Archive for April, 2009

Message from the editor

Welcome to the latest edition of E Parkinson Post!

We kick-off this issue with a focus on non-motor precursors of Parkinson’s. Research is showing increasingly that the non-motor symptoms can be just as debilitating for people with Parkinson’s and can have severe impacts on quality of life. We bring you up to date on some recently-published research on depression and REM sleep behaviour disorder and an ongoing Canadian study of loss of smell in Parkinson’s.

Since April is Parkinson’s Awareness Month, in this issue, you will also find out about the advocacy program outreach that coincides with the national advertising campaign we’re running on television and in print for a second year, under the themes: Nothing’s easy when your body turns against you. Everything’s harder when your body turns against you. You will see the posters, billboards and media stories of people living with Parkinson’s in your area some time soon. As well, you will find our new Progression of Parkinson’s disease Information Sheet along with our most recent Clinical Fellowship recipients.

Several stories in this issue link to our web site which has been revamped with a special April Welcome page, a new Creative Expressions section and the PSC Advocacy Café. And online registration is now open for SuperWalk for Parkinson’s 2009.

Comments, questions and story ideas are always welcome. You can send them to editor@parkinson.ca.

We hope you enjoy this issue.

Marjie Zacks
Editor

editor

Precursors to Parkinson’s disease

Research interest in pre-clinical markers for Parkinson’s disease is fuelled by the desire to identify one or more biomarkers that can be used to provide earlier diagnosis of Parkinson’s and new treatments to delay or even prevent the progression of the disease.

 

Depression can be an early symptom of Parkinson’s

“Years before being diagnosed with Parkinson’s, I began experiencing bouts of depression. I sought treatment and was hospitalized in 1995. I also had electroconvulsive therapy. I wasn’t diagnosed with Parkinson’s until December 1998. After I began taking Parkinson’s medication, I did notice some improvement in my mood. I haven’t experienced depression since.” ~Peggy Sturge, Newfoundland

Many people experience depression after being diagnosed with Parkinson’s. However, what’s less well-known is that, for some people, depression is one of the earliest symptoms of Parkinson’s, appearing even before the onset of motor symptoms.

“Depression can be part of the disease itself and not just a reaction to having a neurological disease,” says Dr. Susan Fox assistant professor of neurology at the University of Toronto and neurologist at the Movement Disorders Clinic at Toronto Western Hospital. “There’s a lot of evidence now that mood disorders are part of the biology of Parkinson’s disease.”

Dr. Fox explains that people with Parkinson’s lose norepinephrine and serotonin. These are neurotransmitters that are involved in mood, in general, as is dopamine.

She says, “Many patients, as they’re starting to lose their dopamine, may not have yet developed a tremor, slowness, or trouble walking, but they may feel anxious and depressed. Some have an inner sense of anxiety; they feel shaky inside. And when they start on medication, it’s often resolved. They report that they feel relaxed and calmer inside.”

Dr. Fox notes that, whatever the cause, depression is treatable, and people experiencing depression should seek help from their family doctor.

 

Are older antidepressants better for Parkinson’s depression?

A study, published in the March 10, 2009 online edition of Neurology, has shown that the tricyclic antidepressant, nortriptylene, may be more effective than the selective serotonin reuptake inhibitor (SSRI), paroxetine, for treating depression in people with Parkinson’s disease.

“The tricyclic antidepressants are an older style of medication that has gone out of favour largely due to side-effects, such as sleepiness; so SSRIs tend to be prescribed,” says Dr. Susan Fox, assistant professor of neurology at the University of Toronto and neurologist at the Movement Disorders Clinic, Toronto Western Hospital.

This study suggests, however, that the tricyclic class of medications may be more effective for depression in Parkinson’s. The tricyclics affect both norepinephrine and serotonin whereas the SSRIs target only the serotonin receptors in the brain.

With only 52 patients, this is the largest placebo-controlled study for Parkinson’s disease depression, to date.

Considering that depression affects up to 50% of people with Parkinson’s disease and negatively affects their quality of life, further research is needed, particularly larger clinical trials.

The study was led by Dr. Matthew Menza, a professor of psychiatry and neurology, at the Robert Wood Johnson Medical School in Piscataway, New Jersey.

 

REM sleep disorder a risk factor for Parkinson’s

A recent study by Dr. Ron Postuma of McGill University in Montreal has shown that people with REM sleep behaviour disorder risk developing Parkinson’s disease or dementia.

