The striatum acts as hub for multi sensory integration

A new study from Karolinska Institutet in Sweden provides insight on how the brain processes external input such as touch, vision or sound from different sources and sides of the body, in order to select and generate adequate movements. The findings, which are presented in the journal Neuron, show that the striatum acts as a sensory 'hub' integrating various types of sensory information, with specialised functional roles for the different neuron types.

The striatum is the main input structure in the basal ganglia, and is typically associated with motor function", says Principal Investigator Gilad Silberberg at the Department of Neuroscience. "Our study focuses on its role in processing sensory input. This is important knowledge, since the striatum is implicated in numerous diseases and disorders, including Parkinson's disease, Huntington's disease, ADHD and Tourette syndrome."

The striatum is the largest structure in a collection of brain nuclei called the basal ganglia, which are located at the base of the forebrain. It is involved in motor learning, planning and execution as well as selecting our actions out of all possible choices, based on the expected reward by the dopamine system. Most research performed in the striatum is focused on the motor aspects of its function, largely due to the devastating motor symptoms of the related diseases.

However, in order to select the correct actions, and generate proper motor activity it is essential to continuously process sensory information, often arriving from different sources, different sides of the body and from different sensory modalities, such as tactile (touch), visual, auditory, and olfactory. This integration of sensory information is in fact a fundamental function of our nervous system.

In the current study, researchers Gilad Silberberg and Ramon Reig show that individual striatal neurons integrate sensory input from both sides of the body, and that a subpopulation of these neurons process sensory input from different modalities; touch, light and vision. The team used intracellular patch-clamp recordings from single neurons in the mouse striatum to show their responses to whisker stimulation from both sides as well as responses to visual stimulation. Neurons responding to both visual and tactile stimuli were located in a specific medial region of the striatum.

"We also showed that neurons of different types integrate sensory inputs in a different manner, suggesting that they have specific roles in the processing of such sensory information in the striatal network", says Gilad Silberberg.

The work was funded by an ERC starting grant to Gilad Silberberg, and grants from the Knut and Alice Wallenberg Foundation, the Karolinska Institutet Strategic Research program in Neuroscience (StratNeuro), and the Swedish Research Council.

http://en.wikipedia.org/wiki/Karolinska_Institute

http://en.wikipedia.org/wiki/Karolinska_InstituteGilad Silberberg & Ramon Reig, Karolinska Institutet

