What are neurotransmitters?

By Jennifer Berry   October 11, 2019

Neurotransmitters are chemical messengers in the body. Their job is to transmit signals from nerve cells to target cells. These target cells may be in muscles, glands, or other nerves.

The brain needs neurotransmitters to regulate many necessary functions, including:

• heart rate
• breathing
• sleep cycles
• digestion
• mood
• concentration
• appetite
• muscle movement

The nervous system controls the body's organs, psychological functions, and physical functions. Nerve cells, also known as neurons, and their neurotransmitters play important roles in this system.

Nerve cells fire nerve impulses. They do this by releasing neurotransmitters, which are chemicals that carry signals to other cells.

Neurotransmitters relay their messages by traveling between cells and attaching to specific receptors on target cells.

Each neurotransmitter attaches to a different receptor — for example, dopamine molecules attach to dopamine receptors. When they attach, this triggers action in the target cells.

After neurotransmitters deliver their messages, the body breaks down or recycles them.

Key types of neurotransmitters

Experts have identified more than 100 neurotransmitters to date.

Neurotransmitters have different types of action:

• Excitatory neurotransmittersencourage a target cell to take action.
• Inhibitory neurotransmittersdecrease the chances of the target cell taking action. In some cases, these neurotransmitters have a relaxation-like effect.
• Modulatory neurotransmitters can send messages to many neurons at the same time. They also communicate with other neurotransmitters.

Some neurotransmitters can carry out various functions, depending on the type of receptor that they are connecting to.

The following sections describe some of the best-known neurotransmitters.

Acetylcholine

Acetylcholine triggers muscle contractions, stimulates some hormones, and controls the heartbeat. It also plays an important role in brain function and memory. It is an excitatory neurotransmitter.

Low levels of acetylcholine are linked with issues with memory and thinking, such as those that affect people with Alzheimer's disease. Some Alzheimer's medications help slow the breakdown of acetylcholine in the body, and this can help control some symptoms, such as memory loss.

Having high levels of acetylcholine can cause too much muscle contraction. This can lead to seizures, spasms, and other health issues.

The nutrient choline, which is present in many foods, is a building block of acetylcholine. People must get enough choline from their diets to produce adequate levels of acetylcholine. However, it is not clear whether consuming more choline can help boost levels of this neurotransmitter.

Choline is available as a supplement, and taking high doses can lead to serious side effects, such as liver damage and seizures. Generally, only people with certain health conditions need choline supplements.

Dopamine

Dopamine is important for memory, learning, behavior, and movement coordination. Many people know dopamine as a pleasure or reward neurotransmitter. The brain releases dopamine during pleasurable activities.

Dopamine is also responsible for muscle movement. A dopamine deficiency can cause Parkinson's disease.

A healthful diet may help balance dopamine levels. The body needs certain amino acids to produce dopamine, and amino acids are found in protein-rich foods.

Meanwhile, eating high amounts of saturated fat can lead to lower dopamine activity, according to research from 2015. Also, certain studiessuggest that a deficiency in vitamin D can lead to low dopamine activity.

While there are no dopamine supplements, exercise may help boost levels naturally. Some research has shown that regular exercise improves dopamine signaling in people who have early stage Parkinson's disease.

Endorphins

Endorphins inhibit pain signals and create an energized, euphoric feeling. They are also the body's natural pain relievers.

One of the best-known ways to boost levels of feel-good endorphins is through aerobic exercise. A "runner's high," for example, is a release of endorphins. Also, researchindicates that laughter releases endorphins.

Endorphins may help fight pain. The National Headache Foundation say that low levels of endorphins may play a role in some headache disorders.

A deficiency in endorphins may also play a role in fibromyalgia. The Arthritis Foundation recommend exercise as a natural treatment for fibromyalgia, due to its ability to boost endorphins.

Epinephrine

Also known as adrenaline, epinephrine is involved in the body's "fight or flight" response. It is both a hormone and a neurotransmitter.

When a person is stressed or scared, their body may release epinephrine. Epinephrine increases heart rate and breathing and gives the muscles a jolt of energy. It also helps the brain make quick decisions in the face of danger.

While epinephrine is useful if a person is threatened, chronic stress can cause the body to release too much of this hormone. Over time, chronic stress can lead to health problems, such as decreased immunity, high blood pressure, diabetes, and heart disease.

People who are dealing with ongoing high levels of stress may wish to try techniques such as meditation, deep breathing, and exercise.

Anyone who thinks that their levels of stress could be dangerously high or that they may have anxiety or depression should speak with a healthcare provider.

