Preventing the Progression of Parkinson's Disease

Free Educational Conference Tuesday, January 8, 2019 at Parkinson Place. Topics include: Preventing the Progression, Healthy Cooking and Nutrition for Parkinson's! RSVP Reservation@Parkinsonhope.org

FoxFeed Blog: Inhaled Levodopa for 'Off' Time Approved by FDA

Posted by  Rachel Dolhun, MD,    December 22, 2018

On December 21, 2018, the U.S. Food and Drug Administration (FDA) approved Inbrija, an inhaled levodopa powder, for "off" episodes in people with Parkinson's disease treated with levodopa/carbidopa. The Michael J. Fox Foundation funded early clinical trials of this therapy, the first to reach market approval with early de-risking from our Foundation. 

Read more on this therapy below and in a press release from Acorda Therapeutics, Inc.:

https://www.businesswire.com/news/home/20181221005620/en/Acorda-Therapeutics-Announces-FDA-Approval-INBRIJA™-levodopa

 We'll share more in the coming weeks on the impact of this new medication for people with Parkinson's and on our Foundation's role in its development.

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UPDATE September 13, 2018: Acorda Therapeutics, Inc today announced that the FDA has extended its decision date on inhaled levodopa to January 5, 2019. According to a press release, the extension is related to submission of additional information on the drug’s chemistry and manufacturing that will take additional time for the FDA to review. 

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POSTED February 20, 2018: Today, Acorda Therapeutics, Inc. announced that the FDA filed its New Drug Application (NDA) for inhaled levodopa. (If approved, the drug will be called Inbrija.) This is the last step in the lengthy drug development and approval process. Now, the FDA reviews everything that is known about inhaled levodopa -- clinical trial data, how the drug works and how it's made. This review process is how the FDA determines whether to approve a new therapy, and Acorda expects a decision no later than October 2018.

Inhaled levodopa is a potential new way to treat "off" times -- periods when Parkinson's symptoms, such as tremor, slowness and stiffness, emerge because medication isn't working well. These "off" times can come on gradually, before it's time to take the next medication dose, or unexpectedly and unpredictably. Inhaled levodopa is an add-on, as needed medication for people who are already taking levodopa drugs, such as Sinemet, but are experiencing "off" times. Some liken inhaled levodopa to the asthma medication inhaler. People with asthma may take a puff from an inhaler when they have trouble breathing. Similarly, some with Parkinson's may soon be able to take a breath of levodopa when they have trouble moving.

"People with Parkinson's and physicians need more options to manage this disease," says Todd Sherer, PhD, CEO of The Michael J. Fox Foundation. "Inhaled delivery of levodopa could help the many people living with Parkinson's facing the complication of 'off' periods as their disease progresses."

The Michael J. Fox Foundation funded Phase I and II studies of inhaled levodopa.

https://www.michaeljfox.org/foundation/news-detail.php?inhaled-levodopa-for-off-time-moves-to-fda-review

Parkinson’s breakthrough – Disease could be treated with stem cells injected into the brain

Joe Mellor    December 20, 2018

Parkinson’s disease really could be treated with stem cells injected into the brain, say Scottish scientists.

They have created cells resistant to the devastating neurological condition – offering hope of restoring normal movement and balance.

Many patients have long pinned hope on the therapy as a potential cure. The first clinical trial started in Japan in August.

Now a University of Edinburgh team have formed stem cells – which have the ability to turn into any cell type – that can’t develop Parkinson’s in the first place. It overcomes a major obstacle in the approach as, over time, transplanted tissue has been able to acquire signs of the disease from nearby cells.

Study leader Dr Tilo Kunath, of the Medical Research Council’s Centre for Regenerative Medicine lab, said: “We know Parkinson’s spreads from neuron to neuron, invading healthy cells.

“This could essentially put a shelf life on the potential of cell replacement therapy. Our exciting discovery has the potential to considerably improve these emerging treatments.”

The study, published in the European Journal of Neuroscience, is a key step towards making stem cell therapy a viable option for Parkinson’s.

It causes progressive loss of neurons that release the vital nerve transmitter chemical dopamine – necessary for controlling body movement.

This leads to symptoms such as tremors and shaking. Sufferers include comic Sir Billy Connolly, Sweet Caroline singer Neil Diamond and actor Michael J Fox whose charity has been funding research for years.

