6 things you should know about vitamin D

Figuring out all the factors that can affect your vitamin D level is complicated. Your body makes vitamin D when sunlight hits the skin. You can also get the vitamin from food (mainly because it's been added; few foods are natural sources of vitamin D) or by taking a supplement.

The process by which the body makes vitamin D is complex. It starts when the skin absorbs rays in the invisible ultraviolet B (UVB) part of the light spectrum. The liver and the kidneys also participate to make a form of the vitamin that the body can use.

A number of factors influence a person's vitamin D levels. Here are six important ones.

1. Where you live. The further away from the Equator you live, the less vitamin D–producing UVB light reaches the earth's surface during the winter. Residents of Boston, for example, make little if any of the vitamin from November through February. Short days and clothing that covers legs and arms also limit UVB exposure.
2. Air quality. Carbon particles in the air from the burning of fossil fuels, wood, and other materials scatter and absorb UVB rays, diminishing vitamin D production. In contrast, ozone absorbs UVB radiation, so pollution-caused holes in the ozone layer could end up enhancing vitamin D levels.
3. Use of sunscreen. Sunscreen prevents sunburn by blocking UVB light. Theoretically, that means sunscreen use lowers vitamin D levels. But as a practical matter, very few people put on enough sunscreen to block all UVB light, or they use sunscreen irregularly, so sunscreen's effects on vitamin D might not be that important. An Australian study that's often cited showed no difference in vitamin D between adults randomly assigned to use sunscreen one summer and those assigned a placebo cream.
4. Skin color. Melanin is the substance in skin that makes it dark. It "competes" for UVB with the substance in the skin that kick-starts the body's vitamin D production. As a result, dark-skinned people tend to require more UVB exposure than light-skinned people to generate the same amount of vitamin D.
5. Weight. Body fat sops up vitamin D, so it's been proposed that it might provide a vitamin D rainy-day fund: a source of the vitamin when intake is low or production is reduced. But studies have also shown that being obese is correlated with low vitamin D levels and that being overweight may affect the bioavailability of vitamin D.
6. Age. Compared with younger people, older people have lower levels of the substance in the skin that UVB light converts into the vitamin D precursor. There's also experimental evidence that older people are less efficient vitamin D producers than younger people.
   
   
   http://www.health.harvard.edu/staying-healthy/6-things-you-should-know-about-vitamin-d

FoxFeed Blog - Bionic Dystonic: How I Advocate for Dystonia Awareness

Posted by  David Novotny, September 23, 2016

David Novotny is a guest blogger from Los Angeles who has lived with dystonia for five years after being diagnosed in his mid-20s. His YouTube channel shares his personal story and experience with dystonia.

There was a time when I had to live life with my head locked in place 90 degrees to the left and tilted 45 degrees to the right. My parents held my head in place, maneuvering my jaw like a nutcracker so that I could chew food. I worked full-time while literally holding my head in place, thus rendering the use of only one hand. Unfortunately, these are ordinary daily occurrences for the estimated 500,000 people living in the United States with the neurological disorder of dystonia.

September is Dystonia Awareness Month and "dystonics" are doing everything they can to make sure the public knows that dystonia is NOT a country. Rather, it's the third most common movement disorder, causing uncontrollable muscle spasms and/or sustained abnormal twisting postures. It can affect one's entire body or be limited to a specific region. Many people with Parkinson's also may experience dystonia as a symptom, but without ever hearing the word beforehand.

This particular September also is of incredible significance to me as my one-year anniversary of undergoing deep brain stimulation (DBS). Twelve months ago I was wheeled into an operating room for this two-part surgery (which can also treat PD motor symptoms in some patients) in which electrodes were implanted inside my brain and connected to a battery pack in my chest via a wire, in order to help me regain control over my motor function.

Today, I am very thankful to say that I no longer experience many of the effects of my dystonia. That being said, I want to make it perfectly clear that DBS is not a cure and success varies from patient to patient. Furthermore, it can take several months after surgery before results occur. I, for example, continue to receive neurotoxin injections as complementary therapy to help lessen dystonic postures and spasms.  

There are many areas of research, treatment and experience which overlap between the "big three" movement disorders of Parkinson's, dystonia and essential tremor. I realized that my treatment, for example, is the sum total of decades of debates, lectures, symposiums, trials, experiments, or simply put the advocacy of the many bold and brave doctors and patients alike who had come before me.

And it is this notion of "pay it forward" that is so essential. I now advocate today for a better tomorrow by helping the dystonia community learn about treatment options and the need for more research. My hope is that one day my DBS hardware will be but an ancient artifact, and that dystonia itself is a thing of the past.

https://www.michaeljfox.org/foundation/news-detail.php?bionic-dystonic

Fake Towns Could Help People With Alzheimer’s Live Happier Lives

September 23, 2016

Model towns meant to spark memories could help patients with dementia

A concept design for the completed Glenner Town Square. (San Diego Opera/George G. Glenner Alzheimer's Family Centers, Inc.)

