Man on bike races train for Parkinson's cause

June 24, 2016

Bike vs. train: A classic showdown

(CNN)The bicycle was invented nearly 200 years ago. History credits Baron Karl von Drais of southern Germany for his 1817 laufmaschine ("running machine"). 

Steam trains were invented only 14 years earlier, with credit going to Robert Trevithick of Wales, who built the first one in 1803. 

Both machines went on to change the world and how we move in it. In a few races around the globe, these two modes of transportation are still battling for supremacy of speed. 

As for popularity, the bicycle pulled ahead a long time ago. Bikes and bike culture are thriving today, arguably at a level not seen since mass production and organized races took Europe by storm in the late 1800s, with bikes even having outsold cars in the U.S. and Europe in recent years. 

These efficient, healthy "running machines" have been popular with every generation in every country for the past two centuries. The bicycle is our buddy and workout partner, regardless of whether you're 5 or 95 years old. And unlike the steam train, bicycles continue to evolve. They've become increasingly safer, materials have gotten lighter, and they are more comfortable than ever. This makes them more fun, especially on endurance races over varying terrain.

Today, there are bike races every day of the year all over the world, professional and non. One in Colorado, which pits the bike against its old train rival, is a favorite of both categories of rider.

Sibling rivalry meets a train

Two brothers, Jim and Tom Mayer, grew up by the train tracks in Durango, Colorado. The narrow-gauge train, which Jim worked on, once carried coal, goods and supplies every day from the mines of Silverton, 50 miles away. But today, it carries tourists.

On one spring weekend in the late 1960s, Tom boasted to his brother that he could beat the train by biking along Highway 550, over the snowy mountains that separate the two towns. To Jim's surprise, Tom did it.

They invited others to join them, but few were interested. They went on to a local bike shop owner, Ed Zink, to see whether he wanted to organize a proper race, and he passed.

But in 1972, town organizers wanted event ideas to kick off the summer tourist season, and Zink suggested the bike-vs.-train idea. They loved it, and with just 36 cyclists that first year, the Iron Horse Bicycle Classic was born.

Today, the town is a hub of bike culture in America. Durango's sidewalks have dismount reminders, metal bike designs are on parking meters, and people move there just to be part of the culture. Registration for the race takes place in early December and is first-come, first-served.

As for the race, held every Memorial Day weekend, the course is a spectacularly beautiful, but grueling, climb along the mountainous highway. There are two peaks, and from Durango's 6,500 feet above sea level, it climbs as high as 11,000. Weather at the top is unpredictable, and the race has been shortened a handful of times -- and canceled twice -- due to snow. Some riders this year were hit with a brief hailstorm.

While most riders leave at the same time as the train, about 30 minutes into the race, their paths diverge. Riders then take the hard way up, and the train stays down in the Animas River gorge. They don't reunite until Silverton. 

Every year, the professionals beat the train, which takes 3½ hours to reach Silverton. 

This year, 2,500 bicyclists came from 43 states and six countries. That number is the maximum allowed for safety reasons (in case they need to be evacuated for extreme weather). Forty riders were professional-level racers and the rest seasoned amateurs. 

The 2016 winner, Payson McElveen, made the run in 2½ hours. As for the rest, only about 30% are faster than the train.

Although it is open to amateurs, the race is not for beginners. The endurance is the equivalent of a marathon and takes almost the same amount of time and exertion. The race is 50 miles but requires the endurance of a 100-mile race (called a "century") because of the elevation. Riders need to pace themselves during the first 15 miles before going straight uphill, and they need to be dressed for heat, cold and unpredictable weather. 

Once a qualifying race for the Olympics, the Iron Horse Classic has become more popular than professional. First place pays only $700, and some riders are on tandem bikes with kids. One racer even did the course on a large unicycle. 

But Iron Horse riders aren't motivated by money; they come for the prestige and the unique history of the race. It's a life experience for the bucket list, highlighted by Outside magazine putting Iron Horse on its 2010 "Life List." For the racers, "this is one of the most exciting days of their life," said Zink, who was the race's chairman for its first 43 years.

