Alzheimer's disease patients with psychosis more likely to be misdiagnosed, study suggests

June 30, 2017  

Dr. Corinne Fischer, director of the Memory Disorders Clinic at St. Michael's Hospital in Toronto and lead author of the study. Credit: St. Michael's Hospital

People with Alzheimer's disease who experience psychosis—including delusions and hallucinations—are five times more likely to be misdiagnosed with dementia with Lewy bodies compared to patients who do not, new research suggests.Alzheimer's disease is a type of dementia characterized by protein deposits in the brain including twisted fibers found inside brain cells. Dementia with Lewy bodies is believed to be caused by the buildup of a different abnormal protein aggregate found in nerve cells in the brain. Effective treatments for these conditions are still under development, but will almost certainly be different, according to the authors.

Researchers also found that Alzheimer's disease was misdiagnosed in 24 per cent of all cases, with false positive and false negative rates both being 12 per cent. Previous research suggested that the rate of misdiagnosis in Alzheimer's disease ranged from 12-23 per cent.

The findings, published online today in Alzheimer's & Dementia: Translational Research & Clinical Interventions, raise concern that there may be an under appreciation of how common psychotic symptoms are in Alzheimer's disease, said Dr. Corinne Fischer, director of the Memory Disorders Clinic at St. Michael's Hospital in Toronto and lead author of the study.

"Psychosis can be a symptom of Alzheimer's disease, but it is a defining clinical feature in other types of dementia, including Parkinson's disease related dementia and dementia with Lewy bodies," she said. "Consequently, clinicians are more reluctant to diagnose a patient with Alzheimer's disease when they present with delusions or hallucinations."

About 36 per cent of people with Alzheimer's are thought to have delusions and 18 per cent have hallucinations. Psychotic symptoms are significant in Alzheimer's patients because they have been shown to be associated with increased burden on caregivers, increased functional decline and more rapid progression of the disease.

Researchers examined 961 people using data from the National Alzheimer's Coordinating Centre database, collected from 29 Alzheimer's disease centres in the United States between 2005 and 2012. They included participants who had been clinically diagnosed with Alzheimer's while they were alive, as well as those whose autopsies showed they the signature physical signs of Alzheimer's in their brains.

Patients who experienced psychosis had a higher rate of false negative diagnosis and a lower rate of false positive diagnosis of Alzheimer's disease compared to those who did not. Whether patients experienced delusions, hallucinations, or a combination of both did not affect the rate of misdiagnosis, according to the authors.

The Alzheimer's Society of Canada estimates there are 564,000 people living with dementia in Canada, and that number is expected to almost double over the next 15 years, thus reinforcing the relevance of the study's findings according to Winnie Qian, a Master's student in the Neuroscience Research Program at St. Michael's and an author on the study.

"An advantage of our study is that we used the final clinical diagnosis after years of follow-up, so the rate of misdiagnosis we described is the rate under ideal conditions," she said.

"This means that it should be considered a minimum. If you extrapolate that and apply it to the general population, the magnitude of the problem could be much greater."

Dr. Fischer said when patients do not present with psychosis, clinicians should be more careful when considering alternative diagnoses to Alzheimer's disease.

"Many dementia patients never receive a definitive clinical diagnosis while they're alive, so the hope is that by understanding what factors can lead to a misdiagnosis, we can be more accurate and provide patients with the best possible care," she said.

Provided by: St. Michael's Hospital

https://medicalxpress.com/news/2017-06-alzheimer-disease-patients-psychosis-misdiagnosed.html

Another Voice: Dangerous chemicals shouldn't be sprayed on lawns

June 30, 2017  By Anita Conron

I never thought I would become one, but I have. Yes, I am a helicopter mom.

It happens every spring. Trucks appear around town with signs painted on the side promising beautiful, lush, green lawns. A young man climbs from the cab of his vehicle and begins the process of unwinding a hose, releasing a lever and spraying a lawn.

I watch. I want to yell, “Put on a pair of gloves. Your mother would want that. Where are your high boots? Wouldn’t you be safer from the spray if you wore a face mask? Do you know exactly what you are applying to that lawn?”

