TRUST WELCOMES NEW PARKINSON’S DISEASE PRACTITIONER

By Island Echo
12 August 2016

A highly experienced Parkinson’s Disease Practitioner has recently taken up post at St Mary’s Hospital.

Sheena Morgan will be delivering care to patients across the Island and supporting them to live well with the disease, from the point of diagnosis to helping them to maintain their health through developing self-care techniques. Sheena will also be providing expert care and guidance to those in need of palliative and end of life care.

Parkinson’s disease is a condition in which parts of the brain become progressively damaged over many years, causing involuntary shaking of particular parts of the body (tremor), slow movement and stiff and inflexible muscles. A person with Parkinson’s disease can also experience a wide range of other physical and psychological symptoms, including depression and anxiety, balance problems, memory loss and difficulty sleeping.

Sheena is an experienced and knowledgeable nurse in this specialty, having previously worked as a Parkinson’s Nurse Specialist for the past 11 years in the New Forest area. Speaking about her new role, Sheena, said:

“It has been a very busy and exciting time establishing the service and getting to know the Island and I am looking forward to meeting more patients and their families over the coming weeks.

“There are approximately 400 people on the Island who have been diagnosed with Parkinson’s disease and clinics are being held at St Mary’s Hospital and soon to be held in the South and West Wight areas too. However, patients who are particularly poorly with urgent clinical needs are being prioritised and invited to attend a clinic. I will endeavour to see all Parkinson’s patients over the coming months.”

Sheena will not only be supporting patients and their families but also sharing her knowledge and expertise with other nursing colleagues across the Trust and working closely with the local Parkinson’s Support Group to continue to develop the service and improve the care for patients.

Alan Sheward, IoW NHS Trust Executive Director of Nursing, said:

“This is an exciting development for the Parkinson’s service on the Island and one which will really help us to improve the care we give and the quality of life for those living with Parkinson’s Disease.”

http://www.islandecho.co.uk/news/trust-welcomes-new-parkinsons-disease-practitioner

Meet the Champions Helping to #End Parkinsons

Aug. 13, 2016

Meet the inspiring PDF Champions who put their passion to work for PD this summer by running, cycling, flying, hiking and hosting garage sales to help #EndParkinsons.

Stan Flies Across the Sky for Parkinson’s

Stan Fenn (photo one), a 72-year-old pilot from Idaho Falls, ID, who lives with Parkinson’s, flew his plane from Idaho to Iowa, raising $1,500 for PDF. “I want to encourage everyone to keep moving, keep motivated and keep setting goals. Let’s beat this disease!” he said. 

Jamie Cycles 514 Miles for a Cure Jamie Malam (photo two) cycled more than 514 miles over six days from San Francisco to Huntington Beach, CA in honor of his father-in-law who lives with PD His wife Lucia supported him along the way and together, they raised more than $2,000 for PDF. “Every effort, no matter how big or small, helps make a difference,” says Mr. Malam. A.C. and Family Paddle for PD A.C. Woolnough of Sandpoint, ID, his grandson Nathan and other family members (photos three and four) Paddled for Parkinson’s this July raising more than $700. “I want to be the last generation living with Parkinson’s. I’m dedicating this kayaking adventure in memory of my late father,” said Mr. Woolnough, Vice Chair of PDF’s People with Parkinson’s Advisory Council. Rachel's Ninth Summer Challenge Nine-time Champion Rachel Isenberg (photo five) of Philadelphia, PA, hiked 12 miles and paddled more than 10 miles along the Maclaren Glacier and River in Alaska, bringing her fundraising total since 2008 to $32,000. “Being able to do this to honor my mom, who faces her disease with strength and grace, is incredible,” said Ms. Isenberg. Garage Sale Benefits PDF Bernadette Lindquist (photo six) hosted a garage sale in Reynoldsburg, OH, in honor of her husband who lives with PD, raising more than $800 for PDF! “While some people came only for the garage sale, we also met many folks who were touched in one way or another by Parkinson's and came out specifically to support PDF.”

Are you interested in helping to #EndParkinsons? Remember, Grandparents Day is coming up next month. Plan something special for a loved one. Our team can help you create a personalized fundraising page and support you every step of the way.

http://www.pdf.org/?utm_source=newsletter&utm_medium=email&utm_campaign=funding

Specific brain-training technique shown to reduce dementia risk

Aug. 4, 2016

 

    Brain-training, when done right, can lower dementia risk.