When San Diego’s Glenner Town Square opens, it will be like stepping into a time warp. Everything from the hospital to the local diner to the city hall at its center will look like it was taken straight out of the 1950s, reminiscent of years and architectural styles gone by. However, this isn’t a new tourist attraction: it’s meant to help people living with Alzheimer's disease to remember their happiest days.

When completed, Glenner Town Square will be a fully functional (if somewhat small) and self-contained city center complete with a classic diner, beauty salon and library. The center is currently being built inside an 11,000-square-foot former warehouse and is being designed to evoke youthful memories of many elderly people currently living with Alzheimer’s Disease, Pam Kragen reports for the San Diego Union-Tribune.

“We have so many family caregivers who cannot take their loved ones to the movie theater or to a restaurant because they don't know what those interactions are going to be like,” Scott Tarde, CEO of the Glenner Center, tells Linda Poon for CityLab. “So we wanted to be able to provide these experiences in a safe environment.”

A model of Glenner Town Square's city hall, based on San Diego's 1950s-era real-life city hall. (San Diego Opera)

Caring for people with Alzheimer’s-related dementia can be stressful for both the patient and their family. Traditional round-the-clock care in homes can be very expensive, but caring for a parent or family member with dementia can be a struggle for people without specialized training. At the same time, living with the disease can be frustrating for the patients, who can become disoriented and lash out. While traditional therapy for Alzheimer’s patients tends to rely on nursing homes and drugs, in recent years centers like Glenner Town Square have begun popping up in communities across the world as a means to care for people with dementia while exposing them to things aimed at triggering happy memories, Poon reports.

“Structure is very important for individuals [with dementia],” Tarde tells Poon. “If you do not engage them, behaviors can start to escalate in the evening because there wasn't a lot of mental stimulation during the day.”

While Glenner Town Square is meant to provide day care for elderly dementia patients, others do provide round-the-clock care and community. One of the first examples of a center structured around this technique (known as “reminiscence therapy”) is Hogewey, a small, enclosed village built outside of Amsterdam that provides dormitories, shops and community spaces for residents with dementia to safely live more independent lives, Ben Tinker reported for CNN.

"We have Dutch design, Dutch cultures, Dutch lifestyles, but the concept is to value the person, the individual... to support them to live their life as usual, and you can do that anywhere," Yvonne van Amerongen, one of Hogewey’s founders, told Tinker.

Glenner Town Square is being designed and built by scenic carpenters and designers with the San Diego Opera, with plans to begin operations in 2018. By building an experience for people with dementia, the center could help provides some sense of structure and normalcy for those who have become unmoored from their memories.

A room inside city hall, complete with working typewriter and books that visitors with dementia can read and write with (George G. Glenner Alzheimer's Family Centers, Inc.)

http://www.smithsonianmag.com/smart-news/fake-towns-could-help-people-alzheimers-live-happier-lives-180960518/

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New treatment for Parkinson's Disease Psychosis shows promise

September 23, 2016

NEW ORLEANS -- Parkinson's Disease is being diagnosed more often as the baby boomer generation ages and while most people know about the shaking and stiffness, many are unfamiliar with another symptom that can scare patients and their families. 

Now there is now hope through a new treatment for Parkinson's Disease Psychosis.

Registered nurse, Jody Wade knew her elderly mother Ruth Ketcham, 91, had Parkinson's for years, but then something besides the movement problems began to happen.

"It started off, you know, with little benign, you know, animals in the house, mice. It did escalate quickly and she became very fearful," said Wade, 54, of Northport, New York.

She would call 911 because she was convinced she was seeing strangers on her roof, and exterminators would be called to her house, but see no evidence that rodents were living throughout her home. Her mother was diagnosed with Parkinson's Disease Psychosis.

"She's not mentally ill. It's not dementia. And don't, you know, don't really engage in an argument with her trying to convince her that, you know, there's not animals in the house," Wade explained.

Dr. Daniel Kremens, Neurologist and Co-Director of the Parkinson's Disease and Movement Disorders Center at Jefferson Medical College of Thomas Jefferson University in Philadelphia, said Parkinson's Disease Psychosis is "perhaps one of the most devastating non-motor symptoms" associated with the disease. 

Doctors say, of the one million American's with Parkinson's, they believe half will develop PD psychosis. Now there is a new drug recently FDA approved to help the hallucinations. Ketcham was one of the first to use NUPLAZID when it was being studied.

"A month after starting it, things were just so much better," Wade said. "She had an occasional hallucination. It was something that we would be able to bring her out of."

"One of the really exciting things about this drug NUPLAZID, is that it can treat those psychotic symptoms without worsening the patient's motor function," said Dr. Kremens.

"On an emotional level as a family, I can tell you that we're just so very grateful that we've had these years with my mom," said Wade about her mother being able to stay in her home longer.

Once Parkinson's patients go into nursing homes, they are more likely to die sooner. This new medication has been found to keep patients in their own homes longer.

To learn more about NUPLAZID visit Acadia Pharmaceuticals website. For more information on Parkinson's, visit The National Parkinson's Foundation's website.

