late stage?
Many people could have been diagnosed, long before they had been, if they had more than a couple of these symptoms.
The one symptom, never mentioned in any articles I have read, is the loss of coordination. I cannot throw anything accurately: a dart; a ball; a stick; or any object that needs to go in a certain direction. I could not toss a tennis ball, up in the air, before serving it. I could not deliver a bowl, without it going up in the air first.
If GP’s kept a list of these symptoms, they would get a fair idea that there was something untoward wrong with their patients, long before the more serious symptoms occur, such as shuffling, which was when my doctor finally realised that I possibly had a neurological problem.
We don’t all get the same symptoms, but several of those on my list would give a fair indication of a neurological problem, especially the coordination. Nobody in their right mind would go running to their doctor if they could not throw a ball properly. I didn’t!
Draw and play keep Parkinson’s at bay
Copied from The Northwest Parkinson’s Foundation Weekly News Update
Euronews - “I lost the swing in my left arm. It did not work very well. I realised something was wrong”.
“My problems started 11 years ago. So I went to the doctors, and they eventually diagnosed Parkinson’s disease. It was 2002”.
“Now I cannot work in the garden as often. At least not for as long as I used to. I really enjoyed electronics and used to solder small components. It is now impossible for me. I cannot do it any more”.
Those are the thoughts of three people who suffer from an incurable disease. In Europe there are around 75,000 new cases of it every year. All have volunteered to find new diagnosis and tools for rehabilitation. This is the story of how European patients and researchers have teamed up to fight Parkinson’s disease.
At a hospital in the Netherlands, an unusual experiment, involving a 68-year-old patient with Parkinson’s disease.
“I started suffering from pain in my lower back. But it took almost 3 years for doctors to identify my disease as Parkinson’s,” explains Harmien Floor-Schotten a Parkinson’s disease patient .
That late, difficult diagnosis motivated her and other volunteers – both Parkinson’s patients and healthy subjects – to take part in a pre-clinical trial aimed at testing a revolutionary pen.
It has been designed to help to identify the elusive early stages of the disease. Esther Smits, Movement scientist at the University Medical Centre Groningen explains: “We have to measure muscle activity so we can see what happens in muscles when volunteers are moving their arms to make the drawings.”
The writing patterns of both Parkinson’s patients and healthy subjects are compared. Those patterns, scientists say, can possibly help them to determine if a patient is suffering from Parkinson’s disease or from other less dramatic neurological disorders.
“We do find some clear differences between the healthy controls and the Parkinson’ s patients that we have measured. On the one hand, these differences are what we expected. So for instance, Parkinson’ s patients move slower in all tasks. But also some differences were a little less expected. For instance, in the writing tasks, we found that Parkinson’s patients write considerably smaller than healthy people, even if they are not complaining of writing smaller. So this in particular can be a sensitive tool for diagnosis,” points out Natasha Maurits, Clinical neuroengineer at the University Medical Centre Groningen.
The pen has been re-engineered by scientists under a European Union research project. The prototype has sensor technologies that help to understand the complex coordination processes used by the nervous system during the course of handwriting.
Rutger Zietsma, is the coordinator of the DiPAR project, “We have built on previous techniques for recording handwriting and motion. Starting with digitising tablets for recording handwriting, also using motion analysis systems to look at upper body motion and limb motion.
‘Then we built this pen system with these different sensors and data analysis techniques. We developed algorithms that would automatically analyse motion, the control behind that motion in the nervous systems of the users”.
The next steps of the pre-clinical trials will involve the comparison of writing patterns between patients with Parkinson’s and those suffering from tremors and other movement disorders.
Early diagnosis, scientists say, is key to offer patients better advice, monitoring and rehabilitation.
“What I would hope is that we have got a tool that is easy to use, and that in 10 or 15 minutes gives you a profile of likely diagnosis. I don’t think we’ ll say with certainty that this is Parkinson’s disease, that is not possible. But it might be possible to say that this is a patient that better be seen by an experienced neurologist,” says Natasha Maurits, Clinical neuroengineer at the University Medical Centre Groningen.