Although many so-called brain-training products claim to keep minds sharper and stave off dementia, evidence in support has not been overwhelming. The latest analysis, however, finds that not all brain-training is equal.

There are many companies that offer computerized brain-training tools, many of which promise to keep older minds more agile for longer.

Individual companies claiming to provide health benefits without the backing of solid evidence has caused a pushback from scientists.

A group of experts from the Stanford Center on Longevity released a statement in 2014, which said: 

"We object to the claim that brain games offer consumers a scientifically grounded avenue to reduce or reverse cognitive decline when there is no compelling scientific evidence to date that they do."

However, according to findings presented at the American Psychological Association's 124th Annual Convention this week, there is one type of training that does have the support of scientific evidence.

The results were presented by Jerri Edwards, Ph.D., of the University of South Florida, who says: "The mistake some people make is thinking that all brain-training is the same."

"Lumping all brain-training together is like trying to determine the effectiveness of antibiotics by looking at the universe of all pills, and including sugar pills and dietary supplements in that analysis. You'll find that some work and some do not. 

To then conclude that brain-training does not work - or is not yet proven - is based on flawed analysis."

Jerri Edwards, PhD

o, although studies, overall, are contradictory in their findings, Edwards believes that by throwing all training regimes into one pot, the results have been homogenized and become meaningless.

To rectify this knowledge gap, Edwards and her team carried out a systematic review and meta-analysis of more than 50 peer-reviewed scientific papers specifically looking at speed of processing training.

Speed of processing training

According to Edwards, speed of processing training improves the speed and accuracy of visual attention, in other words, someone's mental agility.

As an example, in one of the tasks, the user identifies a target object in the center of the screen, a truck or car, for instance. The participant is then required to identify a second target in the periphery of their vision.

With practice, the time taken to identify the peripheral target gets shorter and shorter. Even when the task is made more difficult by adding distracting objects around the targets, people improve their performance over time.

Speed of processing training was found to improve a number of areas of cognitive performance including attention, behavioral (such as depressive symptoms and feelings of control), and functional performance in real-life situations.

One of the most transferable benefits of speed of processing training is its demonstrable effect on driving ability. Studies have shown that this type of brain-training improves stopping distance by 22 feet at 55 miles per hour and decreases dangerous maneuvers by 36 percent.

The results of the ACTIVE study

Alongside the review and analysis, the researchers also presented results from their Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. 

The study was the first large-scale, randomized trial to test the long-term impact of brain-training on the prevention of cognitive impairment in an individual's daily life.

The study used 2,832 individuals, aged 65-94, and examined the long-term effects of brain-training on dementia prevention. The team found that the cohort's dementia risk was reduced by 48 percent over 10 years for those who completed 11 or more sessions of the brain-training technique.

Overall, risk of dementia was reduced by 8 percent for each session of speed processing training.

Edwards concludes: "Some brain-training does work, but not all of it. People should seek out training backed by multiple peer-reviewed studies. The meta-analysis of this particular speed of processing training shows it can improve how people function in their everyday lives."

The fact that something as accessible as a computer-generated program might stave off dementia and make American roads safer is certainly a reason to be excited.

Written by Tim Newman

http://www.medicalnewstoday.com/articles/312112.php

Medtronic earns CE mark for deep brain stimulation software

by  Alyssa Huntley 

Aug 9, 2016

Medtronic ($MDT) has earned a CE mark for its SureTune2 software. The tech offers physicians patient-specific visualizations which help them to “tune” a patient’s deep brain stimulation (DBS) therapy.

DBS therapy is a targeted treatment that offers specific symptom control through mild electrical stimulation in the brain. “The brain targets are stimulated through lead(s) inserted into the brain and connected to an implantable neurostimulator through extensions running under the skin,” Medtronic explained in the announcement. “A medical professional uses an external programmer to set and adjust stimulation settings.”

Having to manually program settings can be a time-consuming process. Medtronic’s SureTune2 aims to alleviate some of the frustrations of this process. Using visualization of patient-specific information, SureTune2 works along with Medtronic DBS therapy and other DBS therapy systems to select the best stimulation settings for a patient.

