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Monday, September 25, 2017

Novel protein interactions explain memory deficits in Parkinson's disease


September 25, 2017
The protein alpha-synuclein (green) and PrPc (red) interact in a neuron (yellow dots marked with arrows).



A study published in the journal Nature Neuroscience, from Nature publishing group, describes the identification of a novel molecular pathway that can constitute a therapeutic target for cognitive defects in Parkinson's disease.
The study coordinated by Portuguese researchers from the Instituto de Medicina Molecular (iMM Lisboa), the University Medical Center Goettingen, Germany and CEDOC - Nova Medical School Lisbon, along with other colleagues from Germany, showed that abnormal forms of Parkinson's disease (PD)-associated protein alpha-synuclein interact with the prion protein (PrP), triggering a cascade of events that culminates in neuronal dysfunction, causing cognitive defects that are reminiscent of those in PD.
"This is the follow up of a previous study initiated in my laboratory, where we found that particular forms of the protein alpha-synuclein cause dysfunction of neuronal circuits involved in memory formation. We did not know how this was happening, and in this new study we have detailed the molecular mechanisms involved, which suggests we now have new targets for therapeutic intervention" - explains Tiago Outeiro, a former Group leader of iMM now in Germany and at CEDOC, who coordinated the study together with Luísa Lopes, a Group Leader at iMM. 
Calcium levels inside a neuron are demonstrated by an intensity scale where blue is low calcium and red high calcium. Credit: Luísa Lopes lab, iMM Lisboa

Using pharmacology and genetics, the team has now defined a series of molecular events that explains the memory defects observed in animals that model some important aspects of PD.
Luísa Lopes adds: "We used a mouse model of PD in which human alpha-synuclein is produced and found that by blocking this interaction with PrP using a caffeine analogue, reverted the abnormal neuronal activity and memory deficits. This study links nicely with our previous work on Alzheimer's disease, further suggesting that molecules like caffeine may indeed have potential benefits against memory deficits upon neurodegeneration".
Parkinson's disease is a devastating disorder affecting millions of people worldwide. Current therapies are only symptomatic, and treat only some of the motor symptoms of the disease. "We now know that PD is much more than just a motor disease, and there is a great demand for novel therapies, especially those capable of modulating disease progression or, ideally, capable of preventing the onset of the disease" - explains Tiago Outeiro.
"We are very excited with the findings of our collaboration, and this study demonstrates that when we pull together our complementary expertise we can make important discoveries that can impact the lives of the millions of people (patients and families) affected by these terrible disorders" - concludes Luísa Lopes.
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Original Publication: Diana G. Ferreira, Mariana Temido-Ferreira, Hugo Vicente Miranda, Vânia L. Batalha, Joana E. Coelho, Éva M. Szegö, Inês Marques-Morgado, Sandra H. Vaz, Jeong Seop Rhee, Matthias Schmitz, Inga Zerr, Luísa V. Lopes* and Tiago F. Outeiro* (2017) α-Synuclein interacts with PrPC to induce cognitive impairment through mGluR5 and NMDAR2B. Nature Neuroscience doi: 10.1038/nn.4648 
About Tiago Fleming Outeiro
Tiago Fleming Outeiro is full Professor and Director of the Department of Experimental Neurodegeneration at the University Medical Center Goettingen. Tiago graduated in Biochemistry at the University of Porto in 1998. He did his PhD thesis at the Whitehead Institute for Biomedical research - MIT, in the USA, and then was a Postdoctoral Research Fellow in the Department of Neurology of the Massachusetts General Hospital - Harvard Medical School where he focused on the study of Neurodegenerative disorders such as Parkinson's and Alzheimer's disease. Tiago directed the Cell and Molecular Neuroscience Unit at IMM, Lisbon, from 2007 to 2014, and has been Full Professor and the Director of the Department of Experimental Neurodegeneration at the University Medical Center Goettingen, in Germany since October 2010. He is also currently leading the Cell and Molecular Neuroscience Group at CEDOC, Nova Medical School, in Lisbon. Tiago is a world leader in the field of Parkinson's and Alzheimer's disease, and has authored >160 research articles in the field of Parkinson's and Alzheimer's disease. He participates in various international collaborative projects with the aim of identifying the molecular basis of neurodegenerative disorders such as Alzheimer's and Parkinson's disease. He has received multiple awards and grants in Germany, from the European Union, and from other leading international funding agencies.
About Luísa Lopes
Luísa V. Lopes is a Group leader@iMM Lisboa, Portugal since 2013 https://imm.medicina.ulisboa.pt/en/investigacao/labs/lopes-lab/. Luísa graduated in Lisbon in 1998 in Biochemistry and then pursued a PhD in Neurosciences being trained in the University of Cambridge, UK and at the Karolinska Institute, Sweden, followed by a postdoc at Nestlé Research Center in Lausanne, Switzerland. Her work focuses on understanding the mechanisms inducing the "early-aging" of the cognitive function. The team has provided evidence for an important contribution of adenosine receptors in pathophysiological context, and their impact in noxious brain conditions such as stress, aging and neurodegeneration. Her team provided crucial evidence of a possible glucocorticoid-adenosine link in Alzheimer's disease (with D. Blum) following previous groundwork suggesting circadian disorders as a trigger for accelerated cognitive loss. 
About iMM Lisboa
Instituto de Medicina Molecular (iMM Lisboa) is a reference biomedical research centre in Portugal, having acquired the special status of Associate Laboratory of the Portuguese Ministry of Science and Technology. iMM's mission is to promote basic, translational and clinical biomedical research, with the aim of understanding the mechanisms of disease and developing new therapeutic approaches. For more information please visit the iMM Lisboa's website: http://www.imm.medicina.ulisboa.pt
About CEDOC
CEDOC - CHRONIC DISEASES RESEARCH CENTER - is an established institute which aims at excellence in medical research on chronic diseases. The general objectives of CEDOC are to form an internationally-recognized Center of excellence in Biomedical, Translational and Clinical Research on chronic diseases; to stimulate collaborative research between groups within the CEDOC; to strengthen research quality and innovation and to promote multidisciplinary projects within and beyond the Center; to provide an exciting research environment for the training of Postdoctoral Fellows, PhD and Master funding at national and international levels; and to simulate the organization of outreach activities at local and national levels. For more information please visit: http://cedoc.unl.pt/
Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system