The latest advance could markedly improve stem cell therapy for the condition, which affects around one in 350 people in the UK. It involves transplanting healthy cells into the damaged parts of the brain.

Dr Kunath and colleagues snipped out sections of DNA from human stem cells using the editing technique known as CRISPR where a chemical is used like a pair of ‘molecular scissors’. In doing so, they removed a gene linked to the formation of toxic clumps, known as Lewy bodies, which are typical of Parkinson’s brain cells.

In tests, the cells were transformed into neurons that produce dopamine – the brain chemical lost in Parkinson’s – in a dish.

After treatment with a specific molecule those that had been gene-edited did not form the toxic clumps, while unedited ones displayed signs of Parkinson’s.

The breakthrough may be most beneficial to younger patients living with Parkinson’s and those with an aggressive form of the condition. The next step is human trials.

The Cure Parkinson’s Trust, which part funded the study with the UK Centre for Mammalian Synthetic Biology and the pharmaceutical company UCB Biopharma, said it was “thrilled”.

Deputy director Dr Simon Stott said: “Cell replacement therapy represents one experimental approach to regenerative medicine for people with Parkinson’s.

“This new research by Dr Tilo Kunath and his team at the University of Edinburgh provides another advancement in the development of this treatment. “The Cure Parkinson’s Trust is thrilled to be associated with this inspiring and innovative research.”

Last year the Japanese scientists carrying out the first human trial of stem cell therapy for Parkinson’s successfully restored nerve cells destroyed by a similar condition in monkeys.

The animals, suffering an artificially induced version of the disease, showed significant improvement two years after having precursor dopamine neurons derived from human stem cells transplanted into their brains.

Prof Jun Takahashi, a Parkinson’s neurosurgeon from Kyoto University, who led the research, said at the time: “The monkeys became more active after cell transplantation: moved more rapidly and more smoothly, and showed more various type of movements and less tremor.”

Parkinson’s is the second most common neurodegenerative disease – a chronic, degenerative neurological disorder, mainly affecting the motor system. It is caused by a shortage of dopamine that enables messages to be sent to the parts of the brain that control movement and some forms of thinking.

Parkinson’s, which is currently incurable, affects approximately one in 100 people over the age of 60. Numbers of people living with the disease are estimated to be at least 130,000 in the UK, one million in the US and five to seven million worldwide. Currently, standard medications used to treat Parkinson’s improve early symptoms but as it progresses and dopaminergic neurons continue to be lost, the drugs eventually become ineffective.

Scientists are investigating how regenerative medicine and stem cell science could be used to treat or prevent Parkinson’s.

The disorder’s underlying cause is still unknown, but researchers do know which cells and areas of the brain are involved, and have been experimentally successful in using stem cells to grow dopamine-producing nerve cells in the lab.

By Mark Waghorn

https://www.thelondoneconomic.com/lifestyle/parkinsons-breakthrough-disease-could-be-treated-with-stem-cells-injected-into-the-brain/20/12/

Pain in Parkinson’s Disease: A Spotlight on Women

By Kristin Della Volpe

Practical Pain Management interviewed Jori E. Fleisher, MD, MSCE, assistant professor of neurology and population health at The Marlene and Paolo Fresco Institute for Parkinson’s and Movement Disorders at NYU Langone Medical Center (New York CIty), a Parkinson’s Foundation Center of Excellence, about the challenges facing women with Parkinson's disease.

Practical Pain Management interviewed Jori E. Fleisher, MD, MSCE, assistant professor of neurology and population health at The Marlene and Paolo Fresco Institute for Parkinson’s and Movement Disorders at NYU Langone Medical Center (New York CIty), a Parkinson’s Foundation Center of Excellence, about the challenges facing women with Parkinson's disease.

Q. What is the pain experience in PD, and does it differ between genders?

Dr. Fleisher: As with almost everything else in PD, the pain experience is highly individualized, and no 2 people, regardless of gender, will have the same symptoms. Female gender appears to be an independent risk factor for chronic pain in PD, even though PD is more common in men than in women.² Pain intensity also is higher in women than in men with PD.¹

There is a lot of interesting research examining the contributions of hormones to the greater prevalence of PD in men or, conversely, the lower prevalence in women.³Once we better understand the roles of sex hormones in the pathophysiology of PD, we may better understand whether hormones also play a role in the higher incidence of chronic pain in women with PD.