Meanwhile, doctors can use epinephrine to treat many life threatening conditions, including:

• anaphylaxis, a severe allergic reaction
• asthma attacks
• cardiac arrest
• severe infections

Epinephrine's ability to constrict blood vessels can decrease swelling that results from allergic reactions and asthma attacks. In addition, epinephrine helps the heart contract again if it has stopped during cardiac arrest.

GABA

Gamma-aminobutyric acid (GABA) is a mood regulator. It has an inhibitory action, which stops neurons from becoming overexcited. This is why low levels of GABA can cause anxiety, irritability, and restlessness.

Benzodiazepines, or "benzos," are drugs that can treat anxiety. They work by increasing the action of GABA. This has a calming effect that can treat anxiety attacks.

GABA is available in supplement form, but it is unclear whether these supplements help boost GABA levels in the body, according to some research.

Serotonin

Serotonin is an inhibitory neurotransmitter. It helps regulate mood, appetite, blood clotting, sleep, and the body's circadian rhythm. Seasonal affective disorder (SAD) causes symptoms of depression in the fall and winter, when daylight is less abundant. Research indicates that SAD is linked to lower levels of serotonin.

Serotonin-norepinephrine reuptake inhibitors (SNRIs) increase serotonin and norepinephrine, which is another neurotransmitter. People take SNRIs to relieve symptoms of depression, anxiety, chronic pain, and fibromyalgia.

Some evidence indicates that people can increase serotonin naturally through:

• being exposed to bright light, especially sunlight
• vigorous exercise

A precursor to serotonin, called 5-hydroxytryptophan (5-HTP), is available as a supplement. However, some research has found that 5-HTP is not a safe or effective treatment for depression and can possibly make the condition worse.

Summary

Neurotransmitters play a role in nearly every function in the human body.

A balance of neurotransmitters is necessary to prevent certain health conditions, such as depression, anxiety, Alzheimer's disease, and Parkinson's disease.

There is no proven way to ensure that neurotransmitters are balanced and working correctly. However, having a healthful lifestyle that includes regular exercise and stress management can help, in some cases.

Before trying a supplement, ask a healthcare provider. Supplements can interact with medications and may be otherwise unsafe, especially for people with certain health conditions.

Health conditions that result from an imbalance of neurotransmitters often require treatment from a professional. See a doctor regularly to discuss physical and mental health concerns

https://www.medicalnewstoday.com/articles/326649.php

4-PART PROTOCOL IMPROVES CARE, LOWERS COSTS FOR HOSPITALIZED PARKINSON'S PATIENTS

BY CHRISTOPHER CHENEY  |   OCTOBER 09, 2019

Medication management is the primary focus of a new care protocol for Parkinson's disease patients in the hospital setting.

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KEY TAKEAWAYS

Medication adherence is essential for people with Parkinson's disease, with delays in drug administration as short as 15 minutes impacting symptoms.

A new Parkinson's care protocol at Hackensack University Medical Center decreased length of stay from 7.125 days in 2017 to 6.750 days in 2018.

The care protocol also decreased the hospital readmissions rate for Parkinson's patients from 13.9% in 2017 to 12.8% in 2018.

Caring for hospital patients who have Parkinson's disease poses challenges for hospitals and health systems, but a new protocol drives significant clinical and financial benefits.

Research has shown that hospitalized Parkinson's patients have higher costs of care compared to patients without the disease, including longer lengths of stay and higher medication costs. A New Jersey-based healthcare organization has worked to improve these metrics.

In 2017, Hackensack University Medical Center in Hackensack, New Jersey, formally launched a strict medication adherence protocol for Parkinson's. In June 2018, the protocol was recognized by The Joint Commission as the Disease-Specific Certification in Parkinson's Disease.Medication adherence is crucial in the care and daily functioning of people with Parkinson's, says Hooman Azmi, MD, director of the Division of Functional and Restorative Neurosurgery at Hackensack University Medical Center.

"Patients with Parkinson's have a significant reliance on their medication. Most patients with Parkinson's develop motor symptoms such as rigidity, stiffness, difficulty moving, and tremors. Rigidity and difficulty moving are particularly debilitating. The patients require their medicine for these symptoms to go away," he says.

In the outpatient setting, patients with Parkinson's work closely with neurologists to develop finely crafted medication regimens, Azmi says.

"When someone has Parkinson's for a long time, the management of symptoms becomes challenging because the effect of medicine is not long-lasting, and it becomes shorter and shorter. They end up requiring more and more doses of medicine. Sometimes, patients take medicine every three hours—or every two hours—around the clock. If patients don't take their medicine or the medicine is delayed, their symptoms can come out. Basically, they can go from being mobile to almost not being able to move," he says.

