Hope or Hurt: Right to Try Legislation

By Dan Glass · February 1, 2019

When many patients with incurable conditions reach a certain point in their battles, it becomes necessary to find hope in any way possible. It’s easy for us to say, “cheer up” or “focus on the good things.” However, sometimes, when people confront their medical situations, they need more definitive assistance. For this, a new and improved medication/therapy routine is a really good place to start making a difference in their quality of life.

If we had an infection, we could take penicillin. With Parkinson’s, we can take a variety of medications to promote dopamine flow, either real or synthetic. From my own personal experience, I take Azilect, which is an MAO-B inhibitor. I also take the anti-viral/dopamine promoter Amantadine. These are my Batman and Robin of fighting tremors and cognitive woes.

Generally, they’re a good combo for keeping me “Dan” for as long as possible.

Granted, I’ve had to stop taking some negative medications. With where my current medications are in my treatment plan, I’m OK with them until I get to levodopa/carbidopa. When I need to switch to levodopa/carbidopa, I’ll be on that process for the long haul. Yes, at some point I will need greater doses while I move up the 5 stage scale to the middle and late stages (I’m in stage 2 now). Until then, I’ll be in Parkinson’s standard hope and treatment track.

Nevertheless, all nasty diseases make people scared. With Parkinson’s deep brain stimulation is something that unnerves us since it involves surgery on the very motor that makes everything we do possible. For me, this is one of those real-life monsters that hover in the distance scaring me (and yes, I’ve watched the video of it being done – trigger warning). Despite this, I know DBS works and can Parkies tremendously. Thus, I/we can eliminate some of this fear by talking to other people or checking out the link above.

The new law in town

Still, it may not be the last or best solution. That “miracle” may be an experimental medication that is still in trials or early stages of development. Last May, President Trump signed a bill that Republican Ron Johnson of Wisconsin presented when he recognized this need. While not universally approved, this gives many patients a fighting chance. With conditions like Lou Gehrig’s disease and cancer, more people would feel a greater hope with experimental medicine.

The key here is that this medication is for a “life-threatening disease or condition.” The patient must also have “exhausted approved treatment options and is unable to participate in a clinical trial.” Another catch is that the company doesn’t have to give the medicine. However, if it does, it protects them and the hospital from legal consequences if prescribed and given within medical standards.

The voice of dissent and worry

The big fears of this legislation is that hucksters might give “snake oil” to patients. If the Food and Drug Administration isn’t regulating these things, more issues of questionable validity may occur (like those with vitamins/supplements).

While the trial medication must clear phase 1 of its study, this only requires a relatively small sample size. What’s more; it would not have gone through longitudinal studies where later side effects may appear.

Didn’t this exist already?

To some degree, there were laws in 38 states, but now the law covers all of America. There are catches though. People have to be ineligible for or unsuccessful at trials. For those people who don’t know, there are many medical studies available through Michael J. Fox Foundation. Additionally, it was estimated by Forbes Magazine that 99% of experimental medication requests are already approved.

However, by mandating this, lawmakers feel that people with extreme health issues will have hope where they had none. Also, the pharmaceutical industry will generate more studies to validate and expedite the medication approval process.

Controversial

As with all laws, not everyone endorses the right to trial medication law. Only you can make the final decision. If you find yourself in need of any therapy/medicine, you should talk with your caregivers/family. Additionally, you should see a doctor and research it at a science-based website or through a reputable organization. Remember, it’s your life, and this, like all medicines, could impact the quality of your life after taking it.

https://parkinsonsdisease.net/living/trial-medication-law-pd/

New drug is designed to offer rapid relief for Parkinson’s patients

By Jim Mendoza | February 1, 2019 

HONOLULU (HawaiiNewsNow) - When Parkinson’s medication is working, it relieves pain and controls tremors. That’s known as the “on” time.

But it wears off.

“When you’re ‘off’ it makes life really hard. You end of up having pain. You have trouble just doing the simplest of tasks,” said Jerry Boster, board president of the Hawaii Parkinson Association.

The FDA recently approved a drug called Inbrija that could help. It’s administered through an inhaler and is designed to offer relief between doses of a patient’s main medication.

Hawaii Pacific Neuroscience tested the drug on 15 Hawaii Parkinson's patients as part of a nationwide clinical trial.

"Our goal was to test them to make sure the device helped them to move easier and better," Dr. Kore Liow said.

Stephanie Cook was part of the Hawaii trial and is amazed at how fast the inhaler worked to bring her relief.

