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Saturday, December 3, 2016
Scientists May Have Found Link Between Gut Bacteria and Parkinson’s
Standing Up May Unmask Cognitive Deficits in Patients With Parkinson’s
In a previous study, Freeman and colleagues demonstrated that orthostatic hypotension is linked to reversible cognitive impairment in patients with a rare neurological disorder called autoimmune autonomic ganglionopathy. In this new study of the far more prevalent Parkinson’s disease, the researchers investigated whether OH is linked to reversible cognitive deficits in patients with PD as well. NeuroscienceNews.com image is in the public domain.
Posture-mediated low blood pressure could serve as a target for intervention.
In a new study published online today in the journal Neurology, a research team led by neurologists at Beth Israel Deaconess Medical Center (BIDMC) and neuropsychologists at Boston University has shown that when patients with Parkinson’s disease experience a drop in blood pressure upon standing up – a condition known as orthostatic hypotension (OH) – they exhibit significant cognitive deficits. These deficits reverse when they lie down and their blood pressure returns to normal.
These cognitive impairments may go unnoticed by physicians assessing patients with Parkinson’s who are lying down or seated, and could lead to difficulty in daily activities performed while standing and walking, such as tracking conversations, counting change and interpreting traffic signals.
“Cognitive impairment is a common symptom of Parkinson’s disease,” said co-senior author Roy Freeman, MD, director of the Center for Autonomic and Peripheral Nerve Disorders at BIDMC and a professor of neurology at Harvard Medical School (HMS). “In this study, we demonstrated that the upright posture in patients with Parkinson’s disease exacerbated cognitive deficits, and that this effect is transient and reversible. Based on these results, we encourage clinicians to include cognitive testing in a variety of postures in their assessments of patients.”
Marked by characteristic tremor, rigidity and slowness of movement, Parkinson’s disease (PD) is a progressive degeneration of parts of the nervous system. It affects many aspects of movement and can cause a masklike, expressionless face, rigid limbs, and problems with walking and posture. PD is also associated with cognitive defects attributed to breakdowns in connectivity between regions of the brain. Up to 50 percent of people with Parkinson’s disease may also have orthostatic hypotension.
In a previous study, Freeman and colleagues demonstrated that orthostatic hypotension is linked to reversible cognitive impairment in patients with a rare neurological disorder called autoimmune autonomic ganglionopathy. In this new study of the far more prevalent Parkinson’s disease, the researchers investigated whether OH is linked to reversible cognitive deficits in patients with PD as well.
Freeman and colleagues including lead author Justin Centi and co-senior author Alice Cronin-Golomb, PhD, director of the Vision and Cognition Laboratory and Center for Clinical Biopsychology and a professor of psychological and brain sciences at Boston University, divided 55 volunteers into three study groups: 18 patients with both PD and OH, 19 patients with PD but without OH, and 18 control participants with neither PD nor OH. All participants were given a series of cognitive tests, with the tests administered while supine and again while tilted to 60 degrees. Researchers measured and recorded the participants’ blood pressure before and during each round of cognitive testing to ensure that participants were never at risk for fainting.
“As we suspected, people with both Parkinson’s disease and orthostatic hypotension showed posture-related impairments when upright relative to supine on nearly all measures of cognition,” said Centi, who noted that study participants with Parkinson’s disease without orthostatic hypotension demonstrated deficits on only two cognitive tests. There was no difference between upright and supine scores for the control group.
When the three groups’ relative performances were compared to each other, postural changes had no significant impact on participants with PD but without OH, compared to the control group. However, Participants with PD and OH were far more susceptible to posture-related impairment on several tests, including those that measured math skills, the ability to produce words easily, keeping information in mind while working on it, paying sufficient attention so that later memory is efficient and searching for items quickly and accurately.
Essentially all neuropsychological tests are given to patients in the seated position in the clinic as well as during most research studies – with the exception of imaging studies in which the patient is lying down,” said Cronin-Golomb. “The cognitive performance that we see in those patients with Parkinson’s disease who are tested when seated or lying down in fact may underestimate their cognitive problems in real life, when they are standing up and going about their business of daily activities. Also, the patterns of brain activity that we see on imaging when they are lying down may not be the patterns that the brain produces during normal upright activity.”
Cognitive deficits in PD result, at least in part, from neurodegeneration, the authors explained. But transient blood pressure changes when upright may indeed play a contributing role. Clinical providers might miss an important target for intervention when not considering OH as a contributor to cognitive impairment.
