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Saturday, December 6, 2014

Psychosis in Parkinson's disease: An LTC perspective





Joseph Friedman, M.D.


The single most important precipitant for placement of Parkinson's disease patients in a long-term care facility is psychiatric dysfunction, particularly psychosis. Although PD is classified as a movement disorder and clinically diagnosed purely based on movement disorder criteria, non-motor, neurological and psychiatric features are crucially important, particularly as the disease progresses.
Commonly detected non-motor symptoms associated with PD include depression, found in 30-50% of patients (depending on the criteria used) and dementia, which did not used to be considered an important feature, but develops by the time of death in about 80% of patients. Anxiety affects about 40%, fatigue affects about 50% (without any correlation with motor severity), apathy affects about 50% (usually associated with dementia) and psychotic symptoms occur in about 30% of patients taking medication for their PD.
Psychotic symptoms may surprise many healthcare professionals, and there is a need to understand how they present in the PD patient, particularly since the symptoms are very different than those that occur in schizophrenia and other primary psychiatric disorders. Visual hallucinations are the most common feature, and are almost always without emotional content. The images are usually people but often animals. They tend to occur in low stimulation environments, when the patient is alone reading or watching TV. He or she may see children playing in the living room or workers planting shrubs in the yard. The images are silent and usually don't pay any attention to the patient. In the beginning, the patient may talk to the hallucination and when it ignores him, the patient goes to the hallucination only to have it disappear. 
Patients will sometimes enjoy the hallucination or find them baffling. A patient told me that he had seen a tractor outside his hospital window, and that this was bizarre since he was on the third floor. Another told me that he enjoyed his hallucination. It was of a baby. He saw it every night and, he noted with a smile, “it never made any noise.” Auditory hallucinations are about half as common as visual, with tactile, olfactory and a sensation of taste considerably less common. The hallucinations may look real, or appear in black and white, or even look like cartoons. They may appear for a few seconds or may be present all the time. They tend to be the same each episode. 
The hallucinations sometimes feel threatening. When a patient awakens at night and sees a strange man, it is difficult to not be frightened. The hallucinations may become real to the patient so that he puts out food for the guests, or argues with his wife about calling the police. Available at the Parkinson's Disease Foundation website is a video of brief descriptions by PD patients of their hallucinations.  
Delusions, another symptom of Parkinson's disease psychosis (PDP), can often be more problematic than hallucinations. A hallucination is a false sensory stimulus, whereas a delusion is a false and irrational belief, which often causes paranoia in the patient. The most common delusion is of the spouse having an affair. This often becomes the “straw that broke the camel's back” in precipitating nursing home or long-term care placement. Other common delusions include the family is abandoning the patient, people are stealing or spying, or people living in the house who don't belong there.
Treatment is, like everything else in PD, individualized. It is important to eliminate contributing factors such as infections, particularly bladder and lung, and other medication effects. Probably the most common medication contributors are anticholinergics used for overactive bladder. When medical problems and other psychoactive medications are excluded, then PD medications are reduced. PD experts recommend that anticholinergics, like trihexiphenidyl and benztropine, be tapered and stopped first, then amantadine, then dopamine agonists, MAO-b inhibitors and COMT inhibitors, and L-Dopa last of all. 
When taking this approach, there is a dilemma in that one cannot usually reduce the PD medications much without imposing worsening mobility. There is no drug approved specifically to treat PDP, so when this point is reached, anti-psychotic agents are introduced. To date, there are only two “second-generation” anti-psychotic drugs that have been studied and identified as controlling for psychosis without worsening motor function in PD: clozapine (at doses between 6.25 mg and 50 mg at bedtime) and quetiapine. Regarding the latter, open label studies show it is effective without affecting motor function, but blind, randomized trials do not. All other antipsychotics have been reported to worsen motor function in PD patients.
An alternative approach to treating PDP is to use cholinergic enhancers, the drugs used to treat Alzheimer's dementia. These have less support for their use and can take several weeks to work. A new drug in development for PDP, pimavanserin, targets serotonin receptors that play a role in psychosis and does not affect dopamine. In clinical studies, pimavanserin was found to be a safe and effective treatment for PDP that does not compromise motor function. If approved by the FDA, this may provide a new and much-needed treatment option for PDP. In the meantime, it is important to understand how the condition presents in PD patients so that an individualized management plan can be developed.
Joseph H. Friedman, M.D., is a Stanley Aronson Professor of Neurodegenerative Disorders and Director at the Movement Disorders Program of Butler Hospital. He also is a professor and Chief, Division of Movement Disorders at the Alpert Medical School of Brown University.

http://www.mcknights.com/psychosis-in-parkinsons-disease-an-ltc-perspective/article/385581/