It was immediately after the first dose," she said.

Cook said Inbrija got her Parkinson’s symptoms under control in about five minutes.

"That fast! Whereas if you take a pill it can be up to 40 minutes to an hour," she said.

It's estimated 6,000 people in Hawaii have Parkinson's and just as many are undiagnosed.

"So what this Inbrija is going to help do is make the patient more consistent daily in how they deal with symptoms, and make their quality of life better," Boster said.

Liow said Inbrija won't replace main Parkinson's drugs, but the inhaler will be a valuable tool for people with Parkinson's.

“With this new drug we’re hoping to help them overcome that ‘off’ period,” he said.

The medication should be available in pharmacies within the next two months.

Go to the following to watch the video:

http://www.hawaiinewsnow.com/2019/02/02/new-drug-is-designed-offer-rapid-relief-parkinsons-patients/

Readers have questions about Parkinson’s disease

SCIENCE NEWS STAFF

Gut connection

Abnormal proteins tied to Parkinson’s disease may form in the gut before traveling through the body’s nervous system to the brain, Laura Beilreported in “A gut-brain link for Parkinson’s gets a closer look” (SN: 12/8/18, p. 22).

The vagus nerve offers a connection between nerves in the gut and those in the brain. Beil reported on one study that showed that people who had their vagus nerve cut above the stomach had a lower Parkinson’s incidence starting five years postsurgery than people who did not have the surgery. 

Reader Terrence Kerwin wondered why there was a delay between the surgery, known as a vagotomy, and the drop in Parkinson’s disease risk.

“It’s possible that by the time of the vagotomy, abnormal proteins may have already reached the peripheral nervous system,” Beil says. From there, the proteins can continue to the brain. So rates might not diverge immediately.

Reader Alecia Flores wanted to know more about fecal transplants as a potential treatment for Parkinson’s.

While growing evidence suggests a gut connection to the disease, the role of the microbiome remains unclear. At this point, fecal transplants are used only for treating infections caused by antibiotic resistant Clostridium difficile bacteria. 

But researchers hope that the transplants or some other gut intervention could someday be a viable treatment option for Parkinson’s, Beil says.

https://www.sciencenews.org/article/readers-have-questions-about-parkinson’s-disease-moth-wings-and-more

8 Videos Provide a Quick Way to Understand the Role of Germs in Alzheimer’s Disease

February 1, 2019     NAPLES, FL, UNITED STATES

A set of eight one-minute videos released by Alzheimer’s Germ Quest, Inc. answers basic questions about the possibility Alzheimer’s disease might be triggered by an infectious agent. 

Video topics include microbes in the brain, the role of plaques and inflammation, possible evidence of transmittal, infections that can take years to surface (e.g., herpes zoster after childhood chickenpox) and possible beneficial effects of antibiotics.

“Historically, research has proven many illnesses not initially suspected of being infectious are linked to germs including polio, ulcers and malaria,” said Dr. Leslie Norins, Alzheimer’s Germ Quest, Inc. CEO. 

The videos can be viewed at www.alzgerm.org/videos or on YouTube.

https://youtu.be/6sK9LWlIuz8

https://www.einpresswire.com/article/475314638/8-videos-provide-a-quick-way-to-understand-the-role-of-germs-in-alzheimer-s-disease?ref=email&code=3WorCQnvElu3nxD6&utm_source=NewsletterPR&utm_medium=email&utm_campaign=Healthcare+%26+Pharmaceuticals+Industry+Press+Releases&utm_content=article

Psychologists Solve Mystery of Songbird Learning

Feb 01, 2019 | Original story by Cornell University

Scientists rely on animal models to gain insight into how humans learn language, but it turns out that one of their favorite models, the zebra finch, has been entirely misunderstood.

New research reveals that these birds don't simply learn their songs by imitating adults: They learn by watching their mothers' reactions to their immature songs.

In "Female Social Feedback Reveals Non-Imitative Mechanisms of Vocal Learning in Zebra Finches," published Jan. 31 in Current Biology, co-authors Michael Goldstein, associate professor of psychology, and doctoral candidate Samantha Carouso-Peck solve the mystery of why juvenile male zebra finches learn to sing better when females are around, even though the females don't sing.

The researchers found that the adult females guide juveniles' song development through specific interactions, similar to how human babies learn to talk. This study brings the number of species known to engage in socially guided vocal learning to four: zebra finches, humans, marmosets and cowbirds.