Dealing with Parkinson's Disease and medical debt

Parkinson’s disease manifests differently in each person. For some, life goes on with modest disruption. For others, essential tasks that may include working, are not possible. The financial impact of Parkinson’s may include loss of income, difficulty paying for medical expenses like medications and therapies, or worry about paying for long term care. If a Parkinson’s disease diagnosis has made employment impossible, or if medical expenses have gotten out of control making it impossible to keep up, there are options that can help reduce debt, or in extreme cases, eliminate it all together. As you consider the possibility of seeking financial help, it’s vital that you not blame yourself for circumstances that are out of your control.  Illness, is after all, not your fault. If you are finding this difficult to accept, consider the following information from CNN: "Bankruptcies due to medical bills increased by nearly 50 percent in a six-year period, from 46 percent in 2001 to 62 percent in 2007, and most of those who filed for bankruptcy were middle-class, well-educated homeowners, according to a report that will be published in the August issue of The American Journal of Medicine". A life time of being financially prudent, with health insurance, does not prevent the possibility that health care bills resulting from treatment for Parkinson’s can be ruinous. Many people find in the later stages of the disease that they need more physical or occupational therapy than what their insurance covers; some medications may not be covered by every insurance company’s formulary, which can quickly add up. "Unless you're a Warren Buffett or Bill Gates, you're one illness away from financial ruin in this country," says lead author Steffie Woolhandler, M.D., of the Harvard Medical School, in Cambridge, Mass. "If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that's the major finding in our study." Hopefully, you are not at the point of declaring bankruptcy, but if you are, remember that bankruptcy laws were enacted to give those with impossible financial obligations a chance to start over. There is no shame in doing what millions of Americans, and countless businesses, have done to relieve financial pressure and begin again with a clean slate. There are different types of bankruptcies and conditions that apply to all of them. In every case, certain income, and savings, and property types are exempted, or have some exemptions. Be certain to consult an attorney with experience in bankruptcy law. Most bankruptcy lawyers offer a free initial consultation, and many offer payment terms. If medical obligations resulting from Parkinson’s disease treatments have not pushed you to the point of declaring a bankruptcy, there are ways to reduce existing, and planned medical expenses.  Negotiation Negotiating service fees from your primary care physician, neurologist, hospital, or other health care provider, may seem unseemly – and something you would prefer to avoid. It’s natural to feel this way, but understand that your doctor is also in business – and that means dealing with payment issues with his or her customers. Health care providers are also consumers, and they know the financial drain medical expenses can have. They are used to negotiating with patients as well as health insurance companies. Giving discounts for unusual circumstances is common practice, and significant discounts are not unusual. Providers will also likely be able to provide resources that can help with the cost of medications. When you begin a negotiation – whether before a service has been received or after - the key to being successful is knowing the range of possible outcomes. For example, you may discover you have been charged $10,000 for a certain procedure or group of procedures. Unable to pay the bill, you ask the doctor or hospital for a reduction down to $3000. The business/billing office refuses your offer. Had you done the necessary research, you would have known that bottom end of the range of expected payment for that procedure in your geographic are  is $4000, an offer that likely would have met their criteria and been accepted. Information is key for medical negotiations. Fox Business tells us that “… patients need to know the fair market price for a procedure or treatment before making any decisions so they can plan accordingly. Information about the cost for different treatments based on the region or even city is readily available online. Consumers can also find the rate the government pays for medical procedures online…” That rate can often be 25% less than even what insurance companies pay. Know the real costs of hospital and doctor visits and procedures Knowing the costs of a procedure or series of treatments is a major component of a successful negotiating strategy. You can find information on medical services and procedures by looking at your insurance company’s website; in most cases, they publish their negotiated rates. If you are having difficulty, New Choice Health is one of several websites that can help you find these figures. With a modest effort you will be successful in determining how much doctors and local hospitals charge and the size discount normally given to an insurer. You will also be able to see a listing of a ‘fair’ self-pay price, which is normally considered a small amount above the fee normally received from an insurer. How to negotiate before treatment For procedures that are done on a non-emergency basis, prepare for your negotiation by determining price reference points charged for the procedure or service.  Before you schedule the procedure, visit the doctor’s office, or hospital, and ask to speak with the business office, or patient business representative. Explain to the representative that the estimate for the Parkinson’s treatments are high, and would they please make a reduction? This is an effective strategy for those in a competitive market, with many doctors and hospitals capable of providing the treatment. In an area where this is not the case, another approach, along the lines of:  ‘I simply cannot afford to pay this amount. Can you please make a reduction”, would be a good strategy. There are endless variations of negotiation strategies, and the key is to use one you are comfortable with. If you simply cannot do it, then bring a family member who can. It’s best to take a non-emotional approach, keeping the conversation and negation focused on the payment options. How to negotiate after treatment If the procedure or services have been completed by the doctor or hospital, the negation process is similar, but with subtle and important differences. The first of these is the absence of choice. The part of your negotiating strategy that included the option to go elsewhere is no longer needed. The other difference is the simple fact that what is done – is done. The doctor or hospital no longer view you and the services