Parkinson’s: let there be light

October 26, 2019     By SUVI MAHONEN

Margaret Jarrett in the garden of her home in Adelaide. Picture: Morgan Sette

Margaret Jarrett was diagnosed with Parkinson’s disease eight years ago. And although she was bothered by many of the ­symptoms that commonly afflict Parkinson’s sufferers — resting tremor, uncertain gait and terribl­e nightmares — one thing that bothered her most was the loss of her sense of smell. 

An avid gardener, she took great pride in her rose garden, but being unable to inhale the flowers’ perfumed scent really got her down. “You take something like your sense of smell for granted,” said Mrs Jarrett, 73.

“You don’t realise how precious something is until it’s gone.”

Parkinson’s disease is a combination of movement disorders including resting tremor, muscle rigidity, impaired balance and slowness of movement. It can also cause neurological problems such as depression, insomnia, memory loss and confusion.

Its cause is unknown but it is associated with dopamine deple­tion and the destruction of neurons­ in the basal ganglia ­region of the brain.

The current mainstay of treatment for Parkinson’s disease involves­ physical therapy and medications that act to increase dopamine levels in the brain. One relatively new avenue of potential treatment for the disease is expos­ure to infrared light therapy.

In 2017, I wrote an article published in The Weekend Australian Magazine titled “Let there be light” about a group of patients in Tasmania who were trialling infrare­d light therapy for their Parkinson’s disease.

The response was overwhelming, with scores of people contacting me, the newspaper and resear­ch­ers named in the article, to request further information.

One person whose interest was piqued was Olivia Nassaris, the chief executive of Parkinson’s South Australia. “When the article was released, it created this massive buzz and I had so many members of my community wanting more information about it,” she told me.

Ms Nassaris contacted Ann Liebert, co-ordinator of photo­molecular research at the Australasian Research Institute, Sydney, who informed her of an upcoming planned trial on infrared light therapy for Parkinson’s disease.

Ms Nassaris subsequently persuad­ed the board of Parkinson’s South Australia to partially fund the trial, on the understanding that at least some of the participants would be from South Australia. In addition to assessing the effectiveness of infrared light therapy for Parkinson’s disease, Dr Liebert also wished to see if exposu­re to infrared light could modulate the gastrointestinal tract’s microbiome in humans.

The science

The gut’s microbiome — composing the trillions of bacteria, fungi and protozoa from hundreds of different species that normally inhabit our gastrointestinal tract — has come under increasing scientific attention over the past decade, with links being established between the microbiome and a number of conditions including obesity, Type 2 diabetes, cardiovascular disease and depression.

Several studies have also observ­ed that the gut microbiome is markedly altered in patients with Parkinson’s disease and that faecal microbiota transplantation can have a protective effect in ­animal models of Parkinson’s.

The reason for this is unknown­; however, an interesting observation is that another common­ pathology seen in Parkinson’s disease is the accumulation of misfolded αa-synuclein proteins, called Lewy bodies, in the brain.

It has been shown that certain sensory cells of the gut contain αa-synuclein. Researchers have hypothesised that it is possible that abnormal forms of the αa-­synuclein protein could travel from the gut to the brain through the vagus nerve, a phenomenon that has been shown in animal models of Parkinson’s.

Further support for this theory comes from findings that people who have had a surgical vagotomy — where branches of the nerve are cut — have a lower lifetime risk of developing Parkinson’s.

“We know that infrared light can reduce Parkinson’s symptoms and offer protection to brain cells. So, we wanted to test if it could modulate the gut’s microbiome as well,” Dr Liebert said.

One of the principal researchers in Dr Liebert’s planned study, Daniel Johnstone, scientist and lecturer at the University of ­Sydney’s Bosch Institute, had previously undertaken a study showing that exposure to infrared light altered the gut microbiome in mice. “One possibility might be that we’re somehow influencing the microbes in the gut, and that’s having an effect on the brain,” Dr Johnstone said.

Based on the mouse study findings, Dr Liebert and Brian Bicknell, honorary fellow in the faculty of health sciences at the Australian Catholic University, conduct­ed a case study last year that showed that infrared light could modulate the human microbiome as well.