The visualizations offer up a comprehensive view which includes anatomy, physiology and calculated stimulation field. Using a greyscale threshold within a region of interest, users can segment structures.

"[SureTune2] simplifies the trial and error process associated with DBS programming by helping me identify the best contacts, which saves me time,” said Jens Volkmann, chairman and professor of neurology at the University Clinic of Würzburg.

Lothar Krinke, the vice president and general manager of the brain modulation business in Medtronic’s Restorative Therapies Group, noted in the announcement that SureTune shows how committed Medtronic is to “providing integrated solutions for improving accuracy and confidence from surgery to post-operative DBS patient management."

Medtronic’s DBS therapy has been used by over 140,000 patients worldwide to help with disabling symptoms of essential tremor, Parkinson’s disease and dystonia. While Medtronic’s DBS therapy system is approved in many locations throughout the world, SureTune2 is not yet approved in the United States.

http://www.fiercebiotech.com/medical-devices/medtronic-earns-ce-mark-for-deep-brain-stimulation-software

Dystonia and Parkinson's Disease

Dystonia is characterized by painful, prolonged muscle contractions that cause involuntary repetitive twisting and sustained muscle contractions. These result in abnormal movements and postures. The symptoms usually begin in one body region, such as the neck, face, vocal cords, an arm or a leg, and then may spread to other parts of the body. The severity varies from person to person. Many people who have dystonia can maintain a relatively normal lifestyle. Others may need full-time assistance. Dystonia is the third most common movement disorder, affecting an estimated 500,000 adults and children in North America.

• What causes dystonia?
• What is the relationship between Parkinson’s and dystonia?
• What are the other types of dystonia?
• What treatments exist for dystonia?
• What therapies are in development for dystonia?
• Where can I learn more about dystonia?

What causes dystonia?

Dystonia likely results from dysfunction of a related brain region affected in parkinsonism, the basal ganglia, although the ultimate cause is not known. Further research is necessary to determine the various genetic, environmental or other underlying mechanisms that may play a role in causing dystonia.

Dystonia is a prominent symptom for people with Parkinson’s who have a mutation in the Parkin gene — one of a handful of Parkinson’s-implicated genes — though more research is needed to understand why this is the case.

What is the relationship between Parkinson’s and dystonia?

Dystonia and Parkinson’s disease (or parkinsonism) are movement disorders that are closely related. Parkinsonism is a term used to describe any clinical presentation that manifests in the cardinal symptoms of Parkinson’s disease (tremor, rigidity and slowness of movement).

Some experts estimate that forty percent of people living with Parkinson's disease experience dystonia as an early symptom or as a complication of treatment. Some forms of dystonia (see below) are characterized by parkinsonism, and other neurodegenerative disorders, such as Wilson's disease, may have symptoms of both dystonia and parkinsonism.

What are the other types of dystonia?

There are two main categories of dystonia: primary and secondary (or non-primary). Primary dystonia is a condition in which dystonia is the only clinical feature. There is no evidence of cell death or a known cause. It is also known as idiopathic torsion dystonia. Primary dystonia is thought to have greater genetic contribution, even in the absence of a family history of dystonia. Among forms of primary dystonia, the most common (and the most debilitating) is generalized dystonia, which affects the legs or one leg and the trunk, plus other regions, most commonly the arms.

Outside the context of Parkinson’s disease, there are several other types of secondary dystonia, in which other symptoms are also present. In this category are:

• Myoclonus dystonia, characterized by dystonia and myoclonus (rapid, lightning-like muscle movements), with onset in childhood or adolescence.
• Dopa-responsive dystonia, a genetic disorder of childhood onset and may have features of parkinsonism or exaggerated reflex responses.
• Rapid-onset dystonia parkinsonism, a rare inherited disorder characterized by sudden development of dystonia and parkinsonism.
• Paroxysmal dystonia, neurological conditions characterized by discrete and sudden episodes of involuntary movements.

Secondary dystonia may also be triggered by trauma to the head or a specific area of the body, drug use or exposure to rare toxins.

As in Parkinson's disease, dystonia can be present in other neurological disorders including:

• Wilson's disease, a rare genetic disorder in which copper accumulates in the organs.
• Huntington's disease, a hereditary progressive neurodegenerative disorder.
• Spinocerebellar ataxias, a group of progressive degenerative inherited conditions.
• Methymalonic aciduria, an inherited disorder of metabolism.