Q. What are the causes of pain in PD?

Dr. Fleisher: There are 4 primary types of pain in PD: musculoskeletal, dystonic, neuropathic, and central pain.²

• Musculoskeletal pain typically is related to involuntary muscle rigidity or bradykinesia, which limits range of motion. For example, it is not uncommon for people with PD to present initially with unilateral shoulder pain (ie, frozen shoulder) for which they have undergone numerous orthopedic and pain management consultations, as well as failed injections and surgeries, before they consult with a neurologist or a movement disorder specialist and are correctly diagnosed with PD.
• Dystonic pain usually manifests as painful curling or bending of the toes/fingers or inversion of one foot but can occur in any area of the body. Sometimes, dystonic pain is a sign of extremely low dopamine levels, especially when it occurs first thing in the morning or late at night.
• Neuropathic pain in PD commonly is related to neuroforaminal compression in the spine resulting from degenerative disc disease, but it also may be related to nerve compression that causes a twisting of the spine in a person with dystonia, or postural deformities related to PD.
• Central pain is relatively rare, occurring in approximately 10% of people with PD at some point.⁴ Symptoms include a vague gnawing, boring, or deep, aching pain that is often hard to describe and may be unrelenting. In some cases, central pain can show up as abdominal pain or a feeling of reflux without a clear etiology. Rarely, people with PD may have perioral/oral pain or genital pain as a manifestation of this central pain syndrome. Because the symptoms of central pain are vague and the syndrome is poorly understood by nonpain specialists, there may be a tendency for physicians and healthcare providers to minimize the symptoms or at least not recognize them as a part of PD.

Q. Are there any gender disparities in the treatment of pain in PD?

Dr. Fleisher: I don’t think there is any literature demonstrating gender disparities in pain treatment among patients with PD, but we do know that there are certainly gender disparities overall in the treatment of women with PD, so it would not be surprising to learn that women with PD-related pain are at a disadvantage and not getting the appropriate care that they need.

Q. What is the role of depression in the pain experience in PD?

Dr. Fleisher: Depression is one of the most overlooked symptoms of PD, and it can affect over 30% of people with the disease at some point in their illness.⁵ I think there is a misconception that depression results from an adjustment disorder following diagnosis. While that may be partially true, patients with PD have alterations in various neurotransmitters—including serotonin and norepinephrine in addition to dopamine—that predispose them to depression.^6,7

Depression is the primary factor related to quality of life in PD and is an independent risk factor for medication nonadherence. A physician could prescribe the most comprehensive regimen to control Parkinson’s symptoms, including pain, but if depression symptoms are not being addressed simultaneously, the likelihood that that person is going to take that regimen is pretty minimal.

Given the link between depression and chronic pain, patients who are depressed should be screened for chronic pain and vice versa. In my practice, we screen every patient with the Unified Parkinson’s Disease rating scale , which has both a patient-reported subjective component that includes questions about depression, pain, and altered sensation, as well as an objective component that includes a physical examination and questions about potential medication adverse effects (AEs). The patient fills out the subjective component every single time they come to the office.

Q. What role does exercise play in pain management in PD?

Dr. Fleisher: Exercise and physical therapy can be tremendously helpful in managing pain in PD, in addition to being important for overall disease management.^4,8 Evidence suggests that exercise is the best option we have to alter the course of PD, and it has been shown to promote neuroplasticity and neurorestoration in PD^.9,10 In addition, research suggests that exercise can activate both dopaminergic and non-dopaminergic inhibitory pain pathways, which may help to modulate the experience of pain in PD.¹⁰

Good exercise options include walking, swimming, dancing, and using a recumbent bike. In particular, forms of dance with smooth movements and those that encourage bigger steps appear to be especially beneficial in helping retrain the brain that the shuffling gait of PD is not the norm. Incredible work has come out of the Mark Morris Dance Company, in New York City, which has started a Dance for PD class that has spread throughout the country. In addition, yoga and tai chi can help with balance and core strength, which are critical for people with PD.