In the study, a subject received infrared light therapy to the ­abdomen three times a week for 12 weeks. Faecal sampling showed an increase, after therapy, of some bacteria that are considered beneficia­l to the gastrointestinal tract, including Akkermansia muciniphil­a, Bifidobacterium and Faecalibacterium.

Dr Liebert wished to see if this finding could be replicated in patient­s with Parkinson’s and a dozen participants each from Sydney and Adelaide were selected, including Mrs Jarrett.

The findings

Provisional results, from the first half-dozen Adelaide participants to have their gut microbiome analysed­, before treatment and 12 weeks after treatment began, have been promising.

Cardiac Health Institute medical director and professor of cardiology at Macquarie University, Hosen Kiat, who oversaw the trial, told The Weekend Australian that the six patients put through a similar protocol as the mice showed an increase by up to 20 per cent “in the favourable micro­biome which is associated with obesity reduction and short-chain fatty acid production’’.

The bacteria associated with rheumatoid arthritis, Crohn’s disease and insulin resistance also “all decreased”.

Mrs Jarrett regained her sense of smell. “For the last three years I haven’t been able to smell flowers,” she said. “But several weeks into the trial I started to smell my roses, daphnes and gardenias again and it was wonderful.”

Another participant, Barry Weldon, 70, had a similar experience. “My sense of smell improved significantly,” he said. “One day I walked into the house and for the first time in a long time I could actuall­y smell the soup my wife was cooking.”

Ron Till, 68, had an even more dramatic improvement. “The trial gave me the ability to sleep again,” he said. “It was amazing.”

Mr Till’s neurologist cautioned him not to get his hopes up before the trial but changed his mind when he saw the results. “He told me it was voodoo medicine and probably wouldn’t work,” Mr Till said. “But after the trial I went back for my three-monthly assessment with him, and he said to me: ‘You’re ­actually testing better than when you first started with me 10 years ago.’ ”

Retired geologist Sean Kennedy­, 76, also experienced an improvement in his co-ordination and balance. “My juggling skills have improved,” he said.

In a review published this week in Photobiomodulation, Photo­medicine, and Laser Surgery, titled­ Photobiomics: Can Light, Including Photobiomodulation, Alter the Microbiome?, Dr Liebert and her co-authors acknowledge that while the exact mechanism by which light therapy alters the microbiome is unknown, there is definite potential in light therapy.

“The ability of PBM (light therapy) to influence the microbiome (if proven to be applicable to humans­) will allow an additional therapeutic route to target multiple diseases, including cardiovascular disease and Parkinson’s disease, many of which have thus far eluded effective treatment approache­s,” the paper concludes.

The future

Professor Kiat is excited by light therapy’s potential. “If we can create­ non-invasively a metabol­ically healthier microbiome through this extremely cheap and easy way, then inflammatory disease­s and neurodegenerative diseases should be positively influence­d,” he said.

Gold Coast-based GP Mark Jeffery is a clinician who has been using lasers in his practice for more than four years. He says the research supports the use of light therapy for a wide range of ­diseases including Parkinson’s, Alzheimer’s, depression and chronic pain. “The reality is there are no real side-effects from low-level laser therapy and it’s one of the safest treatments you can ever do,” Dr Jeffery said.

Dr Liebert said the promising results seen thus far would inform a large, double-blind randomised control trial planned for 2020. “It has the potential to apply to huge fields of medicine,” she said.

Mr Weldon’s neurologist, Chris Kneebone, is keeping an open mind on the potential of ­infrared light therapy. “We all just have to wait and see what the trial results tell us,” he said.

He had advice for people who wished to give it a try for their Parkinson­’s. “If you want to give it a go, give it a go,” he said. “I’ve got no reason not to recom­mend it, but at this stage I’ve got no reason to think it is helpful either.”

As for Mrs Jarrett, she has no doubts that infrared light therapy has helped her. She is enjoying pottering around in her garden again and has more energy than she has had for a long time.

“I feel like I could take on the world again,” she said. “My garden has never looked better.”

https://www.theaustralian.com.au/science/parkinsons-let-there-be-light/news-story/0e02406336b7501ec6d7e8b3a6cc64d0

Visual Dysfunction: An Underrecognized Symptom of Parkinson's?

