Parkinson's-related mutations may also affect vision
Copied from The Northwest Parkinson’s Foundation Weekly News Update
News Medical - The most common genetic cause of Parkinson's is not only responsible for the condition's distinctive movement problems but may also affect vision, according to new research by scientists at the University of York.
Parkinson's, the second most common form of neurodegenerative disease, principally affects people aged over 60. Its most common symptom is tremor and slowness of movement (bradykinesia) but some people with Parkinson's also experience changes in vision.
Now for the first time, researchers in the University's Department of Biology have established a link between a mutation which triggers Parkinson's and problems with vision in an animal model.
The latest research, part-funded by leading research charity Parkinson's UK is published in Human Molecular Genetics. Scientists at York studied the impact of the most common Parkinson's-related mutation on nerve cells in the visual system of the fruit fly, Drosophila.
Using electroretinagram (ERG) technology they found a gradual loss of function in eye nerve cells with the mutant gene. The fly visual system is a useful laboratory model as it contains similar amounts of dopamine to the human eye.
However, the research team, which was supported by the University's Centre for Chronic Disease and Disorders (C2D2), found that other Parkinson's-related mutations did not affect eye nerve cell function and there was no loss of vision.
Dr Chris Elliott, who led the research, said: "This is a significant step forward as it will help to identify those people with Parkinson's who may be at greater risk of changes in their vision. It will assist clinicians to manage the condition more effectively.
"We have to get away from the idea that Parkinson's is only about movement problems. This work indicates that changes in vision may also affect people with the most common form of inherited Parkinson's."
Claire Bale, Research Communications Manager at Parkinson's UK added: "This new research has uncovered a potentially interesting relationship between one of the most common genes linked to Parkinson's and the development of visual problems.
"But crucially this study looked at fruit flies, so we need to do more research to find out how relevant the findings are to people living with the condition.
"If you have Parkinson's and notice changes in your eyesight, such as blurred or double vision, it's important to discuss this with your specialist or Parkinson's nurse."
Source: University of York
Early Parkinson’s Patients May Suffer Some Symptoms in Silence
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Health.com - People with early stage Parkinson’s disease often experience anxiety, constipation, drooling and other symptoms not related to movement problems, new research finds.
Because movement problems are the main symptom of the disease, these non-motor symptoms often go undiagnosed and untreated, according to the study, which was published in the Jan. 15 issue of the journal Neurology.
“Oftentimes people with early Parkinson’s don’t even mention these symptoms to their doctors, and doctors don’t ask about them,” study author Tien Khoo, of Newcastle University in England, said in a journal news release. “Yet many times [the symptoms] can be treated effectively.”
The researchers asked 159 newly diagnosed Parkinson’s disease patients and 99 people without the disease whether they experienced any of 30 non-motor symptoms, including gastrointestinal problems, sleep problems and sexual problems.
The Parkinson’s patients had an average of eight of the non-motor symptoms, while those without Parkinson’s had an average of three. The most common symptoms for Parkinson’s patients were drooling, urinary urgency, constipation, anxiety and a reduced sense of smell.
Excess saliva or drooling was a problem for 56 percent of Parkinson’s patients and only 6 percent of those without the disease. Constipation affected 42 percent of Parkinson’s patients and 7 percent of those without the disease. Anxiety was reported by 43 percent of Parkinson’s patients and 10 percent of those without the disease.
“These results show that Parkinson’s affects many systems in the body, even in its earliest stages,” Khoo said. “Often these symptoms affect people’s quality of life just as much if not more than the movement problems that come with the disease. Both doctors and patients need to bring these symptoms up and consider available treatments.”
The U.S. National Institute of Neurological Disorders and Stroke has more about Parkinson’s disease.
Contributed by : Beatrice Rabkin - Nutritional Therapist
These are some other options to relieve constipation:
1. Epsom salts (Tastes nasty!) 1tsp. in a glass of water and then a second 2 hours later, if no response. This can be used as a once off, to clear out impacted stool, can do it 1-2 week if needed.