Training to beat the train

Unless you have ridden similar mountain races, you would be wise to get a professional trainer for Iron Horse.

Biking is one thing. Biking uphill is another. 

Locals can take a cycling and strength training class offered by the city of Durango's Parks and Recreation department, but anyone seeking professional help for mountain racing should probably give themselves three to six months of proper training, depending on the level of fitness they're are starting from.

Competing in the Iron Horse means being in good enough physical condition to exert yourself for up to five straight hours, with particular strength needed in your core mid-section and back. And, course, with an uphill climb, the less you weigh, the easier it will be, so that's more motivation to get trim.

It's difficult to say conclusively, but biking may be better fitness than running. According to a fitness expert who compared the two for CNN, running outdoors burned 970 calories an hour, while biking was only 570 calories. But biking uphill burns a lot more depending on percent grade and headwind; you can say it's anywhere from two to four times the number of calories than on a flat surface.

Biking is also better for your knees, as many runners turn to the sport after an injury, and engages all the major leg muscles from your rear to your ankles: glutes, quadriceps, hamstrings and calf muscles.

The Iron Horse has made the town of Durango a lot more fit than it used to be, according to Zink, as many locals take part. One mother told Zink "you all saved my son's life" after he lost 75 pounds for the race.

Local racer Joe Williams credits his bike training for the slowdown of his symptoms of Parkinson's and now races in Iron Horse with a team to raise awareness. "Biking seems to decrease tremors and the need for medication for several hours after each ride," explained CNN Chief Medical Correspondent Dr. Sanjay Gupta. "The theory is that cycling temporarily activates the brain the same way a medication does."

As for the train, it can be a motivator. Even if you can't see it, you know its time, and that 3½-hour time can push you forward. 

Giving yourself a goal drives you to beat it; just ask Tom Mayer.

See Video:http://www.cnn.com/2016/06/24/health/bike-race-iron-horse-fit-nation/#

http://www.cnn.com/2016/06/24/health/bike-race-iron-horse-fit-nation/

Local photographer highly commended

June 24, 2016

Alan Osborne with his highly commended photograph of a red squirrel.

A BARNSLEY photographer and sufferer of Parkinson’s disease has been highly commended at the 2016 Mervyn Peake Awards.

Alan Osborne, 61, was commended in the photography category at the awards, which are organised by the charity Parkinson’s UK, in memory of the late artist and author Mervyn Peake, who lived with Parkinson’s.

The Mervyn Peake Awards are exclusively open to people with Parkinson’s, and invites people to submit creative entries in a range of categories, including photography, books and poetry.

“Photography, and anything creative, seems to let me be free for a little while from the grip of my Parkinson’s,” said Alan.

http://www.barnsley-chronicle.co.uk/news/article/12682/local-photographer-highly-commended

Antipsychotics May Boost Risk of Movement Disorders

Cross-sectional data suggest link in patients with depression and schizophrenia

June 23, 2016 By Kristina Fiore

BERLIN -- Antipsychotics are tied to a higher risk of movement disorders in both depressed and schizophrenic patients, researchers reported here.

In a cross-sectional study, being on typical antipsychotics carried an increased risk of movement disorders in both schizophrenic (OR 3.4, 95% CI 1.2 to 9.8) and depressive patients (OR 6.1, 95% CI 2.4 to 15.3), according to Santiago Perez-Lloret, MD, of the National Research Council in Buenos Aires, and colleagues.

However, the risk was not increased among those on atypical antipsychotics, they reported at the International Congress of Parkinson's Disease and Movement Disorders here.

"We don't know why the risk was higher for depressed patients compared with schizophrenic ones, but this is important because clinical trials are not good for assessing the safety of drugs, and this is one of the first postmarketing studies," Perez-Lloret told MedPage Today.

"It's important for physicians to be aware of the possibility of these disorders and to have a close look when they give antipsychotics to their patients," he added.

Ron Postuma, MD, of McGill University in Montreal, who was not involved in the study, told MedPage Today that the findings suggest that it "really does seem to be the medications themselves driving the effect on movement disorders, rather than the underlying condition."