 October 25, 2019         Sue Hughes

Visual symptoms are a potentially underrecognized and undertreated cause of reduced quality of life in Parkinson disease patients, a new study suggests.

By analyzing data from a large population health survey, researchers from the University of Pennsylvania, Philadelphia, found that visual dysfunction is significantly more common in individuals with Parkinson disease than in the general adult population.

"The idea that visual symptoms may be associated with Parkinson's disease is not new, but this is the first time it has been reported on a population level," lead author Ali Hamedani, MD, told Medscape Medical News.

"In a survey of more than 150,000 individuals, we found that people with a diagnosis of Parkinson's disease were more than twice as likely to report impairment in eyesight than those without a Parkinson's diagnosis, and there were similar increases in long distance or near vision," he noted.

"I think our data confirm what people have already suspected ― that Parkinson's disease is associated with visual impairment ― but this is the largest study ever done to look at this association," he added.

The study was published online October 19 in the European Journal of Neurology.

Problems with vision in Parkinson's disease patients are increasingly being recognized by the patients themselves, their caregivers, and by physicians on a local level, but the problem hasn't been studied comprehensively or documented in large-scale studies before, Hamedani explained.

"We wanted to look in a large cohort of people how visual dysfunction related to Parkinson's disease," he said.

To do this, he and colleague Allison Willis, MD, analyzed data from adults aged 50 years or older from the Survey of Health, Ageing and Retirement in Europe (SHARE), a multinational population-based health survey of adults living in one of 27 European countries and Israel. The survey asked questions about a spectrum of health issues, including medical conditions that had been diagnosed, visual problems, as well as demographic information and other factors.

The diagnosis of Parkinson disease was self-reported. Impairment in overall, distance, or near eyesight was defined as a score of 4 or 5 on a 1–5 scale.

Adjusted logistic regression was used to determine the association between Parkinson disease and self-reported vision.

Results showed that among the 115,240 age-eligible participants in the SHARE study (mean age, 64.3 years), 1438 (1.25%) reported a diagnosis of Parkinson disease.

In adjusted logistic regression models, Parkinson disease was associated with increased odds of impaired overall eyesight (odds ratio [OR], 2.67), distance vision (OR, 2.55), and near vision (OR, 2.07).

Individuals with Parkinson disease were also less likely to report having had an eye examination within the previous 2 years (OR, 0.59), but this did not remain statistically significant after adjusting for confounders."This result will provide greater awareness that visual symptoms can be an issue in Parkinson's disease," Hamedani said.

He noted that they did not have information on the duration of Parkinson's in this study, so it was not possible to determine whether vision dysfunction is an early symptom or a later symptom of the condition.

"Ultimately, there may be guidelines for people with Parkinson's disease specific for screening and treatment of visual symptoms, but there is a lot more work to be done before we get there," Hamedani suggested.

"At present, I think we can say that visual dysfunction is something to look out for in Parkinson's disease patients, but the exact nature and significance of these symptoms are not yet clear. And we don't know whether the mechanism is a result of Parkinson's-associated changes in the brain or in the eye."

He noted that there have been some suggestions of a subtle change in color vision in the years before Parkinson's is diagnosed, but patients themselves are unlikely to notice this. "It would have to be uncovered by screening, but it is too early for any recommendations on this," Hamedani said.

"I would say that at present, our results would prompt clinicians to pay more attention to the eyes in Parkinson's patients. They should ask patients if they are having any visual problems and encourage patients to get regular eye examinations. Preventative eye examinations are important for all older adults, especially for patients with Parkinson's disease and similar conditions.

"Eye problems in Parkinson's patients can be numerous and can include dry eyes, double vision, difficulty reading. But the current study didn't address exactly what the issues were."

He added that dry eyes are common in Parkinson's patients because the spontaneous blink reaction is reduced in persons with the condition. Double vision is caused by misalignment of the eyes, and this could be due to problems in areas of the brain involved in coordinating eye movement.

The researchers are planning further work to investigate the specific visual symptoms associated with Parkinson's and how vision affects outcomes such as falls, hallucinations, and cognition.

"I think we need to be thinking outside the box on these outcomes, which may well be reduced by addressing vision issues," Hamedani said.