2. Aloe Ferox (Timjan available from liquor stores as it contains a small amount of alcohol) or other Aloe Ferox available from most Health shops or pharmacies. The Timjan is particularly potent, so be careful. Try a teaspoon/day to start with and increase as needed. Other Aloe products are less potent and require 50ml, 3 x daily. This can be taken for several months, it has great healing properties, for many things other than constipation.
4. Vitamin C 1000mg, up to 12g/day, and it should be taken to bowel tolerance, in other words when the stool gets loose, cut back until stool is soft but still has form. Start with 1-2g every hour until you get a result. One would then keep on with 2-3g/ day - and up it when there is a problem.
3. Magnesium - good for so many things, and one of them is a muscle relaxant - It is the magnesium in the Epsom salts that is the active ingredient. 2-3 x 200mg magnesium citrate (400-600mg) tablets every night will improve peristalsis. Also encourages a more restful sleep.
5. Soaked flax seeds:
Soak some flax seeds in warm water for several hours or overnight. Take one or more tablespoons of the flax "goo" and stir into juice or water. One of the best ways to take it is as morning tea made with very hot (but not boiling) water that has the juice of a fresh lemon squeezed in it and a tablespoon or two of flax goo. You can also mix the goo with yogurt to hide the rather slimy texture. Store the gel in the refrigerator and it will last a long time.
6. Caricol – Solgar product – very good natural digestive and encourages regular stool
Copied from The Northwest Parkinson’s Foundation Weekly New Update
Jeri Logemann, Ph.D., Charles A. Stewart, M.D., Jane Hurd, MPA,
Today's Caregiver - At the age of 78, Maxine was a poster girl for an active senior lifestyle. She loved being the unofficial social director of her assisted living community in the Texas Hill Country, organizing shopping trips to San Antonio and calling the numbers at the daily bingo game. Physically, Maxine was in great shape. She took a brisk walk every morning and had a regular annual physical exam. Her only chronic health problem was mild Parkinson’s, which she controls with daily medication.
Since Maxine especially enjoyed sitting with her special friends at dinner, she was very concerned when she began to experience prolonged coughing fits at the table. At first she thought the problem might be simply trying to talk, eat, and breathe at the same time – so she decided to listen more and speak less. Things got better for a while, though her friends did notice how quiet and subdued she seemed.
Eventually, Maxine began to skip going to dinner and ate in her room instead. She also began to have difficulty swallowing her medication and vitamins. Sometimes she needed a whole glass of water to get them down. Worried, she began to have trouble going to sleep, which made her look tired. This change was very apparent to Maxine’s daughter when she came to visit from out-of-state. Maxine had always been so upbeat and positive. Now, for the first time, she seemed confused and depressed.
What we don’t know can hurt us.
Dysphagia is the medical term for difficulty or inability to swallow. Although it’s rarely talked about, dysphagia can have an immediate negative impact on quality of life. Eating, after all, is a pleasurable group activity. A good meal satisfies more than just the appetite. This may be especially true for residents of independent or assisted living communities, for whom mealtimes are a highlight of the day. Beyond the social issues, dysphagia can also have serious health-related consequences, including malnutrition, dehydration, and aspiration pneumonia.
Yet difficulties in swallowing are not a natural result of aging. They are treatable and preventable, with recognition of the problem as the first step. However, there is evidence that dysphagia is often undiagnosed or untreated: a recent study in Los Angeles County found incidence of swallowing issues in approximately 11 percent of seniors in assisted or independent living facilities. Administrators in these facilities confirm that residents’ swallowing disorders are often unnoticed until the condition has become fully established. At that point, a feeding tube may become necessary. As a result, the resident may need to be transferred to a skilled care environment where appropriate support can be provided. Ignored or unidentified, dysphagia can lead to a basic loss of independence and self-sufficiency.
Recognition, Education, Control
Dysphagia has a variety of causes and can manifest in a variety of ways. To identify the problem, the right questions need to be asked in easily understood language. It may also be necessary to eliminate some common myths and misunderstandings. Education, therefore, is a key element in bringing dysphagia under control. This can begin with an understanding of the swallowing process itself.