ABOUT THIS PARKINSON’S DISEASE RESEARCH ARTICLE
In addition to Freeman, Centi, and Cronin-Golomb, study coauthors included Christopher H. Gibbons, MD, of BIDMC and HMS; Sandy Neargarder, PhD, of Boston University and Bridgewater State University; and Alex Canova of Boston University.
Funding: This work was funded by grants from the National Institutes of Health, National Institute of Neurological Disorders and Stroke (R01NS067128) and support from a Ruth L. Kirschstein National Research Service Award (F31NS074801).
Source: Jacqueline Mitchell – BIDMC
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Abstract for “Effects of orthostatic hypotension on cognition in Parkinson disease” by Justin Centi, Roy Freeman, Christopher H. Gibbons, Sandy Neargarder, Alexander O. Canova, and Alice Cronin-Golomb in Neurology. Published online November 30 2016 doi:10.1212/WNL.0000000000003452
Abstract
Effects of orthostatic hypotension on cognition in Parkinson disease
Objective: To investigate the relation between orthostatic hypotension (OH) and posture-mediated cognitive impairment in Parkinson disease (PD) using a cross-sectional and within-group design.
Methods: Individuals without dementia with idiopathic PD included 18 with OH (PDOH) and 19 without OH; 18 control participants were also included. Neuropsychological tests were conducted in supine and upright-tilted positions. Blood pressure was assessed in each posture.
Results: The PD groups performed similarly while supine, demonstrating executive dysfunction in sustained attention and response inhibition, and reduced semantic fluency and verbal memory (encoding and retention). Upright posture exacerbated and broadened these deficits in the PDOH group to include phonemic fluency, psychomotor speed, and auditory working memory. When group-specific supine scores were used as baseline anchors, both PD groups showed cognitive changes following tilt, with the PDOH group exhibiting a wider range of deficits in executive function and memory as well as significant changes in visuospatial function.
Conclusions: Cognitive deficits in PD have been widely reported with assessments performed in the supine position, as seen in both our PD groups. Here we demonstrated that those with PDOH had transient, posture-mediated changes in excess of those found in PD without OH. These observed changes suggest an acute, reversible effect. Understanding the effects of OH due to autonomic failure on cognition is desirable, particularly as neuroimaging and clinical assessments collect data only in the supine or seated positions. Identification of a distinct neuropsychological profile in PD with OH has quality of life implications, and OH presents itself as a possible target for intervention in cognitive disturbance.
“Effects of orthostatic hypotension on cognition in Parkinson disease” by Justin Centi, Roy Freeman, Christopher H. Gibbons, Sandy Neargarder, Alexander O. Canova, and Alice Cronin-Golomb in Neurology. Published online November 30 2016 doi:10.1212/WNL.0000000000003452
http://neurosciencenews.com/parkinsons-blood-pressure-5670/
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Being Part of a Community Group May Protect You From Cognitive Decline
Previous research has suggested that social integration, social engagement and strong social networks may be associated with better cognitive outcomes. Neurosciencenews image is for illustrative purposes only.
Social engagement through civic group activities, such as being a member of a political party, an environmental group, neighborhood watch, a voluntary service group or other community based groups, is associated with better cognitive function at age 50, according to a study published in the open access journal BMC Psychology which included 9,119 men and women from England, Scotland and Wales.
Researchers at the University of Southampton found that a person’s cognitive ability at age 11; their participation in civic activities at ages 33 and 50; frequent physical activity; higher educational qualification and female gender were all associated with better cognitive function at age 50. Having low socio-economic status as a child and reporting worse mental well-being in adulthood were both associated with worse cognitive function at age 50.
Professor Ann Bowling, lead author of the study said: “While the associations between adult social engagement and cognitive function at age 50 we found were moderate, they persisted after we adjusted for covariates, such as health, socio-economic status and gender. The implication is that if people continue to engage socially throughout life, maintaining related behaviours that require cognitive skills such as memory, attention and control, there may be some protection from cognitive decline. Public health policy interventions aimed at promoting cognitive health could include encouraging civic engagement and providing people with opportunities for this.”
Previous research has suggested that social integration, social engagement and strong social networks may be associated with better cognitive outcomes. Furthermore, social capital – opportunities within communities for social, leisure, recreational activities, voluntary work or group membership – have been shown to be associated with enhanced well-being and better reported mental health, as well as reduced levels of stress, loneliness and isolation. However, few of these studies followed participants throughout their life.
