A few personal thoughts to round the year off.

At Predict-PD Towers we have had a busy and successful year. We have rebuilt the website from scratch, taking the opportunity to really review all the questions in the surveys, and select the very best questions to help us answer our research questions. We have pioneered new techniques that are now included in the website, including an online trailmaking task and making the tap-test even better. We have made excellent progress with the imaging substudy: selecting some high risk and similar low risk controls to see if we can see some of the early changes associated with Parkinson’s using cutting edge MRI techniques. We’ve been travelling the length and breadth of the country seeing many of the participants in our ‘special groups’: people with smell loss, and people with a certain kind of sleep disorder, to conduct physical and cognitive examinations in their own homes. We have grown our team allowing us to do similar in person assessments in the homes of many of our ‘regular’ participants, and now have some specialist statistical and techincal data management help. Most crucially of all, we have launched the second phase of the study, in which we aim to recruit 10,000 new participants aged 60-80 – please spread the word, and encourage as many friends and relatives to head to the website (www.predictpd.com) and consider taking part. It takes only about 25 minutes and could potentially change the future of Parkinson’s disease.

I also wanted to reflect on the festive period and what advice or suggestions I could make to individuals or families with someone who has Parkinson’s.

Christmas is a time for family and celebration. When someone has Parkinson’s not only can movement be slow, but many non-motor symptoms can make this time of year hard. Depression, apathy and difficulty keeping up with conversations can make participation in family events so much harder. If Parkinson’s affects your family, friends or neighbours, please try and make the effort not to leave them behind. Social and physical exercise are vital to people with Parkinson’s, so make the effort to make that easy. The post-Christmas lunch walk may doesn’t need to be fast, but by making it inclusive you’ll make a real difference.

Another, far less pleasant aspect of this time of year, is flu. Flu continues to be a significant cause of illness and even death, and although there is no magic bullet, for many people it is potentially preventable. The simplest things are the most effective: handwashing with soap and water (especially after using public transport, before eating, and after coughing and sneezing), using disposable tissues (catch it, bin it, kill it), and the flu jab. It is worth busting a few common flu-jab myths: the immunisation does not contain the live virus – therefore you cannot catch the flu from the jab. While the recommended time to have the jab is October – November, flu cases continue to be common all the way through to the end of March, so better late than never. Each year the vaccine covers different strains of the flu, so that is why it is recommended to have it every year. This also means that the vaccine won’t protect you from evey strain  of flu (there are hundreds), but it will protect you from the ones that are likely to be the most common each year. Being otherwise healthy doesn’t protect you: despite running around 50 miles a week and generally enjoying excellent health, I’ve had a grotty end to the year, with the flu, which then predisposed me to pneumonia (and as a responsible health professional, yes I did get the jab in October, but that just means I was unlucky, and would still recommend it). 

We are of course indebted and grateful to Parkinson's UK for the funding that has allowed us to do this research, and for the support they continue to give. I'm looking forward to my first training run on Christmas day for the London Marathon, where I'll be aiming to break both my targets: under 3 hour finishing time and over £2500 for Parkinson's UK (http://bit.ly/RNR4Parkinsons for those that are interested).

Finally, from the entire team at Predict-PD, we thank you for your interest and participation throughout this year, and wish you and your family a very merry Christmas, and a happy and healthy 2019.

RNR

Gout again.. and is work affected by early Parkinson's?

After my positive blog-post on uric acid a while ago, we have another reminder that unfortunately in research things are often not so simple, especially when moving from observational findings to affecting real-world changes. We are ending the year with another negative trial in Parkinson's - it's recently been announced that the trial of urate-elevating drug Inosine is ending early as the investigators don't believe that the trial will achieve it's stated goal of slowing progression of Parkinson's. Alastair's paper on the causal relationship between urate levels and Parkinson's https://www.ncbi.nlm.nih.gov/pubmed/30014513 gave us a hint that uric acid, while associated with reduced risk, may not be directly causing this - so it's still important to understand more about these relationships and it will be instructive to read about the data that has been collected when this is published next year.

Talking of real-world impact, this interesting paper below explored the very real impact of early symptoms of Parkinson's disease on the workforce. At PREDICT-PD we are fascinated by what happens in the years before diagnosis of Parkinson's - a lot has been published on non-motor symptoms such as constipation, depression and sleep disorders - but not much on how this affects specific activities such as work. They looked at patients with Parkinson's who had to take sick leave and compared them to people who had taken sick leave for other reasons. Those with Parkinson's sick leave were more likely in the preceeding 5 years to have taken sick leave for reasons other than Parkinson's and more likely to have taken sick leave for musculoskeletal issues in particular. Given that the study was only able to look at sick-leave episodes exceeding 14 days, it illustrates the significant impact that these symptoms are having on patients in the early disease and even before diagnosis.