But I remain quiet and observe from afar. He completes his task and places yellow warning signs at intervals around the yard.

The young man departs and I leave my parental post.

Chemicals such as glyphosate, carbaryl, malathion and 2,4-D are used to keep our lawns devoid of weeds, bugs and grubs. The compounds in these products are linked to a variety of diseases: Hodgkin lymphoma, prostate cancer, Parkinson’s disease, to name only a few (New York Times: The Toxic Brew in Our Yards, May 10, 2014).

Rain takes what is sprayed on your lawn and releases it into the soil, streams and eventually Lake Erie, the main source of our drinking water. Water treatment does not remove these chemicals. So-called “acceptable” amounts of chemicals have a cumulative effect in our bodies. Residue from our sprayed lawns and fields remains on shoes, children’s bare feet in the summertime and our pets’ paws, and is deposited on carpets and floors.

I am familiar with one of these diseases, Parkinson’s. My husband, Bill, suffered from the relentless progression of this debilitating condition for over 17 years. He died at age 67 from complications of the disease.

I recall Bill saying, “I had the best job for two summers during college. I sprayed trees for the City of Newport [R.I.]. I got up at 4 a.m., sat atop a huge truck and sprayed trees until 11. That left the rest of the day to go to the beach.”

Two years after my husband celebrated his 50th birthday he was diagnosed with Parkinson’s. We traveled to the Cleveland Clinic, Dent Neurologic Institute and Strong Memorial Hospital for opinions. The same question was asked at all three medical institutions: Have you ever been exposed to chemicals or pesticides? The answer was yes. A nine-year study (2006) confirmed that patients exposed to pesticides had a 70 percent higher incidence of Parkinson’s (Scientific American: Parkinson’s Disease and Pesticides: What’s the Connection? April 8, 2014).

It is possible to have a green lawn without applying chemicals. Adding clover supplies nutrition to your lawn. Cut it less to develop a deep root system. Dig up a section of your grass and enjoy the pleasure of growing vegetables. Learn to love the colorful, delicate flowers that pop up in the spring.

Maybe if we do this, the young man on the pesticide truck will no longer be spraying chemicals on our lawns and fields, but happily enjoying new and safer employment.

Anita Conron, of East Aurora, is a board member of Aurorans for Climate and Environmental Sense.

http://buffalonews.com/2017/06/30/another-voice-dangerous-chemicals-shouldnt-sprayed-lawns/

People with Parkinson's disease dance for exercise, fun in new Boca class

June 30, 2017

Luzviminda Raymundo, 79, of Delray Beach, joins Marie Giguere, instructor and part-owner of Arthur Murray Dance Studio Boca Raton, in a tango routine done across the floor. (Jayda Hall) 

For a few minutes without her walker, Lillian Vairo shuffled across the dance-room floor with the help of her husband and instructor.

And Marie Giguere, the instructor, marked each step by loudly saying, letter by letter, “T-A-N-G-O!”

“The teachers are so patient,” said Vairo, 85. “That is why I love this class.”

Vairo is among those participating this summer in a new Boca Raton dance class meant for people with Parkinson’s disease.

The program, offered by Arthur Murray Dance Studio, involves a variety of movements ranging from the waltz, cha-cha and tango, said Bethany Mollo, owner of the studio. It’s meant to get people socializing and exercising, which doctors say is beneficial to those with Parkinson’s.

“They do a lot of beautiful movements, and there’s something for everyone,” Mollo said. “Some people are able to move more than others, so the instructors keep it very simple.”

Dr. Arif Dalvi, a 20-year neurologist at the Palm Beach Neuroscience Institute, said most patients with Parkinson’s are aware exercise is vital. “But it’s hard for them to find something enjoyable so they dance since it’s fun for them,” he said.

Dancing is a supplement to medical treatment, helping improve the mood and energy levels of those diagnosed, Dalvi said.

“A little bit of both is ideal,” he said. “Dance therapy cannot take the place of medicine or physical therapy, but the repetition is important and it’s useful.”

For 10 years, Vairo and her husband, Phil Vairo, 84, walked five miles together every morning.

But their routine shifted from walking pavements to gliding across hardwood floors at dance studios after she was diagnosed with Parkinson’s disease at age 80, her husband said.