To investigate associations between people’s social engagement throughout their adult life and cognitive function at age 50, the researchers used data from the British National Child Development Study (NCDS), a general population sample in England, Scotland and Wales. Baseline data was collected at birth in 1958 and study participants were followed up at several points later in life.
At age 33, 83% of all respondents reported that they did not participate in any civic organization. This number dropped to 64% at age 50. Participating in one civic organization was reported by 14% of respondents at age 33 and by 25% at age 50. Out of the overall sample, 8,129 participants completed cognitive tests at ages eleven (reading, writing, math, and general ability tests) and 50 (memory and visual attention, speed and concentration tests). The researchers found that almost a third of the sample population’s cognitive ability deteriorated between ages eleven and 50, while remaining unchanged in less than half of participants (44%). A quarter of participants showed improved cognitive ability at age 50. Those who reported that they participated in civic groups at age 33 and 50 scored higher in cognitive tests. Also, participation in each additional civic group was found to further increase scores on cognitive tests.
The present study used a large, longitudinal cohort with strong initial response rates, allowing the researchers to take into account complex interactions between social and biological processes and to adjust for various confounding factors. However, observational studies like this one cannot show cause and effect, but can describe possible links.
ABOUT THIS NEUROSCIENCE RESEARCH ARTICLE
Source: Anne Korn – Biomed Central
Image Source: This NeuroscienceNews.com image is in the public domain.
Original Research: Full open access research for “Is mid-life social participation associated with cognitive function at age 50? Results from the British National Child Development Study (NCDS)” by Ann Bowling, Jitka Pikhartova and Brian Dodgeon in BMC Psychology. Published online December 2 2016 doi:10.1186/s40359-016-0164-x
Abstract
Is mid-life social participation associated with cognitive function at age 50? Results from the British National Child Development Study (NCDS)
Background
Some studies have indicated that social engagement is associated with better cognitive outcomes. This study aimed to investigate associations between life-course social engagement (civic participation) and cognitive status at age 50, adjusting for social networks and support, behavioural, health, social and socio-economic characteristics.
Methods
The vehicle for the study was the National Child Development Study (1958 Birth Cohort Study), which is a general population sample in England, Scotland and Wales (9119: 4497 men and 4622 women) participating in nationally representative, prospective birth cohort surveys. The primary outcome variable was cognitive status at age 50, measured by memory test (immediate and delayed word recall test) and executive functioning test (word fluency and letter cancelation tests). The influence of hypothesised predictor variables was analysed using linear multiple regression analysis.
Results
Cognitive ability at age 11 (β = 0.19;95% CI = 0.17 to 0.21), participation in civic activities at ages 33 (0.12; 0.02 to 0.22) and 50 (0.13; 0.07 to 0.20), frequent engagement in physical activity (sport) (β from 0.15 to 0.18), achieving higher level qualifications (β from 0.23 to 1.08), and female gender (β = 0.49;95% CI = 0.38 to 0.60) were positively, significantly and independently associated with cognitive status at age 50. Having low socio-economic status at ages 11 (β from -0.22 to -0.27) and 42 (β from -0.28 to -0.38), and manifesting worse mental well-being at age 42 (β = -0.18; 95% CI = -0.33 to -0.02) were inversely associated with cognitive status at age 50. The proportion of explained variance in the multiple regression model (18%), while modest, is impressive given the multi-faceted causal nature of cognitive status.
Conclusions
The results indicate that modest associations between adult social engagement and cognitive function at age 50 persist after adjusting for covariates which included health, socio-economic status and gender, supporting theories of neuroplasticity. In addition to the continuing emphasis on physical activity, the encouragement of civic participation, at least as early as mid-life, should be a targeted policy to potentially promote and protect cognitive function in later mid-life.
“Is mid-life social participation associated with cognitive function at age 50? Results from the British National Child Development Study (NCDS)” by Ann Bowling, Jitka Pikhartova and Brian Dodgeon in BMC Psychology. Published online December 2 2016 doi:10.1186/s40359-016-0164-x
http://neurosciencenews.com/cognitive-decline-social-group-5668/
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Parkinson’s ‘fool’ conjures up music, magic, motivation
Richard Horn doesn’t let Parkinson’s stop him from playing piano. |
Friday, December 2, 2016
Social-Media Hype about Diseases and Treatments Does Patients No Favors
- By Israel Robledo on December 2, 2016
A Radiation-Free Approach to Imaging Molecules in the Brain
Deep Brain Stimulation: Indications and Applications
By ZeeshanHashmi
NeuroDerm Announces Top-Line Results of Pilot PK Trial Comparing ND0701 with Commercial Apomorphine
Regulatory Development of ND0701 in the EU to Proceed Based on PK Similarity for the Treatment of Parkinson’s Disease
Trial 101 was a pilot crossover, randomized, two-sequence, 12-hour study with 18 healthy volunteers. The primary objective was to evaluate the PK and relative bioavailability of sub-cutaneous infusion of ND0701 and commercial apomorphine. No formal power analysis was performed for this study.
