April 28, 2011

Let's talk about my biggest fear -- dementia

I'm not overly concerned about living with prostate cancer and Parkinson's. I had the radical prostatectomy in January, 1995.  Post-operation PSA readings showed that some cancer cells remain. The  PSA readings have been growing very slowly over the past 16 years.  I hardly ever even think about the cancer.

My Parkinson's was diagnosed in September 2009, although I now realize I had PD years earlier.  But thus far it too seems to be progressing slowly.  As I've commented many times, the diagnosis has given my life a challenge and a focus that has contributed to making this the best and most rewarding time of my life.

So, as is often the case, the known demons are manageable and don't cause any panic.  But the unknown -- will I come down with dementia? -- is what scares me.

I've seen others who are pretty far down the road of Parkinson's progression and I generally find them inspiring, not frightening, in their efforts to make the best of the cards they have been dealt.

I've seen others who are well into dementia and I want no part of it. I don't want to live robbed of my personality and my ability to interact with others and to function effectively. I don't want to put my family through what Nancy Reagan, for example, had to deal with.  And I would rather my money went to educate my grandchildren and great-grandchildren than to the care and upkeep of my unresponsive body.

For years I've been concerned about some quirks in my memory.  Even in my 40's and 50's, I'd hear others discuss in detail a movie I'd recently seen or a book I'd read and I'd have little recollection of it. I've never been good at remembering names or personal narratives.  As I've aged, of course, the memory problems have worsened.

I'm aware that some of my memory lapses are attention-deficit related. And my internist and other medical authorities assure me that memory defects do not automatically signal impending dementia.  Still I worry.

One way of dealing with this worry is to become better informed about dementia.  So I've done some research on it, which I'll share in upcoming posts.

Meanwhile, what about you?  Do you have similar dementia fears? How do you deal with them?  What are your questions about dementia?

April 26, 2011

A new and gorgeous addition to my family!

Three lovely ladies -- My granddaughter Jessie, my great-granddaughter Kaylee who will be 5 in July, and her sister Mckensie who was born April 25.

April 24, 2011

Easter, Passover, Spring -- Time for reflection, renewal and resolutions

Easter morning and it's a beautiful spring day in D.C. Later today I'll go to my son's house in the wooded hills north of Frederick, Md. for a get-together with my family - my growing family with the imminent arrival of my second great-granddaughter.

Last Monday I had a nice Seder at a friend's house. Yesterday I had my backyard pond cleaned and refreshed. And, after a cool and rainy Friday, I did some planting and transplanting.

All of which reminds me that this is the time of year, rather than New Year's Day,  when I reflect on the past year and think about ways in which I might make the renewed year even better. Thinking about this, I remembered a "spring cleaning" video posted recently by my favorite Parkinson's blogger, "Dopadoc."

"Dopadoc" is Dr. Marshal Davidson who was diagnosed with Parkinson's in 2006 at age 44.  His blog website is informative, entertaining, and inspiring. See:


All of us, not just those with Parkinson's, could benefit from his suggestions.  Here's the video:

April 23, 2011

I graduated from Georgetown University . . . . Hospital's incontinence program


Thursday I had my final meeting with Lisa, my exercise therapist at Georgetown University Hospital, to complete their program of exercises to alleviate problems with incontinence. As I mentioned before, I probably never would have signed on for a training program like this had it not been for my taking their BIG exercise program designed for people with Parkinson's.  Since this proved so beneficial, I decided to give the incontinence program a try but without much expectation that it would really work.

I was wrong (once again). Within a week after the first session, which just focused on mastering the Kegel exercise,  I was only making  one bathroom visit a night instead of my former 3 or 4 trips.  Kegel exercises involve tightening the pelvic floor muscles by contracting them as you would if you wanted to stop the flow of urine. It helped having Lisa as a coach to be sure I was getting this right.  But if you go to YouTube and search for "kegel exercises," you'll find a number of instruction videos.  It's basically a simple exercise that can be done while waiting for a pot to boil, a TV commercial to end, or a red light to change. But it's probably better to just do a set of them while not distracted by other things.  It only takes a few minutes.