Some studies have shown that antipsychotics are related to movement disorders in schizophrenia patients, but it is hard to tease out cause and effect, the researchers explained. The drugs have also been prescribed to patients with depression, and it is not clear if the drugs are related to movement disorders in this population as well.

Perez-Lloret and colleagues therefore looked retrospectively at 814 patients with depressive disorders or schizophrenia treated at several clinics in Central America. Overall, 25% of the patients had schizophrenia, 33% had major depression, and 42% had bipolar depression.

Overall, 7.5% of patients had movement disorders, which included 10.8% of those with schizophrenia and 6.4% of those with depression.

The most common movement disorder was tremor, at 5.9% of schizophrenia patients and 3.6% of depressive patients, followed by akathisia (3.4% and 1.5%, respectively) and tics (2.9% and 3.6%).

Factors associated with movement disorders included being male (OR 2.21, 95% CI 1.26 to 3.88), being on typical antipsychotics (OR 4.49, 95% CI 1.19 to 16.89), and being on lithium (OR 4.55, 95% CI 1.18 to 17.54).

Atypical antipsychotics and antidepressants were not associated with movement disorders, the researchers noted.

Being on typical antipsychotics was associated with an increased risk of movement disorders for both schizophrenia patients (OR 3.4, 95% CI 1.2 to 9.8) and depressive patients (OR 6.1, 95% CI 2.4 to 15.3).

That risk was significantly higher for depressive patients (OR 4.5, 95% CI 1.6 to 12.3), but Perez-Lloret said the reasons for this association are not clear.

He added that both groups also reported worse quality of life if they had a movement disorder.

When asked about potential mechanisms for the association, Perez-Lloret said that the researchers "really don't know: These patients have an alteration in dopaminergic pathways, which may by itself lead to movement disorders, so there may be an interaction at that level."

He acknowledged that the cross-sectional nature of the study makes it impossible to draw conclusions about those relationships, and noted that other confounders could be at work, including the fact that some patients who experience movement disorders may be switched to other drugs -- which could account for the lack of an association between atypical antipsychotics and movement disorders, he said.

"So we can't exclude the possibility that being on atypical antipsychotics is also a risk factor for movement disorders."

http://www.medpagetoday.com/MeetingCoverage/MDS/58719?xid=nl_mpt_DHE_2016-06-24&eun=g972365d0r

Long-Acting Drug Safe in Dyskinesia

June 23, 2016

BERLIN -- An extended-release formulation of amantadine for levodopa-induced dyskinesia is well tolerated in the long run, researchers reported here.

In an interim analysis of data from an ongoing open-label safety study, adverse event rates for those on ADS-5102 were similar to those in earlier studies over a total of 41 weeks, with the most common being falls (20%) and hallucinations (11%), Rajesh Pahwa, MD, Director of the Parkinson's Disease and Movement Disorder Center at the University of Kansas Medical Center, and colleagues reported at the International Congress of Parkinson's Disease and Movement Disorders.

For the side effects profile, the numbers aren't any different," Pahwa told MedPage Today. "The benefit is maintained long-term, and people tolerate the drug very well."

Amantadine is an old drug for Parkinson's disease that has been used to treat levodopa-induced dyskinesia, but it has to be taken two to three times a day, and its effects are not lasting, explained Claudia Trenkwalder, MD, of the University of Gottingen in Germany, who was not involved with the study.

Adamas Pharmaceuticals, therefore, developed a long-acting, extended-release version that can be taken before bedtime, before early-morning levodopa starts to produce dyskinesia, she explained: "This may be helpful and more efficient if you can give it at night as a sustained-release that works all day long," she told MedPage Today.

The EASE LID 2 trial was an open-label safety study conducted at 56 centers in North America and Western Europe. All patients either continued or started the 340-mg dose of ADS-5102 after the initial 24 weeks of the study, and the interim analysis also included data from patients with deep brain stimulation who still had levodopa-induced dyskinesia but had not been in the earlier trial.