To view video:
https://www.eurekalert.org/pub_releases/2017-09/idmm-npi092517.php#.Wcl1bKokleg.

https://www.eurekalert.org/pub_releases/2017-09/idmm-npi092517.php

Parkinson's Symposium

September 24, 2017  By Alyssa Meisner, Digital Journalist/Anchor





CHARLESTON- The state's first Parkinson's Symposium was held at the University of Charleston. Almost 200 people came out to hear local and national experts in the field of Parkinson's disease. They held a demonstration to show how boxing could help this disease. Organizers say exercise and remaining active is the best way to keep symptoms at bay.
"Exercise is very important with someone with Parkinson's. It can help alleviate some of the physical problems, and people don't realize. People will find themselves sitting in a chair all day, if you don't use it, you're going to lose it, especially with Parkinsons," George Manahan, of the Charleston Parkinson's Support Group, told 13 News.
The Charleston Parkinson's support group collaborated with Cabell-Huntington Hospital, Marshall University and CAMC for the conference.
To view video:
http://www.tristateupdate.com/story/36440498/parkinsons-symposium#.Wclyx3WHtlg

http://health.einnews.com/article/405846921/_NCTjVxHIdCKSxuM?lcf=Hzf-KE6h-Xmcpvzwcdl3CuzbRmZ8XaTUdg3y3lN96pg%3D

9 Tips to Help You Get Over a Freezing Episode

SEPTEMBER 25, 2017   BY WENDY HENDERSON IN SOCIAL CLIPS.



It’s estimated that around a third of people living with Parkinson’s disease experience “freezing” from time to time. “Freezing” often happens when patients are walking and suddenly change direction or while raising the foot to go up a step, but it can also affect arm movements and even speech.  Freezing can lead to falls and contribute to loss of mobility.
While it may not be possible to avoid freezing incidents altogether, there are ways to quickly overcome the episodes according to the American Parkinson’s Disease Association.
Change direction
If you freeze while moving forward, try moving to the side or backward for a couple of steps.