needed as representing a financial opportunity which they would like to get the as much out of as is ethically reasonable. Now, you represent a debt that they want to recover, and they will do whatever is possible to get the most they can from that debt. In most cases, doctors and hospitals have extended payment plans, sometimes with interest and sometimes without. While a full payment of the settled amount can be an important negotiation tool, if that is not possible a payment plan for the settled amount is a common request, and normally granted. Healthcare providers, as mentioned, are understanding of the predicament many of their patients find themselves in and are willing to discuss and negotiate bills. But, bear in mind, this goodwill is usually limited to one negotiation. Failure to meet the agreement frequently will likely result in quick collection action. It’s also the case that both hospitals and doctors do not want to attempt legal remedies to collect a debt. Collection services take as much as 50% of the collected amount, plus any costs incurred in the collection. On an average basis, the total received from all collected accounts may be in range of 25%, and the health care provider may wait a considerable period of time to be paid from the collection agency. If you make an offer of 35%, there is a good chance it will be accepted, and a better chance if you can offer immediate payment. If an offer has been agreed to, and for one reason or another payment is not made, be certain to have the agreement put in writing. This may seem obvious, but with healthcare providers, we tend to forget the need to secure basic protections. “Get explanations in writing and take protests to the top. All communications with a provider should be in writing, experts say. Insist that your account be placed on hold until the dispute is resolved to avoid having the bill sent to collections.” - Los Angeles Times Dealing with collection agencies If your account has been sent to a third party collection agencies, there are plenty of options still available. Credit.com tells us: “How you ultimately resolve a debt with a contingency debt collector is going to depend on: your monthly cash flow that can be used to make payments; the parameters the collector has to work with on their end; and even by the date on the calendar.” Credit.com goes on to say: “Setting up a payment arrangement you can afford given your monthly budget is not all that difficult. And if the collector can get you set up with a payment, they often get to retain the account while your payments are being made. This means your interests and the collector’s are aligned when you are actively looking for a solution.” Be realistic in your plan. It is easy under the pressure of negotiating to agree to a price that may reflect a big discount, but is still outside your means. Be completely honest about what you can pay, and how long you will need to pay it. Payment as a negotiating tool Most experts advise against using credit cards for payment.  CBS News tells us:  “Forgo the credit card if you think you might be asking for a discount later. Using plastic puts you in a weaker bargaining position with the hospital. ‘We recommend against credit cards, because the hospital loses any interest in negotiating with you’ once they have your money, says Carol Pryor, policy director at The Access Project. And your bills could be even higher if you end up paying interest on the charges.” If the procedure has been done, using a credit card is a valid option. Getting help Some of us simply are not comfortable negotiating anything, let alone a hospital bill or a bill to a doctor that we have come to depend upon and trust. This does not change the need for relief, but it does change the strategy. There are services like Medical Billing Advocates of America, who will negotiate on your behalf for a fee. There are nonprofit advocates as well, and an attorney is usually an excellent choice. The Federal Trade Commission (FTC) says that: Reputable credit counseling organizations can advise you on managing your money and debts, help you develop a budget, and offer free educational materials and workshops. Their counselors are certified and trained in consumer credit, money and debt management, and budgeting. They discuss your entire financial situation with you, and help you develop a personalized plan to deal with your money problems. An initial counseling session typically lasts an hour, with an offer of follow-up sessions The los Angeles Times provides this advice: Seek help and file complaints. If your bill is large or you're having a hard time making headway, patient advocates can help sort things out. For either a flat fee or a share of the money you save, organizations such as Medical Billing Advocates of America (www.billadvocates.com) and Health Proponent (www.healthproponent.com) can help you fight charges or lower your bill. If you're being stonewalled by your healthcare provider, and your insurer hasn't helped, Quincy of Consumers Union suggests filing a complaint with your state's department of insurance. In California, patients with HMO coverage can file a complaint with the California Department of Managed Health Care by calling (888) 466-2219 or visiting healthhelp.ca.gov. Californians with PPO coverage should try the Department of Insurance at (800) 927-HELP (4357) or visit http://www.insurance.ca.gov. If your provider isn't contracted with your insurer, your state's attorney general's office is a place to turn for help. Government Resources that help with medical bills: State Human/Social Service Agencies provide direct aid and give referrals for other organizations. State Medicaid Offices will help see if you are qualified to receive help. Local Department of Veterans Affairs (VA) Offices has programs to help veterans. Eldercare Locator their information specialists will put you in touch with programs and resources that are designed to help seniors. State Children's Health Insurance Programs (SCHIP) they help insure the children of working families unable to  afford health insurance . Benefits.gov allows you to submit a confidential questionnaire to get a list of helpful programs. USA.gov: Benefits Page gives information for benefits, grants, and other financial aid. Local Social Security Administration (SSA) Offices provide help for those on Social Security and/or Medicare. You can phone the SSA at 1-800-772-1213. Disability.gov gives information and provides resources for those with disabilities. HealthCare.gov can help  find insurance options, and compare care, and to help learn about prevention, and the Affordable Care Act. If you are receiving Medicare and need assistance. contact the Centers for Medicare and Medicaid Services (CMS) or view Programs to Help You Pay Medical Expenses. You can also call or write to CMS Phone: 1-877-267-2323 or 1-410-786-3000 Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore MD 21244-1850