In Picture A, a morsel of food has been chewed and is ready to enter the throat.
The food then pushed toward the back part of the mouth, against the muscles of the pharyngeal wall as seen in Pictures B and C.
In Pictures D and E, the airway lifts and closes off when the soft pallet closes, protecting the entrance to the nose. Then the entrance to the oesophagus opens, allowing food to bypass the airway and enter the oesophagus.
Finally, in Picture F the food passes down the oesophagus. The airways reopen to allow continued breathing.
When this sequence is disrupted at any point, dysphagia can result. Because individuals may seek to avoid the embarrassment of coughing or choking during meals, they isolate themselves to the extent that early signs go unrecognized. In making the diagnosis, it’s important to be aware of conditions such as Parkinson’s or gastro-oesophageal reflux (GERD), which can heighten vulnerability. Dysphagia may also arise as a side effect of medication often used for arthritis, Parkinson’s disease, depression and other common conditions.
While it’s important to educate care providers about dysphagia, it’s also crucial that seniors themselves learn to recognize symptoms and seek treatment. For this to happen, a number of longstanding barriers need to be overcome:
Many people with symptoms of dysphagia fail to report them to physicians or caregivers, often to avoid embarrassment. They may fear loss of independence, or reduced enjoyment from meals.
In its early stages, individuals may be unaware of the signs and symptoms of dysphagia, or may choose to ignore them.
Dysphagia may be seen as a “normal” part of the aging process.
A person may be unaware of the mechanics of swallowing and of safe swallowing strategies.
Individuals may not realize that there is a clinical specialty dealing with swallowing problems, and that help is readily available.
Most importantly, people may see swallowing issues as insignificant, and remain unaware of the potential consequences.
The Happy Ending
With her daughter’s help, Maxine’s story began to turn around. Her daughter arranged for Maxine to visit her primary care physician, who referred Maxine to a speech and language pathologist in the outpatient department of a local medical center. Janice, the SLP, asked Maxine about her medical history and her current medical status. Then Janice performed a “tabletop clinical evaluation,” examining Maxine’s facial and throat muscle strength, and watching her swallow measured amounts of water, pudding, and Lorna Doone cookies. This wasn’t at all an unpleasant or threatening experience. In fact, Maxine began to feel better right away because Janice assured her that there were definitely ways to improve her swallowing even if she were found to have a dysphagia.
Janice recommended that Maxine’s doctor refer her to the medical center’s radiology department for an x-ray procedure called modified barium swallow, or MBS. Maxine was impressed by the fact that the radiologist would watch her swallowing in real time and could see exactly where she was having a problem - but she was also apprehensive about having to swallow the small amount of barium. But it turned out to be no problem, and no more uncomfortable than the “tabletop clinical evaluation,” and Janice was with her the whole time.
As it turned out, Maxine did have dysphagia, probably brought on by her Parkinson’s. But by identifying the problem early, she was able to improve her swallowing and go back to her busy social life. Janice taught her exercises to improve the strength, range of motion, speed, and coordination of her swallowing process. She also learned which foods are most likely to cause choking. These can vary from one person to another. In Maxine’s case they included anything with vinegar and foods such as watermelon that have both solid and liquid consistency. While she will always need to be careful, Maxine is back to her cheerful self, presiding over meals and bingo games.
Charles A. Stewart, M.D. is the Chairman of the Department of Medical Imaging and Acting Chief Medical Officer at Rancho Los Amigos National Rehabilitation Center, and Clinical Associate Professor of Radiological Science at the David Geffen-UCLA School of Medicine.
Jane Hurd, MPA, is a healthcare administrator with experience at hospitals affiliated with both the USC School of Medicine and David Geffen-UCLA School of Medicine. She holds an MPA from the University of Southern California.
Diane J. Aschman, MS, a pharmacist entrepreneur, with over 25 years in the healthcare industry, is President of Advancing Health LLC.