Move differently
Point to the ceiling or touch your nose — just doing something different from the original movement should be enough to break the freezing.

Use a laser pointer
A laser pointer can be useful to help you quickly overcome freezing, pointing the laser in front of your foot and then standing on the laser spot will usually do the trick.

Step over something
You can either step over a crack on the sidewalk or visualize an item to physically step over.

Use a mini metronome
A mini, portable metronome is useful for providing a beat which can help you avoid freezing or get you started again.

Singing or humming
Singing or humming a song and then restarting in time with the beat can help break the freezing spell.

Counting
Counting out a rhythm or saying “one, two, three, go” can help overcome freezing.

Shift your weight
Shifting your weight from side to side can often help you take that first step.

March
Marching up and down on the spot for a few moments can help restart your momentum.

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Parkinsons’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.
https://parkinsonsnewstoday.com/2017/09/25/tips-help-get-over-freezing-episode/

New Microsoft Watch Can Quiet Parkinson’s Tremors

 SEPTEMBER 25, 2017    BY WENDY HENDERSON IN SOCIAL CLIPS.



Tech giant Microsoft has just unveiled one of their newest, most innovative designs: a wristwatch that can temporarily halt tremors in people with Parkinson’s disease.
The prototype was showcased at the Microsoft Build 2017 event in Seattle, Washington. The watch works by vibrating in a certain pattern which disrupts the patient’s own tremors and quiets them. According to USA Today, the “Emma” watch was originally designed for a British graphic designer, whose Parkinson’s disease had left her unable to do her job. Microsoft engineers accepted a challenge on behalf of the BBC television program The Big Fix and astounded everyone when Emma was able to write her name while wearing the device.
Although the watch doesn’t cure tremors, it could offer a practical solution to millions of people living with the disease and the technology can be built upon to come up with other creative ideas that may help tremors in other parts of the body.
###
Parkinsons’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.
https://parkinsonsnewstoday.com/2017/09/25/new-microsoft-watch-can-quiet-parkinsons-tremors/

Doctors Should Ensure that PD Patients Adhere to Antidepressants, Study Suggests

 SEPTEMBER 25, 2017    BY IQRA MUMAL



Poor adherence to antidepressants is correlated with an increase in all-cause mortality in patients with Parkinson’s disease (PD), a new study suggests. Based on the findings, the study’s authors recommend that neurologists, psychiatrists, and primary-care physicians prioritize the use of, and adherence to, antidepressants as indicated.
One of the most common psychiatric symptoms of PD is depression, which is associated with a decrease in the quality of life and worse clinical outcomes. Studies estimate that 50% of PD patients have symptoms of depression, and approximately 10-20% have major depressive disorder (MDD).
The main treatment for MDD in PD patients is antidepressant medication, which also has been shown to positively affect other PD-associated physical conditions.
Studies have shown that using antidepressants has clear benefits for people with PD, but those benefits are directly linked to whether or not a patient adheres to taking them. For example, MDD patients who have low adherence to antidepressants — in other words, who don’t take them as prescribed — tend to have more emergency room visits, higher hospitalization rates, and greater severity of depression, the study found.
Adherence to antidepressant medication tends to vary for patients with PD and is often low. That is linked to poorer clinical outcomes and higher health-related costs.
Until now, studies had been lacking that evaluated the influence of antidepressant adherence to outcomes in patients with PD, particularly in the context of mortality. Researchers set out to fill in those gaps, hypothesizing that the risk of mortality increases if PD patients have low adherence to antidepressant medication.
From a database of over 4 million people, researchers retrospectively followed 8,553 PD patients who purchased an antidepressant between 2008 and 2011.
Adherence was measured as a ratio between dispensed and prescribed durations. Good adherence meant a ratio higher than 80% (4,219 patients), while moderate adherence was 50-80% (1,584 patients), poor adherence was 20-50% (1,184 patients), and non-adherence was less than 20% (1,566).
Initial study results showed that the unadjusted mortality rates for non-adherent, as well as poor, moderate, and good adherence, were 20.4%, 25.1%, 23.4%, and 25.6%, respectively. However, after adjusting for demographic and clinical variables, the non-adherent group had a significantly higher mortality rate, as did the poor-adherence group. These patients had a 43% and 26% higher risk of death, respectively, compared with the good-adherence group.
Men had a 49% higher risk than women.
Researchers also looked at comorbidities (simultaneously existing conditions) and their correlation to mortality. They found that when patients had three to four comorbidities, their risk of death was 30% greater than those with none to two comorbidities. That risk increased to 78% for patients with five or more comorbidities.
“The present four-year follow-up study is the first to demonstrate the inverse association between adherence to [antidepressants] and all-cause mortality in a general population-based large cohort of patients with PD,” the team stated. “The beneficial effect of adherence to AD may be particularly important in the high-risk population of patients with PD.”
“We suggest that neurologists, psychiatrists, and primary-care physicians prioritize the diligent use and efforts to enhance their patients’ adherence to [antidepressants] when indicated, as it may be associated with increased life-expectancy,” they added.
https://parkinsonsnewstoday.com/2017/09/25/parkinson-disease-patients-with-low-antidepressants-adherence-have-increased-mortality-risk-study-finds/