Nico Leenders, Neurologist at the University Medical Centre Groningen adds: “We can make a distinction between Parkinson’s and other conditions, like essential tremor. Or we can assume, well, this is perhaps a movement problem, but it is more related to an elderly person, and it will not develop into a Parkinsonian symptom. Then, you can tell the person more safely what his or her future will be.”
Meanwhile, in Belfast, researchers are trying to develop new rehabilitation tools based on sensorial stimulation.
The first thing scientist had to understand was if and how Parkinson’s patients’ movements can improve when there is a sort of trigger in their environment.
Marta Bienkiewicz, Cognitive neuroscientist at Queen’s University Belfast explains: “We are trying to understand more what happens when there is additional sensory information in the environment that you can perceive by hearing or seeing. And why it improves the motor control, the movement in Parkinson’s disease patients.”
“I can see the benefit. My golf swing, to start with has much improved,” says William McDonald a Parkinson’s disease patient.
Researchers then developed tailor made video games on existing commercial platforms. Games allow Parkinson’s patients to improve balance
and overall mobility.
Cathy Craig is the coordinator of the Tempus_G project. “We are interested in understanding how the brain can use perceptual information to guide our actions. So for instance in the games that are being played, you see the falling apples. That is perceptual information that tells us what is happening. And that information guides the movements. The apples are falling at a certain speed, and the players have to control the movement of the basket so they actually catch the apples”.
Both patients and researchers see huge psychological and physical advantages in these easy, fun rehabilitation techniques.
“I find it fun. I find it enjoyable. I find it worth doing. During this trial, John and I have been coming together as volunteers. And we have this feeling of competing against each other. It does not matter who wins. It is just the fun of it, the companionship,” Jim Henry a Parkinson’s disease patient.
Caroline Whyatt a psychologist at Queen´s
University Belfast says: “A video game like this makes you realise how much you can actually do. And I think that confidence then will help people like John to have this confidence to go for a walk or do other types of physical activity which will then help the balance as well. So it is a kind of circular motion. It is building up. So it is getting the confidence from the games, and then using that confidence to go for a walk, and when you go for a walk you have more confidence, so you are going to walk more often. So it is kind of a cycle”.
“I find the mobility is the big issue here. The objective is to be more mobile than what we normally are. I find it very useful,” says John Herron a Parkinson’s disease patient.
“From a physical point of view, the patient is essentially encouraged to move, particularly around the torso area. A lot of participants in the trial have commented that they feel much looser here, that they can rotate a lot better. And that rigidity in the body is lost a little bit. So patients feel a lot freer, and more mobile,” explains Cathy Craig the coordinator of the Tempus_G project.
Jim Henry reflects: “It is brilliant. It has made a big change for me, because it is exercise for fun”.
But researchers see even further. They are currently investigating if Parkinson s patients can improve their gait by just listening to regular sounds, including, for instance, the sound emitted by their own feet during walking.
Will Young a psychologist at Queen’s University Belfast explains: “Using these reflective markers we can get very detailed information about how people can regulate the timing of their walking. One thing that tends to happen with Parkinson’s is that patients tend to shuffle. And one thing we can measure is stride length, so we can look to help people to extend that length to walk more efficiently.”
Matthew Rodger also a psychologist at Queen´s University in Belfast says, “What this graph shows us is how the different parts of her body, so the head, the torso, the arms and the legs importantly, how these parts are moving as she walks. And so we can try to understand what sort of differences there are in the patient’s walking when she is perceiving the sounds, compared when she is walking without all these sounds. So we can check if there is any improvement, if there is a better stability in her actions.”
Researchers, scientists and patients who have volunteered hope that will lead to better easier and more effective rehabilitation treatments in the near future.