The primary outcome was safety and tolerability, but the researchers also looked at efficacy as measured on the Unified Parkinson's Disease Rating Scale (UPDRS) Part IV, Pahwa said.

Overall, 129 patients had at least one post-baseline visit prior to the data cutoff date.

The researchers found rates of complications that were similar to those of the initial study, although patients who had originally been on placebo had slightly higher adverse event rates, which was expected, Pahwa said.

Discontinuation was also higher for those who had been on placebo initially compared with those who continued the study drug (17.6% versus 3.6%), which was also expected.

The most common adverse events overall were falls (20.2%), visual hallucinations (11.6%), abnormal dreams (7%), dizziness (7%), peripheral edema (7%), constipation (5.4%), and dry mouth (5.4%).

There was one urinary tract infection that was deemed to be drug-related, and the two deaths in the study were not thought to be related to extended-release amantadine, the researchers reported.

n terms of efficacy, the reductions on the UPDRS Part IV that were seen at the end of the randomized controlled trial were maintained in the follow-up period, and those who switched from placebo caught up to those who were on the drug the entire time, Pahwa said.

UPDRS scores were reduced from baseline by an average of 6 points for those who had been on placebo and by 6.6 points for those who had been on active drug. These reductions were driven by improvements in two items on the scale: functional impact of dyskinesia and functional impact of fluctuations, Pahwa said.

He added that the benefits were achieved without compromising the underlying control of Parkinson's symptoms, and concluded that the results demonstrate the long-term safety and efficacy of extended-release amantadine.

Adamas previously completed two pivotal phase III trials and is actively planning to file a New Drug Application with the U.S. Food and Drug Administration, according to a company spokesperson, although they would not disclose a timeline.

Trenkwalder noted that several other compounds have been evaluated for treating levodopa-induced dyskinesias, but this is one of the first to demonstrate safety and efficacy in phase III trials.

"It's difficult to measure dyskinesia, but this study relied on home diaries and succeeded," she said.

http://www.medpagetoday.com/MeetingCoverage/MDS/58734?xid=nl_mpt_DHE_2016-06-24&eun=g972365d0r

News from the AAN Annual Meeting: What is the Role of Vascular Etiologies in Parkinsonism? Experts Offer Two Different Views

June 23, 2016

Collins, Thomas S.

ARTICLE IN BRIEF

Two movement disorders specialists debate whether vascular risk factors contribute to parkinsonism. One cites data showing comorbid vascular diseases, while the other counters that it is difficult to make the association because the definition of vascular parkinsonism is ill-defined.

VANCOUVER—Whether vascular causes play a major role in parkinsonism is a gray area, said two Parkinson's disease experts here in a plenary discussion of controversies in neurology at the AAN Annual Meeting in April. And they said how to answer that question is a matter of debate.

The lack of a universal rule on how to define parkinsonism contributes to the controversy, both experts agreed.

Aron S. Buchman, MD, professor of neurological sciences at the Rush University Alzheimer's Disease Center, said a review of cases at his center seems to show that vascular diseases, risk factors, and pathologies in the brain and spinal cord are strongly related to parkinsonism, while Alberto J. Espay, MD, FAAN, clinical research director of the James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders at the University of Cincinnati, countered that it's difficult to make that claim.

THE CASE FOR VASCULAR ETIOLOGY

 DR. ARON S.  Buchman  

Dr. Buchman cited data from the Religious Order Study, in which more than 1,300 nuns and priests across the US have been followed up at a 95 percent rate and with a 90 percent autopsy rate, adding up to more than 600 autopsies, and the Chicago-area Memory & Aging Project, with 1,800 people followed up at a rate of 90 percent, with 650 autopsies available.

At Rush, researchers categorized people as demonstrating parkinsonism using the 26 items in the motor section of the Unified Parkinson Disease Rating Scale, which is divided into four domains — parkinsonian gait, rigidity, bradykinesia, and tremor — with several tasks within each domain. If a person met two or more criteria within a domain, that domain was considered to be present. The presence of two more domains meant that a person was considered to have parkinsonism.

