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Wednesday, June 8, 2011

10 Early Signs of Parkinson's Disease That Doctors Often Miss

Melanie Haiken, - 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.
  • PDtrials - Parkinson's Disease Clinical Trials

  • /Clinical Research News

  • Clinical Research News

    Co-Enzyme Q10 Study Stopped Because of Lack of Evidence that It Delays Progression of Early PD

    On May 27, the National Institute of Neurological Diseases and Stroke (NINDS) announced the halt of a large clinical trial conducted by the Parkinson Study Group (PSG) on the potential beneficial effects of the dietary supplement coenzyme Q10 (CoQ10) on reducing the progression of early Parkinson’s disease (PD). Their reason: a mid-study analysis suggested that there is no improvement in the CoQ10-treated individuals in comparison to those receiving placebo (empty tablet) treatment and that continuing the program would have a very low likelihood of demonstrating any benefit from coenzyme Q10 usage in delaying the progression of early PD.
    For this reason, the Data Safety Monitoring Board of the program recommended stopping the study. Individuals currently enrolled in the program have been notified and the study sites are in the process of meeting with all participants.
    For the PD community, both scientists and people with Parkinson’s and their care partners, this outcome is disappointing. In an earlier, far smaller study, there was preliminary evidence that people taking CoQ10 at 1200 mg/daily appeared to slow disease progression. For this reason, the current study focused on the effects of CoQ10 at 1200 and 2400 mg daily. The study involved the participation of 600 individuals with early Parkinson’s in 67 North American study centers. To date, there were no reported safety concerns related to CoQ10 at dosages of 1200 mg/day and 2400 mg/day for up to 16 months of treatment.
    Christopher G. Goetz, M.D., Chair of the Parkinson's Disease Foundation Medical Policy Subcommittee comments:
    “While a final judgment on the efficacy of CoQ10 must await full analysis of the data and peer review, PDF trusts the conclusion of the study sponsors that there is no evidence that CoQ10 reduces the progression of Parkinson’s disease. The action taken on May 27 shows the vigilance of NINDS and PSG in assuring that individuals in the study are kept well informed throughout the duration of a study, and are advised immediately in the event that an investigative treatment is found to have little likelihood of success.
    “People with PD who are receiving CoQ10, and who feel they have been substantially helped while taking this over-the-counter product, may wish to discuss with their physician whether the group results should lead them to stop CoQ10 treatment or to continue treatment because of their individual response.
    “Fortunately, there are several new and on-going programs that are studying the same question of whether early treatment of PD can positively delay clinical decline. These agents work differently from CoQ10 and they offer individuals in the current CoQ10 program – as well as other people with early PD – key opportunities for potential enrollment to continue our quest to delay the clinical decline of PD.”

    Parkinson's Disease May Boost Melanoma Risk: Study

    Parkinson's Disease May Boost Melanoma Risk: Study

    Patients with the brain disorder should get checked annually for the skin cancer, expert advises

    By Steven Reinberg
    HealthDay Reporter
    MONDAY, June 6 (HealthDay News) -- People with Parkinson's disease may have twice the risk of developing the deadly skin cancer melanoma, a new report confirms.
    Parkinson's disease, which affects about one million people in the United States, is a progressive neurological disorder that causes tremors, stiffness and difficulty with movement, coordination and walking. Melanoma, with nearly 70,000 new cases diagnosed each year in the United States, is the most dangerous type of skin cancer.
    "Over the past decade there has been accumulating evidence that Parkinson's disease patients are less likely to have most types of cancers, particularly smoking-related cancers; however, they were more likely to have melanoma," said lead researcher Dr. Honglei Chen, head of the Aging & Neuroepidemiology Group at the U.S. National Institute of Environmental Health Sciences.
    Not only are people with Parkinson's disease more likely to develop melanoma, but people with melanoma are more likely to develop Parkinson's disease. "It appears the association is bidirectional," he said.
    Scientists have theories about why these conditions seem to co-occur, but no firm answers. They know it's not the drugs Parkinson's patients take, Chen said.
    "Both conditions may have common genetic pathways or environmental factors or both," he said. "We understand very little about this possible relationship."
    Ultraviolet radiation from the sun can cause skin cancer, including melanoma. No association was found between Parkinson's disease and skin cancers other than melanoma, however, the investigators said.
    The report, which was supported by the National Institute of Environmental Health Sciences, is published in the June 7 issue of Neurology.
    For the study, Chen's team analyzed 12 epidemiologic studies dating from 1965 through 2010 that looked at a possible association between Parkinson's disease and melanoma. This is a process called a meta-analysis, in which data from various studies are pooled together to try to find a consistent statistical pattern.
    While most of these studies reported fewer than 10 cases where both conditions occurred, the researchers found that men with Parkinson's disease were twice as likely to develop melanoma as men without Parkinson's disease.
    For women, the risk of melanoma was one-and-a-half times greater if they had Parkinson's disease than if they didn't, Chen's group found.
    However, since both conditions are relatively rare, the odds of having Parkinson's disease and melanoma are only about 4 percent, Chen said. "The absolute risk is not that high," he added.
    Still, "it is prudent for Parkinson's disease patients to be a little cautious about their skin health," Chen said. "Be prudent, but do not be alarmed."
    Limitations of the study include the fact that most of the studies were not originally designed to evaluate the association between melanoma and Parkinson's disease, and the analysis is based on a very small number of cases, the authors noted.
    The authors also acknowledged that their research is preliminary and said more studies are needed to explore the relationship between the brain disorder and the potentially lethal skin cancer.
    Joyce Oberdorf, CEO of the National Parkinson's Foundation, said an association between the two conditions is becoming increasingly evident, but most patients and doctors are unaware of the possible connection.
    "Drawing attention to the risk is definitely required," Oberdorf said, adding that the foundation is launching a campaign to alert patients.
    "We are making the recommendation that every person with Parkinson's wear sunscreen and receive an annual screening by a dermatologist for melanoma," she added.
    More information
    For more information on Parkinson's disease, visit the U.S. National Institute of Neurological Disorders and Stroke.
    SOURCES: Honglei Chen, M.D., Ph.D., head, Aging & Neuroepidemiology Group, U.S. National Institute of Environmental Health Sciences; Joyce Oberdorf, CEO, National Parkinson's Foundation; June 7, 2011, Neurology
    Last Updated: June 06, 2011
    Copyright © 2011 HealthDay. All rights reserved.