The researchers' clue to the zebra finch mystery came when they considered that birds see the world at several times the "critical flicker fusion rate" of humans. Simply put, birds can perceive events that happen much too fast for a human to see, and most previous research on social learning has not taken into account such rapid "bird time," in which tiny behaviors can have large social effects.

Using slowed-down video, the Cornell researchers were able to identify tiny movements, imperceptible to the human eye, made by the female zebra finches to encourage the baby songbirds. These included wing gestures and "fluff-ups," an arousal behavior in which the bird fluffs up its feathers.

"Over time, the female guides the baby's song toward her favorite version. There's nothing imitative about it," said Carouso-Peck.

The study included nine pairs of zebra finches, genetic brothers raised for the first 35 days by their respective parents. When they reached the age at which they begin to produce practice song (subsong), the siblings were split up, moved into individual soundproof containers and randomly assigned to one of two conditions: "contingent" or "yoked."

Contingent birds were monitored by Carouso-Peck, and each time they sang in a way that matched their fathers' song, she triggered a video playback of a female performing a fluff-up. The yoked bird saw the same fluff-up video at the same time as his contingent brother, but from his perspective the fluff-ups happened at random times unrelated to his song production.

After the birds' songs "crystallized" into the final version, the researchers compared them to the songs of the juveniles' fathers. They found that the birds in the contingent group learned significantly more accurate songs than their yoked brothers. Had the traditional model of song learning as pure imitation been correct, both birds would have learned the same song, because they had the same opportunity to memorize it early and practice it, according to Goldstein.

One possible reason for the zebra finch learning style, according to the researchers, is that because zebra finches use their songs to attract mates rather than defend territory, integrating female preferences into song is "a highly adaptive strategy for future reproductive success," they wrote.

"Historically we've been studying these birds in isolation. That means we've been missing out on the entire social aspect of song learning," Goldstein said.

Similarly, he said, most labs study human babies more or less in isolation.

"But what babies -- zebra finch or human -- are good at is exploiting social information in their environment," Goldstein said. "These immature behaviors are not mindless practice and noise. Their function is to motivate the adults in the room to provide information."

Zebra finches are widely used in research of vocal learning and production as well as research on Parkinson's disease, autism, stuttering and genetic disorders of speech. "Incorporating social factors into studies of zebra finch learning will strengthen the species as a model system," the paper's authors write, "as it will uncover new possibilities for drawing parallels with human speech acquisition."

This article has been republished from materials provided by Cornell University. Note: material may have been edited for length and content. For further information, please contact the cited source.

Reference:

Samantha Carouso-Peck, Michael H. Goldstein. Female Social Feedback Reveals Non-imitative Mechanisms of Vocal Learning in Zebra Finches. Current Biology, Jan. 31, 2019; DOI: 10.1016/j.cub.2018.12.026

https://www.technologynetworks.com/neuroscience/news/psychologists-solve-mystery-of-songbird-learning-314897

Take Root to host creative movement concert with Oakland Family Services at Strand Theatre

February 1, 2019

Take Root will host a creative movement concert featuring the children of Oakland Family Services on Wednesday, February 13 at the Flagstar Strand Theatre in Pontiac.

Take Root, a contemporary dance company-in-residence at Oakland University, will host a creative movement concert featuring the children of Oakland Family Services on Wednesday, February 13 at the Flagstar Strand Theatre in Pontiac.

“Take Root’s mission is to impact lives through dance,” said OU Dance Associate Professor Thayer Jonutz, who co-founded Take Root in 2013 with fellow Associate Professor of Dance Ali Woerner. “We have been accomplishing this mission through professional performances, modeling high level of artistic productivity to our OU students, and our community engagement work.”

While Woerner oversees Take Root’s Dance for Parkinson’s Disease program, which will be hosting a special presentation and dance session with OU medical students on Thursday, Feb. 7 on the fifth floor of the Human Health Building, Jonutz heads up the dance company’s Arts Education program.

“Since September, Take Root’s Arts Education faculty have been in residency at Oakland Family Services, teaching creative movement classes every Wednesday to about 50 preschoolers, Jonutz said. “All of the classes taught have focused on movement games to help the kids tap into creativity.”

According to Jonutz, the children “will demonstrate their own interpretations of guided improvisations” during the concert, while Take Root professional dancers will perform excerpts from this year’s repertory.

The concert, which is free and open to the public, begins at 4:30 p.m.

