June 30, 2015

"We Can't Let This Moment of Amazing Grace Just Fade Away"

That was my thought when I finished reading the piece reprinted below. Written by Michael Cohen, it's from Saturday's issue of The Guardian. I hope you will read it and share it with others.

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Ten days that turned America into a better place

Some day, people are going to write books about what happened over the last 10 days in the United States. It began with a depressing reminder of what is, perhaps, the worst of America. A disturbed young man, armed with an easily obtainable and high-calibre handgun, shot down nine people in cold blood. It was a shocking act, but largely because Americans have become so inured to the daily carnage of gun violence that the only types of incidents that stand out are those that are uniquely horrific.

June 29, 2015

Curcumin's Growing Reputation as an Effective Treatment for Many Conditions



Over three years ago, in an April 2012 post, I described my decision to start taking curcumin, the active ingredient in the Indian curry spice turmeric. Since then, I've written about 20 posts on the subject.

Coconut Oil and Curcumin: Fad and Fact
Many earlier posts grew out of my frustration at seeing all the hoopla about coconut oil as a "cure" for Alzheimer's -- and then Parkinson's disease (PD) -- when no studies existed to support those claims. Curcumin, the subject of thousands of studies, was ignored.

What a difference a few years make.

The coconut-oil-for-Alzheimer's bandwagon has run out of steam. Dr. Mary Newport, the band leader, clearly abandoned her promotions of this "miracle" last year (http://bit.ly/1v8lxsY). The first real study on coconut oil and Alzheimer's is finally underway, and we may see a report later this year.

Recent Reports on Curcumin
A review of the turmeric/curcumin research appeared this May in the journal Molecules. The Pittsburgh Post-Gazette picked up that story, and it spread from there. The information below comes from that report.

Multiple studies show that turmeric -- particularly its active ingredient curcumin -- can help prevent or treat many ailments, including:
  • many cancers
  • inflammatory conditions
  • autoimmune problems
  • neurological ailments including Alzheimer's and Parkinson's
  • cardiovascular disease
  • diabetes and diabetes neuropathy
Interest in turmeric and curcumin began decades ago when researchers started asking why India posts some of the lowest rates of colorectal, prostate and lung cancers in the world (those rates in America are up to 13 times higher). They noted that Indian peasants have one of the world's lowest rates of Alzheimer's. Why?

June 28, 2015

That Was The Week That Was!

Not too many of you remember the 1961-62 British comedy show on TV that had that title. But it popped into my mind as I thought about the events of this past week which almost restored my faith in our democracy.

I need time to mull over all of this. But I wanted to do something today to recognize and honor what has happened. Usually I don't spend a lot of time on Facebook but I did yesterday. What a day -- so many of my friends superimposing the rainbow flag on their profile pictures: seems like everybody has something positive and loving to say.

I decided the best thing I could do today was just copy some of what I found on Facebook. Here goes:


And it wasn't just the White House

June 26, 2015

"American Exceptionalism" in Healthcare: Exceptionally High Costs and Exceptionally Poor Results

"American exceptionalism" is the theory that the U.S.A. is inherently different from other nations. From our origins in the American Revolution, this concept grew as we developed a uniquely American ideology.

But today the term has been corrupted by conservatives and super patriots to mean that we are far superior to other nations, and that our quality of life is by far the best on Earth. The tragic shooting in Charleston last week prompted David Niose of the American Humanist Association to write an article -- "Anti-intellectualism Is Killing America" -- in which he notes that quality-of-life ratings place America far from the top.

Rankings of U.S. on Health Care Issues
Here's a headline in the July, 2015 issue of the University of California, Berkeley Wellness Letter: "The U.S. spends more on health care per capita than just about any other country but ranks poorly in terms of many healthcare outcomes, especially compared to other developed countries. "

Using the latest statistics from the Social Progress Index (compiled by the nonprofit Social Progress Initiative), the newsletter reports that out of 133 countries, America ranks:
  • 30th in life expectancy
  • 37th in a mortality rate from infectious diseases
  • 38th in childhood mortality rate
  • 35th in terms of women surviving childbirth.
We have higher homicide rates than 40 countries, higher traffic fatality rates than 37, and higher suicide rates than 81. 