Using data from these studies, they looked at whether vascular diseases and vascular risk factors were related to parkinsonism. They reported in a 2011 paper in Stroke that demographics, such as age and education, together with vascular diseases like myocardial infarction and stroke as well as risk factors such as body-mass index and diabetes, accounted for approximately 30 percent of the parkinsonism variance they saw in the cohort. But they also found other vascular factors, such as claudication and hypertension, were not significant predictors.

What's more, Dr. Buchman said, researchers have also found that cerebrovascular pathology is associated with the severity of parkinsonism, with macroinfarcts, microinfarcts, and arteriolosclerosis predicting the severity of parkinsonism even when controlling for demographics and Parkinson's disease pathology of the substantia nigra.

“This finding of the microinfarcts and arteriolosclerosis is very important,” he said. “About one-third of the cohort had these. These abnormalities would not be seen with ante-mortem magnetic resonance imaging [MRI]. You could only see them postmortem. And so it suggests that it's an unrecognized cause of parkinsonism that you wouldn't be able to see even if you did an MRI.”

Researchers also closely examined the microvascular pathology in the brains and spinal cords of 150 people, and found that arteriolosclerosis of the spinal cord was present to a greater degree than arteriosclerosis in the brain, and it was the only factor that explained any of the variance of parkinsonism.

“All the other brain pathologies” — which included atherosclerosis, Lewy Body, nigral neuronal loss, and Alzheimer's disease pathology — “fall out and don't explain any of the variance of parkinsonism,” Dr. Buchman said.

This, he said, “suggests that there's a tremendous gap in our ability to understand what the basis of parkinsonism is. It suggests that we need to look at the entire pathway that probably includes the nerve and muscle and the musculoskeletal element to really explicate what we're talking about.”

THE CASE AGAINST VASCULAR INVOLVEMENT

Dr Alberto Espay

Dr. Espay countered that it's difficult to make the claim that vascular etiology is a common cause of parkinsonism because “vascular parkinsonism” (VaP) is so ill-defined. It's a diagnosis, he said, without specific clinical, imaging, or pathologic features.

One systematic review, published in 2010 in the journal Movement Disorders, covered 25 articles on differentiating vascular parkinsonism from idiopathic Parkinson's disease and found no abnormal imaging pattern that was specific to vascular parkinsonism.

There also seems to be no clinical-pathological correlation, Dr. Espay said. In one of only two post-mortem studies, with vascular parkinsonism defined as the presence of parkinsonism and pathological evidence of cerebrovascular lesions but no depigmentation or Lewy bodies at the substantia nigra, researchers found no difference in the extent of vascular lesions in the basal ganglia between those with VaP and those with Binswanger's disease, or subcortical vascular dementia.

The term “vascular parkinsonism” itself is defined very loosely, he said. A study that helped generate the current criteria for the syndrome showed that the severity of microscopic small-vessel disease did not differ between the frontal, temporal, parietal, occipital, and striatal regions. There was also no clinical specificity in its VaP definition — with VaP criteria met, for instance, with either acute, delayed, or insidious presentations, either uni- or bi-lateral parkinsonism, with or without gait impairment, or with focal or diffuse lesions.

He added that data on prevalence also don't seem to support a causal connection between vascular etiology and parkinsonism.

“If you truly think that there is a condition called ‘vascular parkinsonism,’” he said, “we could assume that cerebrovascular disease and parkinsonism are going to increase in prevalence in parallel. But the data that have accumulated so far show that there really isn't a correlation between cerebrovascular disease and parkinsonism.”

Both Drs. Buchman and Espay agreed, however, that if the term is going to be used, it's in the best interests of the field to begin describing vascular parkinsonism using objective measures. Dr. Buchman described how his center is beginning to use body sensors to describe gait in a more thorough, objective fashion.

“I think that moving in the direction of having objective measures and dispensing with qualitative labels would be very helpful for moving forward to understand the biology,” he said.

Dr. Espay agreed. “I suspect that many of the concepts related to parkinsonism and vascular phenotype are really driven by a poor characterization of the gait and the overall features,” he said. “And in this I agree that we need to have more sophisticated measurements and certainly cannot rely purely on imaging.”