Subsequent training sessions with Lisa added to the basic Kegel  the pelvic brace exercise which strengthens the surrounding muscles and adds further strengthening to the bladder floor. The brace exercise calls for on the exhale pulling in your stomach as though you were puncturing a balloon (a big one in my case) and then tightening the lower abdominal muscles while continuing to breath (i.e., not holding your breath).  It took me awhile to zero in on this, but it paid off.  Now, in addition to only making one bathroom visit during the night, I can go 3 hours or more during the day without desperately looking for the nearest men's room.  

I can remember going to the theater last summer to see the Scottish Black Watch play and becoming very nervous when I was told that my seat was going to be in the stands they had set up on the stage. My immediate thought was "Jeez! what if I have to go in the middle of the performance."

For an example of how different things are now, I went to the annual meeting of my company  last Saturday, drank several cups of coffee, sat through the meeting and the lunch that followed without even thinking about locating the men's room.

My final instruction sheet from the training program calls for me to combine the basic Kegel exercise with the pelvic floor brace exercise and to do a set of "quick" exercises and "endurance" exercises a couple of times a day. The quick exercise calls for rapidly contracting the muscles -- holding for 2 seconds and relaxing for 5 seconds 10 times.  The endurance exercise calls for contracting the muscles and holding for 10 seconds and then relaxing for 10 seconds. Both should be done in coordination with the breath - contracting on exhalation. It's also recommended that I count out load while doing the endurance exercise to make sure that I'm breathing regularly and  not straining.    I have to be careful to not use the buttock or leg muscles while doing the exercises.The relaxation pauses are as important as the exercises.

I found it was a great help for me to work with a trainer on this.(And, with a prescription from my neurologist, it was covered by Medicare.)  But if one isn't available, written instructions can be helpful.  Here's one that's pretty good:


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April 20, 2011

My garden/yard in April

Last year I threw myself into gardening like I never had before. In previous years, whenever we had a decent spring/summer/fall day, I would usually get on my bike and head out for a ride. The garden/yard took a back seat.

But now that Parkinson's and aging have restricted my biking primarily to short rides around the Washington mall museums, my obsessive/compulsive impulses have turned to gardening. Last year I spent a lot of $$, time, and energy in plantings but unfortunately kept little record of what I'd done. This spring should be full of surprises as I watch what crops up. If you see anything you recognize in the pictures below, please let me know!

Given this obsession, I've decided to start a monthly photo journal of the garden as a  part of the blog.

For years our backyard was dominated by a huge hackberry tree. We tried maintaining whatever grass would grow in the mostly shady yard. When the tree died, I was so depressed that I decided to lift my spirits by hiring a landscaper to come up with a major transformation. I was pleased with the results and pretty much left it alone until last year when I decided to make some changes and add features of my own.

Here's the mid-April view from my back porch rocking chair:

And here's the view from the back of the garden looking toward the porch:

A few weeks ago I added my first garden sculpture. (That's an i-Pod around his neck.) Pink flamingos will be next.

Here's a shot of the garden pond and waterfall:

A couple of years ago I got fed up with pushing the power mower around the lawns on the front and side yards in DC's 95 degree heat and humidity, so I again called in my landscaper to do away with the grass lawns and substitute perennial plantings.  Most of my gardening craze last year was directed at the back yard but I did begin to add some planting to the front and side yards as well.

Here's the front yard in mid-April:

And here's the side yard:

Assembling this garden preview, I once again shudder as I remember how close I came to abandoning all of this pleasure by selling the house and moving into a senior residence. Those were the dark days before I was diagnosed with Parkinson's, didn't realize that I also was suffering from the depression that often accompanies PD, and thought the problems I was having were just due to aging and would only get worse.  A close call!