Say No to Parkinson's with Regular Exercise

By Express News Service

Published: 06th December 2014 10:00 PM
Last Updated: 06th December 2014 10:52 AM


The risk of developing Parkinson’s can be reduced if one involves moderate amount of physical activity daily. A study published in Journal of Neurology reveals the importance of exercise in preventing the dreaded disease. “We found that a medium level of daily total physical activity is associated with a lower risk of Parkinson’s disease,” the study states.

http://health.einnews.com/article/238391778/dfoesQo4WoytcKH9?n=2&code=ga_qGBxHZ2aVYO4P

Friday, December 5, 2014

Off switch' for pain discovered: Activating the adenosine A3 receptor subtype is key to powerful pain relief

Date:
November 26, 2014
Source:
Saint Louis University Medical Center
Summary:
A way to block a pain pathway in animal models of chronic neuropathic pain has been discovered by researchers, suggesting a promising new approach to pain relief.


Pain is an enormous problem. As an unmet medical need, pain causes suffering and comes with a multi-billion dollar societal cost. Current treatments are problematic because they cause intolerable side effects, diminish quality of life and do not sufficiently quell pain.
Credit: © Feng Yu / Fotolia

In research published in the medical journal Brain, Saint Louis University researcher Daniela Salvemini, Ph.D. and colleagues within SLU, the National Institutes of Health (NIH) and other academic institutions have discovered a way to block a pain pathway in animal models of chronic neuropathic pain including pain caused by chemotherapeutic agents and bone cancer pain suggesting a promising new approach to pain relief.

The scientific efforts led by Salvemini, who is professor of pharmacological and physiological

sciences at SLU, demonstrated that turning on a receptor in the brain and spinal cord counteracts

 chronic nerve pain in male and female rodents. Activating the A3 receptor -- either by its native 

chemical stimulator, the small molecule adenosine, or by powerful synthetic small molecule drugs

 invented at the NIH -- prevents or reverses pain that develops slowly from nerve damage without

causing analgesic tolerance or intrinsic reward (unlike opioids).
An Unmet Medical Need 
Pain is an enormous problem. As an unmet medical need, pain causes suffering and comes with a 

multi-billion dollar societal cost. Current treatments are problematic because they cause intolerable

 side effects, diminish quality of life and do not sufficiently quell pain.
The most successful pharmacological approaches for the treatment of chronic pain rely on certain 

"pathways": circuits involving opioid, adrenergic, and calcium channels.
For the past decade, scientists have tried to take advantage of these known pathways -- the series of

 interactions between molecular-level components that lead to pain. While adenosine had shown 

potential for pain-killing in humans, researchers had not yet successfully leveraged this particular 

pain pathway because the targeted receptors engaged many side effects.
A Key to Pain Relief 
In this research, Salvemini and colleagues have demonstrated that activation of the A3 adenosine 

receptor subtype is key in mediating the pain relieving effects of adenosine.
"It has long been appreciated that harnessing the potent pain-killing effects of adenosine could 

provide a breakthrough step towards an effective treatment for chronic pain," Salvemini said. "Our

 findings suggest that this goal may be achieved by focusing future work on the A3AR pathway, in

 particular, as its activation provides robust pain reduction across several types of pain."
Researchers are excited to note that A3AR agonists are already in advanced clinical trials as anti-

inflammatory and anticancer agents and show good safety profiles. "These studies suggest that A3AR 

activation by highly selective small molecular weight A3AR agonists such as MRS5698 activates a 

pain-reducing pathway supporting the idea that we could develop A3AR agonists as possible new 

therapeutics to treat chronic pain," Salvemini said.

Story Source:
The above story is based on materials provided by Saint Louis University Medical CenterNote: Materials may be edited for content and length.

Journal Reference:
  1. J. W. Little, A. Ford, A. M. Symons-Liguori, Z. Chen, K. Janes, T. Doyle, J. Xie, L. Luongo, D. K. Tosh, S. Maione, K. Bannister, A. H. Dickenson, T. W. Vanderah, F. Porreca, K. A. Jacobson, D. Salvemini. Endogenous adenosine A3 receptor activation selectively alleviates persistent pain statesBrain, 2014; DOI: 10.1093/brain/awu330

Cite This Page:
Saint Louis University Medical Center. "'Off switch' for pain discovered: Activating the adenosine A3 receptor subtype is key to powerful pain relief." ScienceDaily. ScienceDaily, 26 November 2014. <www.sciencedaily.com/releases/2014/11/141126132639.htm>.