Jeri Logemann, Ph.D., is Ralph and Jean Sundin Professor of Communication Sciences and Disorders at Northwestern University, and Professor of Otolaryngology and Maxillofacial Surgery and Neurology at Northwestern University Medical School. She has published and lectured widely both nationally and internationally on evaluation and treatment of swallowing disorders.
Nancy L. Matthews, MA, manager of the Dysphagia Among Seniors in Los Angeles County: Planning and Pilot Study (2007), has over 20 years experience developing and managing ‘Quality of Life’ programs and services which serve the community and currently is a lecturer at a California State University, Long Beach.
Linking restless legs syndrome with Parkinson's disease: clinical, imaging and genetic evidence
Copied from The Northwest Parkinson’s Foundation Weekly News Update
Tasneem PeeraullyEng-King Tan
7th Space Interactive - Restless legs syndrome (RLS) and Parkinson's disease (PD) are both common neurological disorders. There has been much debate over whether an etiological link between these two diseases exists and whether they share a common pathophysiology.
Evidence pointing towards a link includes response to dopaminergic agents in PD and RLS, suggestive of underlying dopamine dysfunction in both conditions. The extrastriatal dopaminergic system, in particular altered spinal dopaminergic modulation, may be variably involved in PD patients with RLS symptoms.
In addition, there is now evidence that the nigrostriatal system, primarily involved in PD, is also affected in RLS. Furthermore, an association of RLS with the parkin mutation has been suggested.
The prevalence of RLS has also been reported to be increased in other disorders of dopamine regulation. However, clinical association studies and functional imaging have produced mixed findings.
Conflicting accounts of emergence of RLS and improvement in RLS symptoms after deep brain stimulation (DBS) also contribute to the uncertainty surrounding the issue. Among the strongest arguments against a common pathophysiology is the role of iron in RLS and PD.
While elevated iron levels in the substantia nigra contribute to oxidative stress in PD, RLS is a disorder of relative iron deficiency, with symptoms responding to replacement therapy. Recent ultrasonography studies have suggested that, despite overlapping clinical features, the mechanisms underlying idiopathic RLS and RLS associated with PD may differ.
In this review, we provide a concise summary of the clinical, imaging and genetic evidence exploring the link between RLS and PD.
10 Early signs of Parkinsons That Doctors Often Miss
Copied from The Northwest Parkinson’s Foundation Weekly News Update
MSN.health - Let's be honest: A diagnosis of Parkinson's disease can be pretty unnerving. In fact, an April 2011 survey by the National Parkinson's Foundation revealed that people will avoid visiting the doctor to discuss Parkinson's even when experiencing worrisome symptoms, such as a tremor.
The problem, however, is that waiting prevents you from beginning treatment that -- although it can't cure Parkinson's -- can buy you time. "We now have medications with the potential to slow progression of the disease, and you want to get those on board as soon as possible," says Illinois neurologist Michael Rezak, M.D., who directs the American Parkinson's Disease Association National Young Onset Center.
Parkinson's disease (PD) occurs when nerve cells in the brain that produce the neurotransmitter dopamine begin to die off. When early signs go unnoticed, people don't discover they have Parkinson's until the disease has progressed. "By the time you experience the main symptoms of Parkinson's, such as tremor and stiffness, you've already lost 40 to 50 percent of your dopamine-producing neurons. Starting medication early allows you to preserve the greatest possible number of them," Rezak explains.
Here, 10 often-missed signs that can help you identify and get early treatment for Parkinson's.
1. Loss of sense of smell
This is one of the oddest, least-known, and often earliest signs of Parkinson's disease, but it almost always goes unrecognized until later. "Patients say they were at a party and everyone was remarking on how strong a woman's perfume was, and they couldn't smell it," says Rezak.
Along with loss of smell may come loss of taste, because the two senses overlap so much. "Patients notice that their favorite foods don't taste right," Rezak says.
Dopamine is a chemical messenger that carries signals between the brain and muscles and nerves throughout the body. As dopamine-producing cells die off, the sense of smell becomes impaired, and messages such as odor cues don't get through. Some researchers consider this change so revealing that they're working to develop a screening test for smell function.