Plasma PK measures of ND0701 were comparable to the reference drug. These results support the continuation of ND0701’s development path to demonstrate its therapeutic equivalence to the reference drug. ND0701 did not raise safety and tolerability concerns, and exhibited a slightly better safety profile than that of the reference drug.
ND0701 contains apomorphine, the most potent dopamine agonist. Apomorphine, administered subcutaneously, is the most effective drug for the symptomatic treatment of Parkinson's disease after levodopa. Apomorphine is approved both in the United States and in the EU for acute administration as rescue treatment for off periods in Parkinson's disease (currently administered subcutaneously as bolus injections) and only in the EU and not in the United States for continuous, subcutaneously delivered chronic therapy of advanced Parkinson's patients. Current commercial apomorphine formulations, based on apomorphine-HCl, are associated with low tolerability and local pain and require daily subcutaneous administration of large volumes that limit its more widespread adoption. ND0701 is being developed as a chronic therapy of Parkinson's disease by continuous subcutaneous apomorphine administration. Based on a proprietary formulation of apomorphine-base, ND0701 is up to five times more concentrated than currently available commercial apomorphine-HCl products and should enable delivery through a small, low-volume, disposable patch-pump. In pre-clinical studies, ND0701 was also shown to have better local tolerability in pre-clinical studies than a leading commercial apomorphine product. ND0701 is designed to offer superior convenience and better tolerability to current, continuous, subcutaneously administered apomorphine-HCl products.
Parkinson's disease is a progressive neurodegenerative illness characterized by reduced dopamine in the brain, resulting in a debilitating decrease in the patient's motor and non-motor functions. Its symptoms, such as trembling in the extremities and face, slowness of movement and impaired balance and coordination, worsen over time and gravely impact the patient's quality of life. It has been shown that continuous administration of dopaminergic therapies, levodopa or apomorphine, can effectively treat motor fluctuations in Parkinson's disease patients without increasing troublesome dyskinesia.
NeuroDerm is a clinical-stage pharmaceutical Company developing central nervous system (CNS) product candidates that are designed to overcome major deficiencies of current treatments and achieve enhanced clinical efficacy through continuous, controlled administration. The Company has three product candidates in different stages of development which offer a solution for almost every Parkinson’s disease patient from the moderate to the very severe stage of the disease. The Company has developed a line of levodopa and carbidopa (LD/CD) product candidates administered through small belt pumps that deliver a continuous, controlled dose of LD/CD. The LD/CD product candidates are ND0612L and ND0612H, which are used for treatment of moderate and advanced Parkinson’s disease patients, respectively, and which are delivered subcutaneously. In addition, NeuroDerm is developing ND0701, a novel subcutaneously delivered apomorphine formulation for patients who suffer from moderate to severe Parkinson’s disease and who do not respond well to LD/CD. NeuroDerm is headquartered in the Weizmann Science Park in Rehovot, Israel.
This press release contains forward-looking statements, within the meaning of the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended that involve risks and uncertainties. Such forward-looking statements may include projections regarding our future performance and may be identified by words like "anticipate," "assume," "believe," "continue," "could," "estimate," "expect," "intend," "may," "plan," "potential," "predict," "project," "future," "will," "seek" and similar terms or phrases. The forward-looking statements contained in this press release are based on management's current expectations and projections about future events. There are important factors that could cause our actual results, levels of activity, performance or achievements to differ materially from the results, levels of activity, performance or achievements expressed or implied by the forward-looking statements. In particular, you should consider the risks provided under "Risk Factors" in our annual report on Form 20-F for the year ended December 31, 2015 filed with the Securities and Exchange Commission. Any forward-looking statement made by us in this press release speaks only as of the date hereof. Factors or events that could cause our actual results to differ may emerge from time to time, and it is not possible for us to predict all of them. We undertake no obligation to publicly update any forward-looking statements, whether as a result of new information, future developments or otherwise.