The strict medication adherence protocol for Parkinson's developed at Hackensack University Medical Center has generated statistically significant reductions in length of stay and hospital readmissions:

• Length of stay for all Parkinson's patients at the hospital decreased from 7.125 days in 2017 to 6.750 days in 2018.
   
• The readmissions rate for Parkinson's patients decreased from 13.9% in 2017 to 12.8% in 2018.
• 
  
• Hackensack University Medical Center's four primary components of the  medication adherence protocol are as follows:

1. PATIENT IDENTIFICATION

Most patients with Parkinson's do not go to a hospital for treatment of the disease, so identifying them and their underlying condition can be a challenge, Azmi says.

"They come into the hospital for everything that everybody else comes into the hospital for—they come in for back pain, kidney stones, heart attacks, and all kinds of conditions. The Parkinson's can be missed in the shuffle because caregivers will focus on the main reason why the patient came to the hospital. So, strict adherence to the Parkinson's medication can be completely misplaced and patients don't get their medication on time, which compounds their problems in the hospital," he says.

HMHUMC is using the hospital's electronic medical record to identify Parkinson's patients, Azmi says. "Whenever a doctor or nurse opens a chart of a patient who has Parkinson's, a flag comes up identifying the patient with the disease. Then care plans are included in the electronic record including the timing of medication and contraindicated medicine."

Delays in administering Parkinson's medications as short as 15 minutes can "wreak havoc," he says.

2. METRICS TO ASSESS MEDICATION

MANAGEMENT
 

To help ensure strict adherence to medication regimens, the hospital monitors several metrics for Parkinson's patients, Azmi says. "The metrics include patient identification, making sure all of the medicines are in the formulary, and making sure that patients get medication in the customized fashion that they get at home—we don't put in default medication regimens. We also have a metric to make sure patients are not getting contraindicated medication."

Close monitoring of the metrics impacts patient care, he says.

"Every time an order is placed for a Parkinson's medication, we make sure the order is placed in a customized fashion. We track the number of customized orders versus non-customized orders, and we try to correct inappropriate orders in real time. With contraindicated medications, we follow up when these medications are ordered. We work very hard to prohibit the ordering of these medications for Parkinson's patients."

3. METRICS EVALUATION AND IMPLEMENTATION OF ACTION PLANS
 

When care teams find that metrics performance needs to be improved for patients, the hospital's Disease-Specific Committee for Parkinson's Disease develops improvements through implementation of action plans, Azmi says.

"Sometimes, there is an issue in a part of the hospital, so we educate the staff in that area. There may be an instance when the pharmacy needs to develop options when certain medications are ordered. Through the disease-specific committee, we have been able to look at the data, assess it, then come up with plans to improve the compliance," he says.

4. EDUCATION
 

Staff throughout the hospital has received education and training for the strict medication adherence protocol, including physicians, advanced practice practitioners, nurses, physical therapists, radiation technologists, and pharmacists.

"Everyone needs to be aware about the importance of medication and avoiding contraindicated medication," Azmi says.

The education and training have been provided in several formats such as webinars, surveys, and a variety of grand rounds for nurses and physicians. "It's an ongoing educational process—it must be continuous because managing these patients poses problems on a continuous basis," he says.

The key to success of the strict medication adherence protocol has been the hospital-wide approach, Azmi says.

"It's a cliché to say it takes a village to raise a child, but it takes an entire hospital to care for one patient. Everything we do for this patient population translates to the entire hospital. This protocol makes us better, and it takes many people from different parts of the hospital—from physicians, to nursing, to physical therapy, to the pharmacy, to regulatory staff, to quality officers. It is truly an interdisciplinary effort to launch an initiative like this throughout the hospital. But it translates into better patient care and financial savings for the hospital."

Azmi is the co-author of a 2018 book about Parkinson's care in the hospital setting, Parkinson's Disease for the Hospitalist: Managing the Complex Care of a Vulnerable Population.

https://www.healthleadersmedia.com/clinical-care/4-part-protocol-improves-care-lowers-costs-hospitalized-parkinsons-patients

Letting Go Is Not ‘Forever Gone’

 OCTOBER 11, 2019  BY DR. C 

“Letting go” is a constant theme with Parkinson’s disease. What used to be easy is now challenging. Gone are my days of hiking for miles or spending hours in the gardens digging, hauling, lifting. Those times when 24 hours of project immersion got me through complex problem-solving and four college diplomas are over. I can’t do it the same way anymore. Giving up these expectations of myself has not been easy, and the process of letting go always presents itself at sanctuary’s door. It is never entirely gone.