• What treatments exist for dystonia?

  Dystonia and Parkinson’s share common forms of treatment. Anticholinergic medications (such as trihexyphenidyl or benztropin) and levodopa may improve both conditions (though dystonia, like other Parkinson’s symptoms, can return or worsen as levodopa wears off and loses efficacy with long-term use). And deep brain stimulation (DBS) is a surgical treatment for both, although the stimulation target in the brain may be different.
  Other medications such as muscle relaxants or antispastic agents may also treat dystonia. In addition, physicians may prescribe botulinum toxin injections. When a small amount of commercially prepared botulinum toxin is selectively injected in overactive muscles, it causes a change in the muscle firing, calming the abnormal movements for up to several months at a time.
  Physical therapy may be helpful as a supplement to other therapies. Many patients report beneficial effects from complimentary therapies such as yoga, tai chi and meditation, although rigorous studies evaluating their efficacy are lacking.

  What therapies are in development for dystonia?

  For dystonia with Parkinson’s disease, researchers are working on better levodopa delivery. Optimizing the current standard of treatment to work more reliably and last longer would help treat dystonia related to Parkinson’s and avoid the medication wearing off and symptoms returning.
  Read more about Parkinson’s therapies in development, including those targeting better levodopa delivery.

  Where can I learn more about dystonia?

  For more information, and a list of groups exclusively focused on dystonia (including pediatric dystonia), visit the Dystonias Information Page of the National Institute of Neurological Disorders and Stroke (part of the National Institutes of Health).
  https://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?dystonia

More people under 40 suffer from Parkinson's disease

Aug. 12, 2016

TAIWAN - More and more people under 40 are being afflicted by Parkinson's disease (PD), and the primary reason might be exposure to volatile gases, farm chemicals, and heavy metal toxicity, according to the Hualien Tzu Chi Medical Center.

Drinking tea and coffee regularly may reduce the possibility of becoming afflicted by the disease, the medical center said.

The Tzu Chi Medical Center and Taiwan Tulip Movement Disorder Association held a conference yesterday for World Parkinson's Disease Day on April 11 and invited patients and researchers to speak.

Chen Shin-yuan, a physician at the Buddhist Tzu Chi General Hospital, studied the lifestyles of 100 PD patients and found that very few of them had been drinking tea or coffee regularly.

Fewer persons with a long history of drinking tea or coffee are afflicted with PD, a finding that is also in keeping with medical research published abroad, Chen said.

Researchers also found that painters and people working in gas stations and electricity power plants are more likely to develop PD.

PD is a degenerative disorder of the central nervous system, the most obvious symptoms of which are movement related. In the early stage, patients may exhibit shaking, rigidity and slowness of movement. Cognitive and behavioral problems might appear later. The cause is still unknown.

Positive Correlation Between Diabetes and PD

A research suggesting positive correlation between diabetes and PD conducted by many Taiwanese medical scholars was published in US medical journal Diabetes Care and broadcast on Fox News.

The research suggests that this positive correlation is most obvious for young patients.

Researchers concluded that common causes might exist for PD and diabetes.

For people more than 9 years old and suffering from diabetes, 3.6 cases of PD were found among 10,000 people per year, while 2.1 cases were found among 10,000 people per year among those who did not have diabetes, according to the research.

The relation between diabetes and PD is stronger in younger persons, the study said. For females from 40 to 50 years old, those who have diabetes are twice more likely to be affected by PD. Similar result was found for males from 20 to 30, according to the research.

A recent study in the United States also shows a similar result. The US study found that among the 21,600 people with diabetes, 0.8 per cent were diagnosed with PD, while only 0.5 per cent of people without diabetes were diagnosed with PD.

http://health.einnews.com/article/339694106/f3sYIK-0qokw8NUF

Scientists Zero in on Brain Area Linked to 'Parkinson's Gait'

Aug. 12, 2016

Discovery could lead to new treatments for the disease's jerky, unbalanced walking, researchers say

The brain's prefrontal cortex may play a role in walking difficulties that afflict Parkinson's disease patients, new research suggests.

The prefrontal cortex is involved in cognitive function, which includes thinking, reasoning and remembering.

This new finding is a new approach in understanding these walking problems and may lead to new treatments, according to the researchers from Tel Aviv University in Israel.