2. Trouble sleeping
Neurologists stay on the alert for a sleep condition known as rapid eye-movement behavior disorder (RBD), in which people essentially act out their dreams during REM sleep, the deepest stage of sleep. People with RBD may shout, kick, or grind their teeth. They may even attack their bed partners. As many as 40 percent of people who have RBD eventually develop Parkinson's, Rezak says, often as much as ten years later, making this a warning sign worth taking seriously.
Two other sleep problems commonly associated with Parkinson's are restless leg syndrome (a tingling or prickling sensation in the legs and the feeling that you have to move them) and sleep apnea (the sudden momentary halt of breathing during sleep). Not all patients with these conditions have Parkinson's, of course, but a significant number of Parkinson's patients -- up to 40 percent in the case of sleep apnea -- have these conditions. So they can provide a tip-off to be alert for other signs and symptoms.
3. Constipation and other bowel and bladder problems
One of the most common early signs of Parkinson's -- and most overlooked, since there are many possible causes -- is constipation and gas. This results because Parkinson's can affect the autonomic nervous system, which regulates the activity of smooth muscles such as those that work the bowels and bladder. Both bowel and bladder can become less sensitive and efficient, slowing down the entire digestive process.
One way to recognize the difference between ordinary constipation and constipation caused by Parkinson's is that the latter is often accompanied by a feeling of fullness, even after eating very little, and it can last over a long period of time. When the urinary tract is affected, some people have trouble urinating while others begin having episodes of incontinence. The medications used to treat Parkinson's are effective for this and other symptoms.
4. Lack of facial expression
Loss of dopamine can affect the facial muscles, making them stiff and slow and resulting in a characteristic lack of expression. "Some people refer to it as 'stone face' or 'poker face,'" says neurologist Pam Santamaria, a Parkinson's expert at the Nebraska Medical Center in Omaha. "But it's really more like a flattening -- the face isn't expressing the emotions the person's feeling."
The term "Parkinson's mask" is used to describe the extreme form of this condition, but that doesn't come until later. As an early symptom, the changes are subtle: It's easiest to recognize by a slowness to smile or frown, or staring off into the distance, Santamaria says. Another sign is less frequent blinking.
5. Persistent neck pain
This sign is particularly common in women, who have reported it as the third most-common warning sign they noticed (after tremor and stiffness) in surveys about how they first became aware of the disease.
Parkinson's-related neck pain differs from common neck pain mainly in that it persists, unlike a pulled muscle or cramp, which should go away after a day or two. In some people, this symptom shows up less as pain and more as numbness and tingling. Or it might feel like an achiness or discomfort that reaches down the shoulder and arm and leads to frequent attempts to stretch the neck.
6. Slow, cramped handwriting
One of the symptoms of Parkinson's, known as bradykinesia, is the slowing down and loss of spontaneous and routine movement. Handwriting is one of the most common places bradykinesia shows up. Writing begins to become slower and more labored, and it often looks smaller and tighter than before. "Sometimes a family member will notice that someone's handwriting is becoming very spidery and hard to read," Santamaria says.
Washing and dressing are other areas where bradykinesia appears. Someone may take a long time to get dressed or be unable to deal with zippers and other fasteners.
7. Changes in voice and speech
As the brain signals and muscles that control speech are affected by Parkinson's, a person's voice begins to change, often becoming much softer and more monotone. This is frequently one of the first early signs of Parkinson's that family and friends notice, often long before the patient becomes aware of it.
Slurring words is also characteristic of Parkinson's, because as the facial muscles stiffen, it becomes harder to enunciate clearly. "Some patients begin to have trouble opening their mouths as wide, making speech harder to hear and understand," says Rezak. This subtle sign is so characteristic of Parkinson's that researchers are working on a voice analysis technique that might eventually be used as an early screening and diagnostic tool.
8. Arm doesn't swing freely
"Reduced arm swing" is how doctors describe this symptom, but that doesn't fully capture what some Parkinson's patients first remember noticing. Instead, think of this sign as a subtle stiffness and reduced range of motion: reaching for a vase on the highest shelf or stretching out to return a serve in tennis and noticing the arm won't extend as far.