Members of a Comprehensive Care Team

Patients suffering from complex, chronic illnesses, such as PD, benefit most from an interdisciplinary team of professionals collaborating to provide individualized treatment and a care plan designed to enhance the quality of life. The National Parkinson Foundation (NPF) promotes this approach in our Centers of Excellence and Care Consortium networks.

Members of a comprehensive care team

Neurologists are doctors who specialize in problems with the nervous system.  A movement disorders specialist is a neurologist who has completed an extra one-to-two years of training in movement disorders such as PD. The neurologist will monitor your case of PD, work with you to prescribe appropriate medications, monitor your response to therapies and make recommendations for care.

Primary Care Providers (PCP) are usually the first point of contact and are usually internists or family practice physicians who will manage your overall health. Don’t be afraid to ask the family doctor for a referral to a specialist. Your PCP should receive periodic reports from your neurologist regarding the current management of your PD.

Physician’s Assistants (PA) have an advanced degree and work under the supervision of a physician.

Nurses are often your primary contact and the central coordinator of your care. Nurse Practitioners (NP) are Registered Nurses (RN) who have an advanced degree and who have passed special licensing requirements. Nurse Practitioners can perform physical exams and prescribe medications and other therapies. They often work with a physician, although they can function independently.

Social Workers provide non-medical assistance and work in a variety of hospital and community settings. Many provide individual, couple and family counseling to help persons cope with stressful life events. Social workers often lead support groups. They can also help you to connect with a variety of community resources and help you and your family plan for the future.

Physical Therapists (PT) are licensed professionals who evaluate and treat mobility problems such as flexibility, strength, balance, posture and walking. They design exercises or provide training to meet an individual’s needs. A PT can also help family caregivers by teaching safe and effective ways to provide assistance.

Occupational Therapists (OT) help to modify or adapt activities of daily living which include dressing, feeding oneself, getting in and out of bed, writing, and performing in the workplace.  An OT can address issues of safety and independence in the home. 

Speech-Language Pathologists (S-LP) are health care professionals trained to assess, manage and treat speech, voice, memory and swallowing problems. Treatment with a therapist can improve problems you may experience with communication or eating.

Nutritionists/Dieticians can help you design an eating plan for overall health. A Nutritionist can be particularly helpful if you have trouble chewing or swallowing, difficulty preparing nutritious meals or problems with your weight.

Pharmacists provide valuable information about prescription medication and can provide counsel on possible drug interactions and side effects. Try to use the same pharmacy all the time so there is a record of all medications being taken.

Neuropsychologists are licensed psychologists with expertise in how behavior and cognitive (thinking) skills are related to brain structure and symptoms.

Psychiatrists are physicians who specialize in the diagnosis and treatment of mental, behavioral or emotional problems such a depression and anxiety. These symptoms may require specialized treatment.

Psychologists can work with individuals and family members by providing advice and counseling for coping with the disease.

Please also remember, that your caregivers and loved ones are often your best advocates and can help you communicate with your health care team.

Depression is More Common in People with Parkinson’s, Study Confirms

Though researchers and people with Parkinson’s have long been aware of a connection, this study validates it.

Depression is More Common in People with Parkinson’s, Study Confirms

www.michaeljfox.org

Biomarkers study supported by the Foundation is building comprehensive data sets.