Psychosis in Parkinson's dementia—new treatment provides hope

September 25, 2017

Around 80 per cent of people with Parkinson's disease develop dementia. Credit: University of Exeter


New research involving King's College London and the University of Exeter has highlighted the benefits of a promising new treatment which could relieve psychosis in thousands of people with dementia related to Parkinson's disease.


Around 80 per cent of people with Parkinson's disease develop , totalling around 100,000 people in the UK. ,The majority of these individuals will experience  such as delusions and hallucinations, often particularly intense in Parkinson's disease.
These symptoms can be terrifying and have a devastating effect on individuals and their families, yet commonly-prescribed sedative antipsychotic medications only have a marginal benefit in reducing psychotic symptoms. Currently, clinicians are advised only to prescribe antipsychotics as a last resort, because of their terrible impacts on health, quadrupling the risk of stroke and death, as well as worsening symptoms of Parkinson's diseases.
The paper, in Nature Reviews Neurology, presents key new information regarding the benefits of pimavanserin, - a novel antipsychotic treatment that follows a completely different mechanism of action than widely-used drugs, and improves  effectively without the damaging impact of other drugs. 
A previous paper in The Lancet in 2014 reported a rigorous six week, randomised, double-blind placebo-controlled trial, in which 199 people were allocated to groups to receive pimavanserin or a placebo. The study demonstrated benefits in treating psychosis in people with Parkinson's disease, leading to the licensing of pimavanserin for this purpose in the USA.
The newly published results from the same trial, presented in the current paper, indicate that pimavanserin is even more effective in improving psychotic symptoms in people with Parkinson's disease dementia. The treatment is well tolerated, causes less negative impact than other antipsychotics in a particularly vulnerable group for whom psychotic symptoms are a major challenge.
Professor Clive Ballard, of the University of Exeter Medical School, said: "Quite rightly, campaign groups have urged clinicians to reserve antipsychotics as a last resort because of the damaging side-effects, however the new results from our clinical trial of pimavanserin show that it effectively improves psychosis in people with Parkinson's disease dementia without this terrible impact. This is a crucial step towards changing an unacceptable situation for millions of people living with Parkinson's disease and Parkinson's disease dementia worldwide.."
Parkinson's Disease and the related disease dementia with Lewy bodies affect up to 15 per cent of all people with dementia – around six million people worldwide. People with these dementias are far more likely to experience highly visual and distressing psychotic episodes.
All other antipsychotics target a receptor for a chemical messenger on neurones called dopamine. This has proved effective in treating psychosis in Schizoprenia, but in Parkinson's Disease and dementia with Lewy bodies, where these receptors are already being lost as a result of the disease, this blocking can significantly worsen motor symptoms of Parkinson's disease causing tremor, slow movements and resulting in problems with walking and falls..
Pimavanserin works differently. It targets the brain's 5HT2A receptors, restricting the activity of another chemical messenger, serotonin.
According to Professor Dag Aarsland at King's College London, "Psychosis in Parkinson's disease is often extremely distressing to patients and their carers, and until now there have been few  available. These findings are extremely encouraging, and we hope that our continuing work in this area eventually leads to better treatment options for the thousands of people in the UK and worldwide affected by this condition."
Claire Bale, Head of Research Communications and Engagement at Parkinson's UK, said: "This new analysis suggests that pimavanserin is even more effective for treating psychotic symptoms – like hallucinations and delusions – in people with Parkinson's dementia than in those with Parkinson's without dementia.
"This is extremely promising because psychotic symptoms are a very common and distressing feature of Parkinson's dementia and current treatment options are extremely limited.
"Pimavanserin has been approved for use by the Food and Drug Administration (FDA) in the US but has not yet been submitted for approval to the European equivalent, the European Medicines Agency.
"It is now imperative that pimavanserin goes through the European approval process to be made available to  who would benefit hugely from the drug. People with Parkinson's can't wait any longer for better treatments."
Journal reference: The Lancet  Nature Reviews Neurology  
Provided by: University of Exeter
https://medicalxpress.com/news/2017-09-psychosis-parkinson-dementianew-treatment.html#nRlv