Parkinson's disease is a chronic, progressive movement disorder. Patients often walk with a shuffle, their steps alternately slow and fast. Sometimes, they freeze in place. Together, these symptoms are known as "Parkinson's gait." Along with reducing patients' mobility, impaired walking can lead to dangerous falls.

Parkinson's patients were asked by the researchers to walk and do a mental task -- such as naming fruits or doing subtraction -- at the same time. As they did, their walking was slower and less stable than when they walked without doing a mental task.

This suggests that cognitive resources in use while they walk play a role in walking difficulties experienced by Parkinson's patients, according to the researchers.

Brain scans of Parkinson's patients showed that the prefrontal cortex was activated even when patients just imagined they were walking.

"The overactivation of the prefrontal cortex has a two-pronged effect in Parkinson's patients. Because the prefrontal cortex is 'saturated,' it is unable to perform other tasks, impairing gait and creating cognitive deficits. The debilitation is twofold," said study co-leader Anat Mirelman, a researcher in the department of neurology. 

Study co-leader Jeffrey Hausdorff is a professor of medicine. "The increased activation during normal walking curtails the ability of Parkinson's patients to recruit further cognitive resources during other challenging tasks. It may even exacerbate the high risk of falling in these patients," he said in a university news release.

The findings were published recently in the journals Parkinsonism and Related Disorders and Neurorehabilitation and Neural Repair.

SOURCE: Tel Aviv University, news release

-- Robert Preidt

https://consumer.healthday.com/cognitive-health-information-26/parkinson-s-news-526/briefs-unknown-date-frontal-lobe-parkinson-s-gait-tau-release-batch-2816-713803.html

Breakthrough in understanding how stem cells become specialized

Older but Interesting

Aug. 4, 2016

Pluripotency factor primes genes involved in differentiation

Fluorescence microscopic view of human skin cells (stock image).

Source:

Sanford-Burnham Prebys Medical Discovery Institute

Summary:

Scientists have made a major advance in understanding how the cells of an organism, which all contain the same genetic information, come to be so diverse. A study shows that a protein called OCT4 narrows down the range of cell types that stem cells can become. The findings could impact efforts to produce specific types of cells for future therapies to treat a broad range of diseases.

Scientists at Sanford Burnham Prebys Medical Discovery Institute (SBP) have made a major advance in understanding how the cells of an organism, which all contain the same genetic information, come to be so diverse. A study published today in Molecular Cell shows that a protein called OCT4 narrows down the range of cell types that stem cells can become. The findings could impact efforts to produce specific types of cells for future therapies to treat a broad range of diseases, as well as aid the understanding of which cells are affected by drugs that influence cell specialization.

"We found that the stem cell-specific protein OCT4 primes certain genes that, when activated, cause the cell to differentiate, or become more specialized," said Laszlo Nagy, M.D., Ph.D., professor and director of the Genomic Control of Metabolism Program and senior author of the study. "This priming customizes stem cells' responses to signals that induce differentiation and makes the underlying genetic process more efficient."

Differentiation matters

As an organism -- such as a human -- develops from its simplest, earliest form into maturity, its cells transition from a highly flexible state -- stem cells -- to more specialized types that make up its tissues. Many labs are trying to recapitulate this process to generate specific types of cells that could be transplanted into patients to treat disease. For example, pancreatic beta cells could treat diabetes, and neurons that produce dopamine could treat Parkinson's.

What OCT4 does

OCT4 is a transcription factor -- a protein that regulates gene activity -- that maintains stem cells' ability to give rise to any tissue in the body. OCT4 works by sitting on DNA and recruiting factors that either help initiate or repress the reading of specific genes.

The new study shows that, at certain genes, OCT4 also collaborates with transcription factors that are activated by external signals, such as the retinoic acid (vitamin A) receptor (RAR) and beta-catenin, to turn on their respective genes. Vitamin A converts stem cells to neuronal precursors, and activation of beta-catenin by Wnt can either support pluripotency or promote non-neural differentiation, depending on what other signals are present. Recruitment of these factors 'primes' a subset of the genes that the signal-responsive factors can activate.