The disease, which causes tremors, slow movement, muscle stiffness and lack of balance, is incurable. She started dancing to keep her tremors and lack of balance under control.

The Vairos also have taken classes at the Boca YMCA and Boca Ballet during the past five years.

Arthur Murray Dance Studio’s class is offered from 1 to 2 p.m. Monday and Thursday each week.

The class is instructed by Giguere, part owner of the studio, and Judy Simon, the founder of The Alzheimer’s Project, a nonprofit.

Simon proposed the idea to Mollo of offering the Parkinson’s classes.

The program is not only to get people to move, said Rebecca Hahessy, South Florida program director of the American Parkinson Disease Association. “It’s great for socialization and coping because they’re with other people like them,” she said.

On a recent Monday, Lillian and other participants were greeted upon arrival as they made their way to seats positioned in a semi-circle. Giguere and Simon faced them with warm smiles and initiated a slow-paced stretching exercise.

A few moments later, Lillian Vairo smiled at her husband as he performed the same movements.

“He’s my husband, my supporter and my everything,” she said.

http://www.sun-sentinel.com/local/palm-beach/boca-raton/fl-pn-fl-parkinsons-dance-class-20170612-story.htm

Professorships support research to help newborns, patients with implants, Parkinson’s

 Melanie Kiev - For The Sentinel-Progress

June 30, 2017

Jeff Anker is an associate professor 

in Clemson’s chemistry department.

CLEMSON — Patients at risk of infections from surgical devices, newborns experiencing opioid withdrawal and people with Parkinson’s disease stand to benefit from research stemming from Clemson University’s newest named professorships.

The Dr. Wallace R. Roy Distinguished Professorships appointments will support translational research partnerships between Clemson faculty members and Greenville Health System and other health system partners.

Translational research is the effort to translate health research knowledge into practical applications that improve health and wellness.

Jeff Anker, Rachel Mayo and Marieke Van Puymbroeck will be the first recipients of the professorships, which are named for the late Wallace Roy, a 1926 Clemson graduate and one of the nation’s leading food technologists. The three-year awards will support faculty working in biomedicine-related fields in two Clemson colleges: the College of Behavioral, Social and Health Sciences and the College of Science.

Rachel Mayo is a professor in Clemson’s public health sciences department.

Monitoring fracture healing and reducing medical-device infections

As Roy professor, Jeff Anker, associate professor in Clemson’s chemistry department, will seek out broader collaborations to advance his research using X-rays for biomechanical measurements and chemical sensing, especially to monitor fracture healing and study implanted medical device-associated infection.

Anker is working with Tom Pace, a physician in the GHS orthopaedic surgery department, on several National Institutes of Health grants, including developing a noninvasive technique to monitor strain on hip screws, as well as a method of using X-ray technology to noninvasively detect orthopedic device infection.

In partnership with Pace, bioengineering faculty member John DesJardins and biological sciences faculty member Jeremy Tzeng, Anker is also working on an innovative program to make “smart” implanted medical devices capable of sensing chemical changes on implant surfaces to measure bone healing and monitor infections.

“Our hope is that these collaborations will help determine answers to important post-surgery questions such as how quickly patients can begin bearing weight and how can we quickly and effectively monitor infections, particularly among patients with open wounds, severe trauma or impaired immunity,” Anker said.

Marieke Van Puymbroeck is a recreational therapy coordinator in Clemson’s parks, recreation and tourism management department.

Palliative care for narcotic-dependent newborns

Mayo, a professor in Clemson’s public health sciences department, will use the professorship to continue to expand her collaboration with Greenville Health System’s Managing Abstinence in Newborns (MAiN) program, an early intervention model for babies born to opioid-dependent mothers.

The program offers an innovative model of care that combines early treatment, rooming-in of babies and mothers at the hospital, interdisciplinary care and outpatient medication weaning, which combine to reduce the need for neonatal intensive care.

Mayo collaborates on the program with Jennifer Hudson, a physician in the GHS pediatrics department. Together, they are studying the health outcomes of babies who receive MAiN program care under Hudson at GHS, and compare those outcomes with those of babies who receive traditional care at hospitals around the state. They are also studying the safety, effectiveness and cost-savings potential of the program.