"Given the important role that vision plays in overall quality of life and the association between vision loss and falls, hip fracture, depression, anxiety, and dementia, visual dysfunction in Parkinson's disease is a significant public health finding regardless of its cause," the researchers add.

Hamedani and Willis receive research support from the National Institutes of Health.

https://www.medscape.com/viewarticle/920438#vp_2

Innovative "LaserCue" Co-created by InStep Mobility & Michael J. Fox, Helps Parkinson's Patients with Freezing & Falls

October 23, 2019  

 New patent-pending cane-attachment module co-created by InStep Mobility and Michael J. Fox assists with "gait freezing" and falls for those with Parkinson's.

Projected Laser Lines on the ground help Parkinson's Patients avoid Gait Freezing and Falls.

The LaserCue Attachment Module

The LaserCue Attachment Module can be attached to virtually any cane.

CHICAGO, IL, USA, October 23, 2019 /EINPresswire.com/ -- In-Step Mobility Launches the Innovative "LaserCue," Co-created with Michael J. Fox

Unique cane-attachment helps those with Parkinson's to reduce gait freezing and falls.

Chicago, IL - In-Step Mobility (www.ustep.com)

In-Step Mobility is launching this month the patent-pending “LaserCue”, a module that attaches to virtually any cane, that projects a red laser line onto the floor. While scientists still theorize as to why it works, a line projected on the floor in front of a person has been proven to reduce “gait freezing” in Parkinson’s patients. 

Beth Israel Deaconess Medical Center and Harvard Medical School published a study showing that “adding a laser light visual cue to a cane or walker can lead to a modest reduction in FOG (Freezing) and may substantially reduce the frequency of falls in PD patients with FOG (Freezing).” 

For twenty-five years, In-Step Mobility has been producing a variety of mobility aids for those with severe walking problems resulting from neurological conditions, including Parkinson’s disease, Multiple Sclerosis, Muscular Dystrophy, Ataxia, Stroke, Brain Injuries and PSP. Both U-Step walkers and the LaserCane incorporate this laser cueing technology. Over 30,000 people have benefited from this technology over the past fifteen years.

One of our customers who benefitted from the LaserCane suggested a variation of the product, which spurred us to invest in the R & D required to introduce this module today. That customer was “Michael J. Fox, letting us know that it would be great if we could offer the laser cueing technology on any cane a person chooses.” 

“Almost every new product or feature has come about because of a customer request.” Jonathan Miller, Founder and President of In-Step Mobility explains, “Each time a customer asks if we can change or add something we try to figure out how to say ‘yes’, because it is often a feature others would appreciate. So we try to make these custom modifications permanent offerings or in cases like this, new products.”  

So Jonathan invited Mr. Fox to share his ideas on an ongoing basis in the development of the product. Through several meetings, they agreed upon the current design. “These meetings were extremely helpful in me understanding his vision for the product. He had a lot of good ideas that I incorporated into the final product” Said Jonathan.

LaserCue is a free-standing module that can be attached to any cane between ¾” -7/8” thick. It sports a streamlined design that is ordered as a right and left-handed unit. It is offered with either a black or clear cover, to suit individual tastes.  

Michael J. Fox says: “This is a breakthrough product for Parkinson’s patients with freezing issues, producing a laser line that motivates you to step up and over and thus regain the rhythm of your stride. It also helps in the dark when footing is uncertain. Jonathan Miller at In-Step developed this invaluable resource for patients with PD and other movement disorders and allowed me to contribute my thoughts and ideas along the way. I really think that this product could change and possibly even save lives.” 

“It has been a pure honor to work on this product with Mr. Fox, who has not only been a customer, but an important voice for the Parkinson’s Community for many years.”  

Jonathan and the In-Step company have decided to donate a portion of the proceeds from every purchase of the new LaserCue to The Michael J. Fox Foundation for Parkinson’s Research (MJFF), the world’s largest nonprofit funder of Parkinson’s research. 

About In-Step Mobililty: In-Step Mobility develops advanced mobility aids for those with severe walking problems resulting from neurological conditions, including Parkinson’s Disease, Multiple Sclerosis, Muscular Dystrophy, Ataxia, Stroke, Brain Injuries, ALS and PSP. Founded in 1994 by Jonathan Miller, it is a Chicago-based company with 14 employees and customers all over the world. 