Video:

http://www.wwltv.com/news/health/new-treatment-for-parkinsons-disease-psychosis-shows-promise/324856812

FDA Approves New Treatment for Essential Tremor

More Updated News 

September 23, 2016

BY FRAN KRITZ

As many as 10 million people have essential tremor, a neurologic condition that causes involuntary and rhythmic shaking, mostly in the hands, but shaking can also occur in the head, arms, voice, and torso, according to the International Essential Tremor Foundation. The condition is sometimes mistaken for Parkinson's disease because tremor is a symptom of Parkinson's. But unlike with essential tremor, tremor in Parkinson's disease is one of many symptoms including a shuffling gait and movement difficulties, says Todd Herrington, MD, PhD, a neurologist at Harvard Medical School and Massachusetts General Hospital.

Essential tremor is incurable but it can be treated with beta blockers and anticonvulsant medication as well as deep brain stimulation (DBS), which involves a neurostimulator, a battery-operated medical device similar to a pacemaker that is surgically implanted into the chest. The neurotransmitter delivers electrical stimulation to targeted areas of the brain that control movement, blocking the abnormal nerve signals that cause tremor. Studies show that it improves arm tremor by 50 to 90 percent, says Dr. Herrington.

Ultrasound Burns Brain Cells

Now, a new treatment has been approved by the US Food and Drug Administration (FDA) that might help patients who haven't responded to other therapies. Called focused ultrasound thalamotomy, the device directs intersecting and concentrated beams of ultrasound energy that heat then burn away a portion of the thalamus, a part of the brain thought to generate some involuntary movement. During the procedure, the patient wears a helmet-like device and lies in a magnetic resonance imaging (MRI) machine. Images on a monitor help surgeons guide the ultrasound beams, and the amount of energy is increased incrementally until surgeons see a lessening of the tremor. No anesthesia or incision is required.

"Individual ultrasound beams pass through the scalp, skull, and brain tissue. Once at the target, the multiple beams converge to a precise focal point. This is a permanent treatment in which some brain cells causing the tremor are burned away," explains Vibhor Krishna, MD, a neurosurgeon at Ohio State Wexner Medical Center, one of six medical centers in the US that performed clinical trials on the procedure. "We hope to increase the effectiveness of this treatment by improving visualization of the brain region involved through advanced neuroimaging," adds Dr. Krishna.

FDA Approval Based on Small Clinical Trial 

The double-blind, placebo-controlled trial, which was published in the New England Journal of Medicinein August, involved 76 patients with essential tremor who had previously not responded to medication. Fifty-six patients were randomly selected for focused ultrasound and 20 for a fake treatment but those patients were able to switch to the actual treatment three months later.

Patients treated with ultrasound showed nearly a 50 percent improvement in their tremors and motor function three months after treatment compared to their baseline score, while patients in the control group had no improvement. Some even experienced a slight worsening before they switched to the treatment group. A year after the procedure, improvement had dropped to 40 percent. Researchers and clinicians are following up with patients to see if the decrease stabilizes or if it's an indication that improvement wanes over time, says Dr. Krishna.

Procedure Has Side Effects

Patients in the clinical trials reported numbness or tingling in the fingers, headache, imbalance and unsteadiness, loss of control of body movements, and gait problems. The energy beams can cause tissue damage beyond the treatment site, as well as hemorrhaging, skin burns, and blood clots.

Not everyone is a candidate for the procedure, according to the FDA, including anyone who has an implantable medical device such as a pacemaker, people who are allergic to contrast dyes used for MRIs, pregnant women, and people with unstable blood pressure.

Pros and Cons

"We don't yet know how long the effects will last," says Dr. Herrington, who was not involved in the clinical trials. The procedure is also irreversible and even though it's termed noninvasive, that's not entirely accurate, he says. "Surgeons create a permanent hole in the brain." Advantages include no risk of infection at the incision site and no need to replace a neurostimulator battery periodically as is the case with DBS. And in rare cases, says Dr. Herrington, the neurotransmitter used for DBS can fail, and another surgery is needed to remove it.

Approval Limitations

Focused ultrasound thalamotomy for essential tremor is approved for use on one side of the brain only and surgeons are most likely to choose the side that is causing tremor in the dominant hand, says Dr. Herrington. "As the device has wider use, we'll have a chance to see how long the effects last and whether we can push it to treat symptoms on both sides," says Dr. Herrington.  "I think it's an exciting tool but will take more time to understand how exactly it fits." Dr. Herrington says another upside is that the location where the energy is directed is similar to targets used for DBS so surgeons are already familiar with the anatomy involved.

Covering the Cost

Insightec, an Israeli company that manufactures ExAblate Neuro, the focused ultrasound device, is in talks with Medicare and private insurers about coverage and expects to have answers by next year, says Rick Schallhorn, vice president of neurosurgery at Insightec.

Meanwhile, the medical centers that conducted the clinical trials have the device so patients should discuss the option with their physician. The procedure, which is not yet covered by Medicare or insurance, currently costs more than $30,000, which includes the device and the surgery.