On a more positive note as we look towards the end of the year and Christmas, we are very pleased that recruitment is ramping up for the next stage of the PREDICT-PD project. We are working towards new publications of our own data in the coming months and we'd like to thank all for their ongoing support. If you or any family members are interested, please do have a look on www.predictpd.com.

Reduced workforce participation 5 years prior to first Parkinson’s disease sick-leave 

Jonathan Timpka, Örjan Dahlström, Armin Spreco, Maria H. Nilsson, Susanne Iwarsson, Toomas Timpka & Per Odin
https://www.nature.com/articles/s41531-018-0072-2 

Wishing you all the best over the festive season.

-anna 

  

Motivation to exercise

Exercise is known to have many benefits to people with and without Parkinsons. In Parkinsons it is known to improve slowness of movement, balance, mood, memory and quality of life. There is also some evidence that it might slow down the progression of the disease. So we know that exercise is good for people with Parkinsons, but we still aren't sure why.

One of the theories is that exercise might cause more dopamine to be released in the brain. Dopamine is the chemical that people with Parkinsons lack, and that is why giving medications which contain dopamine are an effective treatment for Parkinsons.

In this study from Canada they used a special scan and tracer to measure dopamine release in the brain before and after exercise in Parkinsons patients. They also compared how dopamine release differed between regular exercisers and more 'sedentary' participants.

They found that even before starting any exercise the regular exercisers had a higher level of dopamine in their caudate (the area of the brain associated with Parkinsons) than the sedentary participants. But when they looked at any differences in dopamine levels in other areas of the brain there was no difference between the two groups.

All the participants then had to cycle on an exercise bike for 30 minutes before they were re-scanned. The second scan found that both groups, as expected, had an increase in dopamine release in the brain. Interestingly the regular exercisers had a bigger increase in dopamine release in the brain, suggesting that regular exercisers get an even greater benefit from exercise.

This study could explain why people with Parkinsons notice that their symptoms improve with exercise. It is also possible that exercise could promote nerve cells to survive for longer. However the problem with this study is that it does not provide any evidence as to whether this is a cause or effect of exercise. In other words, does the exercise cause higher levels of dopamine in the brain or do the higher levels of dopamine in the brain make those Parkinsons patients more likely to exercise. Either way, whether you have Parkinsons or you don't, the evidence is overwhelming that moderate exercise is good for your whole body including your brain. So unless you have a compelling reason not to, its a good idea to get and hopefully stay active.

Mov Disord. 2018 Oct 30. doi: 10.1002/mds.27498. [Epub ahead of print]

Habitual exercisers versus sedentary subjects with Parkinson's Disease: Multimodal PET and fMRI study.

Sacheli MA¹, Murray DK^1,2, Vafai N³, Cherkasova MV¹, Dinelle K³, Shahinfard E¹, Neilson N¹, McKenzie J¹, Schulzer M¹, Appel-Cresswell S^1,2, McKeown MJ^1,2, Sossi V³, Jon Stoessl A^1,2.

Author information

Abstract

BACKGROUND:

The benefits of exercise in PD have been linked to enhanced dopamine (DA) transmission in the striatum.

OBJECTIVE:

To examine differences in DA release, reward signaling, and clinical features between habitual exercisers and sedentary subjects with PD.

METHODS:

Eight habitual exercisers and 9 sedentary subjects completed [¹¹ C]raclopride PET scans before and after stationary cycling to determine exercise-induced release of endogenous DA in the dorsal striatum. Additionally, functional MRI assessed ventral striatum activation during reward anticipation. All participants completed motor (UPDRS III; finger tapping; and timed-up-and-go) and nonmotor (Beck Depression Inventory; Starkstein Apathy Scale) assessments.

RESULTS:

[¹¹ C]Raclopride analysis before and after stationary cycling demonstrated greater DA release in the caudate nuclei of habitual exercisers compared to sedentary subjects (P < 0.05). Habitual exercisers revealed greater activation of ventral striatum during the functional MRI reward task (P < 0.05) and lower apathy (P < 0.05) and bradykinesia (P < 0.05) scores versus sedentary subjects.

CONCLUSIONS:

Habitual exercise is associated with preservation of motor and nonmotor function, possibly mediated by increased DA release. This study formulates a foundation for prospective, randomized controlled studies