For more information, additional photos, or to schedule an interview contact Rachel Moore at: 609-388-1234, or rachel@mooreconnected.com.

###https://www.einpresswire.com/article/500147740/innovative-lasercue-co-created-by-instep-mobility-michael-j-fox-helps-parkinson-s-patients-with-freezing-falls?ref=email&code=3WorCQnvElu3nxD6&utm_source=NewsletterPR&utm_medium=email&utm_campaign=Healthcare+%26+Pharmaceuticals+Industry+Press+Releases&utm_content=article

Dynamic images show rhomboid protease in action

OCTOBER 25, 2019     by Forschungsverbund Berlin e.V. (FVB)

Investigation of the rhomboid protease GlpG by solid-state NMR. Credit: Barth van Rossum, FMP

Rhomboid proteases are clinically relevant membrane proteins that play a key role in various diseases. Using solid-state NMR spectroscopy, researchers from Berlin's Leibniz-Forschungsinstitut für Molekulare Pharmakologie (FMP) have now been able to watch rhomboid proteases in a native lipid environment at work. The obtained dynamic images will be useful for the development of new medication for diseases such as Parkinson's and malaria. The results of this pioneering work have just been published in the Journal of the American Chemical Society.

Tens of thousands of proteins are at work in our cells, around the clock. Some of these industrious workers sit in the cell membrane, among them the family of rhomboid proteases. Given that these intramembrane proteases are involved in many biological processes, and also play a key role in diseases such as Parkinson's, diabetes, cancer and malaria, they are highly clinically relevant.

Previously, it had been possible to view rhomboid proteases using X-ray crystallography. However, this method was only able to provide static images from proteins in an artificial environment. Therefore it remained of great interest to see what happens in the cell membrane where the proteins go about their main task, which is cleaving other membrane proteins, triggering a signaling cascade.

The long-suspected gate that opens does in fact exist

The research group led by Professor Adam Lange from the Leibniz-Forschungsinstitut für Molekulare Pharmakologie (FMP) has now been able to investigate this highly complex process, for the first time using solid-state NMR spectroscopy in a native-like environment. The researchers were able to observe how certain parts of the protease move. They also noticed that, in order to cleave other proteins, a gate opens briefly to let these substrate proteins enter the active center of the protease.

Findings relevant for pharmacological interference

The project, undertaken within the UniSysCat Cluster of Excellence, sets a base for an even better characterization of rhomboid proteases. What is more: The knowledge gained will be useful for researchers to investigate how they can pharmacologically influence the clinically relevant membrane proteins. Also Lange and his team now want to search for substances to inhibit errant rhomboid proteases.

More information: Chaowei Shi et al, Structure and Dynamics of the Rhomboid Protease GlpG in Liposomes Studied by Solid-State NMR, Journal of the American Chemical Society (2019).  DOI: 10.1021/jacs.9b08952

Journal information: Journal of the American Chemical Society Provided by Forschungsverbund Berlin e.V. (FVB) https://phys.org/news/2019-10-dynamic-images-rhomboid-protease-action.html

A tiny sensor that may play a significant role in the future treatment of illnesses

OCTOBER 25, 2019    by Riikka Hopiavaara, Aalto University

This needle-type sensor is suited to measurements of brain sections, for example. The tip has a diameter of just one micrometre. Credit: Iiro Immonen

Academy of Finland Research Fellow Emilia Peltola holds in her hand a sensor that will play a significant role in the future treatment of illnesses. Many diseases, such as depression, chronic pain, Parkinson's and epilepsy are caused by neurotransmitter disorders. Among other things, neurotransmitters enable cells to communicate with each other. Problems in the production of these chemicals are the cause of symptoms like, for example, shaky hands in sufferers of Parkinson's disease.

Deep brain stimulation has achieved good results in the treatment of Parkinson's disease and epilepsy. The therapy involves electrically stimulating the patient's brain to produce neurotransmitters like dopamine. If a sensor were added to treatment devices installed in the brain, physicians would know in real time how the neurotransmitters were responding to treatment. Neurotransmitters are too small to be seen by the naked eye, and therefore no device can visualize us how they function directly, forcing us to employ other means to gather information.

