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Just as people in the general population have to contend with various unrelated medical conditions, so may people with Parkinson's disease (PD). Such conditions are termed "comorbidities," that is, diseases or conditions occurring along with, in this case, PD. Examples are cardiovascular disease, strokes, arthritis, diabetes, asthma, cancer, cataracts, other diseases of aging, as well as those that can occur at any stage of life. An important consideration is to determine which health professional would be best at addressing them and who coordinates the care. A movement disorders specialist may feel comfortable treating a general neurological condition in addition to PD, but in this podcast episode, movement disorders neurologist Ashley Rawls, MD, MS of the University of Florida College of Medicine in Gainesville, a Parkinson's Foundation Center of Excellence, emphasizes that one's time with her is best used addressing the person's PD, while comorbidities are most appropriately managed by specialists in those particular areas. For best patient outcomes, proper coordination of care and sharing of information will give each health professional a total picture of the person's medical management, including prescribed drugs and possible drug interactions.
La distonía es un trastorno del movimiento que causa contracciones involuntarias de los músculos. Estas contracciones llevan a posturas anormales de partes del cuerpo y a veces a movimientos repetitivos.
En este episodio, hablamos con la doctora Marta San Luciano, Profesora Asociada de Neurología en la University of California San Francisco, acerca de la definición y el manejo de la distonía. La doctora San Luciano nos explica que la distonía es un síntoma común de la enfermedad de Parkinson que puede aparecer al principio o a lo largo de la enfermedad.
Aprendemos que la distonía generalmente ocurre en los periodos "off", cuando el cuerpo tiene poco medicamento para el Parkinson, pero también puede aparecer en el medio de una dosis, en un periodo "on".
Además de las terapias que existen para controlar la distonía, como los medicamentos y la fisioterapia, la doctora San Luciano comparte ejemplos de actividades diarias que pueden ayudar a manejar la distonía.
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Forty percent of people living with Parkinson's disease (PD) are women, but compared to men, they have a longer time to diagnosis, less access to neurologist care, and are underrepresented in research studies. Although PD presents special considerations for women, they are, overall, treated the same as men. Some of the differences are body weight, drug metabolism, symptoms, monthly hormone cycles, hormonal changes across different stages of life, pregnancy, and family and other care giving responsibilities and occupational demands, all of which can affect their disease and its treatment. However, these special needs have largely been underrecognized and under-addressed by the medical profession.
Six women health care professionals, three of whom have PD, authored a paper titled "Unmet Needs of Women Living with Parkinson's Disease: Gaps and Controversies" to bring these issues to the fore, identify current knowledge, gaps, and possible strategies to meet the neglected needs of women with PD.
Some of these areas of need are management of the disease, psychosocial issues, advocacy, research on sex and gender issues, and participation of women in research studies. One of the authors is Annalien Oosterbaan, MD, PhD, who has Young-Onset Parkinson's disease and is an obstetrician/gynecologist, researcher at the Radboud University Medical Center in Nijmegen, The Netherlands, and a mother, and whom we spoke with for this podcast. She said the paper lays out a path forward for medical professionals to recognize the unique needs of women with PD and for women to become educated and empowered to communicate their symptoms and needs, participate in research, and to organize as a community.
Dyskinesia is a condition involving erratic, uncontrollable muscle movements such as twitches, jerks, twisting, or writhing of the face, arms, legs, or trunk. It can be a complication after long-term use of levodopa to treat Parkinson's disease. Dyskinesias can be mild, or they may be severe enough to interfere with normal functioning.
Basic laboratory research has revealed some of the changes in the brain after long-term exposure to levodopa. In this episode, Kathy Steece-Collier, PhD, a professor in the Department of Translational Neuroscience in the Michigan State University College of Human Medicine in Grand Rapids, discusses her research into the biologic mechanisms of levodopa-induced dyskinesias and a possible future prevention and treatment for them.
Funded by an International Research Grant from the Parkinson's Foundation, she delineated the role of calcium channels, which allow calcium to enter nerve cells in the brain, in the development of levodopa-induced dyskinesias. Based on those findings, she is now working on an approach that uses a single injection into a part of the brain that is affected in Parkinson's disease (the striatum) that may have the potential for long-term prevention or relief of dyskinesias. The idea is to introduce a short piece of RNA with a tight hairpin turn in it, called a short hairpin RNA (shRNA), to silence the gene that leads to abnormal calcium channel signaling in the striatum that causes dyskinesia. Dr. Steece-Collier also explains how this technique may have advantages over drug therapy to control dyskinesia.
En los últimos años, se han publicado varios estudios que sugieren que empezar la fisioterapia en las etapas tempranas de la enfermedad de Parkinson puede tener beneficios neuro-protectores, lo que significa que ayuda a mantener el cerebro más saludable. En el caso de las personas con Parkinson, la fisioterapia puede ayudar con el equilibrio, con la marcha y para mantener buena fuerza.
En este episodio, hablamos con Ana Sanchez Junkin, doctora en fisioterapia con especialidad clínica en neurología. Ana trabaja clínicamente en el hospital Beth Israel Deaconess Medical Center en Massachusetts, Centro de Excelencia de la Parkinson's Foundation. Además, trabaja con estudiantes como instructora clínica en el MGH Institute of Health Professions.
Ana comenta que es recomendable que las personas con Parkinson vayan a su primera evaluación con un fisioterapeuta tan pronto como sean diagnosticados. Esto ayuda al fisioterapeuta a identificar problemas antes de que empiecen a impactar funcionalmente a la persona.