June 25, 2015

The Bright Side of Parkinson's

It's been a particularly bad week for me, my Parkinson's, and my Parkinson's pals. I already wrote about the death of Allen Weinstein, a treasured friend before and after our Parkinson's disease (PD) diagnoses. We spoke honestly with each other about our fears -- and other feelings -- at weekly PD support group meetings, and when we met socially.

Richard Wilson, another close friend from our support group, died the week before. We often went to lunch at the Politics & Prose bookstore café after our meetings.

About a dozen people typically attend those weekly meetings. One member has been dealing with dementia for several years. Now, two others are clearly slipping into the fog. I wrote recently about recent studies confirming that dementia and cognitive impairment often go hand-in-hand with Parkinson's.

Today our latest spell of heat and humidity broke, and I got to spend much of the day in the back porch rocking chair. FedEx brought me a package with two good-sized koi for the pond. (Is there anything we can't order online these days?)

I want to continue this upbeat turnaround with tonight's post. I remembered a New York Times piece (shown below) in my files by Jon Palfreman, professor of broadcast journalism at the University of Oregon. Palfreman is also the author of the forthcoming book "Brain Storms: The Race to Unlock the Mysteries of Parkinson's." I just pre-ordered it on Amazon.com.

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June 24, 2015

Allen Weinstein on His Reaction at Age 8 to FDR's Death

The multi-talented Allen Weinstein, who died on June 18, was a treasured friend. He was a dedicated member of our Parkinson's support, which I described in yesterday's post.

Leon Paparella, the moderator of our support group, remembered Allen's sharing with us a short piece he had written. Fortunately, Leon retained his copy of this charming story. Here it is:

June 23, 2015

Allen Weinstein and Our Parkinson's Support Group



At our Parkinson's support group meeting last Friday, one of our members brought in a copy of the obituary from that morning's Washington Post for Allen Weinstein, a devoted member of our group. He had died on June 18 at a nursing home in Gaithersburg, MD.

The Post's obituary, and the equally laudatory one in the New York Times, describe his many accomplishments. He is perhaps best known as the author of Perjury: the Hiss-Chambers Case. Historian Arthur Schlesinger called it "the most objective and convincing account we have of the most dramatic court case of the century."

Weinstein was an academic with professorships at Smith College, Georgetown University, and Boston University. He founded the Center for Democracy in Washington. His work there prompted the Los Angeles Times to describe his group as "the advance team in America" for Boris Yeltsin, the Russian reformist leader. That team helped establish representative governments in Eastern Europe as the Soviet Union collapsed. The Center monitored elections in several countries, including the Philippines, Panama, and Nicaragua.

In 2004, President George W. Bush nominated him to head the National Archives and Records Administration. He resigned from that position at the end of 2008 as his health declined from Parkinson's disease (PD).

Allen and Parkinson's and our Support Group
I joined the group shortly after being diagnosed with PD in the fall of 2009. Allen joined about a year later.

June 19, 2015

Rytary: It's New and Costlier. But Will It Work Better?

A few days ago I reported that my neurologist had just prescribed rytary, the new Parkinson's drug approved by the FDA earlier this year to improve the delivery of levodopa.

I was looking forward to starting rytary the next day, but it didn't happen.

My CVS pharmacist said they didn't have rytary in stock, but thought they'd get it today (Friday, June 19). The pharmacist called this afternoon. They received the rytary, but my insurance company wouldn't cover it. The tab without insurance? Over $900.

I left a phone message for my neurologist about these developments. I suspect my insurance provider hasn't yet reviewed the new med, but will cover it when they do.

I'm not too concerned. In fact, I've been wondering whether rytary was really right for me.

Ever since I switched from the regular levodopa pills to an older extended release version, I've felt good. Should I really mess with this success?

Then at today's meeting of my Parkinson's support group, a fellow member who had started taking rytary just last week said he'd already stopped taking the new med because it was causing distressing nausea.

Is a New Med Necessarily Better than the Old One?
I've seen reports from physicians that new versions of older drugs often don't work as well. For example, many doctors now prescribe antidepressant drugs called tricyclics (developed in the 1950s) instead of SSRIs (from the 1980s).

June 18, 2015

My Day Starts and Ends with Good Nutrition

Fifteen years ago, one shelf in my kitchen cabinet was devoted to all the dietary supplements and other pills I was taking: aspirin, multivitamins, various B vitamins, calcium, vitamins D, C and E, niacin, omega-3 fish oil, coenzyme Q10, creatine, and glucosamine/chondroitin... just to name a few.