"A definite benefit of such sensors would be the real-time nature of the data they produce. Neurotransmitters move from cell to cell very rapidly, and only a real-time method can let us know how much of a specific substance is present at each given moment. Treatments would become more effective and the risk of adverse effects would reduce," Peltola says. 

Peltola is both a Doctor of Science in Technology and a medical researcher. A multidisciplinary background is an advantage in her work, which combines technology and biology. Funded by a grant from the Academy of Finland received in spring 2019 and funding from the Jane and Aatos Erkko Foundation, she is searching for the optimal synthetic material for use in sensors, which measure neurotransmitters.

Toward new types of treatment

In addition to neurotransmitter concentration, it is important to know the location in which neurotransmitters are being released, how rapidly cells are releasing the substance as well as how long it takes for the cell to uptake it. Existing methods are unable to gather this information. 

The part of the brain in which the sensor is placed determines which neurotransmitter should be measured. The functioning of glutamate, the neurotransmitter that affects learning and memory, is studied in the hippocampus in particular. Local measurements yield fresh information on disease mechanisms as well as on the functioning of the brain and pharmaceuticals.

Peltola believes that if measurements inside the body were to become possible, researchers could develop new diagnostic and treatment methods.

"We could have new treatments that would not only slow down diseases, but stop or even cure them."

Academy Research Fellow Emilia Peltola is searching for the best synthetic material to use in sensors that measure neurotransmitters. Credit: Iiro Immonen.

The right material would make sensors part of the body

What happens when you get a splinter in your finger and can't get it out? To protect you, your body grows scar tissue around the stick. This is a good thing, as otherwise an infection might spread and potentially endanger your life. Your body will react the same way when, instead of a splinter, it encounters an object, such as a sensor, intentionally placed there for therapeutic purposes.

The immune system that protects us makes Emilia Peltola's work challenging because the scar tissue, which develops around a sensor, prevents the substances it's supposed to measure from reaching its surface. And this prevents accurate measurements.

Researchers hope that sensors embedded into the body would become part of its tissue. This is what happens when nerve cells attach to sensors. But our body can send glial cells to surround sensors, and they form scar tissue that hampers measurements. In order for a sensor to attract the right kinds of cells, its surface must be of a specific type. But researchers have not yet determined what this type is like.

Good and bad proteins

Solving the scar tissue problem alone will involve plenty of work. In addition, proteins are causing a headache as well.

Proteins are the building blocks of all cells and they perform nearly all of a cell's functions: cell motility, cell fusion, signal transduction and immune defense. But proteins, though vital to humans, are detrimental to the functioning of sensors. They settle on the surface of the sensor, preventing the substance being measured from getting there. The sensors work well in saline solution, but whenever the fluid, such as a blood sample or cell culture, contains proteins, measurements are not as successful.

Research is made more challenging by the finding that protein attachment on the surface doesn't always ruin measurements. The correlation between the functioning of a sensor and the amount of proteins remains a mystery, however. Experiments have detected that a sensor's electrochemistry still functions even when lots of proteins are attached to its surface. This means that the presence of proteins in large amounts alone doesn't mean that a sensor won't function. Researchers still need to explore how surface structures could be used to steer the attachment of proteins in a way that doesn't disturb measurements.

Local information of cell cultures can be obtained using this kind of dishes. The bottom of the well contains 44 microscopic sensors laid side by side. Photo: Iiro Immonen.

Nanofibre thickness is decisive

Emilia Peltola works at Micronova, which has good facilities for experimental research. Sterile working is a must for examining finished sensors, although an actual cleanroom is not required. A cabinet in her lab holds various sample sensors for study. Their materials combine different carbon allotropes. Once sensor materials are prepared, it is time for the actual experiments, which study the measuring of neurotransmitters as well as interactions between cells and various carbon surfaces or between proteins and surfaces. 

While researching carbon nanofibers, Peltola and her colleagues have identified a connection between the thickness of nanofibers and cellular shapes. This link has helped them deduce that thickness also affects which cells, desirable nerve cells or undesirable glial cells, attach onto sensor surfaces. 