The Flagstar Strand Theatre is located at 12 N Saginaw St. in Pontiac.

http://www.oakland.edu/oumagazine/news/smtd/take-root-to-host-creative-movement-concert-with-oakland-family-services-at-strand-theatre

Tucson native Linda Ronstadt opens up about Parkinson's in CBS interview

Cathalena E. Burch  Arizona Daily Star  Feb 1, 2019 

Linda Ronstadt 

Linda Ronstadt says she's not afraid of dying, but she is afraid of suffering from the effects of Parkinson's disease.

She made the comments in an interview with "CBS Sunday Morning," set to air at 9 a.m. Sunday, Feb. 3. 

Ronstadt also said she is hopeful they will find a cure for Parkinson's, which she was diagnosed with in early 2013. She went public with the diagnosis in August of that year and said at the time she had been experiencing symptoms for years before that included not being able to sing.

Tucson native Ronstadt, 72, performed her last hometown concert in 2007 at the AVA at Casino del Sol. She has returned twice since for speaking events at Fox Tucson Theatre.

Ronstadt told "CBS Sunday Morning" host Tracy Smith that she realized something was wrong with her voice as early as 2000. And while she can no longer sing — “I can’t even sing in the shower," she told Smith — she isn't angry.

“When you’ve been able to do certain things all your life, like put your shoes on and brush your teeth or whatever, you – when you can’t do that, you sort of go, ‘What’s this?’” says Ronstadt, who sold more than 100 million records in her nearly five-decade career that landed her in the Rock and Roll Hall of Fame in 2014. “You know, what’s happening here? Come help me with this. And then you have to learn to ask people to help, and that – that took a little doing. But I do that now, because I need the help.”

Linda Ronstadt at Tucson's Symphony Cotillion Ball in 1977.

In the interview, which covered her career and touched on her recent theater "conversation" events around the country including at Fox Tucson Theatre in 2014 and last year, Ronstadt expressed confidence that researchers will one day find a cure for Parkinson’s. 

“I’m sure they’ll find something eventually,” she tells Smith. “They’re learning so much more about it every day. If not, I mean, I’m 72. We’re all going to die. So, they say people usually die with Parkinson’s. They don’t always die of it because it’s so slow-moving. So, I figure I’ll die of something. And I’ve watched people die, so I’m not afraid of dying. I’m afraid of suffering, but I’m not afraid of dying.”

"CBS Sunday Morning" airs from 9 to 10:30 a.m.

To view more photos:

https://tucson.com/entertainment/music/tucson-native-linda-ronstadt-opens-up-about-parkinson-s-in/article_1597c1b8-2640-11e9-8c5d-67cf4f6f492a.html#1

Finding Words to Describe Parkinson’s Pain

 FEBRUARY 1, 2019 BY DR. C 

Parkinson’s disease (PD) pain is unique, so finding words to describe it is difficult. Not all those with a diagnosis experience pain. But for some, like me, pain is the major, disabling symptom. It is important to find words that describe the pain experience as clearly as possible. There is no “grin and bear it,” nor is this “a pity party.” Instead, this is a search for accurate articulation of the pain experience to help maintain quality of life.

Pain may be an early symptom of PD, according to a study presented at the 2018 World Congress on Parkinson’s Disease and Related Disorders titled “Pain: A marker of prodromal Parkinsons disease?” The American Parkinson Disease Association published research that supports the connection of pain with Parkinson’s, suggesting that if the pain is relieved with dopaminergic medication and the patient has a pattern of painful sensations that correlate to “off” episodes, more credence can be given to the idea that the pain is PD-related.

PD pain can resemble pain from other disease processes, especially as the patient ages and faces a multitude of other pain-causing conditions such as arthritis, spine degeneration, poor muscular conditioning, and such. In my case, PD pain is distinguished by the following:

• The progression of body pain correlated with the progression of the disease over time.
• Levodopa, a dopaminergic therapy, successfully reduces the pain.
• The pain is worse during “off” periods.

My PD pain also has a particular characteristic: stinging (sometimes knife-jabbing), irritating tingling, burning, and muscle heaviness with increased pain on movement. This pain happens over large regions of the body and varies in severity. At its worst, it can last several days and reach level 7, inducing spontaneous tears.

PD with episodic chronic pain is disabling in several ways. First, high levels of pain obstruct clear thinking. Second, high levels of pain induce the fight-or-flight response, which interferes with emotion management. Third, the amount of energy necessary to manage it is very tiring (even more so in the face of the deep fatigue associated with PD). Chronic PD pain entails much more than body symptoms.