April 19, 2011

Progressive muscle relaxation routine enhances my 3-4 a.m. meditation hour

For years, I've seen recommendations about using progressive muscle relaxation to dissipate stress, but I never found a way of incorporating this into my daily routines. Now I have. 

What I'm going to describe works for me, but that doesn't mean it necessarily will work for you.  The key, I've found, is to look at what's been tried by others but then find an adaptation that works for me. Here's my version of progressive muscle relaxation.

As I've mentioned before, the previously dreaded awakening at  3-4 a.m. with the accompanying difficulty getting back to sleep now is one of my favorite times of day (almost up there with my coffee hour after my afternoon nap!),  I meditate (and daydream) for about an hour after my middle-of-the-night bathroom visit and then easily return to the bed and sleep.

I've now inserted a muscle relaxation routine in the middle of that meditation hour. Since this exercise is preceded and followed by  deep breathing meditation, I incorporate the breath exercises into the muscle relaxation to retain the mellow mood that helps me get back to sleep.

I don't try to get this aging body into the lotus position for meditation. I just sit in a straight-backed chair that I keep in my bedroom and sit on one slim pillow pad while resting my arms on another pad in my lap. I then position my hands in the "secret handshake." See: http://parkinsonsand5htp.blogspot.com/2010/12/how-does-old-man-with-parkinsons.html

For each of the steps listed below, I do the exercise by tightening the body part and holding it for a count of 8 inhales-exhales, then I relax the muscles slowly.   Between each step, I do five breathing-ins/breathing-outs. (I mix the breathing exercises in with the muscle relaxation exercises out of concern that doing the muscle relaxation exercises nonstop might be too stimulative and might make it difficult to get back to sleep.)

  1. Raise the front of the foot while keeping the heel on the floor; squeeze the toes downward and relax.
  2. Same  raising of the front of the foot but this time widening the toes to separate them and relax.
  3. Tighten and relax the calve muscles
  4. Tighten and relax the thigh and butt muscles.
  5. Pull in and tighten the stomach muscles and relax.
  6. Tighten and relax the chest and shoulder muscles
  7. Arch the back; hold; relax
  8. Make a tight fist and relax.
  9. Spread the fingers wide apart and then relax.
  10. Tense the forearm and upper arm and   then relax.
  11. Tense the neck while pulling chin down toward the chest; relax.
  12. Tighten the face muscles by grimacing; relax
  13. Stretch the face muscles by opening the mouth and eyes wide; relax.


April 16, 2011

My exercise routine looks like a lot but it really isn't

Here's the exercise routine I try to do every day:

  • I give top priority to my BIG exercises. As I've mentioned before, the BIG exercise program was specifically designed for people with Parkinson’s by the same organization – Lee Silverman Voice Treatment (LSVT) – that developed the LOUD speech therapy for PD people.  Fortunately for me, training in the program is offered at Georgetown University Hospital, where my neurologist practices.The program involves two one-hour training sessions each week for four weeks.  But once you've got the training, it doesn't take much more than 10 minutes to do all seven exercises.  Since I can tell that it's been a big help to me, I'm pretty faithful about doing these exercises every day.  If you are interested in seeing if BIG training is offered in your area, click on the “Find a Clinician” button on this home page for LSVT: http://www.lsvtglobal.com/index.php?action=what-is-lsvt).
  • My BIG exercise therapist mentioned that the hospital's physical therapy department also offered training in alleviating incontinence. Given the progress I'd made with BIG, I decided to sign on for this and got a prescription for the exercise therapy from my urologist.  This training has turned out to be as beneficial as BIG.  Six months ago I was making bathroom visits  3, 4, or 5 times a night.  Now I get up only once.  And formerly I'd  have difficulty sitting through a movie without having to interrupt it with a men's room visit.  Today, for example, I used the bathroom about 9 a.m. before heading out to a meeting where I had my third cup of coffee for the morning and sat through a two-hour meeting followed by a lunch.  It was probably 12:30 or later before I made a men's room visit. This exercise program involves doing quickie Kegel exercises (which take a little over a minute to do a set of them and easily can be done, for example, during a TV commercial break, while waiting for water to boil in the kitchen, or while waiting for something to happen on the computer.  The second part of the program consists of pelvic floor strengthening exercises that involve using elastic stretch bands and takes a little more time, but the full set of exercises doesn't take much more than 5 minutes.For a fuller description of this exercise program, see http://parkinsonsand5htp.blogspot.com/2010/12/exercise-program-for-incontinence-that.html.
  • I try to do a variety of mini exercises while taking computer breaks.  I can get too absorbed and carried away when working on the computer so I keep a kitchen timer on my desk set for 45 minutes. When it goes off, I take a break and do a few minutes of exercise.  I keep a set of  hand weights in my home office/den for that purpose.  I've also added a couple of bean bags that I use for some of the exercises featured in the "Active Aging and Mobility" video that I reviewed earlier this week. And I sometimes use a few of the exercises depicted  in the excellent book: "Delay the Disease: Exercise and Parkinson's Disease."
  • During my 4 a.m. meditation hour I've incorporated a progressive muscle relaxation exercise that I'll describe in a separate post.
As I said, this looks like a lot. But even if I did them all in a day (which I'll admit I seldom do), it probably wouldn't add up to much more than 30 minutes total. None of the above exercises are very vigorous or aerobic.  My gardening is where I get that type of exercise. As I've mentioned before, in years past any day with decent weather you'd find me out on my bike.  But now that my biking is pretty much restricted to short rides on flat terrain, I've thrown myself instead into gardening big time.  And I'm thoroughly enjoying it.  Unlike biking or working out in a gym, gardening not only provides exercise but a tangible resulting product.

Walking continues to be another welcome exercise outlet. Fortunately I live in a neighborhood where I can walk to the bank or the grocery store. The Washington Mall, Capitol Hill, Georgetown, Dupont Circle, the new U Street neighborhood... all offer interesting opportunities for exploratory walks.

The one big problem with Washington is that the climate often discourages outdoor exercise in the winter and summer.  Actually, the winters don't bother me too much, but as I age, I find it increasingly difficult to deal with DC's heat and humidity.

April 14, 2011

So what happened to your promise to post about dementia?

Yeah.  In  an earlier post, I said I would take up the subject of dementia this week.  Well, last weekend I watched the exercise video that I discussed in the April 12 posting and the next day the news came out on the findings in the study of which exercise programs are most beneficial for people with Parkinson's. So I was off and running on that tangent. I decided to devote this week's posts to the subject of exercise.

This blog is a work in progress.  I keep testing out new ideas and approaches. This week's idea was to select a "Topic of the Week"  and devote most of the week's postings to that topic.  So this has been Exercise Week.  Next week will be Dementia Week.

In my professional career, my colleagues often would complain about my butterfly/grasshopper tendencies to jump from one enthusiasm to another. So "the more things change, the more they remain the same."

I do believe in the importance of keeping promises. So I apologize for not getting to dementia this week. But it will be the centerpiece of next week's postings.

New study has surprising findings on which types of exercise work best

Here's a test question for you.  Suppose you took 67 Parkinson's patients who had trouble walking and randomly assigned them to these three different exercise groups:
  1. High-intensity treadmill walking (walking at faster speeds but for a shorter duration of 30 minutes)
  2. Low-intensity treadmill walking (walking at slower speeds but for  a longer period of 50 minutes)
  3. Stretching and resistance training which included leg presses, extensions and curls.
Which group do you think would show the greatest progress?

I'd have guessed (reluctantly) that the high-intensity treadmillers would score highest.  But a study done by scientists at the University of Maryland found that those who did the low-intensity treadmill training performed better than the other two groups on distance and speed tests, and experienced the most consistent improvements in gait and mobility. Only stretching and resistance training improved scores on a standardized Parkinson's rating scale, probably because that type of exercise improved flexibility, researchers said.