For more information about focused ultrasound thalamotomy for essential tremor, visit the FDA at bit.ly/FDA-Tremor or Insightec, the company that created the device, at bit.ly/ExAblateNeuro. Also, talk to your doctor to see if the procedure is something for you to consider. For more about essential tremor, visit our archives at bit.ly/NN-Ess

http://journals.lww.com/neurologynow/blog/breakingnews/Pages/post.aspx?PostID=395

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Research on Stress Hormone Effects on the Brain Reveals Unexpected Findings

NEUROSCIENCE NEWSSEPTEMBER 23, 2016

Summary: New findings suggest common concepts cited in textbooks may need to be adjusted.

Source: University of Bristol.

The researchers also discovered that MRs and GRs don’t always act separately but can actually bind together at the same site within hippocampal genes after stress, possibly resulting in a boost in the expression of such genes. NeuroscienceNews.com image is credited to the researchers.

Stress is a common problem often resulting in poor health and mental disorders. New research has revealed that current concepts on how stress hormones act on the brain may need to be reassessed.

It is thought that disturbances in the action of stress hormones play a key role in causing mental disorders, like major depression and post-traumatic stress disorder (PTSD).

Learning to cope with stressful events is known to require changes in the expression of genes in the hippocampus, a limbic brain region involved in learning and memory. Such changes in gene expression are brought about by stress-induced glucocorticoid hormones acting via receptors that can directly bind to genes and alter their expression.

A BBSRC-funded study, published in the international journal Proceedings of the National Academy of Sciences (PNAS), has found that the action of mineralocorticoid receptors (MRs) at the neuronal genome cannot be predicted based solely on receptor occupancy by glucocorticoid hormone. As a result the concept on tonic and feedback action, which over the past few decades has been cited in textbooks, may require some adjustment.

Professor Hans Reul together with Dr Karen Mifsud, of the University’s School of Clinical Sciences, investigated the actual binding of MRs and glucocorticoid receptors (GRs) to genes in the hippocampus after stress.

To their surprise they found the binding of MRs to genes was not constantly high but actually low under non-stress conditions and increased substantially after stress. GRs, however, followed the expectation that binding to target genes would be minimal under baseline conditions and increase dramatically after stress following the GR binding profile to glucocorticoids.

Hans Reul, Professor of Neuroscience, said: “These novel findings are a significant step forward in our understanding of how glucocorticoid hormones act on the brain after stressful events. They allow for the first time identification of genes within the hippocampus of the brain that are directly affected by GR/MR binding after stress. Given that stress-related psychiatric diseases such as major depression, anxiety and PTSD are an ever-increasing burden in our society, these new insights are important to find novel treatments and therapies in the future.”

The researchers also discovered that MRs and GRs don’t always act separately but can actually bind together at the same site within hippocampal genes after stress, possibly resulting in a boost in the expression of such genes. Their work provides the first strong evidence in vivo that MR and GR are heterodimerising and that MRs may require the presence of GRs in order to bind to specific target genes.

Thirty years ago, Professor Reul, who was working at Utrecht University in The Netherlands, observed that glucocorticoids exert their effects on the brain via two different types of receptors, the MRs and the GRs.

Professor Reul discovered that due to their extraordinarily high affinity for glucocorticoids, MRs are always fully occupied by these hormones whereas GRs, as a result of their lower binding affinity, only became occupied after a stressful event. Based on these results, the concept was launched that MRs have a constant (‘tonic’) action on brain function whereas GRs mediated negative feedback and enhance learning and memory after stress. Due to Dr Mifsud and Professor Reul’s new research at the University of Bristol, this concept may require reassessment.

ABOUT THIS NEUROSCIENCE RESEARCH ARTICLE

Funding: Professor Reul and Dr Mifsud will pursue this ground-breaking work after recently receiving grants over £1 million from BBSRC to continue with this successful stress research programme.

Source: University of Bristol 

Image Source: This NeuroscienceNews.com image is adapted from the University of Bristol press release.

Original Research: Abstract for “Acute stress enhances heterodimerization and binding of corticosteroid receptors at glucocorticoid target genes in the hippocampus” by Karen R. Mifsud and Johannes M. H. M. Reul in PNAS. Published online September 21 2016 doi:10.1073/pnas.1605246113

Abstract

Acute stress enhances heterodimerization and binding of corticosteroid receptors at glucocorticoid target genes in the hippocampus

A stressful event results in secretion of glucocorticoid hormones, which bind to mineralocorticoid receptors (MRs) and glucocorticoid receptors (GRs) in the hippocampus to regulate cognitive and affective responses to the challenge. MRs are already highly occupied by low glucocorticoid levels under baseline conditions, whereas GRs only become substantially occupied by stress- or circadian-driven glucocorticoid levels. Currently, however, the binding of MRs and GRs to glucocorticoid-responsive elements (GREs) within hippocampal glucocorticoid target genes under such physiological conditions in vivo is unknown. 