"With the onset of Parkinson's, people begin to have what we call increased tone, which means the muscles are stiffer and more limited," says Santamaria. "The arm just won't go where the brain tells it to go." Some people first notice this when walking, as one arm swings less than the other. One way to distinguish this symptom from arthritis or injury: The joints are unaffected and there's no pain.
9. Excessive sweating
When Parkinson's affects the autonomic nervous system, it loses its ability to regulate the body, which can cause to changes in the skin and sweat glands. Some people find themselves sweating uncontrollably when there's no apparent reason, such as heat or anxiety. For a woman, these attacks may feel much like the hot flashes of menopause. The official term for this symptom is hyperhidrosis.
This condition can also show up in the form of excessively oily skin or an oily scalp resulting in dandruff. Many Parkinson's sufferers also notice a problem with excessive saliva, but this is actually caused by difficulty swallowing rather than producing more saliva.
10. Changes in mood and personality
Experts aren't certain why, but there are a variety of related personality changes that come with Parkinson's, including pronounced anxiety in new situations, social withdrawal, and depression. Several studies show that depression, in someone who hadn't previously experienced it, was the first sign many Parkinson's patients and their families noticed, but at the time they weren't able to attribute it to Parkinson's.
Some people also experience subtle changes in their thinking abilities, particularly in concentration and the so-called "executive functions" that govern planning and executing tasks. The first sign of decline is loss of ability to multitask. "People who used to be able to do three or four things at once perfectly well find that they have to do one thing at a time or they can't keep it all straight," Rezak says. Some experts believe that thinking problems and mood issues go hand in hand -- that the sense of slipping mentally leads to anxiety, feeling overwhelmed, and social withdrawal.
Note by John Pepper
There are many other symptoms, which are normally associated with Parkinson’s Disease:
- Inability to throw a ball, or any other object (Co-ordination)
- Chest infections, caused by the phlegm not being removed properly from the chest.
- Loss of libido
- Bad Posture
- Loss of balance
- Difficulty swallowing
- Dry Mouth
- Falling asleep, during the daytime
- Inability to walk on uneven surfaces
- Inability to write properly (Gets very small)
- Short-term memory loss
- Speech problems
- Abnormal emotional behaviour
Brain feedback may ease Parkinson’s
Copied from Northwest Parkinson’s Foundation Weekly Newsletter
Futurity - People experiencing the early signs of Parkinson’s disease could see their symptoms improved through a process of regulating and re-training how their brains respond to certain activities and actions.
Experts from Cardiff University report in a paper published in the Journal of Neuroscience using real-time brain imaging to identify how people with Parkinson’s disease react to their own brain responses.
Scientists used a technique known as neurofeedback to monitor brain activity in an MRI scanner. The activity levels are then fed back to the patient in the form of a display on a screen.
Using this feedback, the study found that patients were able to learn to alter activity in specific parts of their brain.
“This is the first time that this neurofeedback technique has been used with patients with Parkinson’s disease,” according to David Linden, a professor from Cardiff University, who led the study, which was a collaboration between scientists and clinicians in Wales, London, and the Netherlands.
“Self-regulation of brain activity in humans based on real-time feedback is emerging as a powerful technique. In this study we assessed whether patients with Parkinson’s disease are able to alter their brain activity to improve their motor function.”
“We found that the five patients who received neurofeedback were able to increase activity in brain networks important for movements and that this intervention resulted in an overall improvement in motor speed—in this case, finger tapping.”
The study involved 10 patients, all with early stage Parkinson’s. The patients were divided into two groups: half the group received brain feedback and the other did not.
While self-regulation using related techniques has been used in other conditions like ADHD, apart from a study on chronic pain the clinical potential of the technique for neurological disorders has not been explored.
Parkinson’s disease was considered a suitable target for the technique—and an opportunity to show that its use could help patients with neurogenerative disorders.
“Whilst this was a very small study the key aim was to establish whether this technique may be feasible for sufferers,” Linden adds.