Preliminary study suggests Parkinson's drugs safe for the heart Last updated: 4 December 2014

Non-ergot derived dopamine agonists used to treat Parkinson's disease may be safe for the heart, according to preliminary research presented at EuroEcho-Imaging 2014 by Dr Hilal Erken Pamukcu, cardiologist at Ankara Diskapi Education and Research Hospital in Turkey.
Dr Erken Pamukcu said: "Parkinson's disease is a neurological disorder that occurs in nearly 1% of the world's population over 60 years of age and in 4% of people over 80 years of age. Various drug treatments are available. Ergot derived dopamine agonists were often used in the past but today their usage is not preferred by most neurologists worldwide because they caused fibrotic heart valve disease and fibrosis in other tissues."
She continued: "Today, non-ergot derived dopamine agonists are widely used in daily clinical practice but recent studies have suggested that the non-ergot derived dopamine agonist pramipexole increases the risk of heart failure. In September 2012 the US Food and Drug Administration (FDA) informed the public about a possible increased risk of heart failure with pramipexole but the studies were inconclusive and the review is ongoing."1
The current study was designed to investigate whether the use of pramipexole and ropinirole, both non-ergot derived dopamine agonists, was associated with heart failure. Heart failure was deemed to occur if patients had asymptomatic myocardial dysfunction and deterioration of myocardial systolic function. These were assessed by examining left ventricular function using two-dimensional strain echocardiography. 
The same measurements were made in patients taking levodopa, a drug commonly used in Parkinson's disease that does not have any adverse cardiac effects. Dr Erken Pamukcu explained: "We could not create a control group of Parkinson's disease patients who were not taking any drugs because most of these patients take one or more drugs. We therefore used patients taking only levodopa as a control group."
The study included 55 patients with Parkinson's disease, of which 24 were taking levodopa alone, 18 were using levodopa and pramipexole and 13 were using levodopa and ropinirole. The mean age of the study population was 63 years. There were no significant differences between groups in age, sex or presence of hypertension.
The researchers did not find any significant differences between groups in the global and segmental longitudinal strain length and strain rate values.
Dr Erken Pamukcu said: "Our measurements of left ventricular function produced similar values in all three treatment groups. We did not detect any evidence of asymptomatic myocardial dysfunction or deterioration of systolic function in patients taking pramipexole or ropinirole."
She continued: "As we did not show any statistically significant myocardial dysfunction in the groups taking pramipexole or ropinirole, our study suggests that these drugs do not cause heart damage. Our conclusion from this small, preliminary study is that non-ergot derived dopamine agonists are safe for the heart."
Dr Erken Pamukcu concluded: "We believe this is the first study to assess left ventricular function using two-dimensional strain echocardiography in Parkinson's disease patients taking non-ergot dopamine agonists. This may be a new approach to study the cardiac effects of these drugs. Larger studies are needed to confirm our results."
Adapted by MNT from original media release

Stem Cells from Adult Nose Tissue Used to Cure Parkinson’s Disease in Rats


Durham, NC (PRWEB) December 05, 2014 


Scientists have for the first time used adult human stem cells to “cure” rats with Parkinson’s disease, a neurodegenerative illness that currently has no cure. The study, published in the current issue of STEM CELLS Translational Medicine, details how a team of researchers working in Germany at the University of Bielefeld (UB) and Dresden University of Technology were able to produce mature neurons using inferior turbinate stem cells (ITSCs). 
ITSCs are stem cells taken from tissue that would generally be discarded after an adult patient undergoes sinus surgery.

The team then tested how the ITSCs would behave when transplanted into a group of rats with Parkinson’s disease. Prior to transplantation, the animals showed severe motor and behavioral deficiencies. However, 12 weeks after receiving the ITSCs, the cells had migrated into the animals’ brains and functional ability was not only fully restored, but significant behavioral recovery was witnessed, too. In another positive sign, no tumors were found in any of the animals after the transplantations, something that also has been a concern in stem cell therapy. 

“Due to their easy accessibility and the resulting possibility of an autologous transplantation approach, ITSCs represent a promising cell source for regenerative medicine,” said UB’s Barbara Kaltschmidt, Ph.D., who led the study along with Alexander Storch, M.D., and Christiana Ossig, M.D., both of Dresden University. “The lack of ethical concerns associated with human embryonic stem cells is a plus, too.”

“In contrast to fighting the symptoms of Parkinson’s disease with medications and devices, this research is focused on restoring the dopamine-producing brain cells that are lost during the disease,” said Anthony Atala, M.D., Editor-in-Chief of STEM CELLS Translational Medicine and director of the Wake Forest Institute for Regenerative Medicine. "These cells are easy to access and isolate from nasal tissue, even in older patients, which adds to their attraction as a potential therapeutic tool.”