At one point, I was working with a dietitian who used a blood sample to produce a list of deficiencies in my body chemistry. It turned out that the best remedies for these "problems" were the exotic supplements available only in the shop next to his office.

Now I've gone to the opposite extreme, not unusual for me. I used to smoke two or three packs of cigarettes a day; I haven't touched a cigarette in over 50 years. Vodka dominated my life for decades; I haven't had an alcoholic drink in 37 years.

The only supplements I take today are vitamin D3, curcumin, ashwagandha and 5-HTP. I subscribe to several health newsletters, and I do lots of online research. The consensus is clear: most of us are better off getting what we need from food, not pills.

I also find eating nutritious food a lot more enjoyable than popping pills. Here are two examples:

My Super Healthy Breakfast

Rytary: My Brand New Extended-Release Carbidopa-Levodopa Capsule for Parkinson's

I had my regularly scheduled meeting with my neurologist today. As a result, tomorrow I'll start a trial of Rytary, the new PD (Parkinson's disease) medication approved earlier this year by the FDA.

For good information on Rytary, go to rytaryhcp.com and click on "For Patients" in the right corner.

This development couldn't be better timed for me. As I reported in a blog post last week, I recently switched from the regular carbidopa–levodopa to the extended release (ER) form of the medication. I was delighted to find that this change resolved my problem with blood pressure (BP) spikes during the "off" periods, when the last pill was wearing off and the new one hadn't yet kicked in. The ER pills apparently smoothed out the levodopa delivery enough to eliminate those bp spikes.

I hadn't consulted my neurologist about the dosage and timing of the ER pills. At today's meeting, we decided I'd discontinue what I’d been taking and try Rytary, a new ER pill. Clinical trials have shown these results:
  • Patients with early PD who took Rytary experienced a significant improvement in their ability to move and perform activities during the day. 
  • Patients with advanced PD who took Rytary experienced significantly less "off" time without troublesome dyskinesia (uncontrollable movements) during the day. 

June 16, 2015

How Likely Is It that You'll Die Within Five Years? Take this One-Minute "Ubble Age" Test

Researchers have developed a test – a simple series of questions – that accurately assesses the risk of dying in the next five years for Brits aged 40-70. Results were published June 3, 2015 in the online journal "The Lancet."

Interested in learning YOUR risk? The link to the test appears at the bottom of this post and takes about one minute to complete. Men need answer only 13 simple questions; women, 11. Remember, the calculations are based on data from people in the UK. So, if you live elsewhere, the accuracy of your assessment is correspondingly compromised.

Andrea Ganna and Eriuk Ingelsson from Karolinksa Institutet and Uppsala University in Sweden carefully evaluated data from a large-scale project called UK Biobank. Between 2006 and 2010, that project had collected 655 health and wellness measurements from 498,103 British volunteers aged 40-70.

Those measurements included blood tests, physical information and biological stats. In addition, all the study participants completed detailed questionnaires about the health and lifestyles.

Next, Ganna and Ingelsson monitored the half million Biobank participants until February, 2014. For those study participants who had died, the researchers used info from the Health & Social Care Information Centre and the NHS (National Health Service) Central Register to determine the causes of death.

From this huge data base, the researchers created two tools.

1) The Association Explorer
In concert with cause-of-death information, the researchers used the 655 UK Biobank measurements previously assembled to determine how closely each of those measurements was associated with death within five years.

June 12, 2015

Tips on Lowering Blood Pressure without Pills

These help lower my blood pressure
Yesterday's post reported on my success in dealing with the problem of very high spikes in my blood pressure. Now I'm back to my more normal blood pressure readings. I'm finding that most of these readings are well below the 150/90 guideline for those of us over age 60. And I no longer take blood pressure meds.

These good readings probably are due, at least in part, to some of the things I've tried over the last couple of years to lower my blood pressure without pills.