Psychology Today columnist Judith Sills, PhD, explains that we tend to get stuck in our past, but by letting go we can move forward. “It’s an axiom of psychology that we are some recombination of all of our yesterdays. To move forward wisely, we are therefore often urged to look back. But there’s a point where appreciation and analysis of the past become gum on your psychological shoe. It sticks you in place, impedes forward motion, and, like gum, it doesn’t just disappear on its own. You need to do some scraping.”

American poet and philosopher Ralph Waldo Emerson said, “A foolish consistency is the hobgoblin of little minds.” When you can’t let go, you are haunted by the hobgoblin. If you let go and have nothing to replace it, the hobgoblin will rush to fill the void. Sanctuary holds safety and sacredness in place of the void allowing the possibility of well-being to unfold.

Letting go is learning to live with the bad things that happen — not by eradicating memory, but by shifting attention and perception. In my quest to let go and accommodate chronic Parkinson’s symptoms, I turn to sanctuary. I know when I am using sanctuary appropriately because I run smack into resistance. It is extremely hard to let go of old habits, old scars, and old voices playing on old tapes. The path of letting go is full of detours and wrong turns. I’m always learning more about how to let go. It is a process, and it’s never done.

Writing on Psych Central, John M. Grohol identifies some key steps in the “letting go” process:

1. Decide to let it go.
2. Express your pain — and your responsibility.
3. Stop being the victim and blaming others.
4. Focus on the present — the here and now — and joy.
5. Forgive others and yourself.

Throughout our lives, much of our self-identity is defined by what we do rather than who we are. Strip away the things that we could do, and we feel naked without the career clothes we used to wear. Social conversation often turns to, “What do you do for a living?” I want to reply, “I’m just trying to survive.” People who still see me as the person I was can’t see my struggle with letting go that drains my energy and creates overwhelming fatigue.

Family, friends, and some medical providers often do not fully understand how letting go carves away the substance of identity, whittling it down to a splinter. The following quote sums it up for me: “Those who mind don’t matter and those who matter don’t mind.” It results in more loss thrown on a plate already overflowing with dead bones.

Letting go occurs for me on many levels, affecting my sensations, emotions, thoughts, and pain. Sanctuary is not merely a place to “feel good.” It gives me the strength and calmness to face my demons, mourn losses, move forward into the future, and find peace with myself and those around me. Letting go is not losing entire memories even when they’re interwoven with the hard times. Letting go is not forever gone. It remains at sanctuary’s door opening the possibility of well-being.

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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/2019/10/11/letting-go-sanctuary-fatigue-acceptance/

FIRE-UP PD Initiative Seeks to Increase Inclusivity in Parkinson’s Research

OCTOBER 11, 2019 BY MARY CHAPMAN IN NEWS.

The Michael J. Fox Foundation (MJFF) and Massachusetts General Hospital have announced an initiative to enhance diversity in Parkinson’s disease research.

Fostering Inclusivity in Research Engagement for Underrepresented Populations in Parkinson’s Disease (FIRE-UP PD) is an MJFF-funded study that will establish and assess outreach programs in Boston, Massachusetts, Weston, Florida, Denver, Colorado, and Chicago, Illinois. Massachusetts General’s Community Access, Recruitment and Engagement (CARE) Research Center is coordinating the effort.

“Parkinson’s research has made significant strides toward better diagnostics and new treatments in past decades, but most research has included only a subset of patients with a common European ancestry,” said Sohini Chowdhury, MJFF deputy CEO, in a press release.

“Imagine where we would be with a more holistic view of the disease. This program aims to broaden the vital partnership between researchers and the people living with Parkinson’s, each and every one,” Chowdhury said.

Jonathan Jackson, the CARE Research Center’s founding director and FIRE-UP PD principal investigator, said that because PD is such a varied disease and affects each person differently, both in terms of symptoms and disease progression, research inclusivity is key.

“When we include people from all backgrounds in Parkinson’s research, we better understand the disease itself, improving our chances at finding treatments that work for everyone. FIRE-UP PD is unique in its attention to diversity in Parkinson’s research and its application of community-based methods across all geographic regions,” he said.

Four academic centers will develop community-centered interventions to produce culturally sensitive messaging and resources that educate and engage around Parkinson’s research. The sites and programs include:

Boston Medical Center: Researchers will partner with community health centers to engage Boston’s Haitian and African American communities by using educational tools emphasizing the importance of Parkinson’s research  and diagnosis.

Cleveland Clinic in Weston, Florida: The focus at this site is southern Florida’s Hispanic communities, and engagement through educational seminars and collaboration with area support groups.

University of Colorado: Through a method called Boot Camp Translation, which recruits healthcare professionals and community members to translate medical information for local populations, investigators will address health literacy in Hispanic and lower-income populations.