We found that forced swim (FS) stress evoked increased hippocampal RNA expression levels of the glucocorticoid-responsive genes FK506-binding protein 5 (Fkbp5), Period 1 (Per1), and serum- and glucocorticoid-inducible kinase 1 (Sgk1). Chromatin immunoprecipitation (ChIP) analysis showed that this stressor caused substantial gene-dependent increases in GR binding and surprisingly, also MR binding to GREs within these genes. Different acute challenges, including novelty, restraint, and FS stress, produced distinct glucocorticoid responses but resulted in largely similar MR and GR binding to GREs. Sequential and tandem ChIP analyses showed that, after FS stress, MRs and GRs bind concomitantly to the same GRE sites within Fkbp5 and Per1 but not Sgk1. 

Thus, after stress, MRs and GRs seem to bind to GREs as homo- and/or heterodimers in a gene-dependent manner. MR binding to GREs at baseline seems to be restricted, whereas after stress, GR binding may facilitate cobinding of MR. This study reveals that the interaction of MRs and GRs with GREs within the genome constitutes an additional level of complexity in hippocampal glucocorticoid action beyond expectancies based on ligand–receptor interactions.

“Acute stress enhances heterodimerization and binding of corticosteroid receptors at glucocorticoid target genes in the hippocampus” by Karen R. Mifsud and Johannes M. H. M. Reul in PNAS. Published online September 21 2016 doi:10.1073/pnas.1605246113

http://neurosciencenews.com/ptsd-cortisol-neuroscience-5115/

Parkinson’s Researchers Shed Light on Brain Area Controlling Eye Movements

SEPTEMBER 23, 2016

Swedish researchers report that the massive burden of prioritizing visual stimuli from our environment lies with the the superior colliculus area of the brain. This ancient part of the brain may provide clues regarding the mechanisms leading to Parkinson’s disease, where patients often have impaired eye movement.

The Karolinska Institute research paper, “Spatiotemporal interplay between multisensory excitation and recruited inhibition in the lamprey optic tectum,” was published in eLife.

The association between  Parkinson’s and multisensory entanglements is well-established. However, specific signaling pathways connecting neurons and motor centers are still puzzling for neuroscientists and frustrating for patients waiting for new therapeutic approaches.

In their study, which relies heavily on lead author Andreas Kardamakis’s previous work, researchers studied the concept of “multisensory integration” – the merging of different environmental messages – and how it may apply to the function of the superior colliculus.

When an event occurs that is detected by our senses, certain neurons in that part of the brain get activated, often leading to a response picked up by our muscles. But when two senses (such as vision and hearing) simultaneously report contradictory events, these neurons become less active and are less likely to respond.

The researchers, who conducted most of their experiments on lamprey fish, were able to shed light on the “neural circuit” of the optic tectum (the superior culliculus of the fish) with the muscle controlling areas of the brain stem.

The study solidifies scientific evidence that indicates there’s an area of the brain with the evolutionary safeguarded ability to refocus a person’s attention and alertness on a particular event — excluding supplementary messages from the rest of the brain.

But that concept may be considered controversial because many researchers agree that stimulus selection is also influenced by other brain regions, such as the cortex. Stimulus selection is the most important part in determining our level of  visual attention.

If scientists can figure out the factors that determine orientation perception, they will be better able to pinpoint what derails the system and causes problems with visual coordination, potentially leading to future therapeutic opportunities.

Future studies are required to determine whether the findings of the research team and the concept of “multiple, simultaneous stimuli reduces alertness” can provide causal links – genetic and environmental – between sensorimotor circuits and their mistranslated signaling in Parkinson’s and other neuromuscular diseases.

http://parkinsonsnewstoday.com/2016/09/23/parkinsons-researchers-study-brain-area-controlling-eye-movements

Using Unified Parkinson’s Disease Rating Scale for the Evaluation

by admin | Sep 23, 2016

Parkinson’s disease causes problems in speech, tremors in hands, unintentional body movements due to rigidity of muscles. The disease affects the nerve cells which produce dopamine, thus leading to altered body conditions. After a thorough diagnosis, treatments can be done to lower the extent of this problem but there are no solutions to cure it permanently.

Evaluation Scale

A Unified Parkinson’s Disease Rating Scale is used to evaluate the conditions of those suffering from it. The rating scale varies between 0 and 4. 0 represents a normal condition whereas 4 shows an extreme case.

Stages of Evaluation

There are several stages of evaluation which we have discussed, in details, below:

Stage 1

This is the most humble stage of the evaluation. At this stage, the mood, mental abilities, and general behavior of the test patient are studied. Swings in mood or deterioration of mental abilities could represent the presence of disease.

Stage 2

In the second phase, the test patient is required to evaluate changes in behavior and general gait, himself. Any abnormalities in the normal activities could be a representation of Parkinson’s. You should immediately rush to your doctor if you find a change in any of these activities;

• Speech: If you feel rigidity in facial muscle while speaking then this could a symptom.

