April is Parkinson’s Disease Awareness Month. For those with Parkinson’s disease (PD), their families, and professionals who help care for them, each day requires our awareness. It is also our responsibility to improve knowledge about this condition and to draw attention to the courage of those facing the challenges of PD each day.
Nationally, an estimated 1 million people are living with Parkinson’s disease (PD). Though there is currently no cure for it, there are some new ways of treating Parkinson’s disease that are enhancing quality of life for people.
What exactly is Parkinson’s disease?
Parkinson’s disease is the second most common degenerative disorder of the brain (after Alzheimer’s disease). It is also considered a movement disorder, causing difficulty with ease of normal movement and extra involuntary movements. The physical symptoms of PD include stiffness of muscles (called rigidity), slow and small movements (called bradykinesia and hypokinesia), shaking of the limbs while at rest (called tremor), and changes in walking and balance.
Parkinson’s disease is a gradually progressive condition. Symptoms will often begin with slowness, stiffness, or shakiness on one side of the body. Symptoms gradually increase in intensity over years, eventually also affecting the other side of the body.
What is the connection between Parkinson’s disease and the brain?
Changes in the brain cause a reduction in the ability to produce the chemical dopamine. Dopamine is vital for the control of movement and mobility. The medications used to treat the physical symptoms of PD mimic or increase the amount of dopamine within the brain. There is growing evidence that non-medication approaches such as exercise, dance, and active lifestyle may also help reduce the impact of Parkinson’s disease on physical function.
How do non-medication approaches like exercise help?
PD affects people in a very broad way, beyond the physical symptoms. This includes changes in sleep, energy, motivation, mood, and anxiety. In the average person without PD, exercise and increased physical activity have been associated with improvements not only in balance, strength, and physical ability, but also in all of the symptoms mentioned earlier. So, it would be no surprise that people with PD would feel better overall with exercise as part of their daily routine.
Beyond the simple benefits of exercise, people with PD appear to have even more to gain. New research gives us a glimpse into opportunities that we need to further explore. For example, focused exercise and partner dancing programs both have been shown to improve ease of walking. Another study of a motorized stationary bicycle that forced a faster than usual pace improved multiple aspects of PD, including tremor and stiffness. Although promising, the shortcomings of many research studies is their brief duration, and the unanswered question of how these activities might influence living with PD over the long haul.
What new treatments are available?
Although many advances have been made in the understanding of Parkinson’s disease, we remain without a proven way to stop or slow the progression of the disease. Exciting breakthroughs in recent years have led to new approaches to how we may accomplish this important goal. Our research team at UVM regularly participates in studies of new therapies for better control of symptoms and to delay progression.
Duopa is a newly-approved treatment for advanced Parkinson’s disease when physical symptoms can no longer be consistently controlled with medicines by mouth. The new therapy requires placement of an intestinal tube, which along with an external pump carried alongside the body, allows delivery of carbidopa/levodopa suspended in a gel. This gold standard medication works well, but has limitations due to inconsistent intestinal absorption. Bypassing stomach and delivering medicine directly to the intestine where it has absorbed, allows for smooth and steady control of symptoms throughout the day. Since 2008, the research teams in Neurology and Gastroenterology at the UVM Medical Center have participated in the research study to bring this therapy to market in the United States. We are excited to be able to offer this new treatment option to our patients.
What kind of care is available to patients at the UVM Medical Center?
In 2013, with the generous support of Dr. Nancy Binter and Dr. Bela Ratkovits, the Frederick C. Binter Center for Parkinson’s Disease and Movement Disorders at the UVM Medical Center was established. Its goal is to provide the most complete and coordinated care of Parkinson’s disease possible. To do so, we have brought together a specialized team to meet all the essential needs of those with PD and their families (including specialty trained physical/ occupational /speech and language therapists, counselor, psychiatrist, and neurologists). The Center seeks to serve as a hub for regional research, education, and patient care in PD. For more information, visit the Center’s website.
Another resource is the Vermont Chapter of the American Parkinson’s disease Association (APDA), a community-based resource for more information and support. The Chapter has associated local support groups and holds several fundraising and awareness events each year. For more information, please visit their website.
James Boyd, MD, is a neurologist at the University of Vermont Medical Center and an associate professor at the Larner College of Medicine at UVM. His areas of specialty include Parkinson’s disease and other movement disorders.