All participants exercised three times a week for three months, supervised by exercise physiologists at the Baltimore VA Medical Center.

“Contrary to evidence suggesting that high-intensity exercise is the most effective, our results suggest that a combination of low-intensity training and stretching-resistance training may achieve the greatest improvements for people with Parkinson’s disease,” Lisa M. Shulman, MD, of the University of Maryland, said in a news release. “These results have important implications for how we manage Parkinson’s disease, since low-intensity exercise can be done by most people with Parkinson’s, and our patients frequently ask what type of exercise they should be doing.”

Researchers concluded that an exercise routine that includes low-intensity walking, as well as stretching and resistance training, might help Parkinson's patients the most. "There has been quite a bit of media attention regarding high-intensity exercise as key, but our research showed low-intensity exceeded its efficacy," said study author Dr. Lisa Shulman, a professor of neurology at University of Maryland School of Medicine. "What was very significant was it was not necessary to increase intensity of walking . . . [and] we can say that virtually everyone at all stages of the disease can achieve some benefit."

Reaction to Study's Report

Bastiaan Bloem, a researcher at the Michael J. Fox Foundation, noted that Shulman's findings underscore the importance of exercise in PD. Regular exercise slows down cognitive decline, helps to prevent bone loss and is good for pulmonary and cardiovascular health.

But he also said that much work remains to be done to pinpoint the most beneficial form of exercise for those living with the disease. He noted that the Shulman study  involved a relatively small number of people and  that the work needs replication before we can draw practical conclusions for patients' day-to-day regimens.  The study's findings, he said, were unexpected at a variance with some earlier studies that found the greatest benefit from strenuous activity.

Bottom Line for Me

The Shulman study at least provides some reassurance and consolation for people like me who like walking, but not jogging or running on a treadmill. Everyone agrees that exercise is crucial.  Laboratory findings as to which forms of exercise show the best results are interesting, but what, for me, is  more important is finding  the exercises that I'm most  likely to incorporate into my daily routine. Even if this study had ranked vigorous workouts on a treadmill as being the most beneficial, you wouldn't find me doing it. Of course, I also have to be willing to "push the envelope" beyond my comfort zone. That's why it's helped me a lot to work with the exercise therapists in the BIG program of exercises specifically designed for people with Parkinson's.

April 12, 2011

Here's an exercise program for preventing falls that looks very good

Next to fears of Alzheimer's/dementia, my biggest and increasing concern as I age is the fear of falling. I'm know most of my contemporaries share this fear.

Here's what the Center for Disease Control has to say about the elderly and falls:

"Each year, one in every three adults age 65 and older falls. Falls can lead to moderate to severe injuries, such as hip fractures and head traumas, and can even increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable."

How can you prevent falling?  Here's CDC's No. 1 recommendation:

"Exercise regularly. It’s important that the exercises focus on increasing leg strength and improving balance. Tai Chi programs are especially good."
A few days ago I finally got around to watching an exercise DVD that I bought at last month's symposium sponsored by the Parkinson's Foundation. It's Vol. One of a planned "Active Aging and Mobility" series put together by exercise therapists Kim Brooks and Bill Swann.

Right from the start I  liked it because Kim and Bill are not the typically slim and buffed therapists usually found on these videos who discourage me at the outset because I know I'll never look like them.  Kim and Bill are even more overweight that I am.  Hooray!!

I only watched the first half of the video. The exercises shown are all done while either standing or seated and none of them are physically taxing. They are simple, easily understood exercises that are designed to enhance the workings of our aging bodies and brains. Watching this part of the DVD took over 45 minutes, but I'm sure that with another one or two viewing I'll get the hang of all the exercises. After that, the exercises can easily be spread out over the course of the day.  Doing a couple of them at a time would only take a few minutes.