Parkinson’s pain is a total experience that touches thoughts, feelings, and relationships. Even when it’s a struggle, finding the words to describe pain experiences is imperative to maintaining quality of life in the face of a difficult diagnosis. Finding the right words helps one communicate the pain experience to care providers, family, and friends — a network of relationships that help form the foundation for quality of life. By communicating the pain, those close to me are more understanding of why I act the way I do, which helps to maintain those relationships.

Over the years, I have watched my PD progression. I have taken the warrior stance to do all I can to slow the progression. My hardest battle is with the total experience of chronic PD pain. Large blocks of time disappear into the fog of war. Over time, I have learned the importance of communicating about the pain daily, sometimes multiple times a day. My partner asks, “Where are you today?” I will say, “I’m at level 5,” followed by a quick mention of the most bothersome symptoms. In the past, I kept track of the pain levels throughout several months to create benchmarks. This is all part of finding the words to describe the Parkinson’s pain experience.

I have been a “communicator” most of my life, but it remains a struggle to find words that describe the unique character of PD pain. If you experience PD pain, please share your descriptors in the comments. Together we may find a common dialogue that will help others.

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

https://parkinsonsnewstoday.com/2019/02/01/parkinsons-pain-disease-words-describe/

Study Urges Activism to Help Prevent Emerging Parkinson’s Pandemic .

FEBRUARY 1, 2019 BY JOSE MARQUES LOPES, PHD IN NEWS

A “PACT” formed by the Parkinson’s community — to prevent, advocate for increased resources, care for all those affected, and treat with new therapies — may help prevent a Parkinson’s pandemic, according to a review study.

The study, “The Emerging Evidence of the Parkinson Pandemic,” appeared in the Journal of Parkinson’s Disease.

Parkinson’s is the fastest-growing neurological disorder in the world, expected to double from 6.2 million to more than 12 million patients by 2040. Similar to pandemics of infectious diseases, Parkinson’s is increasing in every region of the world, though shiftingfrom the West to the East mainly because of changes in aging and industrialization.

“By 2040, we can truly talk about a pandemic that will result in increased human suffering, as well as rocketing societal and medical costs,” Patrik Brundin, MD, PhD, one of the study’s guest editors, said in a press release. “How can the community be made aware of this scenario and implement changes in research priorities and care programs to lessen the burden of the upcoming pandemic?”

Aging populations — particularly a rapid rise in people older than 65 — and increasing life expectancy are two of the contributing factors to the rise in Parkinson’s. According to a 2018 study, increased life expectancy will extend the survival of 65-year-old Parkinson’s patients in France by nearly three years between 2010 and 2030, increasing disease prevalence by 12%. The number of people with advanced Parkinson’s is also expected to rise.

As smoking has been associated with a 40% lower risk of Parkinson’s, the current decline in smoking rates may also result in greater disease incidence. A recent study estimated that diminishing smoking rates in the U.S. may boost Parkinson’s incidence by 10% above projections that account for aging only.

Byproducts of industrialization — including specific pesticides (such as paraquat), solvents (such as trichloroethylene) and heavy metals — have also been linked to Parkinson’s. In China, a country with rapid industrialization, the prevalence of Parkinson’s increased more from 1990 to 2016 than in any other country. The ongoing use of these products in large quantities may accelerate the increase in cases.

Overall, “assuming a 12% increase due to increasing longevity, a 10% increase due to decreasing smoking, and that about half (10%) of the observed increase in age-adjusted prevalence rates persists due to environmental factors, the burden of [Parkinson’s] could exceed 17 million by 2040,” researchers said.

Unlike most diseases whose burden lessens with improving socioeconomic levels, disability because of Parkinson’s disease increases with income per capita and education. Besides patients, caregivers are also affected by the disease. Parkinson’s is further associated with a growing economic burden, currently directed at institutional care in the U.S.

Activism has played a key role in confronting pandemics of polio, breast cancer, and HIV in the past century, leading to effective prevention, more resources, better care, and new therapies.

“Following these examples,” the researchers proposed, “those with and at risk for [Parkinson’s] can form a “PACT” to prevent, advocate for, care, and treat the disease.” This would involve reducing or eliminating the use of chemicals known to boost Parkinson’s risk, securing more funding to better understand its root causes and to expand new care models, as well as develop new and effective therapies.

The Parkinson’s pandemic “is preventable, not inevitable,” researchers emphasized.