Howard I. Hurtig, MD, emeritus professor of neurology specializing in Parkinson's disease at the University of Pennsylvania Perelman School of Medicine, who attended the debate, called Dr. Buchman's view a “plausible hypothesis.”

“I definitely accept that that's a possibility,” he said. “I don't think he goes overboard and says that strokes in old people definitely cause Parkinson's or parkinsonism signs. He says they may contribute, which is reasonable.”

Clinically, insofar as this view leads to more awareness of vascular health, it is helpful, he said. “Forever we've struggled with the fact that hypertension is under-treated in society, and if people were more aware of the risks of stroke-related hypertension, then individuals would be more vigilant about watching their blood pressure and having it treated. So I think to the extent that this has a practical application, it's a good point. If you can prevent cerebrovascular disease by simply treating high blood pressure, which is one of the most important causes of stroke and microinfarcts, then at least you've achieved something in the realm of public policy.”

“It's good to assume that vascular factors can contribute,” Dr. Hurtig continued. “The big problem of course is that it's [often] too late for treatment when someone starts to develop these signs.”

http://journals.lww.com/neurotodayonline/Fulltext/2016/06230/News_from_the_AAN_Annual_Meeting__What_is_the_Role.10.aspx

Pride in Mann: Pullyman is a true entertainer

June 23, 2016

Michael Cowin, aka Pullman

Whether it’s in his weekly newspaper column or radio slot or live in front of an audience, Pullyman has certainly shown that he has a way with words.

Michael Cowin was diagnosed with Parkinson’s disease 10 years ago. He discovered writing four years ago when he woke up one morning with a ready-formed poem in his head that went on to be broadcast.

Since then, he’s written five booklets of poems and essays, got every Tynwald member to read one of his poems for a CD, and had weekly slots with the Manx Independent and Manx Radio for two and a half years.

He’s put himself firmly in the spotlight with sell-out Pullyman and Friends variety shows held at Peel’s Centenary Centre and Erin Arts Centre.

He’s now set his sights on the Gaiety Theatre for his next concert on November 18. In the process, he’s raised many thousands of pounds for Parkinson’s and other charities.

Now, Pullyman, 75, who lives in Groudle Road, Onchan, has been nominated in the Steam Packet Pride in Mann Awards by one of his fellow performers, Di Benson.

Nominating him in the Culture and Arts Champion category, she said: ‘I would like to nominate Michael for all the pleasure he brings with his poetry and tall stories not only on the radio but in the paper.

‘He has helped me with becoming a performance poet and I was able to perform in his last show Pullyman and Friends. He raises a great deal of money for charity, especially Parkinson’s.’

Pullyman’s creations range from the nostalgic to the side-achingly funny. He said the pleasure and the warmth he gets from the people that he’s talking to is hugely rewarding. So it’s no surprise he can’t wait to be performing in front of his biggest audience yet, at the Gaiety.

‘We’ll have people on stage that have only been on stage twice before. It’s a huge step for them to stand there and do it. And it’s a huge step for me to stand up and say I can make it possible for them. I’ve never done anything like it.’

He added: ‘We’re a bunch of amateurs who are going to make everyone laugh. They will because they have absolute confidence they can do it.’

Pullyman said his plan had evolved over the four years but that everything had always fallen into place. The Centenary Centre show last October came to him when he was driving past the venue one day.

‘I thought: “I wonder what it would be like putting on a show there?”. There and then I shook hands on the day I was going to put a concert on.’

He said: ‘Apart from the efforts of my fellow performers, the production and success of the shows has only been possible because of the commitment of my hard working friends on the team, Hazel and Bill, and tech Ernie.’

When he first took part in an open mic night four and a half years ago he almost ‘bottled it’, and it was his wife Irene who persuaded him to perform. ‘Since Parkinson’s I have had no inhibitions about standing up in front of people.

‘If I can overcome this...’ he said.

http://www.iomtoday.co.im/news/isle-of-man-news/pride-in-mann-pullyman-is-a-true-entertainer-1-7974638