FoxFeed Blog

Study Confirms Depression More Common in Parkinson’s Disease

Posted by  Maggie McGuire, August 26, 2014

A recent paper shared the first longitudinal findings from theParkinson’s Progression Markers Initiative (PPMI), the landmark biomarkers study sponsored by The Michael J. Fox Foundation. One of the unique advantages of PPMI is its design to follow hundreds of patients and control volunteers from around the world over time, or longitudinally.

Researchers from the University of Pennsylvania affiliated with PPMI published in the journal Neurology that depression, anxiety and fatigue are more common in newly diagnosed Parkinson’s disease patients compared to the general population.

The researchers’ examined data from 423 newly diagnosed, untreated Parkinson’s patients and from 196 control volunteers at the beginning of the study. Of these, 261 PD patients and 145 controls were evaluated at 12 months, and 96 PD patients and 83 healthy controls evaluated at 24 months. PD patients were permitted to begin dopamine therapy at any point after their first evaluation.

These findings aren’t very surprising to the research field and probably not to the patient population, either. We’ve long known that depression, anxiety and fatigue are symptoms of Parkinson’s, but one of the aims of PPMI is validation.

“PPMI is building comprehensive data sets — detailed information on many subjects — that can confirm some of the ‘truths’ we believe and may point to new findings, especially as we follow these volunteers over the next few years,” said Mark Frasier, PhD, vice president of research programs at MJFF.

“It's really a chance to assess the frequency and characteristics of psychiatric and cognitive symptoms in PD, compare it with healthy controls, and then also look at its evolution over time,” said Daniel Weintraub, MD, the senior author on the paper.

One illuminating finding from Dr. Weintraub’s study is that depression may be undertreated in the Parkinson’s population. Two-thirds of patients who screened positive for depression during the study were not taking an antidepressant.

Watch Yourself: Device Data May Improve Research and Parkinson's Monitoring

Posted by  Maggie McGuire, August 13, 2014

MJFF Teams Up with Intel on Wearable Devices

The Michael J. Fox Foundation and Intel announced their partnership on a project to use wearable devices, like smartwatches, for tracking Parkinson’s patients 24 hours a day, seven days a week.

If you’re living with Parkinson’s disease, you’re familiar with the clinical exam at the doctor’s office. You tap your fingers and rise from a chair, which tells your physician how you’re doing and helps determine any changes in your treatment regimen. Research studies use the same measures to evaluate the impact of potential therapies.

Such outdated methods used only at periodic appointments tell far from the whole story. Parkinson’s is a 24-hours-a-day, seven-days-a-week disease. Patients and their doctors need a better way to monitor PD, and researchers need a more objective way to measure the effect of new drugs. The solution might come through the use of wearable devices such as smartwatches.

Wrist-worn devices that track users’ movement have exploded in the market over the last few years, and The Michael J. Fox Foundation and Intel Corporation are partnering to gather and analyze data from these devices worn by people with Parkinson’s. The results could help individuals and their doctors better manage disease and could progress research toward better treatments and a cure.

As Michael J. Fox told USA Today, "The answers are within us. We just need to find a way to let people into our brains both literally and figuratively to help us figure this out."

Wearable Devices May Measure Parkinson’s Symptoms
MJFF’s partnership with Intel began earlier this year, when we launched a study to evaluate three wearable devices for tracking measurable features of Parkinson’s like slowness and frequency of movement.

Participants with and without PD wore the devices during two clinic visits and at home over a few days. Intel engineers are now comparing the device data to clinical observations and patient diaries to test the devices’ accuracy, and are developing algorithms (mathematical formulas) to measure symptoms and disease progression.

These wearable devices can capture up to 300 observations per second, so algorithms or formulas to interpret all that data and report what it means related to someone’s Parkinson’s can help individuals and their physicians monitor disease.

Device Data Can Speed Research
Researchers need to monitor disease, too. Research studies use the same office exams or patient diaries to test if an experimental drug has a positive impact on symptoms or disease progression. Clinical trials could use wearable devices and data algorithms to give a clearer picture of a new therapy’s effect. These tools would ease some of the burden for volunteers participating in trials, too.