The big picture

"Our findings suggest a general principle for how the same differentiation signal induces distinct transitions in various types of cells," added Nagy. "Whereas in stem cells, OCT4 recruits the RAR to neuronal genes, in bone marrow cells, another transcription factor would recruit RAR to genes for the granulocyte program. Which factors determine the effects of differentiation signals in bone marrow cells -- and other cell types -- remains to be determined."

Next steps

"In a sense, we've found the code for stem cells that links the input -- signals like vitamin A and Wnt -- to the output -- cell type," said Nagy. "Now we plan to explore whether other transcription factors behave similarly to OCT4 -- that is, to find the code in more mature cell types.

"If other factors also have this dual function -- both maintaining the current state and priming certain genes to respond to external signals -- that would answer a key question in developmental biology and advance the field of stem cell research."

This research was performed in collaboration with scientists at the University of Debrecen in Hungary, the University of Leicester in the United Kingdom, the Max Planck Institute for Molecular Genetics, the University of Würzburg and the Max Delbrück Center for Molecular Medicine in Germany, the Institut de Génomique in France, and Weill Cornell Medical College, and supported by grants from the Hungarian Scientific Research Fund, the Hungarian Brain Research Program, and the U.S. National Institutes of Health.

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Story Source:

The above post is reprinted from materials provided by Sanford-Burnham Prebys Medical Discovery Institute. The original item was written by Jessica Moore. Note: Content may be edited for style and length.

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Journal Reference:

1. Zoltan Simandi, Attila Horvath, Lyndsey C. Wright, Ixchelt Cuaranta-Monroy, Isabella De Luca, Katalin Karolyi, Sascha Sauer, Jean-Francois Deleuze, Lorraine J. Gudas, Shaun M. Cowley, Laszlo Nagy. OCT4 Acts as an Integrator of Pluripotency and Signal-Induced Differentiation. Molecular Cell, 2016; DOI: 10.1016/j.molcel.2016.06.039

https://www.sciencedaily.com/releases/2016/08/160804140503.htm

What matters most: the survey results

11 August 2016

Earlier this year you told us what matters most to you and the issues we should prioritise in an online survey.

I was overwhelmed by the response to this survey.

Laura Cockram, Policy and Campaigns Programme Manager

Over 1,000 people across the UK shared their views. Here's what you said we should be campaigning on:

•  improving financial support and benefits for people with Parkinson's

•  improving access and the quality of health and care services across the whole of the UK

•  the development of new and better treatments and ensuring the funding to deliver these is adequate

Financial support and benefits

People affected by Parkinson's told us they want us to "ensure that the benefits system is fair for people with Parkinson's."

We will:

•  campaign to improve the benefits system so that it works better for people with Parkinson's and also defend support such as Attendance Allowance from cuts. We will also campaign for free prescriptions in England

Access and the quality of care

Those affected by Parkinson's stated they want "good care available locally. Not a postcode lottery." And "availability of therapies e.g. physiotherapy to make life bearable."

We will:

•  improve access and the quality of health and care services across the whole of the UK including improving access to therapies and respite care and eligibility for NHS Continuing Care

•  grow and empower local campaigners to increase the amount of specialist staff so that everyone has the same access to support regardless of where they live.

Development of new and better treatments

People living with Parkinson's told us they want "a cure to give us hope for our future."

We will:

•  campaign to protect research funding 

•  ensure there is investment and support for our work around drug repurposing

Public awareness

However the biggest majority of respondents in the survey stated improved public awareness of the condition would help them. "Awareness – particularly relating to non-motor symptoms."

Therefore we'll be working across the charity to ensure we improve awareness of the condition.

We will:

•  raise awareness with decision makers in Parliament, local government and health and social care professionals about the full range of Parkinson's symptoms

•  continue to improve understanding in hospitals and care homes about people with Parkinson's getting their medication on time

•  encourage local councils, retailers and providers of public services to deliver our Parkinson’s awareness sessions.

We can't do this on our own

Laura Cockram, Policy and Campaigns Programme Manager said:

"I was overwhelmed by the response to this survey. People affected by the condition have shared their views and now we'll be using this to direct the campaigns we will deliver to the end of 2019.

"We can’t do this on our own so would welcome anyone who wants to get involved and join our network of campaigners to improve health and care services across the UK."

To get involved in campaigning to deliver changes for people affected by the condition please visit our campaign pages.

http://www.parkinsons.org.uk/news/11-august-2016/what-matters-most-survey-results