“The training resulted in clinically relevant improvement of motor functions—so assuming patients can learn to transfer the strategies used during neurofeedback into real-life settings, it might also become possible to sustain the clinical benefits.”
The scientists now hope to take this method further in formal clinical trials in order to establish whether it holds promise for patients.
“We have to be clear: This research won’t stop the progression of the disease nor should it offer sufferers false hope—but, it does have the potential to alter the course of motor symptoms and possibly reduce drug requirements in early disease,” says Linden.
“This may have the effect of delaying more severe motor complications and improve the quality of life of patients affected by Parkinson’s disease.”
*Note by John Pepper
I wonder if this concept is the same as I used, without any scans, when I examined my bad walking habits – I was dragging one foot and taking short steps – and then correcting the habit by consciously controlling the actual movements. I overrode the normal subconscious brain control of my walking, by consciously controlling the actions. Yes! We can overcome bad movement habits by using the conscious brain to control our movements!
Have you noticed, now that you have Parkinson’s Disease that you often bump into objects, while walking around your house? It might be a doorjamb or a chair leg. The problem is, that our brain does not pass this information to other areas of the brain, so that you automatically avoided those objects. Although you are conscious of seeing these objects, you still bump into them! The reason is lack of neurofeedback!
What Parkinson’s Teaches Us About the Brain
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The New York Times - Scientific discoveries can be serendipitous, and so it was when Jay L. Alberts, then a Parkinson’s disease researcher at Emory University in Atlanta, mounted a tandem bike with Cathy Frazier, a Parkinson’s patient.
The two were riding the 2003 RAGBRAI bicycle tour across Iowa, hoping to raise awareness of the neurodegenerative disease and “show people with Parkinson’s that you don’t have to sit back and let the disease take over your life,” Dr. Alberts said.
But something unexpected happened after the first day’s riding. One of Ms. Frazier’s symptoms was micrographia, a condition in which her handwriting, legible at first, would quickly become smaller, more spidery and unreadable as she continued to write. After a day of pedalling, though, she signed a birthday card with no difficulty, her signature “beautifully written,” Dr. Alberts said. She also told him that she felt as if she didn’t have Parkinson’s.
Impressed, Dr. Alberts, who now holds an endowed research chair at the Cleveland Clinic in Ohio, embarked on a series of experiments in which he had people with Parkinson’s disease ride tandem bicycles. The preliminary results are raising fascinating questions not only about whether exercise can help to combat the disease but also — and of broader import — whether intense, essentially forced workouts affect brains differently than gentler activity does, even in those of us who are healthy.
Scientists have known for some time that in lab animals, forced and voluntary exercise can lead to different outcomes. Generally, mice and rats enjoy running, so if you put a running wheel in a rodent’s cage, it will hop aboard and run. That activity, obviously, is voluntary. But if you place an animal on a treadmill and control the speed so that it must keep pace, often with help from a finger prod or electrical shock, the activity becomes forced.
Interestingly, in animals, the effects, especially on the brain, typically are more beneficial after forced exercise. In one study from 2008, rats forced to run wound up with significantly more new brain cells after eight weeks than those who ran when they chose, even though the latter animals ran faster. And in another, similar experiment, mice that were required to exercise on treadmills subsequently performed better on cognitive tests than those given access to running wheels.
Before Dr. Alberts’s work, there had been few comparable experiments in humans, primarily because no one had known how, ethically, to “force” people to exercise. Dr. Alberts solved that problem by placing volunteers with Parkinson’s on the back seat of a tandem, which had been modified to ensure that the back rider would have to actively pedal; he or she could not just passively let the pedals turn. First, though, he had each volunteer ride a solo stationary bicycle at his or her own pace. Most chose a pedalling cadence of around 60 revolutions per minute, an un-strenuous level of exertion.
But on the tandem, the rider in front had been instructed to pedal at a cadence of about 90 r.p.m. and with higher force output or wattage than the patients had produced on their own. The result was that the riders in back had to pedal harder and faster than was comfortable for them.