Importantly, there doesn’t appear to be an upper limit for the benefits of exercise on the disease. I encourage patients to aim for at least 30 to 45 minutes a day at least 3 to 4 days a week. Patients who are sedentary should start with 5 minutes per day for a week, and then increase the duration each week.

One way to incentivize exercise is to reserve your favorite television shows only for times that you are exercising. This can be helpful in motivating people to stick with a regimen. If a patient is going to binge watch TV, they should reserve that time for when they are on a recumbent bike, treadmill, or elliptical machine.

Q. Which pharmacotherapies are best for treating pain in PD?

Dr. Fleisher: The first step is to make sure that Parkinson’s medications are optimized. For example, dystonic or musculoskeletal pain may be caused by Parkinson’s motor symptoms (eg, rigidity, bradykinesia, dystonia) when dopamine levels are too low. If the patient is able to keep a pain diary, it may show a clear pattern of pain occurring the hour before each dose or before specific doses, suggesting the need to either increase the dosage preceding the pain episode, increase the frequency of medication dosing, or use adjunctive dopaminergic therapies to achieve more steady dopamine levels throughout the day.

In addition, optimal management of comorbidities (eg, diabetes, osteoarthritis, depression) that may contribute to pain is needed. The choice of pain medication depends on the pain type.

The first lines of treatment for musculoskeletal pain can be heat and cold packs and nonsteroidal anti-inflammatory drugs alone or in combination with acetaminophen.  

For dystonic pain, adjustment of dopaminergic medications is particularly critical; however, if dystonia consistently occurs in 1 particular body part, botulinum toxin injections also can be helpful. The goal of botulinum toxin injection is to weaken the muscle enough to stop the abnormal contractions and twisting, but the patient may lose function in the body part as a result (eg, foot drop). Thus, patient counseling is important to manage expectations.

For neuropathic pain, anticonvulsants such as gabapentin (Neurontin, Gralise, others) or pregabalin (Lyrica) can be effective. As second-line therapy, tricyclic antidepressants may be effective. However, in many patients, the adverse effects of those medications, particularly the anticholinergic effects (eg, confusion, dry mouth, urinary retention, or constipation)—which patients already may experience as symptoms of PD—outweigh the benefits.

Central pain is the most difficult type of pain to treat. Antidepressants (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, or atypical antidepressants) or anticonvulsants (gabapentin or pregabalin) may be helpful. In select cases, opioids may be necessary. Consultation with a pain management specialist for additional expertise is warranted in these difficult cases.

When treating women of childbearing age, it is important to make sure that medications are appropriate for women who are pregnant or breastfeeding or who want to become pregnant. Consultation with the patient’s OB/GYN may be warranted in some cases to rule out contraindications.

Q. Are there any alternative therapies that are effective for pain in PD?

Dr. Fleisher: Although alternative therapies may be helpful, there is little evidence-based research to support their use. Certainly massage therapy, anecdotally, seems to be helpful for managing pain. Small studies suggest that acupuncture might improve sleep in patients with PD, but data on the effects on pain in PD is lacking. Larger, more well-controlled and reproducible studies of these therapies are needed.

Patients frequently ask about the effects of medical marijuana in managing PD, including pain symptoms. Several studies have looked at efficacy of marijuana in PD and have found that it probably is ineffective for most PD symptoms.¹¹ However, we just don’t have enough evidence to know for sure. The most rigorous study of medical marijuana in PD showed a trend toward worsening tremor.^11,12

For most people, stress and anxiety worsen tremor, and anything that relieves anxiety will improve tremor. Thus, modalities such as yoga, meditation, and mindfulness training will improve tremor. Similarly, medical marijuana may improve tremor in certain people by temporarily reducing anxiety and stress, but the evidence has not borne this out yet.

Q. Is there anything else you would like to tell our readers?

Dr. Fleisher: There are so many symptoms of PD that it can be easy to overlook pain symptoms if a patient doesn’t report them. Remember that pain may be a really prominent symptom for patients, but, given that we have only learned how pain is connected to PD in the past 20 years, patients may not be aware of the association and may not bring up pain symptoms with their neurologist.