###
The full article, “Intrastriatal transplantation of adult human neural crest-derived stem cells improves functional outcome in Parkinsonian rats” can be accessed at http://www.StemCellsTM.com.

http://bio-medicine.org/medicine-news-1/Stem-Cells-from-Adult-Nose-Tissue-Used-to-Cure-Parkinson-u2019s-Disease-in-Rats-138259-2/

Wednesday, December 3, 2014

SONOGRAPHY FOR DIAGNOSIS OF PARKINSON'S DISEASE


Transcranial sonography is a non-invasive diagnostic technique that makes use of sound waves to create a digital image to aid the diagnosis of Parkinson's Disease. The sound waves are typically produced by a transducer. Strong, short electrical pulses from the ultrasound machine make the transducer ring at the desired frequency. Materials on the face of the transducer enable the sound to be transmitted efficiently into the body. The sound wave is partially reflected from layers between different tissues. Sound is reflected anywhere there are density changes in the body. Some of the reflections return to the transducer. The return sound wave vibrates the transducer, which turns the vibrations into electrical pulses that travel to the ultrasonic scanner where they are processed and transformed into a digital image

For more information go to : http://www.biomedcentral.com/1471-2377/10/9

The primary area of the brain concerning Parkinson's Disease is the substantia nigra. The substantia nigra echogenic area was found to be larger in those people with Parkinson's Disease. Substantia nigra echogenicity was also larger in
males than in females. Age did not correlate with substantial nigra echogenicity in any group. After multivariate analysis, only the substantia nigra hyperechogenicity was associated with the diagnosis of Parkinson's Disease.
Transcranial sonography consequently showed good diagnostic validity for the diagnosis of Parkinson's Disease. 

However, in a previous study the diagnostic accuracy in the early stages of Parkinson's Disease was not sufficient for routine clinical use.



Reference : Journal of Ultrasound in Medicine [2014] 33 (12) : 2069-2074 (A.AlonsoCánovas, 
J.L.López-Sendón, J.Buisán, A.deFelipe-Mimbrera, M.Guillán, N.García-Barragán,
I.Corral, M.C.Matute-Lozano, J.Masjuan, J.C.Martínez-Castrillo, U.Walter)
Complete abstract : http://www.ncbi.nlm.nih.gov/pubmed/25425362
http://www.viartis.net/parkinsons.disease/news/141202.pdf
mail@viartis.net
©2014 Viartis

Proper copper levels essential to spontaneous neural activity


In recent years it has been established that copper plays an essential role in the health of the human brain. Improper copper oxidation has been linked to several neurological disorders including Alzheimer's, Parkinson's, Menkes' and Wilson's. Copper has also been identified as a critical ingredient in the enzymes that activate the brain's neurotransmitters in response to stimuli. Now a new study by researchers with the U.S. Department of Energy (DOE)'s Lawrence Berkeley National Laboratory (Berkeley Lab) has shown that proper copper levels are also essential to the health of the brain at rest.
"Using new molecular imaging techniques, we've identified copper as a dynamic modulator of spontaneous activity of developing neural circuits, which is the baseline activity of neurons without active stimuli, kind of like when you sleep or daydream, that allows circuits to rest and adapt," says Chris Chang, a faculty chemist with Berkeley Lab's Chemical Sciences Division who led this study. "Traditionally, copper has been regarded as a static metabolic cofactor that must be buried within enzymes to protect against the generation of reactive oxygen species and subsequent free radical damage. We've shown that dynamic and loosely bound pools of copper can also modulate neural activity and are essential for the normal development of synapses and circuits."
Chang , who also holds appointments with the University of California (UC) Berkeley's Chemistry Department and the Howard Hughes Medical Institute (HHMI), is the corresponding author of a paper that describes this study in the Proceedings of the National Academy of Sciences (PNAS). The paper is titled "Copper is an endogenous modulator of neural circuit spontaneous activity." Co-authors are Sheel Dodani, Alana Firl, Jefferson Chan, Christine Nam, Allegra Aron, Carl Onak, Karla Ramos-Torres, Jaeho Paek, Corey Webster and Marla Feller.
Although the human brain accounts for only two-percent of total body mass, it consumes 20-percent of the oxygen taken in through respiration. This high demand for oxygen and oxidative metabolism has resulted in the brain harboring the body's highest levels of copper, as well as iron and zinc. Over the past few years, Chang and his research group at UC Berkeley have developed a series of fluorescent probes for molecular imaging of copper in the brain.
"A lack of methods for monitoring dynamic changes in copper in whole living organisms has made it difficult to determine the complex relationships between copper status and various stages of health and disease," Chang said. "We've been designing fluorescent probes that can map the movement of copper in live cells, tissue or even model organisms, such as mice and zebra fish."
For this latest study, Chang and his group developed a fluorescent probe called Copper Fluor-3 (CF3) that can be used for one- and two-photon imaging of copper ions. This new probe allowed them to explore the potential contributions to cell signaling of loosely bound forms of copper in hippocampal neurons and retinal tissue.
"CF3 is a more hydrophilic probe compared to others we have made, so it gives more even staining and is suitable for both cells and tissue," Chang says. "It allows us to utilize both confocal and two-photon imaging methods when we use it along with a matching control dye (Ctrl-CF3) that lacks sensitivity to copper."
With the combination of CF3 and Ctrl-CF3, Chang and his group showed that neurons and neural tissue maintain stores of loosely bound copper that can be attenuated by chelation to create what is called a "labile copper pool." Targeted disruption of these labile copper pools by acute chelation or genetic knockdown of the copper ion channel known as CTR1 (for copper transporter 1) alters spontaneous neural activity in developing hippocampal and retinal circuits.
"We demonstrated that the addition of the copper chelator bathocuproine disulfonate (BCS) modulates copper signaling which translates into modulation of neural activity," Chang says. "Acute copper chelation as a result of additional BCS in dissociated hippocampal cultures and intact developing retinal tissue removed the copper which resulted in too much spontaneous activity."
The results of this study suggest that the mismanagement of copper in the brain that has been linked to Wilson's, Alzheimer's and other neurological disorders can also contribute to misregulation of signaling in cell-to-cell communications.
"Our results hold therapeutic implications in that whether a patient needs copper supplements or copper chelators depends on how much copper is present and where in the brain it is located," Chang says. "These findings also highlight the continuing need to develop molecular imaging probes as pilot screening tools to help uncover unique and unexplored metal biology in living systems."
http://www.medicalnewstoday.com/releases/286197.php  Adapted by MNT from original media release