Some of the exercises, I could do in bed before getting up in the morning. Others can be done while waiting for my computer to boot up or download. All of them can easily be scattered throughout the day -- while waiting for a pot to boil (or, in my case, waiting for the microwave to do its thing), while standing in line at the grocery store, while watching TV, while sitting at the computer, etc.

One thing I'll have to be careful about, however, is to keep from only doing the exercises that are fairly easy for me and ignoring those that are more difficulties.  The difficult ones are the ones that provide the greatest benefit in exercising the brain by giving it new challenges.

For me, the difficult ones all involve trying to do two or three different body movements at the same time, such as trying to perform one movement pattern with the right hand while the left hand performs a different one. But I was reassured that I was not a "retard" by subsequently seeing a report on a study that found seniors have a much greater difficulty multi-tasking. See:

I'll take a look at the second half of the DVD, which features Qu Qong and the "Tai de Tango." later this week and let you know how that goes.

To purchase the DVD, which costs $25, go to:


How about you? What have you found in the way of exercise programs that work?

April 9, 2011

A Primer on Parkinson's and Its Treatment

 Last month I went to the annual symposium sponsored by the local (National Capital Area) chapter of the Parkinson' Foundation.  The opening presentation was an excellent overview of current treatment options available to those diagnosed with Parkinson's. It was presented by Dr. Linda Sigmund, the medical director of the local chapter, and a doctor at the Neurology Center of Fairfax, VA. 

Luckily for me, Dr. Sigmund has posted the slides that accompanied her presentation on the chapter's website, so the summary of her talk that follows isn't just dependent on my note-taking abilities.

(To see the slides, go to: http://www.parkinsonfoundation.org/2011_Symposiumslides.html.)

Early symptoms that predate motor symptoms

Typically with Parkinson's, the following symptoms develop years before the motor symptoms:

  • loss of sense of smell -- occurs in up to 90% of PD patients and may predate clinical PD by at least  four years.
  • constipation -- occurs in 60-80% and may predate motor symptoms by 10 years
  • sleep disorders -- RBD (acting out vivid dreams as you sleep) may precede motor symptoms by years; 15-38% of RBD patients are subsequently diagnosed with PD.
  • depression -- may occur in up to 28% of early stage PD patients

The  stages of PD after onset of motor symptoms

  • Stage 1 -- Unilateral (one side) motor symptoms
  • Stage 2 -- Onset of bilateral motor symptoms
  • Stage 3 -- Postural instability and restriction of activities
  • Stage 4-5  -- Severely disabled with possible cognitive decline
The duration of each stage is highly variable among individual PD patients, Usually there is a robust response to therapy at the outset that lasts for several years.

Azilect -- Several studies show that the early use of Azilect is effective in slowing the progress of PD. Studies also show that a 1 mg dose is better than 2 mg.

Treatment strategies for younger (under age 70) patients

Younger patients:

  • Are at greater risk of developing motor fluctuation and dyskinesia.
  • Have a longer treatment time horizon
Since long-term use of  levodopa can lead to motor fluctuations and dyskinesia, the treatment strategy for younger patients most often involves delaying the start of levodopa and instead using at the outset an MAO-B inhibitor and then supplement with a dopamine agonist.

[Note: Motor fluctuations are caused by the wearing off of the levodopa's effectiveness between doses, resulting in unpredictable "on-off" periods. Dyskinesia is the uncontrollable movement of, most commonly, the upper body but can also be seen in the lower extremities. A related symptom is dystonias in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures.]

Treatment strategies for older (age 70 and beyond) patients

These older patients:

  • Are at a lower risk of developing motor fluctuations and dyskinesia
  • But are more prone to acute side effects, particularly confusion and hallucinations 
The treatment strategy here may involve starting with levodopa immediately or starting with an MAO-B inhibitor and instituting levodopa later.