In REM sleep behaviour disorder, you violently act out your dreams – punching, kicking, crying out or throwing yourself out of bed. You may even injure yourself or your bed partner.

Dr. Postuma’s research, at the sleep disorders laboratory at Montreal’s Sacré-Coeur Hospital, studied 93 patients, who had been diagnosed with REM sleep behaviour disorder, and followed them for 5, 10 and 12 years for signs of neurodegenerative disease.

The average age of the participants was 65 years. Eighty per cent were men.

After 12 years, 26 of the 93 patients had developed a neurodegenerative disease:
• 14 developed Parkinson’s disease
• 1 had Multiple System Atrophy (a related Parkinson’s condition)
• 11 had dementia

Using life table analysis to define disease risk over 5, 10 and 12 years, the study estimated a
• 17% risk of developing neurodegenerative disease at 5 years
• 40% risk at 10 years
• 52% risk at 12 years

The study, published online in the journal, Neurology, in December 2008, is the largest study attempting to quantify the risk of developing neurodegenerative disease for people with REM sleep behaviour disorder.

 

Seeking smell test for Parkinson’s

“I noticed I was losing my sense of smell in the 1990s when I was still working as a food inspector. Smell is an important tool for detecting freshness of food; so I told my supervisor about my problem. I went to my doctor but he couldn’t find a reason for it. He referred me to a neurologist who recommended an MRI but also had no answers. At that time, I had no tremor, no sign of Parkinson’s at all. It wasn’t until fall of 2004, that I was diagnosed with Parkinson’s.”  ~Arnold Forsyth, Nova Scotia

Dr. Harry Robertson, a professor in the Brain Repair Centre and Department of Pharmacology, at Dalhousie University in Halifax, is seeking to find a diagnostic tool that can capitalize on the fact that a majority of people with Parkinson’s lose their sense of smell.

“The general consensus is that the changes in olfaction (ability to smell) occur about five years before the Parkinson’s diagnosis,” says Dr. Robertson. “If we could stop the process, that is, stop the loss of the neurons, we could stop people from ever developing the severe symptoms of PD. That’s the dream – to stop the Parkinson’s before it becomes disabling. I’m sure smell testing is going to be one component of that.”

In the first phase of his research, Dr. Robertson will try to identify smell deficits in about 20 people between the ages of 45 and 65 who have been recently diagnosed with Parkinson’s.

Using diffusion tension imaging (DTI), a special type of magnetic resource imaging (MRI), he will measure changes in two areas of the brain – the olfactory tract, which is the pathway for the sense of smell and the substantia nigra, where neurons degenerate in Parkinson’s.

In the second and larger phase of the study, Dr. Robertson will test olfactory function in up to 500 or more people who have not been diagnosed with Parkinson’s. Participants will be given a booklet of scratch and sniff pages and asked to sniff the pages and try to identify the smells. People with the lowest scores, indicating the most impaired sense of smell, will then undergo the brain imaging.

Research participants are needed from the Maritime Region

You may be eligible to participate in phase one of Dr. Robertson’s research, if:
• You have been recently diagnosed with Parkinson’s.
• You are between the ages of 45 and 65.
• You are otherwise in good physical health.

The study is being conducted at Capital Health and the IWK Health Centre in Halifax.

For more information, contact Dr. Harry Robertson, (902) 494-2563, har1@dal.ca.

New in Parkinson’s research

Fellowship award winners announced

Parkinson Society is pleased to announce that, commencing July 1, 2009, fellowships for post-residency training, have been awarded to:
• Dr. Manon Bouchard (one year)
• Dr. Amitabh Gupta (one year)
• Dr. Michael Sidel (two years)

Dr. Manon BouchardDr. Manon Bouchard
Clinical Movement Disorders Fellowship ($50,000)
Foothills Hospital, University of Calgary

Neurologist Dr. Manon Bouchard will spend her fellowship year working with Dr. Oksana Suchowersky at the Movement Disorders Clinic at the Foothills Hospital in Calgary and gaining expertise in treating Parkinson’s patients for sleep disorders. She will also learn how to select candidates for deep-brain stimulation (DBS) surgery and how to program and re-program the stimulator for DBS patients’ follow-up care. Once trained, Dr. Bouchard will return with her new expertise to Hôtel Dieu de Lévis Hospital in Quebec.