As a Roy Professor, Mayo will expand the research with Hudson to explore other areas of pediatric health, including breastfeeding and jaundice, the usefulness of the Ballard Score (a commonly used technique of gestational age assessment) and a curriculum design for medical students. Mayo and Hudson will also develop an application for a National Institutes of Health grant that would expand the MAiN program to hospitals outside South Carolina.

“The professorship will position our collaborative research team to move to the next level of nationally competitive research in neonatal health research, specifically mitigating the long-term consequences of opioid use that has emerged as a national crisis,” Mayo said.

Improving mobility among Parkinson’s patients

With her Roy professorship, Marieke Van Puymbroeck, recreational therapy coordinator in Clemson’s parks, recreation and tourism management department, will continue research on programs designed to improve mobility and quality of life for people with Parkinson’s disease.

Van Puymbroeck recently completed a randomized controlled pilot trial examining the effectiveness of yoga as a therapeutic intervention for Parkinson’s patients in conjunction with Greenville Health System’s rehabilitation and neurology departments.

Encouraged by the trial results — which indicated that yoga improved balance, gait, postural stability and quality of life — she is working with GHS on the development of a National Institutes of Health grant for a larger trial.

Van Puymbroeck’s most recent research collaboration is with Larry Hodges, a professor of human-centered computing at Clemson and chief operating officer of Recovr Inc., a company providing therapist-designed rehabilitation exercise games that use virtual reality technology.

Van Puymbroeck and Hodges are submitting a National Institutes of Health grant to develop Duck Duck BaM (Balance and Movement), a virtual-reality game prototype aimed to improve gait, mobility and balance among people with Parkinson’s disease.

“One million people live with Parkinson’s disease, and as a result of mobility and balance issues, approximately 70 percent of them fall within a given year,” Van Puymbroeck said. “Falls lead to serious and costly secondary complications, including increased mortality, fractures, medical costs and reduced quality of life. Our research aims to meet a critical need for innovative programming and research designed to reduce falls.”

The Roy professorships support the university’s ClemsonForward strategic plan and its goals to improve research, solve real problems and foster a curiosity-driven intellectual environment. The professorships have been selected to recognize research in health innovation, one of the plan’s key strategic research focus areas.

The professorships are the latest in a growing collaboration between Clemson and health-delivery systems such as GHS, which Clemson serves as its primary research partner.

“The Roy Professorship is another example of the power of collaborative research to transform the health-delivery system, patient outcomes and health status,” said Windsor Westbrook Sherrill, associate vice president for health research at Clemson and chief science officer at GHS. “When philanthropic generosity combines with research expertise and clinical excellence, patients and families are the true beneficiaries.”

Wallace R. Roy

Wallace R. Roy of Orlando, Florida, was a 1926 Clemson chemical engineering graduate and one of the nation’s leading food technologists. He held at least six patents, four of which relate to the development of frozen orange juice concentrate.

A former vice president and board member of Minute Maid and former vice president for technical services for the Coca-Cola Co., he helped develop the Fresca and Fanta brands.

He also maintained a lifelong relationship with Clemson. He was inducted into the Athletic Hall of Fame in 1977 for accomplishments in track, football and basketball. In 1986, he received the Alumni Association’s highest honor, the Distinguished Service Award.

After Roy passed away in 2009 at age 97, his daughter, Patty Roy Edwards, established an endowment through the Clemson University Foundation to fund the Dr. Wallace R. Roy Distinguished Professorships.

Melanie Kieve works in the College of Behavioral, Social and Health Sciences, at Clemson University.

http://www.sentinelprogress.com/features/7694/professorships-support-research-to-help-newborns-patients-with-implants-parkinsons

Deep Sleep Linked to Slower Parkinson's Progression

Pauline Anderson

June 29, 2017

AMSTERDAM — Patients with Parkinson's disease (PD) who are deep sleepers, defined as getting more slow-wave sleep, have slower progression of their disease compared to light sleepers, new research suggests.

If that's the case, enhancing deep sleep may be a treatment target in PD patients, said Simon Schreiner, MD, Department of Neurology, University of Zurich, Switzerland.