More Data Means More Insights
In addition to its use in personal disease management and in separate research studies, wearable device data could lead to new areas of research. Intel has developed a data platform that could store de-identified device data from millions of people with Parkinson’s.

Analysts could apply algorithms and other techniques to a mass of data, which may highlight trends or differences among people with PD. These nuances may point researchers to new areas of interest in our pursuits of learning more about Parkinson’s and of developing a cure.

Like many other MJFF initiatives, the platform would be open-access so researchers could upload de-identified data from their studies and could also access others’ de-identified data. Such a model means more data to learn from and more smart minds working on uncovering new clues.

“Data science and wearable computing hold the potential to transform our ability to capture and objectively measure patients’ actual experience of disease, with unprecedented implications for Parkinson’s drug development, diagnosis and treatment,” said MJFF CEO Todd Sherer, PhD.

Next Phase Recruiting Soon
The next phase of the MJFF-Intel study will capture data to measure medication response such as on/off episodes. Recruitment is expected to begin this fall in locations including New York City and Boston and Tel Aviv, Israel.

As we learn more about what wearable devices can tell us about daily living with Parkinson’s, MJFF plans to expand their use to other clinical studies.

 MJFF and Intel.

The Michael J. Fox Foundation and Intel announced their partnership on a project to use wearable devices, like smartwatches, for tracking Parkinson’s patients 24 hours a day, seven days a week.

https://www.youtube.com/watch?feature=player_embedded&v=s8-oOfrY1xk

Tests that could spot Parkinson's decades before symptoms start

By PAT HAGAN FOR THE DAILY MAIL

PUBLISHED: 20:16 EST, 25 August 2014 | UPDATED: 05:26 EST, 26 August 2014

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Secretary Sharon Blight was diagnosed with Parkinson's disease at just 49

Secretary Sharon Blight initially put the numbness and 

tingling in her right hand and foot down to a tennis injury. 

'I'd fractured my right collarbone after falling over on court 18 months before,' she recalls.

Surgery and physiotherapy restored full movement to her arm and shoulder, and when she developed the numbness and tingling, she thought it was a trapped nerve. But then her physiotherapist noticed a slight tremor in her foot and recommended seeing a GP.

'My GP said it was probably nothing to worry about, but I should see a neurologist,' says Sharon, a married mother-of-two from Aldershot, Hampshire. 

But after ten minutes of examining her, the neurologist said he was almost certain Sharon had Parkinson's disease.

'I was in complete shock,' she says. 'I was only 49 and as far as I was concerned, Parkinson's was something that only affected the elderly and mainly men.' 

It's a common misperception, which will only have been cemented by recent announcements about celebrity patients. 

Comedian Billy Connolly, 71, has recently been diagnosed with the disease. Sir Roger Bannister, 83, the first man to run a four-minute mile and a former neurologist, has been suffering from Parkinson's for the past three years. 

Most sufferers are diagnosed later in life, on average at 65. But scientists now believe the disease, which affects 127,000 people in the UK, begins to develop up to 20 years before the appearance of the first symptoms, such as uncontrollable tremor, slow movements or muscle stiffness. This means many people may have hidden Parkinson's in their 40s or earlier. 

'There's a lot of debate about this but it's thought patients may start to lose nerve cells in the brain anywhere between five and 20 years before symptoms appear,' says Claire Bale, research communications manager with the charity Parkinson's UK.

Now the race is on to develop new ways to identify patients during the 'pre-onset' years, and give them a better quality of life.

Parkinson's is caused by a loss of nerve cells in an area of the brain that controls movement and feelings of reward and addiction. These cells produce dopamine, a chemical that shuttles messages between the brain and nervous system, helping to control body movement.

If these cells become damaged or die, levels of dopamine are reduced. Symptoms of the disease appear only when 80 per cent of the nerve cells have been lost.

Parkinson's is diagnosed by studying a patient's symptoms and movement, often followed by a DAT scan, which measures dopamine levels in the brain.