“To see that researchers are taking such an interest in the disease it is really encouraging. To see that there is a life with Parkinson’s. That it is not that you are just coming to an end,” says Mary McAllister a Parkinson’s disease patient.
More information: http://www.dipar.org
http://www.qub.ac.uk
http://www.euronews.com/2012/04/03/draw-and-play-keep-parkinson-s-at-bay/
10 Early signs of Parkinsons That Doctors Often Miss
Copied from The Northwest Parkinson’s Foundation Weekly News Update
MSN.health - Let's be honest: A diagnosis of Parkinson's disease can be pretty unnerving. In fact, an April 2011 survey by the National Parkinson's Foundation revealed that people will avoid visiting the doctor to discuss Parkinson's even when experiencing worrisome symptoms, such as a tremor.
The problem, however, is that waiting prevents you from beginning treatment that -- although it can't cure Parkinson's -- can buy you time. "We now have medications with the potential to slow progression of the disease, and you want to get those on board as soon as possible," says Illinois neurologist Michael Rezak, M.D., who directs the American Parkinson's Disease Association National Young Onset Center.
Parkinson's disease (PD) occurs when nerve cells in the brain that produce the neurotransmitter dopamine begin to die off. When early signs go unnoticed, people don't discover they have Parkinson's until the disease has progressed. "By the time you experience the main symptoms of Parkinson's, such as tremor and stiffness, you've already lost 40 to 50 percent of your dopamine-producing neurons. Starting medication early allows you to preserve the greatest possible number of them," Rezak explains.
Here, 10 often-missed signs that can help you identify and get early treatment for Parkinson's.
1. Loss of sense of smell
This is one of the oddest, least-known, and often earliest signs of Parkinson's disease, but it almost always goes unrecognized until later. "Patients say they were at a party and everyone was remarking on how strong a woman's perfume was, and they couldn't smell it," says Rezak.
Along with loss of smell may come loss of taste, because the two senses overlap so much. "Patients notice that their favorite foods don't taste right," Rezak says.
Dopamine is a chemical messenger that carries signals between the brain and muscles and nerves throughout the body. As dopamine-producing cells die off, the sense of smell becomes impaired, and messages such as odor cues don't get through. Some researchers consider this change so revealing that they're working to develop a screening test for smell function.
2. Trouble sleeping
Neurologists stay on the alert for a sleep condition known as rapid eye-movement behavior disorder (RBD), in which people essentially act out their dreams during REM sleep, the deepest stage of sleep. People with RBD may shout, kick, or grind their teeth. They may even attack their bed partners. As many as 40 percent of people who have RBD eventually develop Parkinson's, Rezak says, often as much as ten years later, making this a warning sign worth taking seriously.
Two other sleep problems commonly associated with Parkinson's are restless leg syndrome (a tingling or prickling sensation in the legs and the feeling that you have to move them) and sleep apnea (the sudden momentary halt of breathing during sleep). Not all patients with these conditions have Parkinson's, of course, but a significant number of Parkinson's patients -- up to 40 percent in the case of sleep apnea -- have these conditions. So they can provide a tip-off to be alert for other signs and symptoms.
3. Constipation and other bowel and bladder problems
One of the most common early signs of Parkinson's -- and most overlooked, since there are many possible causes -- is constipation and gas. This results because Parkinson's can affect the autonomic nervous system, which regulates the activity of smooth muscles such as those that work the bowels and bladder. Both bowel and bladder can become less sensitive and efficient, slowing down the entire digestive process.
One way to recognize the difference between ordinary constipation and constipation caused by Parkinson's is that the latter is often accompanied by a feeling of fullness, even after eating very little, and it can last over a long period of time. When the urinary tract is affected, some people have trouble urinating while others begin having episodes of incontinence. The medications used to treat Parkinson's are effective for this and other symptoms.