Thus, the burden is on us to ask about pain, particularly if the patient is depressed. If a patient with PD has both pain and depression, both of those comorbidities should be targeted, because it can be hard to achieve successful outcomes for either pain or depression if one is treated without the other.

https://www.practicalpainmanagement.com/pain/other/co-morbidities/pain-parkinson-disease-spotlight-women

IBM researchers monitor Parkinson’s disease with fingernail sensors

Kyle Wiggers   December 21, 2018

https://youtu.be/fYyPx8jw_3k

Grip strength can reveal a lot about a person — including whether a neurodegenerative disease is about to set in and how far it has progressed. In a study published in the journal Scientific Reports, researchers from IBM describe a wearable system — a “fingernail sensor” — that measures how a person’s fingernail bends and moves continuously (a key indicator of grip strength), and machine learning models that can derive health state insights from those metrics.

As study coauthors Stephen Heisig and Katsuyuki Sakuma point out in a blog post, grip strength is associated in medical literature not only with the effectiveness of medication in Parkinson’s disease patients, but with people’s cardiovascular health, overall cognitive function in schizophrenics, and “all-cause mortality” in geriatrics. Fingernail monitoring is ideal for elderly patients, they claim, who risk infection from alternative options, like skin-based sensors.

“The project began as an attempt to capture the medication state of people with Parkinson’s disease … The majority of people with Parkinson’s are older, an age group with increasingly brittle, friable skin,” Heisig and Sakuma wrote. “By pushing computation to the end of our fingers, we’ve found a new use for our nails by detecting and characterizing their subtle movements.”

Fingernails provide a valuable structure for the body’s somatosensory system, as it turns out. As people move through the environment throughout the course of a day, neurons on the tips of their fingers act as near-constant sources of pressure, temperature, and texture feedback, leading them to interact with objects in somewhat repetitive, predictable ways.

This insight led the  team “to believe it might be possible to derive … signals from how the fingernail bends,” Heisig and Sakuma wrote.

So they built a system of strain gauges — sensors that measure the amount of strain on an object — that they affixed with adhesive to the fingernails of study subjects, along with small computers that sampled strain values recorded by those gauges. In addition to the strain gauges, the sensor packages contained a microcontroller with a wireless antenna board, a silicon prosthesis, an accelerometer board, and a coin battery.

As the aforementioned computer collected data, it communicated with a smartwatch (an Apple Watch Series 3), which sent the info on to a paired iPhone (via Bluetooth) and subsequently to cloud-based machines for retention, analysis, and model training. Locally, inference models correlated the data with three well-established symptoms of Parkinson’s disease: bradykinesia (slowness of movement), tremor, and dyskinesia (abnormality of voluntary movement).

One of the fingernails’ functions is to focus fingertips on objects being manipulated — fingernails slightly bend and move when they’re used for gripping and grasping, and even when fingers are merely flexed and extended. It’s a movement that’s tough to see with the naked eye, the researchers say — usually in the order of single-digit microns, less than the length of a typical human hair (between 50 and 100 microns across) or a red blood cell (less than 10 microns across). But the device’s strain sensors are sensitive enough to capture those bends and other minute changes in orientation, direction, and force of interactions.

Above: A view of the fingernail sensor’s hardware stack.

Image Credit: IBM

In tests, the sensor package and machine learning models managed to differentiate activities involving pronation — downward rotations of the palm — and supination — upward rotations — such as turning a key, opening a doorknob, and using a screwdriver. They even predicted with 94 percent accuracy which digits wearers were writing as they used a pen and paper.

The study’s authors believe the system could serve as the foundation for a future wearable that’s “entirely on the nail” and capable of characterizing various kinds of gestures, which they say might be used to perform operations like scrolling, paging, shrinking, or expanding images on a smartphone or PC. In the short term, hardware improvements will focus on shrinking the electronics using “wafer-level chip” scale packaging, switching to a flexible substrate, and reducing power consumption.

Above: Fingertip surface profile measurements from the sensor.

Image Credit: IBM

“With the sensor, we can derive health state insights and enable a new type of user interface,” Heisig and Sakuma said. “This work has also served as the inspiration for a new device modeled on the structure of the fingertip that could one day help quadriplegics communicate.”