Two New Therapies for Parkinson’s Disease Patients to get Excited About: Vaccines and Monoclonal Antibodies


You can find out more about NPF's National Medical Director, Dr. Michael S. Okun, by also visiting the NPF Center of Excellence, University of Florida Health Center for Movement Disorders and Neurorestoration. Dr. Okun is also the author of the Amazon #1 Parkinson's Best Seller 10 Secrets to a Happier Life.
In September 2012, the What’s Hot in Parkinson’s Disease? blog featured a new therapy that at that time had entered into human testing. The Austrian company AFFiRiS A.G. launched a two-year long clinical trial of a vaccine designed to stop Parkinson’s disease progression. In this month’s What’s Hot Column we will bring you an update on the vaccine and an update on another therapy (monoclonal antibodies) for the treatment of Parkinson’s disease.

Parkinson’s disease is a neurodegenerative condition associated with deposition of a brain protein known as alpha-synuclein.  This protein clumps and spreads throughout the brain, and the spread of the protein parallels the progression of Parkinson’s disease.  Many experts believe that much of the damage in Parkinson’s disease traces to the brain’s failure to process, and to clear these bad proteins.

The idea underpinning the Parkinson’s disease vaccine is simple.  Patients receive injections with the hope that these injections will stimulate an immune system response against alpha-synuclein, and that antibodies will attack these brain proteins; and ultimately clear them.  Thirty-two human Parkinson’s disease patients were part of a two year safety and tolerability study called the PD01A project.  The study ultimately would be the first step in modifying disease progression in human Parkinson’s disease patients.

The preliminary results of the study revealed the vaccine was safe and well-tolerated, though relatively few people were tested.  Half of those in the study developed antibodies against alpha-synuclein, and for those patients the investigators believe that the appearance of antibodies was a positive sign.  Why some patients did not develop antibodies remains unknown, and a follow-up study will address the use of booster vaccine shots.

Using a different approach, Prothena and Roche are developing monoclonal antibodies (i.e. antibodies that are specific and only bind to a single substance) that will directly target alpha-synuclein.  What is the difference between monoclonal antibodies and a vaccine?  The monoclonal antibodies are injected into the patient as a direct therapy, whereas the vaccine shot stimulates the immune system to produce antibodies against alpha-synuclein.  Both are considered under the umbrella of “immunotherapies.”  Two dose-finding and human safety trials of the first Parkinson’s monoclonal antibody PRX002 are underway.

It is important to keep in mind that not all experts believe that removal of these brain proteins will result in clinically meaningful changes and/or disease modification.  Additionally, we must keep in mind that one highly publicized attempt to target amyloid in Alzheimer’s patients led to serious safety concerns, and termination of a vaccine study known as AN1792 because several patients developed a meningoencephalitis.

What patients need to know about the vaccine and about monoclonal antibodies is that both are still in the very early stages of testing, but that the idea of boosting immunity and using immunotherapy is novel and promising.  Safety, tolerability, and clinical efficacy will need to be demonstrated before the vaccine and the monoclonal antibodies can move into the next phase of clinical testing.  Our hope is that clearance of the Parkinson’s associated brain proteins will translate into disease modification.  A similar approach is also being tested in other diseases such as Alzheimer’s disease, diabetes, and atherosclerosis.  These are definitely potential Parkinson’s disease therapies to get excited about.