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Además, el entendimiento a fondo que un fisioterapeuta tiene del Parkinson le permite personalizar los ejercicios de sus pacientes para las cosas con las que están teniendo dificultades. Además de la fisioterapia, Ana opina que lo más importante es encontrar una forma de ejercicio que disfrute, para que sea más fácil crear un hábito de ejercitarse con frecuencia.
Regular exercise in its various forms is one of the most important things that people with Parkinson's disease (PD) can do for themselves. It can promote aerobic conditioning, strength, balance, and flexibility and help slow the decline in mobility while improving quality of life.
Findings from the Parkinson's Foundation Parkinson's Outcome Project, the largest ever clinical study of PD, suggest that people with PD engage in at least two and a half hours of exercise each week to improve quality of life. Thus, recognizing the importance of exercise, the Parkinson's Foundation, in collaboration with the American College of Sports Medicine, has created new Parkinson's Exercise Recommendations to ensure that people with PD receive safe and effective exercise programs and instruction.
These guidelines were developed and reviewed by a panel of exercise and Parkinson's experts who recommended the frequency, intensity, time, type, volume, and progression of exercises that are safe and effective for people with PD. They include four domains important for people with PD: aerobic activity; strength training; balance, agility and multitasking; and stretching. Each recommendation is paired with specific types of activity and special safety considerations for people with PD. Besides addressing people with PD, the guidelines also are a framework for exercise professionals to help develop safe and effective programs to improve quality of life for the PD community.
In this episode, we have two exercise professionals specializing in Parkinson's disease. Daniel Corcos, PhD, a professor in the Feinberg School of Medicine at Northwestern University in Chicago, was an outside reviewer of the Parkinson's Foundation's Exercise Competencies and Criteria Initiative, which spells out general principles for people with PD to engage in endurance exercise. He explains endurance (cardiovascular) exercise, in which one aims to raise the heart rate to specific levels. Lee Dibble, PhD, PT, ATC, professor and chair of the Department of Physical Therapy and Athletic Training at the University of Utah in Salt Lake City, discusses resistance training, also called strength training.
Medicare, the U.S. government health insurance program, covers more than 63 million people, with more than 49 million people also receiving prescription drug coverage. It provides health insurance for adults over 65 as well as people with some medical conditions or disabilities. The system has many moving parts, and beneficiaries need to understand it to derive the most benefit, know what it covers and does not cover, and what costs they will be responsible for. An important time is the initial enrollment period, when people need to decide what kind of plan they want to select, either "original" Medicare through the government or a Medicare Advantage plan with a private insurer. Receiving prescription drug coverage is another decision, one that is particularly important to someone with Parkinson's disease. Fortunately, there are several resources to help people sort out all the options, and once enrolled, the year-to-year coverage decisions are much less burdensome. In this episode, Jane Sung, JD, a senior strategic policy advisor at the AARP Public Policy Institute, explains some of the intricacies of the Medicare system and helps to sort out the kinds of decisions people need to make about Medicare coverage.
Sabemos que existen otras cosas aparte de la medicina como parte del tratamiento para una persona con la enfermedad de Parkinson; por ejemplo, la actividad física, que sabemos que puede ayudar a la salud del cerebro.
En este episodio, hablamos con la doctora Giselle Petzinger, Profesora Adjunta de Neurología en la Keck School of Medicine de la University of Southern California, acerca de un estudio que llevó a cabo para comprender mejor si usar un fitbit con entrenamiento puede promover la actividad física en las mujeres hispanas con enfermedades neurológicas crónicas como el Parkinson.
Aunque muchas participantes sabían que la actividad física es importante para la salud, no sabían que también puede ayudar a la salud del cerebro. La meta del estudio fue promover la actividad física utilizando la tecnología del fitbit, entrenamiento y educación llevado a cabo en un centro comunitario.
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As many people get older, they start to think about where they want to reside for the rest of their years. For many of them, that place is the home they are already in. But it is not as simple as just staying put. One must consider mobility issues, staying safe physically, nearby services, social support, transportation issues, along with present and future medical needs.
These are issues common to most people as they age, and Parkinson's disease adds another level of considerations. Fortunately, many resources are available to help in planning for the future. In general, the topic goes under the term "Aging in Place," which the U.S. Centers for Disease Control and Prevention defines as "the ability to live in one's own home and community safely, independently, and comfortably, regardless of age, income, or ability level.
In this episode, Rodney Harrell, Vice President for Family, Home, and Community at the AARP Public Policy Institute describes what Aging in Place should mean, misconceptions about it, barriers to it, what to consider, and how best to prepare for Aging in Place. Then Scott Rider, a Parkinson's Foundation Aware in Care Ambassador, National Development Committee Member and Carolinas Chapter Advisory Board Member, discusses how he has put an Aging in Place plan into practice by adapting his home for his current needs and anticipated future needs considering, specifically, his Parkinson's disease.
Among the many kinds of outreach and activities that help people with Parkinson's disease (PD), art programs are popular and beneficial. They can provide social interaction, creativity, and movement, with the potential to enhance emotional and physical wellbeing. One program, Smile Through Art, benefited from a Community Grant from the Parkinson's Foundation, allowing it to continue to reach people with PD and their care partners throughout the pandemic. Smile Through Art Workshops encourage creativity and movement, using art to address problems of fine motor control, rigidity, and tremors while providing cognitive stimulation. The goals are to foster confidence, mood, and optimism.
In this episode, Saba Shahid, the Chief Smile Officer and President of Creative Neurology, the company that developed the Smile Through Art program, discusses what the workshops entail, the success that they have had, and how a Community Grant from the Parkinson's Foundation allowed the program to continue to reach people with PD during the pandemic.
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