After eight weeks of hour-long sessions of forced riding, most of the patients in Dr. Alberts’ study showed significant lessening of tremors and better body control, improvements that lingered for up to four weeks after they stopped riding.
These findings are exciting, Dr. Alberts says, because they contrast with some earlier results involving voluntary exercise and Parkinson’s patients. In those experiments, the activity was helpful, but often in a limited, localized way. Weight training, for instance, led to stronger muscles, and slow walking increased walking speed and endurance. But such regimens typically did not improve Parkinson’s patients’ overall motor control. “They didn’t help people tie their shoes,” Dr. Alberts says.
The forced pedalling regimen, on the other hand, did lead to better full-body movement control, prompting Dr. Alberts to conclude that the exercise must be affecting the riders’ brains, as well as their muscles, a theory that was substantiated when he used functional M.R.I. machines to see inside his volunteers’ skulls. The scans showed that, compared with Parkinson’s patients who hadn’t ridden, the tandem cyclists’ brains were more active.
Why forced exercise would have a greater effect on brain functioning than gentler regimens isn’t clear. Scientists have speculated that in animal experiments, being forced to work out may cause the release of stress-linked hormones in rodents’ brains, which then prompt various reactions in the cells and tissues. But Dr. Alberts suspects that in Parkinson’s patients, the answer may be simple mathematics. More pedal strokes per minute cause more muscle contractions than fewer pedal strokes, which, in consequence, generate more nervous-system messages to the brain. There, he thinks, biochemical reactions occur in response to the messages, and the more messages, the
Whether forced exercise would similarly affect healthy brains is unknown at this point, he says, as is the question of whether riding on the back of a tandem behind a stronger cyclist is the only qualifying exercise. “Pedalling at 90 r.p.m. is a fairly intense activity,” he says.
“It seems likely,” he continues, that intense exercise of any kind should produce comparable brain reactions. “There is data showing that people who exercise intensely have less risk” of developing Parkinson’s and other neurological diseases, he says. So perhaps, if you have no access to a tandem (or no stomach for being harangued to pedal harder by the rider in front), try cranking up the speed on your next treadmill session, until you are outside your normal running comfort zone.
Dr. Alberts remains most enthused, though, about the implications of his findings for people with Parkinson’s and other brain-related conditions. He has partnered with Y.M.C.A.’s in several cities to offer special tandem cycling programs for Parkinson’s patients and is hoping to expand the program nationwide. He’s also planning studies with patients who’ve suffered strokes, in hopes that the brain changes following forced exercise could ease the relearning of physical skills.
“This is not a cure” for Parkinson’s or other brain conditions, he cautions. “But it seems to help significantly” with tremors and other symptoms, “and it gives people a chance to be active participants in their own treatment.”
He plans to return to the Iowa bike event next summer, as a representative of a program he founded, Pedalling for Parkinson’s, and expects, he says, to be joined by Ms. Frazier, who still frequently rides a tandem and signs her name legibly.
*Note by John Pepper:
I am very interested in this article, as it relates to my own experiences.
When I wrote the first edition of my book, I had managed to PUSH my performance up from over ten minutes per kilometre to under seven minutes per kilometre. During that time, my PD symptoms got appreciably better.
Then, being happy with my performance times, I managed to maintain that performance level for several years. However, After picking up an injury, over three years ago, I was unable to do my walking for over two years, because of various other injuries and PD related chest problems. I have still not been able to get back to less than seven minutes per Kilometre.
Interestingly; over the past three years, many of my symptoms have got noticeably worse, and I am also getting a lot older, so have not pushed myself to the limit, thinking that I just needed to walk for one hour, three times a week.
This appears not to have done me any good. My symptoms are nowhere near as good as they were, three years ago, and are not improving, even though I walk for one hour, three times a week.
After reading this article, I am going to force myself to walk faster and see what happens. This is not going to please my daughter, who thinks I should start taking things easy. After all, I am over seventy seven and not getting younger. If I injure myself again, as I did three years ago - when I was pushing hard in soft sand, on the beach - I will be unable to continue my quest and will have to be prepared to see my Pd get worse. I will keep you informed.