A fair amount of artificial intelligence (AI) research in health care has involved Parkinson’s disease prediction. Researchers at the Institute for Robotics and Intelligent Systems in Zurich, Switzerland published a recent paper describing an AI system that can diagnose Parkinson’s disease from smartphone-based tests designed to measure movement, speech, finger dexterity, and spatial memory impairments. Moreover, scientists at the University of Oxford demonstrated a machine learning model that automatically detects rapid eye movement (REM) sleep behavior disorder (RBD), an early predictor of Parkinson’s.

Chinese giant Tencent, meanwhile, recently partnered with health care company Medopad and the Parkinson’s Center of Excellence at King’s College Hospital in London to develop AI-driven software that can detect signs of Parkinson’s within minutes, using a smartphone camera to monitor patients’ fine motor movements.

https://venturebeat.com/2018/12/21/ibm-researchers-monitor-parkinsons-disease-with-fingernail-sensors/

Parkinson's Disease Treatment Soon to Be Discontinued

December 20, 2018   Da Hee Han, PharmD

The Food and Drug Administration (FDA) has posted a discontinuation notice for Requip (ropinirole HCl; GlaxoSmithKline) tablets and certain Requip XL (ropinirole HCl; GlaxoSmithKline) extended-release tablets. 

Requip and Requip XL are non-ergot dopamine agonists indicated for the treatment of Parkinson's disease. 

The affected products include Requip 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg, and 5mg strength tablets in 100-count bottles, and Requip XL 2mg strength tablets in 30-count bottles. The anticipated final dates of availability to patients are as follows:

• Requip 0.25mg (NDC 0007-4890-20): April 2019
• Requip 0.5mg (NDC 0007-4891-20): May 2019
• Requip 1mg (NDC 0007-4892-20): January 2019
• Requip 2mg (NDC 0007-4893-20): January 2019
• Requip 3mg (NDC 0007-4895-20): April 2019
• Requip 4mg (NDC 0007-4896-20): May 2019
• Requip 5mg (NDC 0007-4894-20): March 2019
• Requip XL 2mg (NDC 0007-4885-13): March 2019

The discontinuation of these products was a business decision, according to the FDA notice. Requip XL is still available as 4mg, 6mg, 8mg, and 12mg extended-release tablets.  

For more information call (908) 293-5330 or visit FDA.gov.

https://www.empr.com/news/requip-ropinirole-discontinued-supply-glaxosmithkline-parkinson-disease/article/822352/

UAB Named Udall Centers for Excellence in Parkinson’s Research

December 29, 2018    Clare Huddleston

BIRMINGHAM, AL (WBRC) - UAB’s Department of Neurology has been named a Udall Centers for Excellence in Parkinson’s disease, which means researchers in Birmingham will receive a five year renewable grant to try to find a cure for Parkinson’s.

The grant is named after the late Arizona Senator, Morris Udall, who died of Parkinson’s in 1998.

Following his death, the National Institutes of Health set up centers around the country to study various aspects of Parkinson’s.

Dr. David Standaert , chair of UAB’s Department of Neurology, will be leading this new study in Birmingham. “What I wanted to do here at UAB was to build a center that could really push the envelope on Parkinson’s research,” said Dr. Standaert, “Our center is really focused on the immune system and inflammation in Parkinson’s disease. That’s unique. None of the other centers are pursuing that angle.”

Dr. Standaert believes if scientists can find a way to interrupt the immune system, they will be able to slow down the progression of Parkinson’s, which would be the first step towards finding a cure.

“Many of them [patients] will tell me ‘you know I have symptoms, I have tremors, I feel a bit slow, but that’s not what bothers me. What bothers me is thinking about my future and if you could tell me that these symptoms that maybe they are permanent but at least they won’t get any worse’ many of my patients would be very satisfied with that,” said Dr. Standaert.

The study will use 60 newly diagnosed Parkinson’s patients and 60 control patients.

You can read more about the study here:  

https://www.uab.edu/news/research/item/9770-uab-joins-ranks-of-national-udall-centers-of-excellence-in-parkinson-s-disease

You can read more about the Udall Centers for Excellence in Parkinson’s disease here.:

https://www.ninds.nih.gov/Current-Research/Focus-Research/Focus-Parkinsons-Disease/Udall-Centers

If you would like more information about this study, you can call UAB’s Movement Center at 205-934-0683.

http://www.wbrc.com/2018/12/20/uab-named-udall-centers-excellence-parkinsons-research/

Different Stages Of Dementia ( 7th Is Shocking) ,You Might Be Unaware

Stage 1: No Cognitive Decline

Stage 1 of dementia can also be classified as the normal functioning stage. At this stage of dementia development, a patient generally does not exhibit any significant problems with memory, or any cognitive impairment. Stages 1-3 of dementia progression are generally known as “pre-dementia” stages.