Peltola thinks her research might progress to animal testing over the course of the five-year Academy of Finland study. Even if it takes more than a decade for the final product to make it into use, the study will provide useful and applicable knowledge for nerve and medical research along the way as well as further our general understanding of the brain and various diseases.

The researchers grow carbon nanotubes and fibers on the surfaces of sample pieces or pipette nanodiamonds onto them. Nanofibres and -tubes are made of graphene, a carbon allotrope, and nanodiamonds are microscopically small synthetic diamonds.

Local information of cell cultures can be obtained using this kind of dishes. The bottom of the well contains 44 microscopic sensors laid side by side.

Provided by Aalto University

https://medicalxpress.com/news/2019-10-tiny-sensor-significant-role-future.html

Procrastination and Other Demons

October 25, 2019 Dr. C

It was one of those ugly days. My Parkinson’s disease (PD) symptoms were maxing out. The viral infection I had picked up made it hard to breathe. My partner was at an appointment, and I had no shoulder to lean on. I was unmotivated to do anything that required more thought than needed to boil an egg.

And it was column deadline day.

Feeling like I can’t write the column and being unable to write are very different things. Sorting out the hesitation to engage in motor action from apathy is complex with PD. Like most PD symptoms, there is not a “one size fits all.” Taking the time to determine the differences helps me avoid the cyclic trap of feeling as if I can’t engage.

I work on this every day, always trying to show up where I am needed. Because I do, people comment on how good I look.

“You are an inspiration to us all,” is said as a compliment. I nod and smile, not knowing how to respond. I look at my life and see those things that I try to do. It takes physical and mental effort, and sometimes what I want to do is difficult to achieve. “Success is 10 percent inspiration and 90 percent perspiration,” Thomas Edison said.

Procrastination prevents people from turning vision into reality.

The wellness map is folded on my dresser, and sanctuary is just beyond the drawn curtains. There are days when I don’t have the energy for them. It’s not procrastination. Fatigue and pain add to an ugly day, making it difficult to accomplish tasks. I work on letting go of the voice that says, “You’re a bad person because you are not getting things done.” I replenish my thoughts with the voice that says, “Let it go. You will have better days.”

I also have lucid moments, and those are precious to me. I give myself permission to treat the difficult days with as much reverence as I give to the good moments. I also know that my wellness map used with sanctuary will decrease the number of bad days and increase the frequency of lucid moments. It opens the possibility for well-being moments.

I know I should get off the sofa and engage, but there are times when I’d rather put it off until tomorrow. I’d rather do something tied to more immediate gratification. This is procrastination. It can become a habit as easily indulged as eating chocolate or surfing through cable television.

We justify “putting off today what we can do tomorrow.”

“It’s too hard.”

“My emotions are blocking progress.”

“I want to avoid the pain of doing this.”

“I need comfort, not to take risks.”

The most common cause is a somnolence of mind induced by procrastination. Finding the passion, purpose, and meaning to act is incompatible with procrastination. Those who procrastinate are filled with ideas of how the world should be, yet leave the fire in the belly without fuel.

Maybe next time someone will say, “You’re a perspiration to us all.”

***

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/2019/10/25/procrastination-symptoms-perspiration/

Therapeutic Potential of Cannabinoid Compounds in Parkinson’s and LID Analyzed in Review Study

 OCTOBER 25, 2019     BY MARTA FIGUEIREDO 

Cannabinoid compounds — particularly cannabidiol (CBD) — show potential to ease symptoms in people with Parkinson’s disease and levodopa-induced dyskinesia (LID), according to a review study.

Data also suggests that their therapeutic effects likely involve the direct modulation of critical messenger molecules in the brain and indirect reduction of brain inflammation.

However, future clinical studies are required to confirm these potential benefits in people with Parkinson’s disease and LID.

The review study, “Cannabidiol and Cannabinoid Compounds as Potential Strategies for Treating Parkinson’s Disease and L-DOPA-Induced Dyskinesia,” was published in the journal Neurotoxicity Research.

Parkinson’s disease is characterized by the presence of motor symptoms, including involuntary tremors, slowed movement, rigidity or stiffness, and impaired balance. However, it also can lead to a range of non-motor symptoms.