• Writing: Hands undergoing tremors while writing or even at rest could be a sign that you have Parkinson’s.

• Walking: If you face trouble with walking then you should consult your doctor and get thoroughly evaluated.

• Similarly, if you have issues when changing clothes or eating food, then get yourself diagnosed.

Stage 3

The third stage of evaluation involves ‘Clinically Monitored Evaluation’. In this phase, expert advice is brought into practice. You’re required to get yourself evaluated by a professional doctor. If prescribed, you move on the 4th stage which involves motor examinations.

Stage 4

In the fourth stage, Hoehn and Yahr’s procedure is carried out for thorough evaluation of your body using motor examinations processes. Deep studies are made regarding your body movements and responses.

• Speech: You are required to read scripts or do the general talking for this process. The movement of your face is evaluated during the speech. The extent of the problem is calculated by measuring the extent of problems you face while talking.

• Face at rest: Apart from speech, the conditions of your face are diagnosed when at rest as well. If you’re suffering from the problem, your face will suffer tremors or rigidity.

• Hand Movement: You are asked to open and close your hand in rapid successions. Those suffering from the disease will have issues doing this.

• Leg Agility: You’re required to tap your feet on the ground for several times. Fatiguing doing this, arresting of your feet, and other impairments tell about the extent of the disease.

Apart from these, there are multiple other tests which are carried in the fourth stage of evaluation. If you have any of these symptoms, then you will be required to take medication to reduce the extent of effects of this disease on your body.

http://www.alifewithparkinsons.com

Whole Body Vibration, Exercise May Improve Motor Performance In Parkinson's

Laura Stiles, Assistant Editor
  September 23, 2016

Pharmacologic intervention is the current standard of care for Parkinson’s disease, yet medications frequently fail to control some symptoms, including tremor and postural instability.

A combination of whole body vibration (WBV) and exercise therapy may result in significant short-term improvements in motor performance, activities of daily living, and postural stability in Parkinson's disease, according to findings presented at the 2016 World Parkinson Congress, held September 20-23, 2016, in Portland, Oregon.

“Pharmacologic intervention is the current standard of care for Parkinson's disease, yet medications frequently fail to control some symptoms, including tremor and postural instability, which degrade functional performance and quality of life. Non-pharmacological treatments, including Whole Body Vibration and exercise therapy may reduce these symptoms,” wrote Drucilla Edmonston and Olivia Gruder, medical students from Florida State University College of Medicine in Tallahassee, Florida.

he researchers recruited 15 participants with Parkinson's disease (stages I through IV) through the National Parkinson's Foundation Center. Participants were excluded if they had a history of dementia, heart disease, exercise intolerance, stroke, or peripheral neuropathy, open wounds; recent surgical implantation was an additional study exclusion criterion. 

Over 6 weeks, the participants underwent 12 sessions of combined WBV and exercise therapy, with a treatment regimen of static and dynamic lower body exercises that were performed on a vibrating platform. The researchers assessed motor performance, functional outcome, and quality of life with the GAITRite®System, Unified Parkinson's Disease Rating Scale (UPDRS parts 2-3), Beck Depression Inventory (BDI), Fatigue Symptom Inventory (FSI), and Healthy Days Measure (HRQOL-14). Data were collected at baseline, 1 day after the 6-week program ended, and 4 days after the program ended.

Statistically significant improvements were seen in combined UPDRS scores (1.474, 20.64) = 26.37, P <.001, decreasing from baseline and at both follow-up measurements:

• UPDRS score at baseline: 29.53±7.60
• UPDRS score 1 day following treatment: 18.00±7.09
• UPDRS score 4 days following treatment: 17.53±5.78

Post-hoc analysis also found UPDRS score decreases:

• From baseline to 1 day post-intervention (10.13, 95% confidence interval [CI]: 4.86-15.41; P<.001)
• From baseline to 4 days post-intervention (10.73, 95% CI: 6.22-15.25; P <.001)

Significant improvements were also found in gait velocity, cadence, and double support time after treatment. No significant change was found in FSI, BDI, and HRQOL-14 scores.

“In conclusion, combination WBV-exercise therapy has significant positive short-term influence on motor performance, activities of daily living, and postural stability. Further investigation is needed to determine long-term effects,” the authors wrote.

http://www.neurologyadvisor.com/wpc-2016-coverage/whole-body-vibration-exercise-may-benefit-motor-function-in-pd/article/524687/

Can brain 'pacemaker' improve lives of head trauma patients?

September 23, 2016 by Don Rauf, Healthy Reporter

(HealthDay)—Deep brain stimulation—a technique that sends targeted electrical impulses to certain areas of the brain—may help people who've had a traumatic brain injury gain more independence, a new study suggests.

"Traumatic brain injury is a common condition with over 80,000 new cases of disability each year," said Dr. Ali Rezai. He's director of the Neurological Institute at Ohio State University in Columbus.

"There are few treatment options to help these individuals. The outcomes of this study demonstrate, however, improvements in disability, functional outcomes, independence, behavioral and emotional regulation, and self-control after two years with DBS [deep brain stimulation] treatment," Rezai said.