Selected References:
  1. Lindström V, Ihse E, Fagerqvist T, Bergström J, Nordström E, Möller C, Lannfelt L, Ingelsson M. Immunotherapy targeting α-synuclein, with relevance for future treatment of Parkinson's disease and other Lewy body disorders. Immunotherapy. 2014 Feb;6(2):141-53. doi: 10.2217/imt.13.162. Review. PubMed PMID: 24491088.
  2. Ghochikyan A, Petrushina I, Davtyan H, Hovakimyan A, Saing T, Davtyan A, Cribbs DH, Agadjanyan MG. Immunogenicity of epitope vaccines targeting different B cell antigenic determinants of human α-synuclein: feasibility study. Neurosci Lett. 2014 Feb 7;560:86-91. doi: 10.1016/j.neulet.2013.12.028. Epub 2013 Dec 19. PubMed PMID: 24361548; PubMed Central PMCID: PMC3928627.
  3. Sanchez-Guajardo V, Annibali A, Jensen PH, Romero-Ramos M. α-Synuclein vaccination prevents the accumulation of parkinson disease-like pathologic inclusions in striatum in association with regulatory T cell recruitment in a rat model. J Neuropathol Exp Neurol. 2013 Jul;72(7):624-45. doi:10.1097/NEN.0b013e31829768d2. PubMed PMID: 23771222.
  4. Rohn TT. Targeting alpha-synuclein for the treatment of Parkinson's disease. CNS Neurol Disord Drug Targets. 2012 Mar;11(2):174-9. Review. PubMed PMID:22483285.
  5. Ha D, Stone DK, Mosley RL, Gendelman HE. Immunization strategies for Parkinson's disease. Parkinsonism Relat Disord. 2012 Jan;18 Suppl 1:S218-21. doi:10.1016/S1353-8020(11)70067-0. Review. PubMed PMID: 22166440.
  6. Schneeberger A, Mandler M, Mattner F, Schmidt W. Vaccination for Parkinson's disease. Parkinsonism Relat Disord. 2012 Jan;18 Suppl 1:S11-3. doi:10.1016/S1353-8020(11)70006-2. Review. PubMed PMID: 22166404.
  7. Hutter-Saunders JA, Mosley RL, Gendelman HE. Pathways towards an effective immunotherapy for Parkinson's disease. Expert Rev Neurother. 2011 Dec;11(12):1703-15. doi: 10.1586/ern.11.163. Review. PubMed PMID: 22091596; PubMed Central PMCID: PMC3263336.
Posted: 12/1/2014 2:55:41 PM by Cathy Whitlock

Help with dignity ! Medications possibly free for those in need!

I will run this several times during the year. This could happen to anyone of us. Don't go without your medicine. This may help you.





Help with dignity

NeedyMeds
The mission of NeedyMeds has been to make information about assistance programs available to low-income patients and their advocates at no cost. Databases such as Patient Assistance Programs and Disease-Based Assistance, government programs and other types of assistance programs are the crux of the free information we offer online.
http://www.needymeds.org/index.htm

RxAssist
RxAssist offers a comprehensive database of pharmaceutical companies’patient assistance programs which provide free medications to people who cannot afford to buy their medicine. RxAssist also provides practical tools, news and articles so that health care professionals and patients can find the information that they need. All in one place.
http://www.rxassist.org
Rx Outreach 
Rx Outreach is managed by Express Scripts Specialty Distribution Services, Inc. (ESSDS), a fully-licensed mail order pharmacy that is committed to making the use of prescription drugs safer and more affordable. Rx Outreach is not a prescription insurance program nor an Internet pharmacy.
ESSDS developed Rx Outreach to provide a safe, affordable, and easy way for people of all ages to get medicines they need. The program offers prescription medicines to uninsured individuals and families, as well as those who have limited prescription drug coverage. Customer Service: 1-800-769-3880. http://rxoutreach.org
Partnership for Prescription Assistance Program
1-888-4PPA-NOW (1-888-477-2669) Their mission is to increase awareness of patient assistance programs and boost enrollment of those who are eligible. The Partnership for Prescription Assistance offers a single point of access to more than 475 public and private patient assistance programs, including more than 180 programs offered by pharmaceutical companies.
https://www.pparx.org
.........................................................................
http://www.parkinson.org/Parkinson-s-Disease/Treatment/Medications-for-Motor-Symptoms-of-PD/Resources-for-Prescription-Assistance

There is an app for smartphones called Good RX . 