Diabetes medicine reduces Parkinson's risk

September 25, 2017

Charalampos Tzoulis (right) and his colleagues, Kristoffer Haugarvoll (left) and Brage Brakedal, hope they are one step closer to a cure for Parkinson´s disease. Credit: Kim E. Andreassen


Norwegian study shows that the taking of diabetes medicine reduces the risk of getting Parkinson's disease.

Researchers at the Department of Clinical Medicine at the University of Bergen (UiB) have discovered that  against diabetes reduces the risk of getting Parkinson's disease by 35 per cent.
"We have made an important discovery, which takes us a step further towards solving the Parkinson's riddle," says researcher Charalampos Tzoulis. He has lead the study together with researcher Kristoffer Haugarvoll at the same department.
One step further
Tzoulis says that the researchers have to do follow-up studies on the diabetes  to fully understand why it protects against Parkinson's disease.
"If we understand the mechanisms behind the protection, then we have a chance to develop a new treatment," Tzoulis says.
Influence the cell's powerhouse
The researchers believe that the diabetes medicines, containing so-called glitazones, are influencing the cells to produce more mitochondria. Mitochondria are the powerhouse of the cells, transforming nutrients that the cells need to work.
Tzoulis' research group has previously shown that the production of mitochondria decreases during Parkinson's.
100 million prescriptions
To see the connection between  and Parkinson's, the researchers analysed and compared data from the Norwegian Prescription Data Base. The database has stored information on all use of prescription the last 10 years and contains data on more than 100 million .
Provided by: University of Bergen
https://medicalxpress.com/news/2017-09-diabetes-medicine-parkinson.html

Sunday, September 24, 2017

Tai Chi for Parkinson's


Tai Chi Practice for those with Parkinson's Disease.

Lesson One focuses on Balanced Opening Stance and Raise Arms with Breath.
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Tai Chi Practice for those with Parkinson's Disease.
Lesson Two focuses on Centered Weight Shifts and Empty Leg Stepping.
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Tai Chi Practice for those with Parkinson's Disease.
Lesson Three focuses on Brush Knee Twist Step Practice.
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Tai Chi Practice for those with Parkinson's.
Lesson Four focuses on Splashing Hands and Tai Chi Boxing.

Seniors learn how to stay vertical this fall

September 23, 2017



It may have been the first day of fall, but those at Valley Presbyterian Church on Friday learned how to do exactly the opposite.
About 125 attended the lectures, a balance class and Tai Chi demonstrations as part of a three-hour program put on by Valley Assistance Services to teach and demonstrate of a variety of ways to avoid falling. The event was timed to coincide with National Fall Prevention Awareness Month.
Associate Professor Ruth Taylor-Piliae, from the University of Arizona's College of Nursing, spoke about fall risk factors. They include advanced age, a prior fall, muscle weakness, balance problems, poor vision, postural hypotension, fear of falling and chronic conditions including stroke, Parkinson’s disease and dementia.
Taylor-Piliae said one-third of adults 65 and older fall every year and less than half report it to their doctor.
Lunch was provided by Valley Galley, during which Donnie Poling from Tai Chi for Health demonstrated exercises that could be done from a sitting position.
Contact Green Valley freelance reporter Ellen Sussman at ellen2414@cox.net.
http://www.gvnews.com/news/seniors-learn-how-to-stay-vertical-this-fall/article_1be8ca02-a09b-11e7-a05d-c35d8b19c579.html