Long-term treatment with levodopa — the gold standard Parkinson’s therapy — leads to levodopa-induced dyskinesia (LID), or involuntary, jerky movements, in more than 50% of Parkinson’s patients.

Levodopa is used to ease motor symptoms by restoring the loss of dopamine — a key neurotransmitter, or messenger molecule in nerve cells — in these patients.

Both conditions (loss of dopamine and LID) are associated with changes in the basal ganglia, a brain region that contains the substantia nigra and the striatum and is involved in motor function.

Numerous studies over the past decade have looked at cannabis and its active components — known as cannabinoids — as potential treatments for motor symptoms in several neurodegenerative conditions.

Cannabinoids and other players of the endocannabinoid system — a complex modulatory network involved in brain development, memory, movement control, hormone production, and immune reactions — are known to have neuroprotective effects.

That is why “manipulation of the endocannabinoid system could be a promising therapy to control [Parkinson’s disease] and LID symptoms,” the researchers wrote.

A team of Brazilian researchers reviewed preclinical and clinical data on the therapeutic potential of cannabinoid compounds in people with Parkinson’s disease and LID.

Several studies have indicated that the endocannabinoid system — including the endocannabinoid anandamide and cannabinoid receptors — is altered in Parkinson’s patients and animal models of the disease, and that targeting it may prevent loss of dopamine-producing neurons, reduce inflammation, and ease Parkinson’s symptoms.

Evidence of an association between a dysregulated endocannabinoid system and LID is not as strong as that with Parkinson’s, but the team noted that there are still data suggesting that modulating this system, and in particular its receptors, may be a potential therapeutic approach.

“Among the cannabinoids investigated so far, CBD appears one of the most promising drugs in preclinical trials,” the researchers wrote.

CBD, the major non-psychoactive component in cannabis, is involved in a variety of important biologic functions. Preclinical studies have suggested that CBD regulates dopamine-dependent nerve communication by increasing dopamine levels, while decreasing the production of potentially harmful reactive oxygen species and pro-inflammatory molecules.

The team noted that “these anti-inflammatory and antioxidant properties may help explain CBD’s neuroprotective action.”

Most studies of CBD in Parkinson’s animal models have showed that CBD reduced the loss of dopamine-producing neurons and eased motor symptoms. However, others reported no significant benefit.

Data from clinical trials suggest that this cannabinoid eases symptoms in Parkinson’s patients, but a consistent beneficial effect on motor symptoms is still lacking. Furthermore, no clinical study has focused so far on the effects of CBD in reducing LID in people with Parkinson’s disease.

Some studies reported that CBD led to a reduction in psychotic symptoms, and improvements in emotional well-being, cognition, communication, and in mobility and body discomfort in Parkinson’s patients. However, these potential improvements in motor function failed to reflect differences in the total motor score, compared with patients receiving a placebo.

While several case reports, uncontrolled trials, and surveys suggest beneficial effects of cannabinoids in Parkinson’s patients, only four randomized placebo-controlled trials have analyzed the effects of different cannabinoids on Parkinson’s motor symptoms such as akinesia, tremor, or LID. Akinesia is the loss of the ability to move muscles voluntarily.

Only one of these trials, which evaluated the cannabinoid nabilone, showed a clear effect on motor symptoms with an ease in LID. Nabilone is a man-made form of cannabis often used to treat severe nausea and vomiting caused by cancer chemotherapy.

The authors also noted that growing evidence suggests that development of LID is associated with increased neuroinflammation, which may be  potentially caused by levodopa and other Parkinson’s treatments. The beneficial effects of anti-inflammatory medicines to ease LID symptoms also reinforce inflammation’s contribution in LID.

Notably, preclinical studies suggest that a combination of CBD with compounds modulating specific non-cannabinoid receptors — associated with neuroprotective and anti-inflammatory effects and activated by endocannabinoids — may be an effective therapeutic approach to ease Parkinson’s motor symptoms and LID.

More clinical trials are required to clarify the therapeutic effects of cannabinoids in people with Parkinson’s disease and LID, and whether the combination with other compounds modulating neuroinflammation boosts their effects.

https://parkinsonsnewstoday.com/2019/10/25/therapeutic-potential-of-cannabinoid-compounds-in-parkinsons-and-lid-analyzed-in-review-study/