Traumatic brain injury can negatively affect memory and thinking, awareness, judgment, decision-making, problem solving and behavioral self-regulation, Rezai noted. 

The DBS system is made up of three parts: the lead (or electrode); the extension; and the pulse generator (essentially the batteries), according to the U.S. National Institute of Neurological Disorders and Stroke (NINDS).

The lead is surgically placed in the area of the brain to be stimulated. The extension is a wire that's implanted from the head, under the skin, through the neck and shoulders to connect the pulse generator to the lead. The pulse generator is implanted under the skin in the collarbone area, NINDS explained.

Rezai and his colleagues investigated the effects of deep brain stimulation in four patients. All had suffered severe brain damage in automobile crashes six to 21 years earlier.

The patients didn't have problems with being awake or alert, but they were significantly impaired when it came to performing daily life functions. All required daily supervision and couldn't be alone overnight. Three needed assistance with dressing, grooming and using the toilet. 

When doctors implanted the DBS system in the patients, the lead was connected to stimulate the damaged areas of the brain with electrical impulses.

After two years of treatment, the researchers reported that three of the four participants demonstrated behavioral and emotional improvements, and substantial gains in functional independence. 

The investigators saw improvements in alertness and engagement among all four participants. Two needed less assistance with the activities of daily living, and three of the four increased their involvement in activities outside of the home.

"Although this is a small study, we are cautiously optimistic in that scientists reported some encouraging results in helping traumatic brain injury patients with their behavioral and their emotional difficulties," said Dr. Eugene Lai. He's a professor of neurology and neuroscience at Houston Methodist Hospital in Texas. 

Lai added that deep brain stimulation has been a well-established procedure for treating Parkinson's disease, a progressive disorder of the nervous system that affects movement.

Lai stressed that additional larger studies are needed to confirm these traumatic brain injury findings and to refine the treatment. 

"With Parkinson's disease, we know the neurophysiology well," Lai explained. "It is a little more difficult to use it on patients with brain injury. Brain injury is not as well defined, and it is still not clear yet as to which targets [in the brain] work the best." 

Although this study focused on just a few car accident victims, Rezai said the technique might be applied to those who have suffered head injuries related to sports or other causes. 

He said the procedure had no major risks, complications or significant adverse events.

Lai added that infection is probably the most common side effect, although this side effect is "relatively rare." 

Rezai said further exploration is needed to understand the exact mechanism of how the treatment works on brain injury. Also, this research was "open label," meaning both the scientists and the patients were aware of the treatment being administered. Rezai indicated that a future trial should be bigger and tested against a placebo (a sham form of therapy). 

The study was published recently in the journal Neurosurgery.

More information: To learn more about deep brain stimulation, visit the U.S. National Institute of Neurological Disorders and Stroke. 

http://medicalxpress.com/news/2016-09-brain-pacemaker-trauma-patients.html

Forest Payne builds golf course; helps him battle Parkinson's disease

By B.J. Harris
September 22, 2016

Photo by B.J. HARGIS: Forest Payne, right, receives a high-five after sinking a putt at his own golf touranament on his own golf course in rural Sullivan County on Sept. 17.

Since early onset Parkinson’s disease took Forest Payne’s livelihood as an electrician six years ago, he has picked up another career.

“I consider myself the world’s worst professional golfer,” said the 58-year old Payne, during what has become his annual golf tournament that takes place on the final day of the Sullivan Rotary Corn Festival on a course he designed on his 40-acre farm just outside of the Sullivan. “It’s what I do for a living now.
“Just keep sending the checks.”

There are as many as 12,000 people diagnosed each year with early onset Parkinson’s disease. Symptoms can include tremor, rigidity, bradykinesia (slow movement), postural instability (balance problems) and walking/gait problems.
“They say you can have it 10 years before you are diagnosed,” said Sharon, his wife of 37 years. “Looking back, we started to see some of the symptons, including his hand starting to shake.”
Forest was diagnosed 12 years ago.

“His doctors wanted him to stop working several years before he did,” said Sharon, who met Forest through her college roomate Vivian, Forest’s sister. “Forest has a good head on his shoulders and is realistic.
“But when you have been a John Wayne guy all your life, it is quite a blow to find out you have early onset Parkinson’s disease at age 46.”
It was 1994 when Sharon, a former nurse and former Sullivan Daily Times employee, and their children moved from Main Street in Sullivan to a farm just outside of town.

“If we lived in town, I don’t know what shape Forest would be in,” she said of the man she has been married to since Dec. 9, 1978. “Or what he would be doing.”
What he is doing now is continuing to turn part of their farm into a golf course.
“This used to be my horse pasture,” said daughter Robin Payne. “I showed horses for about nine or 10 years until I was out of high school.
“There were cattle trails and very bad drainage. He has made so many improvements to the property. He is into it 100 percent. I think it is great what he has done and what he is doing.”