    Drifting Pesticides May Endanger People in Nearby Workplaces

    California study finds higher Parkinson's risk among non-agricultural workers

    FRIDAY, June 3 (HealthDay News) -- People who work near fields sprayed with pesticides face an increased risk for Parkinson's disease, a new study has found.
    Not just agricultural workers but teachers, firefighters, clerks and others whose workplaces are near fields in California's Central Valley are at greater risk for the degenerative disorder of the central nervous system, according to researchers from the University of California, Los Angeles.
    "This stuff drifts," the study's senior author, Dr. Beate Ritz, an epidemiology professor at the UCLA School of Public Health, said in a university news release. "It's borne by the wind and can wind up on plants and animals, float into open doorways or kitchen windows -- up to several hundred meters from the fields."
    The study focused on three pesticides used on the fields: the fungicides maneb and ziram and the herbicide paraquat. The researchers estimated the exposure of 703 people who lived or worked in the area over a 25-year span, taking into account how far they were from the fields sprayed with the chemicals. About half of the people in the study had Parkinson's.
    The risk for Parkinson's rose threefold for those who worked near fields sprayed with the three pesticides, the study found. Exposure to just ziram and paraquat raised risk by 80 percent. Earlier analysis by the researchers had found a 75 percent jump in risk for people who lived near fields where maneb and paraquat were sprayed.
    The findings suggest that the chemicals act together in increasing the risk for Parkinson's, according to the study, published online in the European Journal of Epidemiology.
    "Our estimates of risk for ambient exposure in the workplaces were actually greater than for exposure at residences," said Ritz. "And, of course, people who both live and work near these fields experience the greatest ... risk. These workplace results give us independent confirmation of our earlier work that focused only on residences, and of the damage these chemicals are doing."
    More information
    The U.S. Environmental Protection Agency offers tips on reducing pesticide risk.
    -- Mary Elizabeth Dallas
    SOURCE: University of California, Los Angeles, news release, May 26, 2011


    1st June
    2011 - New research


    European Journal of Neurology [2011] 18 (1) : 106-113 (Y.Miyake, W.Fukushima, K.Tanaka, S.Sasaki, C.Kiyohara, Y.Tsuboi, T.Yamada, T.Oeda, T.Miki, N.Kawamura, N.Sakae, H.Fukuyama, Y.Hirota, M.Nagai)
    Antioxidant vitamins are expected to protect cells from oxidative damage in Parkinson's Disease by neutralizing the effects of reactive oxygen. However, evidence regarding the association between antioxidant vitamin intake and Parkinson's Disease is limited and inconsistent. So researchers investigated the relationship between the dietary

    intake of selected antioxidant vitamins, vegetables and fruit and the risk of Parkinson's Disease. Higher consumption of vitamin E and ß-carotene (a form of vitamin A) were significantly associated with a reduced risk of Parkinson's Disease - down to only 45% for vitamin E, and down to 56% for ß-carotene. However, this relationship was only significant in women. The lesser likelihood of Parkinson's Disease was not related to the intake of vitamin C, a-carotene, cryptoxanthin, green and yellow vegetables, other vegetables, or fruit.
    Dietary intake of antioxidant vitamins and risk of Parkinson's disease: a case-control study in Japan.

    Source: Department of Public Health, Faculty of Medicine, Fukuoka University, Fukuoka Department of Public Health, Osaka, Japan.

    BACKGROUND: antioxidant vitamins are expected to protect cells from oxidative damage by neutralizing the effects of reactive oxygen species. However, epidemiological evidence regarding the associations between antioxidant vitamin intake and Parkinson's disease (PD) is limited and inconsistent. We investigated the relationship between dietary intake of selected antioxidant vitamins, vegetables and fruit and the risk of PD in Japan using data from a multicenter hospital-based case-control study.

    METHODS: included were 249 patients within 6 years of onset of PD. Controls were 368 inpatients and outpatients without a neurodegenerative disease. Information on dietary factors was collected using a validated self-administered diet history questionnaire. Adjustment was made for sex, age, region of residence, pack-years of smoking, years of education, body mass index, dietary intake of cholesterol, alcohol, total dairy products, and coffee and the dietary glycemic index.

    RESULTS: higher consumption of vitamin E and β-carotene was significantly associated with a reduced risk of PD after adjustment for confounders under study: the adjusted odds ratio in the highest quartile was 0.45 (95% confidence interval [CI]: 0.25-0.79, P for trend = 0.009) for vitamin E and 0.56 (95% CI: 0.33-0.97, P for trend = 0.03) for β-carotene. Stratified by sex, such inverse associations were significant only in women. No material relationships were shown between intake of vitamin C, α-carotene, cryptoxanthin, green and yellow vegetables, other vegetables, or fruit and the risk of PD.

    CONCLUSIONS: higher intake of vitamin E and β-carotene may be associated with a decreased of PD.