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Scientists are trying to find ways to test for the condition in early stages. A most promising way is a blood test for raised levels of alpha-synuclein, which is released in clusters in the brain when the disease is setting in

Professor Patricia Limousin, a specialist at the National Hospital for Neurology and Neurosurgery in London, warns that the classic symptoms neurologists instantly look for often go unnoticed by GPs.

'We look for tremor, especially when the arm is at rest, and slowness of movement, reduced swinging of the arm when walking, and stiffness of muscles. 

'Most patients have had some or all of these symptoms for months or years before they see us. 

Some may have noticed a slight tremor but didn't seek help, others have been to a GP but are told it's down to stress.'

The disease has been known about since ancient times - it was referred to as 'shaking palsy' as early as AD175. 

But what triggers it is still unclear. The consensus seems to be that some people may carry a mixture of genes that predispose them to damage by toxins in the environment - such as from pesticides - and this sets Parkinson's in motion.

Men are 50 per cent more likely to get it than women. One theory is that oestrogen may have a protective effect.

''I was in complete shock. I was only 49 and as far as I was concerned, Parkinson's was something that only affected the elderly and mainly men'

For most people, having Parkinson's will not significantly affect life expectancy. But in its advanced stages it can lead to chronic pain, sleep disruption, anxiety and depression, and problems affecting movement. Years of being ill can leave patients vulnerable to infections. 

The earlier Parkinson's is treated, the better, as currently drugs can slow down - but not halt - the loss of brain cells.

So scientists are trying to find easy ways to test for the condition in the early stages. One of the most promising is a blood test for raised levels of the protein  alpha-synuclein. This is released in clusters in the brain when the disease is setting in - but usually before symptoms appear. 

In 2011, scientists at Lancaster University discovered a way to detect the protein in blood samples of Parkinson's patients. Now trials are looking at whether an alpha-synuclein blood test could be the early warning sign doctors hope for

An Austrian team is even testing a vaccine that could prime the immune system to attack and destroy the clusters. First results are due in a few months.

'Although we know alpha-synuclein is involved in  nerve-cell death in the brain, there are many types of the same protein, and we are still some way off having a readily available blood test,' says Claire Bale.

There are other, perhaps slightly surprising, clues that Parkinson's may be developing.

One is a loss of smell. As brain cells die off, one of the areas of the brain affected fairly early is the olfactory bulb, which processes and identifies odours. Up to 80 per cent of patients recall losing some or all of their sense of smell months or years before the onset of other symptoms.

Another potential early warning sign is constipation. As dopamine-producing cells die off, muscles controlling contractions in the bowel also seize up, because dopamine is produced by nerve cells in the enteric nervous system - which controls digestion. Around 60 per cent of sufferers experience constipation early on.

'We think these nerve cells outside of the brain are affected earlier, or start to show symptoms earlier than those in the brain,' says Claire Bale.

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Scottish actor Billy Connolly is a sufferer

A third indicator is vivid dreams, or acting out nightmares. At  least five years before patients suffer stiffness, many have  REM sleep behaviour disorder.

Rapid eye movement sleep is the stage where we have vivid dreams. To stop us acting them out, the brain temporarily paralyses us. But the damage to brain cells in Parkinson's switches off this mechanism.

Individually, none of these indicators are strong enough to confirm that Parkinson's has set in. But it may be that a collection of such warning signs could justify further investigation.

It's hoped new drugs could stop the progression of the disease altogether. Current treatments, such as levodopa - a drug which has been around for nearly 50 years - address only the  symptoms by replacing some of the missing dopamine. 

A more extreme treatment is deep-brain stimulation, where electrodes are implanted into the brain to 'deactivate' affected areas.

It can ease symptoms, and patients are often able to reduce their drug dosage. This is vital: dopamine-replacing drugs have been associated with severe behavioural side-effects, such as gambling or sex addiction. 

One of the most promising new treatments could be a relatively cheap drug already widely and used for type 2 diabetes.