Sharon said that Forest always played golf, and stared chipping around in the yard when he was forced to retire from IBEW Local 725.
“It was in 2010 when he first went on disability,” Sharon said. “It was about the same time he started playing in the yard.
“He took out the fence and all the fence posts and started remaking the property. This has been very good therapy for him.”
Robin said her father never really had time to play golf when he was healthy.
“It is a bit ironic how everything has worked out,” she said. “He had worked so long that he never had a chance to explore, like he does now.
“Time and his love of golf and determination have helped make this course a reality.”
Forest was born in Heidelberg, Germany, to career U.S. Army serviceman Alva Payne of Robinson, Ill. and Wilma Unger of Carlisle. He said they moved to Sullivan when he was 5 years old and he has lived here since.
“I remember some of my teachers telling my mom that I could take school or leave it,” he said. “They told her that Forest just doesn’t care about school.”
Forest said that there used to be a barn, silo and a fenced corral for Robin’s horses.

“She used to show horses in 4-H,” he said. “But she has grown too old to do that and now lives in Bloomington.”
He said his brother-in-law Pat Jones was the one that mentioned putting in a green.
“When he said that, a light came on,” Forest said. “The first green I put in was at the bottom of the hill, and it was washed out.”
He also said part of the course used to have even more soybeans planted on it.
“It was small, and I kept it mowed for a few years,” he said.
Now, there is one green, and it is less than 75 yards from his back door.
“Right now, there are nine different tee boxes that we use,” he said. “On five of the holes, you have to hit over the soy beans, and you have to hit over the pond on two of them.

“The holes range in length from as short as 45 yards to the longest hole, which is 220 yards. Some of the holes are easier than others, but some of them are not what you would call easy. They require a variety of different shots, because of the obstacles and the distances. The fairways are pretty narrow.”
Robin said the golf tournament, which also features food, a fish fry and games, is fun.

“The whole family gets together on the Saturday of the Corn Festival,” she said. “It is a good natured rivalry.
“It is great for him. He has put some of this land to pretty good use, even though I still miss the horses. It was a tough break for anybody. You think of Parkinson’s as an old man’s disease.”
She added it has been an adjustment for him.
“He was the big, strong manual-labor guy. He could fix anything, He still can, but it might take him a little longer,” she said.

Sharon added that she has seen the progress her father has made.
“He has grown as a person because of it,” she said. “He has had to overcome and say this is what I can do today. His outlook is fabulous.”
Forest said he tries to catch the fish throughout the year for his big day.
“We just try to have a good time and play a little golf,” he said. “But this year, I did not catch many after a huge fish kill last year.
“We had to go and buy some fish. The pond got a little shallow. We are going to try to restock the pond for next year.”

Forest said he is planning to put in a second green in 2017.
“Then, we would have 18 holes,” he said. “Usually, I am out here either playing  or working on the course every day. I have been working on it for what seems like years.
“It’s funny I like playing a game that I am so bad at. I am going to buy more seeds for a second green that I hope to finish next year.”
During the course of his outing, Forest knocked in a 10-foot putt for a birdie.
“That’s what you call home field advantage,” laughed Forest. 
He added that when the soybeans are harvested, he finds all the lost balls.
“I usually find at least a 100 or more golf balls after they harvest the beans,” said Payne.
He scoffed when he was compared to a golfing greats Jack Nicklaus or Fuzzy Zoeller, who also design golf courses.
“I wish I could play like Jack Nicklaus,” he said.
Sharon said that Rick Rucker of Rucker’s Candy in Bridgeport, Ill. was a mentor to Forest.

“He really helped both of us a lot,” said Sharon. “Because of Rick’s help, Forest has become even more resilient.
“He goes out there and works, even when he doesn’t feel like it. It affects everybody so differently. His mom had Parkinson’s. Heredity loads the gun and the environment pulls the trigger. Forest worked with his hands over his head all the time as an electrician. The Parkinson’s Awareness Association of Central Indiana in Indianapolis has been very helpful.”

According to their website (www.paaci.org), they help people with Parkinson’s, their friends, the families and caregivers navigate through this unpredictable life with Parkinson’s disease. They offer an annual Symposium and Open House, Holiday Party and Parkinson’s Awareness Event.
“Forest’s doctor is on the board of the PAACI,” she said. “They have been very helpful to us. We try to go up there every year.

“They can be reached by phone at (317) 255-1993. If somebody needs help with Parkinson’s, they are the one’s to contact.”
Patience and faith have been key for the Paynes.
“We have just learned to take things as they come. Long before this, I knew that we don’t have control over anything in our lives.
“We have been blessed. We had a three-year disability policy that payed off  the final three years of our mortage.
Forest said former pastor Terry Chandler at Shelburn United Methodist church motivated him.

“Instead of saying why me?, he would say, ‘Why not me?’” said Forest. “I would like to use my battle with early onset Parkinson’s to help others.
“My philosophy is that I am not going to hide behind my disease. If somebody reads this and says ‘If that so and so can do it, so can I.’”

https://www.sullivan-times.com/sports/article/id/19270

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