"The association we found between slow-wave sleep and PD progression was very robust," said Dr Schreiner. "It indicates that higher slow-wave sleep predicts a slower progression of axial symptoms as well as gait and postural function in patients with Parkinson's disease."

He presented his study here at the Congress of the European Academy of Neurology (EAN) 2017.

Sleep disturbances are common in PD. It's believed that the underlying neurodegeneration affects the brain system that regulates the sleep-wake cycle, said Dr Schreiner.

However, there's growing evidence of a bidirectional relationship: that sleep disturbances also influence neurodegeneration as well as the other way around, he said.

Very Relevant

"This is very relevant," said Dr Schreiner. "If this is true, this could lead to a vicious cycle resulting in accelerated neurodegeneration due to sleep disturbances. On the other hand, this could offer treatment possibilities aimed at sleep enhancement."

Experts believe that deep sleep (slow-wave sleep) is the most restorative type of sleep. It may have a positive influence on neurodegeneration by promoting clearance of toxins, such as β-amyloid and possibly α-synuclein (a presynaptic neuronal protein linked to PD) from the brain.

Dr Schreiner and his colleagues conducted a retrospective analysis of 131 consecutive patients with PD (mean age, 62.6 years; 34% female), who were seen at their movement disorders outpatient clinic. All the patients had undergone polysomnography.

The mean disease duration of these patients was 5.2 years. The median time between baseline and polysomnography was 3 months.

Researchers collected clinical data at two time points: baseline and a follow-up at least 2 years later. During these examinations, investigators obtained Unified Parkinson's Disease Rating Scale (UPDRS) scores. They also looked at an index of seven UPDRS 3 symptoms (the UPDRS progression factor), which, according to Dr Schreiner, best indicates PD progression. 

These seven symptoms are speech, hypomimia, arise from chair, posture, gait, postural stability, and body bradykinesia.

To quantify deep sleep, investigators used a measure called slow-wave energy (SWE). "This measure represents the depth and duration of slow-wave sleep," said Dr Schreiner.

He noted that the study sample represented "a real-life-scenario cohort" in that the patients were receiving "best medical treatment at each time point."

Over a mean observation time of about 5 years, the levodopa equivalent dose was significantly increased, as were the UPDRS 3 score and the "progression factor."

"As expected, there was a progression of PD," said Dr Schreiner.

The researchers split the sample into deep sleepers (high SWE) and light sleepers (low SWE). The groups were similar in terms of age, disease duration, and clinical subtypes (tremor, akinetic-rigid, mixed). "I think this is important when you compare these two groups," said Dr Schreiner.

However, he noted that there were significantly more female deep sleepers. "This makes a lot of sense because women are known to be deeper sleepers than men."

At baseline, there were no statistically significant differences between the groups for UPDRS score or for levodopa equivalent dose. However, at follow-up, the deep sleepers had a significantly lower UPDRS score (P < .001) and significantly less levodopa equivalent dose (P = .04).

For the UPDRS progression factor, there were no differences between the groups at baseline, but there were "marked differences" with "much higher scores" for the light sleepers compared with the deep sleepers (P < .001) at follow-up.

"In clinical terms, the progression was much faster in the group of light sleepers compared to the group of deep sleepers," he said.

This finding was confirmed by a "very strongly significant interaction" of the high and low SWE measure with time, he added.

Novel Finding

An "obvious" limitation of the study was its retrospective design, although the associations that were uncovered were "very robust," said Dr Schreiner.

And although the finding is novel, he added, it needs to be replicated, "ideally in a prospective manner."  

Future studies should address whether slow-wave sleep may be progression marker of PD and whether it has a direct or indirect effect on the disease course, he added.

Asked about medications interfering with sleep quality, Dr Schreiner said he and his colleagues attempted to control for this. Dopamine agonists, in particular, are known to affect slow-wave sleep, he said.

"We included these medications as control variables and didn't really see an effect."

If deep sleep does slow disease progression, session co-chair Alberto Albanese, MD, professor, neurology, Institute of Neurology, Catholic University of the Sacred Heart, Milan, Italy, wanted to know what difference this would make per year on the UPDRS.

r Schreiner noted that in the study, the difference for the UPDRS total sum score "was not that pronounced, but it was still there."