Stage 2: Age Associated Memory Impairment

This stage features occasional lapses of memory most frequently seen in:

• Forgetting where one has placed an object
• Forgetting names that were once very familiar

Oftentimes, this mild decline in memory is merely normal age-related cognitive decline, but it can also be one of the earliest signs of degenerative dementia. At this stage, signs are still virtually undetectable through clinical testing. Concern for early onset of dementia should arise with respect to other symptoms.

Stage 3: Mild Cognitive Impairment

Clear cognitive problems begin to manifest in stage 3. A few signs of stage 3 dementia include:

• Getting lost easily
• Noticeably poor performance at work
• Forgetting the names of family members and close friends
• Difficulty retaining information read in a book or passage
• Losing or misplacing important objects
• Difficulty concentrating

Patients often start to experience mild to moderate anxiety as these symptoms increasingly interfere with day to day life. Patients who may be in this stage of dementia are encouraged to have a clinical interview with a clinician for proper diagnosis.

Stage 4: Mild Dementia

At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:

• Decreased knowledge of current and/or recent events
• Difficulty remembering things about one’s personal history
• Decreased ability to handle finances, arrange travel plans, etc.
• Disorientation
• Difficulty recognizing faces and people

In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.

Stage 5: Moderate Dementia

Patients in stage 5 need some assistance in order to carry out their daily lives. The main sign for stage 5 dementia is the inability to remember major details such as the name of a close family member or a home address. Patients may become diso

riented about the time and place, have trouble making decisions, and forget basic information about themselves, such as a telephone number or address.

While moderate dementia can interfere with basic functioning, patients at this stage do not need assistance with basic functions such as using the bathroom or eating. Patients also still have the ability to remember their own names and generally the names of spouses and children.

Stage 6: Moderately Severe Dementia

When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:

• Delusional behavior
• Obsessive behavior and symptoms
• Anxiety, aggression, and agitation
• Loss of willpower

Stage 7: Severe Dementia

Along with the loss of motor skills, patients will progressively lose the ability to speak during the course of stage 7 dementia. In the final stage, the brain seems to lose its connection with the body. Severe dementia frequently entails the loss of all verbal and speech abilities. Loved ones and caregivers will need to help the individual with walking, eating, and using the bathroom.

http://www.bloomarticles.com/2018/12/03/different-stages-of-dementia-7th-is-shocking-you-might-be-unaware/?fbclid=IwAR3TEl4x34Y8sGzkd0tvqk09faX2DW1-M9FCErUF7oP0WxsknXh4lWxUhP4

Making A Difference: Local dance teacher 'unlocks' mobility in students with Parkinson's disease

BY MEL LEONOR Richmond Times-Dispatch   December 21, 2018

Veronica Nugent first saw the effect of music on people living with Parkinson’s disease when her father hoisted himself out of his wheelchair and strode across a Texas dancefloor to a live rendition of Frank Sinatra’s “New York, New York.”

That was more than a decade ago, and Nugent’s father has since died. His memory, she says, lives on in her work as a dance teacher for others living with the condition in the Richmond area, where weekly classes attract dozens.

“It’s a special thing. Because I lived far away, I couldn’t help my dad. This is in memory of him,” Nugent said during an interview at her dance studio, Simply Ballroom, located in Chesterfield.

The studio offers a wide range of dance classes, but on Wednesday mornings, a few dozen chairs form a wide circle of dancers struggling with different stages of Parkinson’s disease.

From their chairs, they point their toes, lift their hips, and hold up their arms to the rhythm of the music. Dancers and teacher joke throughout the class, and warmly welcome late-comers all hour long.

“I can move and retain my control,” said Terry Kyle, 71, who has been attending Nugent’s class for four years with his wife, Louise. “Every Wednesday I look forward to it.”