HELPFUL ITEMS TO GIVE TO THOSE WITH PARKINSON'S DISEASE COPIED FROM PARKINSON'S JOURNEY

I copied this from Parkinson's Journal. This is a wonderful thing you do! Thank You  Sherri Woodbridge!
Posted: 28 Nov 2014 09:54 AM PST

It’s that time of year again and so, here’s the 3rd annual list of great ideas for gifts for people with Parkinson’s disease and is suitable for those who live with other chronic illnesses. If you have ideas/suggestions not on the list, feel free to add to the list by leaving a comment.
  • Because people with PD and/or otherr chronic illnesses ingest so much medication, it can slow the outflow process. In other words, they can easily suffer from constipation. The Squatty Potty is a help to those who find it difficult to have bowel movements. For a list of Squatty Potties and their like-competitors, go here: Squatty Potty and such
  • Many people with PD who loved to write without the aide of a keyboard, sorely lose out when it comes time for sending (handwritten) notes any time of the year. Weighted pens (and pencils) are a god-send to those with PD, as they give more stability to a trembling hand.
  • A sturdy, plastic cup with a straw is a great and simple gift and there are so many fun ones to choose from. These are great for people with PD. They’re not only fun, but the straw stays put and are perfect since most PD patients do better using a straw when they drink. For the healthiest choice, choose BPA-free.
Readers Choices:
  • “One of the gifts I am proudest of (and has gotten most use, I think!) for my step-father with PD was an ink stamp of his signature. One of the first things he had trouble with was signing his name, and the stamp works perfectly on cheques, documents, etc. I took a high resolution scan of the signature from before he had the shaking, and then went to an ordinary business solutions website, [Staples, Office Max/Depot, etc) and voila! Now he can sign his own name and it looks like it used to.” (Note: Get the signature during a “ON” time of medication for best results for the best signature.) -submitted by Anonymou
  • “…for men who have always cut their own hair– military and men of a certain generation who just like to avoid the hassle of a salon. Remington makes a cordless short-cut clipper that is easier to hold and works just like a brush, specially on the back of the head. It’s a simple tool but keeps one more…task easier and in the home.” -submitted by Erin
  • “My wife was diagnosed with early onset PD early 2014 at the age of 43. She also has recently been diagnosed with Lupus. I purchased a Tens unit and an extra large 12×24 heating pad to help alleviate her aching muscles and joints. I will get her a few gift cards for massages from the local spa. I am also researching a percussion massager so I can help when she has a flare up and isnt feeling her best.” -submitted by Big Jake (Note: Please consult your doctor first before using the Tens unit for placement of pads if you have had DBS.)
  • “My father in-law has quite advanced Parkinson’s and I’ve just bought him a DAB radio. It will be ideal for when he’s not feeling to good too get out of bed or watch the TV. I think you can feel very lonely with Parkinson’s and hopefully the radio will help.” –  submitted by Claire
    And last but not least, a greast stocking stuffer would be a tube(s) of Arnica Gel. This works wonders for stiff necks/shoulders. It comes in cream (not greasy) as well, but the gel dries really fast. Both the gel and the cream work equally well. No fragrance. This really helps the stiffness in the neck which in turn helps to reduce the headaches associated with PD. I can attest to this fact!
    For a list of gift ideas from previous years, click here.  And don’t forget to leave a comment if you have a suggestion.
The post 2014 Holiday Gifts/Ideas for People with Parkinson’s Disease appeared first on

Tuesday, December 2, 2014

Google's Latest: A Spoon That Steadies Tremors


Google Tremor Spoon
Google is throwing its money, brain power and technology at the humble spoon.
But these spoons (don't call them spoogles) are a bit more than your basic utensil: Using hundreds of algorithms, they allow people with essential tremors and Parkinson's disease to eat without spilling.
The technology senses how a hand is shaking and makes instant adjustments to stay balanced. In clinical trials, the Liftware spoons reduced shaking of the spoon bowl by an average of 76 percent.
"We want to help people in their daily lives today and hopefully increase understanding of disease in the long run," Google spokesperson Katelin Jabbari said.
Other adaptive devices have been developed to help people with tremors ? rocker knives, weighted utensils, pen grips. But until now, experts say, technology has not been used in this way.
"It's totally novel," said UC San Francisco Medical Center neurologist Dr. Jill Ostrem, who specializes in movement disorders like Parkinson's disease and essential tremors.
She helped advise the inventors and says the device, which has a fork attachment, has been a remarkable asset for some of her patients.
"I have some patients who couldn't eat independently, they had to be fed, and now they can eat on their own," she said. "It doesn't cure the disease ? they still have tremor ? but it's a very positive change."
Google got into the no-shake utensil business in September, acquiring a small, National of Institutes of Health-funded startup called Lift Labs for an undisclosed sum.
More than 10 million people worldwide, including Google co-founder Sergey Brin's mother, have essential tremors or Parkinson's disease. Brin has said he also has a mutation associated with higher rates of Parkinson's and has donated more than $50 million to research for a cure. But the Lift Labs acquisition was not related, Jabbari said.
Lift Lab founder Anupam Pathak said moving from a small, four-person startup in San Francisco to the vast Google campus in Mountain View has freed him up to be more creative as he explores how to apply the technology even more broadly.
His team works at the search giant's division called Google(x) Life Sciences, which is also developing a smart contact lens that measures glucose levels in tears for diabetics and is researching how nanoparticles in blood might help detect diseases.
Joining Google has been motivating, said Pathak, but his focus remains on people who are now able to eat independently with his device.
"If you build something with your hands and it has that sort of an impact, it's the greatest feeling ever," he said. "As an engineer who likes to build things, that's the most validating thing that can happen."
Pathak said they also hope to add sensors to the spoons to help medical researchers and providers better understand, measure and alleviate tremors.
Shirin Vala, 65, of Oakland, has had an essential tremor for about a decade. She was at her monthly Essential Tremor group at a San Ramon medical clinic earlier this year when researchers developing the device introduced the idea and asked if anyone was interested in helping them.
As it was refined, she tried it out and gave them feedback. And when they hit the market at $295 apiece, she bought one.
Without the spoon, Vala said eating was really a challenge because her hands trembled so hard food fell off the utensils before she could eat it.
"I was shaking and I had a hard time to keep the food on a spoon, especially soup or something like an olive or tomatoes or something. It is very embarrassing. It's very frustrating," she said.
The spoon definitely improved her situation. "I was surprised that I held the food in there so much better. It makes eating much easier, especially if I'm out at a restaurant," she said.
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Follow Martha Mendoza at https://twitter.com/mendozamartha .