However, for the progression index — the seven symptoms — "there was a very strong progression in the one group and not so much progression in the other group," he said.

One delegate noted that there is no real agreement concerning the use of the "UPDRS progression factor."

Dr Schreiner has disclosed no relevant financial relationships.

Congress of the European Academy of Neurology (EAN) 2017. Abstract O3207. Presented June 26, 2017.

http://www.medscape.com/viewarticle/882316#vp_1

CF scientists use new tool in Parkinson's research

Naseem S. Miller  June 30, 2017

Dr. Yoon-Seong Kim has been studying Parkinson’s disease for nearly two decades, trying to figure out why a particular protein is found at higher levels in the brain cells of patients.

He may be closer to some answers.

He and three of the scientists in his lab at UCF’s Burnett School of Biomedical Sciences have successfully used a cutting-edge technology to develop a tool that monitors in real time the activity of a gene that produces the protein alpha-synueclein.

The new method, published in the journal Scientific Reports in April, is a step toward understanding the disease and finding potential treatments for it. But it’s even more exciting for the local scientists, because it makes them one of the first research teams at UCF to publish a study involving the use of game-changing gene-editing technology called the CRISPR method.

CRISPR was first discovered in the immune system of bacteria as a defense mechanism against viruses. By 2013, researchers showed that the system can be used in animal and human cells to target specific stretches of DNA at precise locations to modify genes.

The CRISPR system is guided by short RNA sequences and binds to the matching sequence, usually a piece that codes for a specific gene, in the animal or human DNA. It then cuts the sequence, hence modifying, turning on or turning off the target gene. 

“We started discussing different ideas and in 2015 we figured this tool can help us do our research and contribute to the Parkinson’s field,” said doctoral student Sambuddha Basu.

Parkinson’s is a progressive and chronic movement disorder that affects nearly 1 million people in the United States. There are an estimated 60,000 new diagnoses each year.

Central Floridians band together to battle Parkinson's »

It’s not clear what causes Parkinson’s, which is one of the reasons that there are no drugs available today that can stop or reverse it. Patients are prescribed medications that target their symptoms, mostly by helping adjust the dopamine levels, which drop as a result of cell death.

But to effectively fight the disease, “we want to stop that [cell] degeneration or reduce the rate of degeneration,” said Kim.

To get to that stage, scientists need to find the cause, and alpha-synuclein, the protein that Kim has been studying, is considered to be one of the culprits.

Researchers know that in patients with Parkinson’s the levels of alpha-synuclein protein are much higher in the brain cells. The protein turns toxic as it aggregates within the cells and eventually kills the neurons.

In less than 10 percent of the population, including some individuals who develop Parkinson’s at a young age, a genetic mutation is to blame. But absent a mutation, scientists don’t know why the gene starts producing more alpha-synuclein than it’s supposed to and why the protein aggretates they way it does.

“The theory is that if you just inhibit the [protein’s] aggregation, then we can reduce the toxicity of this protein and maybe prevent the degeneration of [neurons],” said Kim.

Once equipped with the CRISPR gene-editing technology, the team decided to use it to shed some light on the gene’s activity. Literally.

They inserted a luminescent tag beside the gene that codes for alpha-synuclein gene, making the resulting protein luminescent.

“In this system, you grow the cells, you treat them and within 10-15 minutes you get your data,” said Dr. Subhrangshu Guhathakurta, a scientist at Kim’s lab.

Researchers can introduce different compounds and stressors to the cells to see how the gene responds. The more proteins the gene produces, the brighter the area.

“We also want to see if we can make use of any drug to lower that high light production,” said Basu.

Lighting up the genes and their products with luminescent tags is not new in research, but UCF scientists say they’re one of the first to use a specific luminescent tag with the alpha-synuclein gene.

“This approach is promising and interesting,” said Dr. Vikram Khurana, principle investigator and associate neurologist at Ann Romney Center for Neurologic Diseases at Brigham and Women’s Hospital and Harvard Medical School in Boston.