Northwestern University, Chicago: A stakeholder partnership of patients, community leaders, caregivers and physicians will conduct focus groups and create community-specific educational toolkits for Hispanic, African American and lower-income residents.

In addition to enhancing disease awareness and fostering trust in Parkinson’s  research participation, the programs hope to promote enrollment in MJFF’s Fox Insight, an online clinical study aimed at building a large, diverse group  of Parkinson’s patients and age-matched control volunteers to gain insight into the disease’s experience, genetics and variability.

To that end, sites in Minneapolis, Minnesota, San Francisco, California, Chicago and Kirkland, Washington will offer Fox Insight materials exclusively in their clinics in order to compare conventional outreach methods with those of the intervention sites.

https://parkinsonsnewstoday.com/2019/10/11/fire-up-pd-initiative-increase-inclusivity-parkinsons-research/

Genetic Parkinson’s More Common Than Thought, Global Survey Reveals

OCTOBER 11, 2019 BY ALICE MELÃO

Cases of inherited Parkinson’s disease may be more frequent than previously reported, results from an online global survey suggest.

The survey, which was conducted by members of The Michael J. Fox Foundation Global Genetic Parkinson’s Study Group (MJFF-GGPSG), also revealed the willingness of investigators to share clinical information on their patients that could be useful to conduct broader and more inclusive studies.

These findings suggest it is necessary to improve the way investigators communicate and assess clinical data. It also highlights the need of new integrative research approaches that can empower teams to enhance the understanding and recognition of genetic mutations contributing to the development of Parkinson’s disease. This could be an important step to improve early diagnosis and define preventive strategies.

The results, “Identifying genetic Parkinson’s disease patients worldwide: Exploiting novel ways of team science,” were presented as a scientific poster during the International Congress of Parkinson’s Disease and Movement Disorders in Nice, France.

“This initiative is of high relevance because it is becoming increasingly clear that even relatively common diseases like Parkinson’s disease are highly etiologically heterogeneous syndromes and that progress towards early diagnosis and causative treatments will depend on the identification of sufficient numbers of well-defined subgroups,” Thomas Gasser, MD, said in a press release. Gasser is director of the department of neurodegeneration at Hertie Institute for Clinical Brain Research, in Tuebingen, Germany.

“This will only be possible by collaborations at a very large, preferably worldwide scale,” he said.

The survey, which was conducted in 2018, was designed to evaluate the availability of demographic, clinical, genetic, and additional data of patients with genetic Parkinson’s disease. It included cases caused by SNCA, LRRK2, VPS35, PRKN, PINK1, PARK7, and GBA mutations.

MJFF-GGPSG researchers addressed the survey to 336 investigators who were selected based on articles that had been published about the subject and were represented at the Movement Disorder Society Genetic mutation database (MDSGene), and through the Genetic Epidemiology of Parkinson’s disease (GEoPD) consortium.

Of the 336 investigators invited to participate in the survey, 162 (48%) responded, 98% of whom indicated interest in further collaboration.

“The overwhelmingly positive response and willingness to collaborate impressively highlight the relevance and power of team science,” the researchers wrote.

Researchers reported information from a total of 8,453 Parkinson’s patients with genetic mutations; more than nine different ethnicities were followed at 103 international sites across 43 countries.

Overall, mutations in the SNCA, VPS35, PINK1, and PARK7 genes were present in 3% (263 patients), 0.4% (35 patients), 3% (260 patients) and 0.3% (29 patients) of this patient population.

The most commonly affected genes were LRRK2, GBA, and PRKN, with mutations present in 38% (3,182 patients), 37% (3,154 patients), and 18% (1,530 patients).

These frequencies are particularly significant given that they represent a threefold higher number of patients with mutations associated with Parkinson’s disease when compared to the cases reported in the literature.

More than 98% of investigators who responded to the survey noted they had demographic data on their patients, with 94% of them having age-at-onset information, and only 66% reported having information on patients’ non-motor signs.

Most investigators (85%) had DNA samples from the patients, while only 8% had cerebrospinal fluid (CSF) samples. (CSF is the liquid that surrounds the brain and spinal cord.)

“This survey is only a very first small step. If international team science is to become successful, many problems concerning standardization of patient ascertainment, data privacy and protection as well as data access and use need to be solved,” Gasser said.

“Nevertheless, the survey raises awareness of these issues and it clearly shows that the Parkinson’s disease research community is ready to begin to tackle these important issues,” he said.

https://parkinsonsnewstoday.com/2019/10/11/genetic-pd-more-common-than-thought-survey-shows/