AU neuroscientist’s Parkinson’s disease work showing results

 September 23, 2017  By Tom Corwin



For Joe Kelley and the CSRA Parkinson Support Group, their investment in the research of neuroscientist Bobby Thomas at Augusta University is paying off, not just in the millions of dollars in federal research money Thomas recently received, but in less tangible results.

My initial reaction is good, there’s another chance. There’s another chance that this will be resolved,” said Kelley, a Parkinson’s disease patient for 15 years and vice president of the support group.
Thomas was recently awarded a $1.9 million, five-year grant from the National Institutes of Health to explore ways of stimulating a hotly pursued pathway for regulating genes involved in antioxidants, molecules that reduce free radicals that can cause the oxidative stress, leading to the damage that causes Parkinson’s. Most of the current treatments for Parkinson’s seek to control the symptoms of the disease, such as tremors and balance problems.
Thomas is pursuing a strategy that seeks to protect and preserve the neurons whose slow loss leads to the disease. His research has always focused on a particular pathway, abbreviated as Nrf2, that has received a lot of attention not only from Parkinson’s researchers, but from others for its role as a master regulator of antioxidant response element genes.
Last year, Thomas was pursuing research on a drug used in multiple sclerosis called dimethyl fumarate that appeared to activate the Nrf2 pathway. Unfortunately, Thomas said, he discovered that it did that by modifying another important protein that is abbreviated as Keap, which targets unwanted proteins and gets rid of them through a “garbage disposal” mechanism in the cell.
Without it, “there will be a lot of unwanted proteins in the cell, they will accumulate and eventually it will damage the cell,” he said. “You don’t want to alter that function of the cell.”
While the Nrf2 mechanism has generated a lot of excitement, not just for Parkinson’s but for other diseases, that is a common problem researchers run up against, Thomas said.
“It is very well-known that this pathway is promising from a therapeutic standpoint,” he said. “But the challenge has been how to activate it in a safe manner.”
Clinical trials in the U.S. currently trying to target the mechanism are looking at, oddly enough, broccoli sprout extract or the chemical component of broccoli sprouts that appears to be active, known as sulforaphane, in chronic kidney disease or rheumatoid arthritis. Another one being studied is curcumin, which is found in the spice turmeric. Those approaches might activate the pathway, but they will likely run into the same problem, Thomas said.
“The challenge in the field has been that all activators of Nrf2 modify Keap,” Thomas said. “As part of this project, we are utilizing an alternate approach.”
His research is now focused on a protein called Bach, which normally sits on those antioxidant response genes and suppresses their activity. Blocking the activity of Bach allows Nrf2 to activate those genes, Thomas said. He is working with a company called vTv Therapeutics that already has a Bach inhibitor drug they are trying to develop. Interestingly, in mice bred to lack the Nrf2 gene, the Bach pathway still appears to work in activating the antioxidant genes, Thomas said.
“Targeting Bach may be a much more potent pathway to activate this (antioxidant) pathway,” he said. Because the company already has the inhibitor under development, if Thomas’ preclinical work in animal models shows promise “then the company plans to run clinical trials on patients,” he said.
That outcome is just what the support group hoped when it gave Thomas $10,000 to do the foundation of the work that led to the grant, Kelley said.
“Several of our recipients do that here at Augusta University, use our grant for proof of principle and then give the proof of principle to NIH for larger grant applications,” Kelley said, “because we can’t fund them fully.”

Support group
The CSRA Parkinson Support Group will hold its annual fundraiser walk on Oct. 7 at First Baptist Church of Augusta, 3500 Walton Way Extension. The event, called People of Parkinson’s Walk, will start at 9 a.m., with the walk beginning at 10 a.m. For more information go to POPWalk.org

http://chronicle.augusta.com/news/2017-09-23/au-neuroscientist-s-parkinson-s-disease-work-showing-results