New Online Tool Trains Doctors to Diagnose and Treat Parkinson's

Tue Dec 2, 2014 6:00am ESTis not responsible for the content in this press release. 

TORONTO, ON--(Marketwired - December 02, 2014) - Parkinson Society Canada is proud to launch its first online learning module accredited by the College of Family Physicians of Canada and available at www.parkinsonclinicalguidelines.ca/education. The module, offered at no cost, enables healthcare professionals to work through practical case scenarios. Family doctors will gain insight into key clinical challenges that can be applied to their own patient management. The content is based on the 84 recommendations from the Canadian Guidelines on Parkinson's Disease. 
"This program teaches physicians to consistently identify the clinical signs and symptoms of Parkinson's so that they can make early referrals to a specialist and helping to improve the quality of care for their patients. Participants can also pose questions about the module content and receive guidance from medical experts," says Grace Ferrari, National Manager, Professional and Public Education, Parkinson Society Canada. 
The module serves as a companion resource to the Canadian Guidelines on Parkinson's Disease, and related reference tools, all released in 2012. The learning module covers commonly known motor symptoms, as well as non-motor symptoms of Parkinson's, which patients report most adversely affect their quality of life and are gaining importance in the patient/health professional dialogue. The online learning module was developed by Parkinson Society Canada with input from its Medical Advisory Committee, comprised of experts including neurologists, movement disorders specialists and family doctors. 
Professionals from a variety of health disciplines can take advantage of the module's transferable content to further their continuing professional education and training. Although the module is geared towards healthcare professionals, anyone with an interest is welcome to use the resource to become better informed about Parkinson's. Participants can access the online course through a secure login and registration process.
About the Canadian Guidelines on Parkinson's DiseaseThe Canadian Guidelines on Parkinson's Disease provides healthcare professionals with a detailed understanding to guide the early diagnosis and ongoing treatment of Parkinson's disease. The guidelines are relevant to a broad range of health professionals including: family physicians, neurologists, nurses, movement disorders specialists, gerontologists, allied health professionals (e.g. occupational therapists, physiotherapists, speech-language pathologists) and other specialists. The guidelines, endorsed by the Canadian Neurological Sciences Federation and the Canadian Physiotherapy Association, were published for the first time in 2012 and are available at www.parkinsonclinicalguidelines.ca.
What is Parkinson's disease?Parkinson's is a chronic degenerative neurological disease caused by a loss of dopamine in the brain. There is currently no cure. Motor symptoms include resting tremor, slowness of movement, stiffness or rigidity of muscles, difficulty with balance and walking, changes in voice volume and speech, and difficulty with fine movements. Non-motor symptoms include depression, loss of sense of smell, sleep disturbances and cognitive changes. The average age of onset is 60, but it can affect people as young as 30 or 40. The Parkinson's population in Canada will grow to 99,000 by 2016 and will double by 2031. 
About Parkinson Society CanadaParkinson Society Canada is the national voice of Canadians living with Parkinson's. Since 1965, Parkinson Society Canada, in collaboration with regional partners and 240 chapters and support groups, provides support services, education, advocacy and research funding to improve the quality of life and ultimately find a cure, for Canadians living with Parkinson's and other related conditions including Parkinson Supranuclear Palsy (PSP) and Multiple System Atrophy (MSA). 

Contact:
Kelly Mills
416-227-9700, ext. 3469
1-800-565-3000; ext. 3469 
http://health.einnews.com/article/237555738/UZvqXnBS2fJ7zoCc?n=2&code=ga_qGBxHZ2aVYO4P