“We hope that this article will raise awareness of the challenge and form the basis for a community-led response to address one of the great health challenges of our time,” said Bastiaan R. Bloem, MD, PhD, a study author from the Radboud University Medical Center in The Netherlands.

https://parkinsonsnewstoday.com/2019/02/01/pact-activism-prevention-resources-care-treatments-may-prevent-parkinsons-pandemic/

Deep Brain Stimulation May Increase Dementia Risk in Some Parkinson’s Patients, Study Suggests

FEBRUARY 1, 2019 BY PATRICIA INACIO, PHD

Parkinson’s disease patients with mild cognitive impairment who undergo deep brain stimulation are at a higher risk of cognitive decline and dementia, a long term “real-life”study suggests.

The study, “Longterm outcome of cognition, affective state, and quality of life following subthalamic deep brain stimulation in Parkinson’s disease,” was published in the Journal of Neural Transmission.

Subthalamic nucleus-deep brain stimulation (STN-DBS) is a surgical treatment for Parkinson’s motor symptoms where a device that generates electrical impulses is implanted into specific regions of the patient’s brain.

Increasing evidence suggests that STN-DBS significantly improves motor symptoms as well as some non-motor symptoms, such as sensory issues and sleep disturbances. However, some reports point to a potential decline in cognition in Parkinson’s patients following STN-DBS.

Researchers here investigated the cognitive status of 104 Parkinson’s patients who received STN-DBS for nine years, from 1997 and 2006, at a single center in Germany.

Neuropsychological data from before the surgery were available for 79 of the patients, of whom 37, diagnosed with Parkinson’s for more than 11 years, were followed long term for a median of 6.3 years after surgery. During this time, they underwent several neuropsychological and motor tests.

In the remaining 42 patients, no follow-up was possible due to patients’ death (21 of the cases), loss of contact (nine patients) and patients’ refusal to undergo follow-up (12 patients).

Researchers measured patients’ dementia rate (using the Mattis dementia rating scale) and cognitive status, focusing on five domains — memory, executive function, language, attention, and working memory — mood (depression and anxiety), and quality of life using the Parkinson’s Disease Questionnaire and the 36-item Short-Form Health Survey.

Motor function was assessed using several motor tests, including the Unified Parkinson Disease Rating Scale motor subscore (UPDRSm) and Hoehn and Yahr Stage, a widely used clinical rating scale, with broad categories of motor function in Parkinson’s.

Prior to the surgery, 28 patients (75.7%) had mild cognitive impairment, while nine patients (24.3%) had normal cognitive function. Moreover, no patients showed signs of Parkinson’s-related dementia.

Patients in the two groups — with and without mild cognitive impairment — showed no differences in age, disease duration, response to treatment, and dosage with levopoda, motor function, and education. Mood and quality of life were also similar.

Patients’ verbal intelligence, measured by a multiple choice word test, and memory were lower in the mild cognitive impairment group.

After undergoing STN-DBS, 18.9%, or seven, of the patients had no cognitive impairment, while the remaining patients (41%) were diagnosed with either mild cognitive impairment (15 patients) or dementia (15 patients).

Mild cognitive impairment has been previously identified as a risk factor for dementia in Parkinson’s patients. Twenty-eight patients categorized as having mild cognitive impairment before STN-DBS developed dementia within 6.3 years after surgery.

Researchers observed a trend, although not statistically significant, between mild cognitive impairment before STN-DBS and progression to dementia according to the patients’ age, sex, and education at the beginning of the study.

Compared with non-demented Parkinson’s patients, those with dementia had longer disease duration (15 years versus 20.2 years, respectively) and more severe motor impairments (UPDRSm score of 23.7 versus 36.1), with demented patients showing a faster progression of several typical Parkinson’s symptoms — bradykinesia (slowness of movement), rigidity, impaired speech, posture, gait, and postural stability.

In general, researchers observed a decline in cognition, including memory and language, in all STN-DBS-treated patients in the 6.3 years after surgery. However, partial working memory (also referred to as short-term memory) was preserved and slightly improved in some cases.

Disease duration, but not age, at the time of DBS surgery had a significant relation to the risk of developing dementia.

“This observational, ‘real-life’ study provides long-term results of cognitive decline in STN-DBS-treated patients with presurgical [mild cognitive impairment] possibly predicting the conversion to dementia,” the researchers wrote.

“Although, the present data is lacking a control group of medically treated PD [Parkinson’s disease] patients, comparison with other studies on cognition and PD do not support a disease-modifying effect of STN-DBS on cognitive domains,” they concluded.

https://parkinsonsnewstoday.com/2019/02/01/deep-brain-stimulation-increased-risk-dementia/