Louise Kyle, 68, said that after her husband’s first class, he came home swinging his arms to The Oak Ridge Boys’ “Elvira.”

“When he leaves here, he moves with more energy. The exercise is so good for him,” she said.

Parkinson’s disease is a disorder of the central nervous system that disrupts dopamine production and limits movement. That can often include tremors, freezing or slowness of movement.

Nugent said that the rhythm in music can often help temporarily “unlock” movement in her students and others with the condition, allowing for comfortable exercise.

“It’s not a cure,” Nugent said. “But it’s exercise, mood-lifting. It’s a happy place for a population that can become homebound and lose social connections as the disease progresses.”

Dick Carlton, 75, was diagnosed with Parkinson’s eight years ago and said the draw of the dance class for him is the “fellowship of people” who share his struggles.

Terry Kyle agreed. “I just enjoy being here with other people, because we all have the same problems roughly,” he said.

A southern Texas native, Nugent became a ballroom dance teacher in the Washington, D.C., area in the early 1990s. It was during a visit home that she saw the potential for dance to better the lives of people like her father.

Soon after, she contacted the Mark Morris Dance Center in Brooklyn, New York, which trains dance teachers to work with students who have Parkinson's disease, and Lynn Klanchar, who at the time led a local support group for people with the disease. The class launched in 2011.

The class is free of charge to the dancers, and Nugent volunteers her time and studio space. Nugent later helped start a nonprofit to support additional teaching staff, refreshments and other costs called the Richmond Parkinson’s Dance Project.

Nugent said she is working to expand the program in the Richmond area. Earlier this year, a new class launched at the West End Academy of Dance.

“The program has just grown and grown,” Nugent said.

https://www.richmond.com/news/special-report/making-a-difference/making-a-difference-local-dance-teacher-unlocks-mobility-in-students/article_065bd500-d1b0-5fae-aa5f-91a02e7f6ffe.html

MJ Fox Foundation Gives Therapeutic Pipeline Award to Progenra, Supporting Work on New Therapies

 DECEMBER 21, 2018 BY JOSE MARQUES LOPES, PHD 

The Michael J. Fox Foundation for Parkinson’s Research (MJFF) has granted a 2018 Therapeutic Pipeline Award to Progenra to support the company’s development of small molecule treatment candidates for Parkinson’s disease.

“Progenra is pleased to have been selected by The Michael J. Fox Foundation to contribute to bringing Parkinson’s and other major neurodegenerative diseases under control by introducing new therapeutic agents,” Tauseef Butt, Progenra’s president and CEO, said in a press release.

The company’s goal is to find new medicines that target enzymes in the ubiquitin proteasome system (UPS). The UPS has been implicated in neurodegenerative diseases, based on the observation of protein deposits tagged with ubiquitin — a marker for degradation in cellular structures called proteasomes — in affected neurons.

Research has shown that impaired UPS function, due to the accumulation of aggregation-prone proteins, delays the degradation of substrates important in cellular processes such as signaling and apoptosis — which refers to “programmed” cell death, rather than death caused by injury — ultimately leading to neurodegeneration.

“We believe that augmenting the activity of a native enzyme known to be beneficial in combating neurodegeneration will provide both mechanistic information and the potential for breakthrough treatment,” Butt stated. “We look forward to working with the many excellent researchers in the foundation’s consortium.”

MJFF’s Therapeutic Pipeline Program grants awards to projects of clinical utility for patients and to proposals believed to have the potential to alter disease course and/or significantly improve treatment over the current standards of care.

Both industry and academic investigators may apply by proposing new strategies or clinically safe therapies used in other diseases. The program covers development from preclinical studies to clinical trials, which includes pharmacological and non-pharmacological approaches such as gene therapy, biological, surgical, and non-invasive methods.

In addition, MJFF’s Target Advancement Program aims to overcome the need for well-validated targets in the disease process. It seeks to foster critical target validation studies that may ultimately speed up subsequent therapy development. The program also supports continuing work on established targets — those already showing links to the disease in patients.

The foundation’s Therapeutic Pipeline Program will begin accepting applications for its next funding cycle on March 11, 2019.

https://parkinsonsnewstoday.com/2018/12/21/michael-j-fox-foundation-grants-therapeutic-pipeline-award-support-progenra-work/