4. Lack of facial expression
Loss of dopamine can affect the facial muscles, making them stiff and slow and resulting in a characteristic lack of expression. "Some people refer to it as 'stone face' or 'poker face,'" says neurologist Pam Santamaria, a Parkinson's expert at the Nebraska Medical Center in Omaha. "But it's really more like a flattening -- the face isn't expressing the emotions the person's feeling."
The term "Parkinson's mask" is used to describe the extreme form of this condition, but that doesn't come until later. As an early symptom, the changes are subtle: It's easiest to recognize by a slowness to smile or frown, or staring off into the distance, Santamaria says. Another sign is less frequent blinking.
5. Persistent neck pain
This sign is particularly common in women, who have reported it as the third most-common warning sign they noticed (after tremor and stiffness) in surveys about how they first became aware of the disease.
Parkinson's-related neck pain differs from common neck pain mainly in that it persists, unlike a pulled muscle or cramp, which should go away after a day or two. In some people, this symptom shows up less as pain and more as numbness and tingling. Or it might feel like an achiness or discomfort that reaches down the shoulder and arm and leads to frequent attempts to stretch the neck.
6. Slow, cramped handwriting
One of the symptoms of Parkinson's, known as bradykinesia, is the slowing down and loss of spontaneous and routine movement. Handwriting is one of the most common places bradykinesia shows up. Writing begins to become slower and more labored, and it often looks smaller and tighter than before. "Sometimes a family member will notice that someone's handwriting is becoming very spidery and hard to read," Santamaria says.
Washing and dressing are other areas where bradykinesia appears. Someone may take a long time to get dressed or be unable to deal with zippers and other fasteners.
7. Changes in voice and speech
As the brain signals and muscles that control speech are affected by Parkinson's, a person's voice begins to change, often becoming much softer and more monotone. This is frequently one of the first early signs of Parkinson's that family and friends notice, often long before the patient becomes aware of it.
Slurring words is also characteristic of Parkinson's, because as the facial muscles stiffen, it becomes harder to enunciate clearly. "Some patients begin to have trouble opening their mouths as wide, making speech harder to hear and understand," says Rezak. This subtle sign is so characteristic of Parkinson's that researchers are working on a voice analysis technique that might eventually be used as an early screening and diagnostic tool.
8. Arm doesn't swing freely
"Reduced arm swing" is how doctors describe this symptom, but that doesn't fully capture what some Parkinson's patients first remember noticing. Instead, think of this sign as a subtle stiffness and reduced range of motion: reaching for a vase on the highest shelf or stretching out to return a serve in tennis and noticing the arm won't extend as far.
"With the onset of Parkinson's, people begin to have what we call increased tone, which means the muscles are stiffer and more limited," says Santamaria. "The arm just won't go where the brain tells it to go." Some people first notice this when walking, as one arm swings less than the other. One way to distinguish this symptom from arthritis or injury: The joints are unaffected and there's no pain.
9. Excessive sweating
When Parkinson's affects the autonomic nervous system, it loses its ability to regulate the body, which can cause to changes in the skin and sweat glands. Some people find themselves sweating uncontrollably when there's no apparent reason, such as heat or anxiety. For a woman, these attacks may feel much like the hot flashes of menopause. The official term for this symptom is hyperhidrosis.
This condition can also show up in the form of excessively oily skin or an oily scalp resulting in dandruff. Many Parkinson's sufferers also notice a problem with excessive saliva, but this is actually caused by difficulty swallowing rather than producing more saliva.
10. Changes in mood and personality
Experts aren't certain why, but there are a variety of related personality changes that come with Parkinson's, including pronounced anxiety in new situations, social withdrawal, and depression. Several studies show that depression, in someone who hadn't previously experienced it, was the first sign many Parkinson's patients and their families noticed, but at the time they weren't able to attribute it to Parkinson's.