“But I think the idea that we have new methods afforded to us by CRISPR is really the story. This is a great example of how CRISPR can potentially impact diseases that have been difficult to find therapies for,” said Khurana, who’s not involved with Kim’s research.

Kim’s studies are still several years away from potentially resulting in a drug that treats Parkinson’s.

The team still has to test its new method in neurons. They’ve been using kidney cells, which are easier to work with.

Next they have to screen and pick out a handful of chemical compounds that have the desired impact on their target gene. A few of those drug candidates are then tested in animals, and if one proves non-toxic and effective, human clinical trials begin.

http://www.orlandosentinel.com/health/os-ucf-parkinsons-research-crispr-20170629-story.html

FoxFeed Blog :Ask the MD: New Video and Guide on Repurposed Therapies in Parkinson's Disease

Rachel Dolhun, MD    

June 27, 2017

Many people with Parkinson's are anxiously awaiting better treatments for their symptoms, and everyone with the disease is hoping for a therapy to slow or stop its progression. So the decade or more it takes to move a drug from discovery of a new compound to patients' hands is frustratingly long.

Enter repurposing -- a strategy that could potentially reduce time and costs associated with drug development. Repurposing, sometimes referred to as repositioning, is taking drugs that often are already approved by the U.S. Food and Drug Administration (FDA) to treat one condition and using them to treat another. (Repurposing also can apply to drugs still under investigation for other conditions and to over-the-counter supplements.) Several repurposed therapies are currently in varied phases of clinical testing to evaluate safety or potential benefit in Parkinson's.

The bottom line? Repurposing is an attractive strategy to potentially decrease time and costs of Parkinson's drug development. But it doesn't eliminate the need for clinical trials. Proceed with caution if you're contemplating adding a repurposed therapy to your Parkinson's regimen before testing is complete.

Watch the video for more on how researchers decide which drugs to repurpose, why additional clinical trials are necessary, and what patients and providers can consider if thinking about pursuing repurposed therapies before trials are complete.

For a deeper dive on this topic, download our new guide, "Repurposed Therapies in Parkinson's Disease: What Patients and Families Need to Know." This free resource provides an overview of repurposing, a discussion of what to consider with your provider if you're thinking about taking a repurposed therapy while it's still in testing (i.e., "off label"), and examples of therapies in clinical trials for repurposing in Parkinson's.

https://youtu.be/06zxLnKgqjI

https://www.michaeljfox.org/foundation/news-detail.php?ask-the-md-new-video-and-guide-on-repurposed-therapies-in-parkinson-disease

FoxFeed Blog: MJFF Scientist Highlights Alpha-synuclein Research Progress in Nature Reviews Drug Discovery

By  Kristen Teesdale,  June 29, 2017

As researchers search for a therapy to slow or stop Parkinson's disease (PD) progression, alpha-synuclein has emerged as a leading target. This protein clumps in the brains of nearly everyone with Parkinson's and it's the primary component of Lewy bodies, the pathological hallmark of PD. At the current time, five therapies representing varied approaches against alpha-synuclein are in different stages of clinical trial testing.

In an interview for Nature Reviews Drug Discovery, Brian Fiske, PhD, senior vice president of research programs at MJFF, discussed the field's focus on alpha-synuclein. "The real unmet medical need [in Parkinson's] is a treatment that can target the underlying disease mechanism and can slow and ultimately halt the disease process. That's where the excitement around targets like a-synuclein comes from."

Read the full article to learn more about alpha-synuclein and the therapies in testing:

http://www.readcube.com/articles/10.1038/nrd.2017.95?shared_access_token=X_NzUw7vu4_cNX_TEJtn69RgN0jAjWel9jnR3ZoTv0MS9PnCoWe_UuQ5GUohdo8M22W0grgKbbY0Rjxk-Vz1YYT1UTtOMNWc3SksCsfsmTh4xco4oNZrI_E7NGyViQhYjiobKCbl_-7CDRPQM8QAJA%3D%3D

Go to the following web site below and click on:Read the full article to learn more about alpha-synuclein and the therapies in testing:

https://www.michaeljfox.org/foundation/news-detail.php?mjff-scientist-highlights-alpha-synuclein-research-progress-in-nature-reviews-drug-discovery

UH Moment: Parkinson’s Disease Balancing App

GREG ORTIZ   june 28, 2017  

“It will improve their quality of life and increase their confidence in performing daily activities.”