At £18 per injection, exenatide helps lower blood sugar levels. But a study with 20 patients last year at University College  London found it appeared to  slow down, or in some cases halt, the progression of Parkinson's. Bigger trials are planned.

Meanwhile, Sharon, now 54, takes a daily cocktail of drugs, including levodopa and up to five paracetamol.

'I hate bedtime because I know in the morning I will be so stiff I can't get up,' says Sharon, who fundraises in her spare time for Parkinson's research.

'I've had to give up my beloved tennis and now play bowls. I'm determined to not let my illness beat me. I may have Parkinson's disease, but it doesn't have me.'

Read more: http://www.dailymail.co.uk/health/article-2734154/Tests-spot-Parkinsons-decades-symptoms-start.html#ixzz3BbkieQSP 
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In Sickness and In Health: Intimacy & Parkinson's

I met my wife, Angela, six years after being diagnosed with Parkinson's disease. I am very fortunate to have met a woman who could love me and accept my illness. With her love, support and encouragement, I finished my book “A Soft Voice in a Noisy World: A Guide to dealing and Healing with Parkinson’s Disease” and together we have stayed active in promoting Parkinson's awareness and advocating for those of us with this disease. As a team, Angela and I attend events, and teach and speak on Parkinson’s disease. In many ways, Parkinson's has brought us even closer together as a couple.

So all in all, there is no doubt that Parkinson's or any chronic illness can change the dynamics of how a marriage or other personal relationship will function. But more importantly, how you interact with each other will determine if you stay close. Sometimes just sharing a laugh and a smile can lighten the moment. Here are some suggestions for creating a deeper intimacy with your loved ones.

Changing roles

As we grow older our health may change, and so may our role in our relationships. Understand that responsibilities will inevitably shift over time and care partners may find themselves making decisions on finances, healthcare or some other related life-changing decision that they never faced before. Or, sometimes the person with Parkinson's is the one caring for their spouse. Learn to embrace change.

Feeling desirable, wanted and needed

Remember, no one is perfect. We all have doubts about our appearance and insecurities about how our bodies may change over time, whether or not we have an illness. Our partner is so important in making us feel desirable. Just knowing that the one you chose still cares and needs you is of great comfort. Express your love and excitement for each other on daily basis.

Commitment

Sadly, I have seen and heard of many relationships that have ended after a spouse became ill. Divorce is over 50 percent, even without having to deal with the challenges of an illness. That’s why a strong friendship, based upon caring and communication, is vital for staying together. Sharing your thoughts, feelings and concerns will increase closeness. And if you can learn to express your frustrations with one another, you will be less likely to build up anger and resentment.

Staying close

Life and our hectic routines can get in the way of spending quality time together. Things like watching TV together on the couch or planning a romantic weekend getaway are important ways to show you still care. Taking time for one another is vital for your relationship. For example, just sharing a meal together can be a special event. Showing and expressing your appreciation for your partner---every day---is an act of intimacy.

Patience and understanding

As we grow older, our bodies may not respond or perform as well as they did in our twenties. To me, maturing is about being comfortable with who you are and staying open to self discovery. Even the healthiest people have issues that interfere with their relationship. Realize that an illness can either help bring you and your partner closer together or push you further apart, depending upon how well you are able to cope with challenges and the strength of your bond, prior to illness. Acceptance and understanding will help you both deal with any problems within your relationship.

Making dates

Parkinson's can be unpredictable. Not knowing when your medicine will work can make being spontaneous difficult. Scheduling a weekly night out is a wonderful way to enjoy each other’s company without distractions. But do not be disappointed if things do not go as expected. The most important thing is to remain flexible and sympathetic to our partner's needs, accepting that plans do change.

Not just sex

Intimacy isn’t just about sexuality. You can still reap the benefits of closeness by sharing time together, holding hands or cuddling. Communication, cooperation and understanding your partner's needs are key to maintaining a loving, satisfying relationship.

Getting help

Never be afraid to ask for help, if you feel that you need it. Sometimes it may take the assistance of a professional counselor or therapist to improve the communication that exists between a couple.