Some people also experience subtle changes in their thinking abilities, particularly in concentration and the so-called "executive functions" that govern planning and executing tasks. The first sign of decline is loss of ability to multitask. "People who used to be able to do three or four things at once perfectly well find that they have to do one thing at a time or they can't keep it all straight," Rezak says. Some experts believe that thinking problems and mood issues go hand in hand -- that the sense of slipping mentally leads to anxiety, feeling overwhelmed, and social withdrawal.
http://health.msn.com/health-topics/caregiving/10-early-signs-of-parkinsons-disease-that-doctors-often-miss?page=2
Note by John Pepper
There are many other symptoms, which are normally associated with Parkinson’s Disease:
- Loss of libido
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Inability to throw a ball, or any other object (Co-ordination)
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Chest infections, caused by the phlegm not being removed properly from the chest
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Bad Posture
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Shuffling
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Loss of balance
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Clumsiness
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Difficulty swallowing
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Dribbling
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Dry Mouth
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Falling asleep, during the daytime
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Fatigue
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Inability to walk on uneven surfaces
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Inability to write properly (Gets very small)
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Short-term memory loss
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Rigidity
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Speech problems
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Tremors
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Abnormal emotional behaviour
New Image Scan Helps Correctly Identify Parkinson's Disease
Copied from The Northwest Parkinson’s Foundation Weekly News Update
wisn.com - New medical advancements are making tests for Parkinson's disease more reliable.
More than one million Americans are currently living with Parkinson's. The condition causes tremors, balance problems and speech issues.
Doctors often use physical examines to test for it, but 40 percent of Parkinson's patients are undiagnosed, and at least 10 percent who are diagnosed don't really have it.
A new image test called DaTscan is giving doctors a better chance of getting it right.
Doctors inject patients with a tracer then scan the brain for dopamine -- a chemical that Parkinson's patients lack.
"This is a game-changer. It's going to lead to earlier diagnosis and clearer diagnosis for patients with tremor," said Dr. Louise Thomson of Cedars-Sinai Medical Center.
An earlier diagnosis means patients can start treatments sooner and potentially slow down symptom development.
There is some debate about the effectiveness of DaTscan.
Some doctors said a negative test does not provide enough evidence to rule out Parkinson's completely.
http://www.wisn.com/health/30392149/detail.html
Diagnosing Parkinson’s before symptoms start
Copied from Northwest Parkinson’s Foundation Weekly News Update
thespec.com - A way to diagnose Parkinson’s disease — before symptoms even start — is being tested by McMaster researchers.
Dr. Ram Mishra, the lead investigator of the study, says:
“right now between 25 and 40 per cent of people diagnosed with the disabling disorder of the brain don’t actually have Parkinson’s.”
That’s significant because:
the drugs used to treat it can have severe side effects.
“There is no simple test to diagnose Parkinson’s disease,” he said. “You can’t really tell, so what happens in many cases is that people are misdiagnosed and put on the drug they use for the treatment.”
Mishra and his colleagues at Université Laval and Université de Montréal believe they have found:
A protein that could be used as a biomarker to flag Parkinson’s disease.
They have received $700,000, of which about $350,000 will go to McMaster, from the Quebec Consortium for Drug Discovery to see how reliable the biomarker proves to be in Quebec and Ontario patients.
“You can diagnose it in the very early stage before even the onset of the disease,”
said Mishra.
He said people high at risk, such as those with a family history of Parkinson’s or who have had exposure to environmental triggers of the disease, could be tested when they’re young. If the catecholamine regulated protein (CRP40) is low, doctors could start to work on that before symptoms start.
“We can turn on the gene for this protein so the body can start making the protein,” said Mishra.
It is one of two recent awards for McMaster.
The university has also been chosen to be part of a national network researching the immune system and vaccines. Seven Canadian universities are part of the Human Immunology Network funded by the Canadian Institutes of Health Research. McMaster’s role will be studying immune therapies for cancer.
“What the network will allow us to do is run multi-institutional studies,” said Dr. Jonathan Bramson, who is leading McMaster’s arm of the network. “In order to move these things forward, you really have to look at them in multiple centres with patients from different demographics.”