Levodopa Treatment

All PD patients sooner of later are put on levodopa which provides relatively rapid symptomatic release and  is well tolerated, with few side effect initially. But prolonged use of levodopa is associated with the development of motor fluctuations and dyskinesias.

This happens with about 80% of patients on levodopa and close to 100% of young-onset patients. It is a major source of disability and  is the commonest problem leading to surgical intervention.

When a patient is started on levodopa, it's usually carbidopa/levodopa IR (Sinemet or its generic). The controlled release version (Sinemet CR or its generic) may be used at bedtime since it has a longer duration of benefit. Later on, when patients are experiencing end-of-dose wearing off, they may be put on carbidopa/levodopa/entacapone (Stalevo) which provides more sustained levodopa levels.

(Since this blog is focused on issues relating to aging, I'll skip the part of the presentation that covered drugs prescribed for young-onset PD to treat the symptoms so as to delay as long as possible resort to levodopa/carbidopa  because of the problems noted above that result from prolonged use of levodopa/carbidopa.)

When patients on levodopa/carbidopa begin to experience significant off episodes, the drug apokyn may be introduced with the intention of reducing the dosage of levodopa which, at this stage, is causing a great deal of dyskinesia and off periods. Apokyn is administered by injection and begins to work within five to 10 minutes and is effective for 30 to 90 minutes. Administered several times a day, it can reduce the "off" periods by an average of two hours a day.  Adverse effects are yawning, drowsiness, hypotension (abnormally low blood pressure), nausea and vomiting. It also can result is some dyskinesias.

Symptoms  that Levodopa Doesn't Address

While levodopa is the gold" standard" med for treating Parkinson's, it doesn't provide relief from all of the symptoms associated with PD. Here are symptoms that aren't affected:
  • Motor symptoms of postural instability, the freezing phenomenon (patient freezes in one spot while walking and finds it difficult to take next step), and speech abnormalities (most frequently a lowering of the voice level).
  • Mental changes of dementia and depression
  • Autonomic nervous system dysfunctions, including constipation, sexual dysfunction, urinary problems and sweating.
  • Sensory phenomenon such as hallucinations
  • Sleep problems
Non-Pharmacological Treatment 

 Throughout the symposium, speaker after speaker emphasized the importance of exercise in treating PD. One speaker said exercise was even more important that pharmacological treatment. Other recommended non-med treatments include:
  • Support groups
  • Education
  • Nutrition
  • Psychosocial needs
  • Therapies -- occupational, physical, speech.

Deep Brain Stimulation

Deep brain stimulation is being used increasingly to alleviate the motor complications that accompany long-term use of levodopa. 

The Food and Drug Administration (FDA) approved deep brain stimulation as a treatment for essential tremor  in 1997, for Parkinson's Disease in 2002, and for dystonia in 2004.  It involves surgical implantation of a brain pacemaker that sends electrical impulses to specific portions of the brain.

The expected improvements with DBS include decreases in dyskinesias, dystonia, the wearing-off symptoms, and tremor. It may not have any impact on speech and gait problems. Also with DBS, the best that the patient can expect is to get back to the best he/she was while on levodopa.  Patients won't get better than that.

Usually patients over age 70 will not be accepted for DBS intervention.  Evidence of dementia also is a disqualifier as is significant untreated depression or anxiety.

Future Treatment Needs and What's in the Pipeline

The single most important unmet medical need in Parkinson's disease today is effective neuroprotection therapy.  Neuroprotection is a treatment that slows, stops, or reverses the disease progression by protecting, rescuing , or restricting nerve cells that degenerate in PD (primarily dopamine).

Things in the pipeline include:

  • Meds with more continuous action -- dopamine agonist patches, levodopa patch, subcutaneous infusions of the meds lisuride and apomorphine, intraintestinal administation of duodopa
  • Antidyskinetic meds 
  • Surgical interventions -- transplanting fetal or retinal epithelial cells, stem cell transplantation, gene therapy.