Usual Recommendations for Life Style Changes
Here are some of the standard recommendations for steps you should take to lower systolic blood pressure readings:
  1. Consume a low-fat diet rich in produce, grains, and low-fat dairy and reduced saturated and total fat.
  2. Be active. Engage in regular aerobic physical activity such as brisk walking at least 30 minutes per day most days. 
  3. Lose excess weight. Aim for a body mass index under 25.
  4. Drink alcohol moderately if at all. Limit consumption to no more than one drink per day for most women and no more than two drinks per day for most men.
  5. Cut back on salt. Consume no more than 2300 mg of sodium per day, the amount in a teaspoon of salt.
But I've been trying other recommendations and these are the ones that I've found most helpful

Hibiscus Tea
Google "hibiscus tea and blood pressure" and you'll find numerous reports about how this tea has a propensity to lower blood pressure significantly. These references include a link to one of my favorite sites for nutrition information – – nutritionfacts.org

Here's a video update from that site:


One study showed that hibiscus tea was as effective at lowering blood pressure as captopril, a prescription ACE inhibitor used to treat high blood pressure and heart failure. In another study three eight-ounce servings of hibiscus tea lowered pre-hypertensive subjects' systolic blood pressure significantly.

I've seen recommendations that you should aim for 3 cups a day. I usually take only one large cup but I use two teabags – – one of the hibiscus tea from Whole Foods   and the other from Red Zinger. Sometimes I manage to take two cups.

Beet Juice 
Beets are a good source of potassium – – and a good source of folate, both of which are important in regulating blood pressure. What's more, beets contain nitrate, which is converted into nitrites once ingested. Nitrites relax smooth muscle tissue and increase blood flow. Finally beets support healthy blood vessel function and battle homocysteine, which can damage blood vessels.

June 11, 2015

My Blood Pressure and Levodopa: Six of My Doctors Were Wrong and I Was Right

For about two years, my major health concern has been the blood pressure (bp) spikes that typically occur during Parkinson’s "off" periods, when the last levodopa pill is losing its effectiveness and the new pill hasn't yet kicked in.
               
My search for a  solution has focused on ways to reduce these off periods. But six doctors I've consulted -- my former internist, the two geriatricians who have replaced the internist, and three different neurologists who specialize in Parkinson's disease (PD) – disagreed with me.

All of them – after checking my blood pressure (bp) in their offices – told me I should take bp meds. A couple of them urged me to stop monitoring my readings so often at home.

I've driven doctors, family, friends -- and myself -- crazy by acquiescing to these drug recommendations… and then changing my mind and abandoning the meds to try my own cures. Nobody was happy with that situation.

Finally, I stumbled upon an approach that has dramatically reduced the bp spikes without using bp pills. And I’m feeling better in other ways, too.

First, some background.

New Thinking About Blood Pressure and Seniors
Recently, an independent group of experts, based on a review of the medical research, concluded that most people age 60+ don't need bp meds until their levels hit 150/90. Several groups, notably the American Heart Association, have not endorsed that new target. But other research suggests drug treatment has not been proved helpful for most people, regardless of age, until systolic pressure hits 160.

Many experts think the goal of 150/90 for most people age 60+ -- and 140/90 for most people with diabetes or chronic kidney disease -- is reasonable. Getting levels below these recommended numbers can require high doses of bp drugs, or even multiple meds that increase the risk of side effects. Those effects can include persistent cough, erectile dysfunction, and frequent urination. The drugs can also cause dizziness, which increases the risk of falls.

Some authorities now argue that anyone over 80 without cardiac problems can stop taking bp pills. One study even found that high blood pressure in those over 85 predicts longer survival, a finding that "would probably be news to 95 percent of practicing physicians,” according to an accompanying editorial in Archives of Internal Medicine.

June 9, 2015

Neurologist/Author Oliver Sacks and French Ambassador to the U.S. Gérard Araud: Two Very Different Gay Lives

The first story below shows the damage done to many gays by internalized homophobia. The second story is an example, I hope, of the prospects for gays now that their sexual orientation is increasingly viewed by others -- and themselves -- as just one facet of their personalities.

Oliver Sacks' Tormented Life as a Homosexual
I'm a long-time fan of Sachs. I loved the movie Awakenings, based on his 1973 book of the same title. The 1990 Oscar-nominated film starred Robert De Niro and Robin Williams. It tells the story of Sacks' work with a group of patients who had been warehoused for decades in a home for incurables. Afflicted with a rare form of encephalitis, these people were brought suddenly back to life by Sacks in 1969 after he administered the then-new "wonder drug" levodopa. I have also enjoyed reading Sacks' other books, like The Man Who Mistook His Wife for a Hat, which details some of his patients' case histories.