wp-ami-gupta2Dr. Amitabh Gupta
Clinical Research Fellowship ($50,000)
Morton and Gloria Shulman Movement Disorders Centre
Toronto Western Hospital

Dr. Amitabh Gupta will train at the Morton and Gloria Shulman Movement Disorders Centre at Toronto Western Hospital, under the supervision of Dr. Anthony Lang. In addition to providing patient care, Dr. Gupta will focus on Multiple System Atrophy (MSA), a condition that is often misdiagnosed as Parkinson’s but has a worse prognosis and limited therapeutic options. Dr. Gupta’s research will seek to improve the diagnostic criteria of MSA, as well as investigate aspects of sleep-related problems and cognitive deficits, in an effort to enhance disease understanding, patient care and therapeutic options.

Dr. Michael SidelDr. Michael Sidel
Clinical Research Fellowship ($100,000)
Lady Davis Institute for Medical Research
Sir Mortimer B. Davis, Jewish General Hospital

Dr. Michael Sidel will spend his two-year clinical research fellowship training under the supervision of three neurologists: Dr. Calvin Melmed and Dr. Alexander Thiel at the Lady Davis Institute for Medical Research at Montreal’s Jewish General Hospital, and Dr. Anne-Louise Lafontaine, director of the Movement Disorders Clinic at the Montreal Neurological Institute and Chair of PSC’s Research Policy Committee. Using a new technique, called transcranial magnetic stimulation, Dr. Sidel will try to determine which brain pathways are involved when people with Parkinson’s experience dyskinesia, the uncontrollable movements that are often a side-effect of Parkinson’s drug treatments. Finding these pathways will enable researchers to develop drugs or new surgical interventions to prevent or treat dyskinesia. Dr. Sidel will also diagnose and treat patients during his fellowship.

NEW – Progression of Parkinson’s Disease information sheet

Progression of Parkinson's DiseaseThis document has been prepared to help you become more informed about Parkinson’s. It is designed to answer questions about Parkinson’s and how it might progress. Included are some suggestions on how to prepare for the Parkinson’s journey.

(Download PDF)

Focus on creativity

Creative Expressions is a new web page we have launched to honour the artistic talents of the many people with Parkinson’s who have chosen to communicate and express themselves through creative writing, visual art and crafts.

Visit Creative Expressions to see their work.

Working with One Voice

Yvon Trepanier By Yvon Trepanier,
Chair, National Advocacy Committee

First steps taken toward national research study

Over 3,000 people with or affected by neurological disorders responded to an online questionnaire, in February 2009, asking what types of information should be collected for a four-year national research study to uncover the incidence, prevalence, risk factors and impacts of neurological conditions across Canada. The study is spearheaded by Neurological Health Charities Canada (NHCC), a collective of organizations that represent people with chronic, often progressive, brain diseases, disorders and injuries in Canada. The federal government has committed $15 million to fund the project. Parkinson Society Canada plays a leadership role in the NHCC.

Tulips sent to Parliament Hill

For the April Parkinson’s Awareness Month, the National Advocacy Committee:
• sent fresh tulips to the Prime Minister and federal Minister of Health;
• had an Awareness Month announcement  read in the House of Commons by Barrie MP Patrick Brown (download wmv), and read in the Senate by Senator Sharon Carstairs;
• mailed Research Highlights (pdf) to all MPs and Senators, along with a letter signed by PSC President & CEO Joyce Gordon and National Advocacy Committee Chair, Yvon Trepanier;
• sent an information page to all MPs for inclusion in their householder newsletters.

Tell us your experiences of genetic discrimination

PSC is participating in an initiative, led by the Huntington Society of Canada, to persuade the federal government to create legislation that will protect the privacy of individual genetic information and protect against discrimination based on genetic predisposition to disease. If you have had personal experience of either a breach of privacy of genetic information or genetic discrimination, contact us at general.info@parkinson.ca.

Meet us at the PSC Advocacy Café

Advocating for a better life for Canadians with Parkinson’s disease and their families is a community effort. We need your voice and support. You can join us at the PSC Advocacy Café to share information and ideas on how we can work together, or send an email to advocacy@parkinson.ca.


Charitable registration number 10809 1786 RR0001
All material related to Parkinson's disease contained in Parkinson Post is solely for the information of the reader. It should not be used for treatment purposes. Specific articles reflect the opinion of the writer and are not necessarily the opinion of PSC.

Twitter Updates