Nearly one million people in the United States are living with Parkinson’s disease. One of the primary symptoms is loss of balance, which can reduce independence in daily activities. Beom-Chan Lee, assistant professor in the University of Houston Department of Health and Human Services, is creating the Smarter Balance System to help with in-home balance training.one million people in the United States are living with Parkinson’s disease. One of the primary symptoms is loss of balance, which can reduce independence in daily activities. Beom-Chan Lee, assistant professor in the University of Houston Department of Health and Human Services, is creating the Smarter Balance System to help with in-home balance training.“It will improve their quality of life and increase their confidence in performing daily activities.”“It will improve their quality of life and increase their confidence in performing daily activities.”POSTED ON JUNE 28, 2017

Nearly one million people in the United States are living with Parkinson’s disease. One of the primary symptoms is loss of balance, which can reduce independence in daily activities. Beom-Chan Lee, assistant professor in the University of Houston Department of Health and Human Services, is creating the Smarter Balance System to help with in-home balance training.

We want to develop a system that can be easily and readily used in a home environment,” Lee said.

The patient wears a belt with sensors that connect to a phone via Bluetooth technology, and the Dynamic Balance app offers individually tailored exercises to improve balance

“It is almost acting as if a physical therapist is with them,” said Alberto Fung, a UH graduate student working with Lee to develop the app.

The app will upload the data to a server where doctors can access the information to see progress and tweak exercise routines.

“It will improve their quality of life and increase their confidence in performing daily activities,” Lee said.

https://www.houstonpublicmedia.org/articles/shows/uh-moment/2017/06/25/206217/uh-moment-parkinsons-disease-balancing-app/

UH Moment: Parkinson's Disease Balancing App

https://youtu.be/a0wD7yiSbpI

Published on Jun 28, 2017

Researchers at the University of Houston are creating an app to help with in-home balance training for patients with Parkinson's disease.

Aware in Care Kit NPF created the Aware in Care kit to help people with Parkinson’s disease get the best care possible during a hospital stay.

Please order your FREE CARE KIT

The Aware in Care kit can be requested at www.awareincare.org or by calling 1-800-4PD-INFO (473-4636).

Did you know that three out of four people with Parkinson’s disease do not receive their medications on time when staying in the hospital? People with Parkinson’s visit hospitals more often, and, combined with the great importance of the timing and dosing of Parkinson’s medications, face greater risks in the hospital.

This is why the National Parkinson Foundation (NPF) has launched the Aware in Careprogram, which aims to help people with Parkinson’s disease get the best care possible during a hospital stay.

To protect, prepare and empower people with Parkinson’s before, during and after a hospital visit, NPF has developed a free Aware in Care kit with tools and information to share with hospital staff during a planned or emergency hospital stay.

The kit is large enough to fit your Parkinson’s medications to take with you on your next trip to the hospital.

The kit includes:

Hospital Action Plan

Read about how to prepare for your next hospital visit—whether it is planned or an emergency.

Parkinson’s Disease ID Bracelet

Wear your bracelet at all times in case you are in an emergency situation and cannot communicate.

Medical Alert Card

Fill in your card with emergency contact information and place in your wallet.

Medication Form

Complete this form and keep copies in your kit for use at the hospital.

Parkinson’s Disease Fact Sheet

Share the facts about Parkinson’s with hospital staff and ask that a copy be placed in your chart.

I Have Parkinson’s Reminder Slips

Share vital information about Parkinson’s disease with every member of your care team in the hospital.

Magnet

Use this magnet to display a copy of your Medication Form in your hospital.

Get the Kit. Know the Facts. Be Aware in Care.® 

NPF has partnered with Parkinson Alberta and Parkinson Society British Columbiato provide the Aware in Care kit to people with Parkinson's in Canada. If you live in Canada, contact Parkinson Alberta at 1-977-243-9992 or Parkinson Society British Columbia at 1-800-668-3330 to order a kit.

https://youtu.be/ZYOJ4xAEw5w

http://www.parkinson.org/find-help/aware-in-care-kit