My interest in Sacks increased when I was diagnosed with Parkinson's because levodopa is the drug of choice for treating the symptoms of the disease. Ironically, Awakenings star Robin Williams was diagnosed with Parkinson's three years before his suicide last August. It's reported that he had learned he was showing signs of the Parkinson's-related dementia. Put "Robin Williams" in the search box to the right, and you'll find other commentaries about this sad case.

In February, I posted the full text of the blunt, eloquent op-ed piece Sacks wrote in the New York Times about his recent terminal cancer diagnosis.

When I heard that Sacks' memoir On The Move had been published, I did an Amazon.com one-click to order it. My daughter noticed the book on my reading stand and mentioned his homosexuality. I was startled. That was news to me.

I did wonder about this photo of Sacks on the cover of his book:

Image result for oliver sacks on the move

I checked the book's index for "homosexuality" and found that Sacks acknowledges his homosexuality and his struggles with it. But I found his comments simply factual, with little indication of the strong emotions that must have accompanied the facts.

I turned to Google and found a terrific essay in the current issue of Vanity Fair written by Lawrence Weschler, who had worked with Sacks on a possible biography back in the early 1980s. Sacks described to Weschler
how he gradually became aware of his homosexuality, a fact that, to put it mildly, he did not accept with ease; and how, following college and medical school, he had fled censorious England, first to Canada and then to residencies in San Francisco and Los Angeles, where in his spare hours he made a series of sexual breakthroughs, indulged in staggering bouts of pharmacological experimentation, underwent a fierce regimen of bodybuilding at Muscle Beach (for a time he held a California record, after he performed a full squat with 600 pounds across the shoulders) and racked up more than 100,000 leather-clad miles on his motorcycle. And then one day, he gave it all up -- the drugs, the sex, the motorcycles, the bodybuilding. By the time we started talking, he had been pretty much celibate for almost two decades.

June 8, 2015

In Honor of a Rare Event: A Weekend in Washington with Perfect Weather

I don't usually post anything on Mondays. But this past weekend was so glorious I wanted to memorialize it. I can look back on this post in the coming months when Washington undoubtedly will revert to the normal heat and humidity of this swamp.

I spent the weekend at home, mostly on the back porch. In my humble opinion, the view from there is hard to beat.

  
My house is one of four virtually identical neighborhood split levels built very close together. I've been working for years to create an oasis in the backyard with plantings that screen out my neighbors' houses. I'm getting close

Our New Grill
These photos were taken last weekend, but I want to show off our new grill. Here Nimesh and Bhawana are studying the instructions on how to put the grill together.


Success!


Sunset Saturday Night
Hard to tell whether I'm reading or sleeping. You can find me doing both in this rocking chair.


Sunday Evening
My housemates are ready to take off for a wedding reception, where they'll perform a Nepali folk song.


I will always remember their performance at an earlier wedding reception:



June 5, 2015

New Help for Gardening and Porch-Sitting

I first came to Washington in April, 1955. So I've had 60 years dealing with Washington's ever-changing weather. But never have I experienced what happened this week. At the start of the week, I had the air-conditioning on as Washington's hottest-ever May continued into June. The next day I turned the furnace back on when the day's temperature didn't rise above 64. The cold snap was accompanied by several rainy days.

Today's forecast promised warmer temps with sunshine breaking through in the afternoon. I was going to take you on a tour of the garden, as I prepare for my belated spring plantings. But we'll have to do that later, since it's still cloudy and cool.

No doubt I'll get into the garden sometime this weekend to replace the pansies with the begonias and New Guinea impatiens I bought today. Easy tasks like these are about all I do in the garden these days. I'm lucky to have my pal Joey -- who works mostly for a neighbor -- available to do the heavier work.

Gardening Aid for Elderly Gardeners
I still enjoy a little putzing around in the garden. But this last year I found I could only work the soil around a tree or a fence; I needed something to hang onto, to lower and raise myself. Then I found this simple, inexpensive garden kneeler bench on amazon.com. One click and it was mine. Here I'm demonstrating what I hope to be doing tomorrow -- replacing a pansy with a begonia.


June 4, 2015

"Free Water" in the Brain: New, Non-Invasive Tool to Better Diagnose and Treat Parkinson's

Researchers at the University of Florida have identified a bio-marker – free water in the brain’s substantia nigra section – that could improve a doctor’s ability to diagnose and treat Parkinson’s disease (PD).

Details of the new study – published last month in the journal Brain – follow recent revelations that loss of smell and severe depression often herald the presence and development of the neurological disease.

How the Study Worked
The study involved 25 people with Parkinson’s and 19 people in a control group. Granted… not a large sample.

Using diffusion imaging – a type of MRI – the Florida team monitored the levels of “free water” in the substantia nigra regions of their subjects’ brains. This free water is fluid that is unconstrained by brain tissue, presumably a result of disease-related deterioration.

The substantia nigra is located mid-brain, and its neurons produce dopamine, a chemical messenger responsible for transmitting signals within the brain that enable coordination of movement.

(In addition, this brain region plays a key role in reward-seeking and addiction. Interestingly, we’ve already seen how certain PD medications complicate reward-seeking and addiction.)

Along with MRIs, the researchers administered the Montreal Cognitive Assessment to all subjects to track mental sharpness at the start of the study, and one year later.

What Researchers Learned

June 3, 2015

My Two Weeks in Tuscany



While Washington sweltered in the warmest May ever, here's where I was based for a delightfully cool two weeks. Truth alert: I didn't take this photo. It comes from an online travelogue.

My son, his partner, and I have traveled in Europe for the past two years, and we travel well together. A favorite stop from an earlier trip was the hill town of Asola, near Venice. When we decided to return to Europe this May, I immediately thought of Tuscany.

Asia -- especially Nepal -- has dominated my travels since 2001. Before that, I traveled in Europe almost every year. Florence is one of my favorite cities, and I always enjoyed the hill towns of Tuscany. Here's how Rick Steve's describes these towns:
The hill towns of central Italy hold their crumbling heads proudly above the noisy flood of the 21st century and offer a peaceful taste of what eludes so many tourists. Sitting on a timeless rampart high above the traffic and trains, hearing only children in the market as the rustling wind ages the weary red-tile patchwork that surrounds me, I find the essence of Italy.
Given my age (86 on May 26) and my Parkinson's, I didn't want to travel the way I used to -- two nights here and three nights there. I wanted to stay in one place and use it as a base for explorations. But which town?

Cortona
Two of my dearest friends, Daniel and Marione Ingram, had lived in Tuscany for years. So I turned to them for advice. I said I wanted to stay in a Tuscan town that wasn't overrun by tourists. Another requirement: a town that didn't require climbing up and down hills. They immediately suggested Cortona.

June 2, 2015

Parkinson’s Disease: The Long Journey from Physical Ailment to Something Much More Complicated


In 1817, James Parkinson published “An Essay on the Shaking Palsy.” He had observed several classic symptoms – tremor, rigidity, postural instability – in a very small group: three of his own patients and three people on the streets of London.

His essay gained little attention. But in 1861, French neurologist Jean Martin Charcot and several colleagues distinguished the disease from other neurological conditions and named it “Parkinson’s disease” (PD).

While Parkinson had the notion that the disease developed in the brain, for a long time it was considered a simpler collection of physical malfunctions.

In 1879, doctoral candidate Paul de Saint-Leger’s used the woodcuts (shown at the top of this post) of the hunched man to illustrate his thesis “Paralysie agistante.” What’s on display is the clear physical manifestation of a PD patient with postural instability and shuffling gait.

Not much more was understood about the disease at the time. And it would take many more decades before the disease – and the science behind it – were understood more fully.

I recently saw a brief essay -- "Parkinson's disease: the flip side of the coin" -- on OUPblog, "Oxford University Press's Academic Insights for the Thinking World." The author is Murat Emre, professor of neurology at the Istanbul Faculty of Medicine, Istanbul University, Turkey, where he chairs the Behavioral Neurology and Movement Disorders Unit. In the piece, Emre quickly traces the evolution of our understanding of PD.

He makes a number of points, including these:
  • PD was first considered a motor disorder with – eventually – impaired mental function.
  • Effective treatments eventually extended the lives of people with PD. As a result, the cognitive effects of the disease became more apparent.
  • More recent research has established dementia and cognitive impairment as integral features of PD. Careful attention to mental slippage can even help diagnosticians identify PD in its early stages, in the same way that other non-motor symptoms – including loss of smell and depression -- can herald the presence and development of the disease.
  • Dementias that follow PD were once thought to be independent, co-incident forms of Alzheimer’s. Now, research shows that dementias associated with Parkinson’s disease (PD-D) have their own unique biochemical and pathological features, which have become markers for specific drugs – now becoming  available -- that target PD-D.

Emre wraps up his essay in this positive way:
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