DaTscan

Several support group members have asked for more information on the DaTscan imaging tool. Listed below is a summary describing what a DaTscan is, why and when it may be used by physicians, and a bit about the process involved in performing a DaTscan on a patient exhibiting some symptoms of PD.

“In cases where the expert is not sure of the diagnosis – is it essential tremor or Parkinson’s, for example– or where a potentially risky procedure is being considered (e.g. deep brain stimulation surgery), it is reasonable for your doctor to recommend a DaTscan. For a person with classic motor symptoms (tremor, slowness, stiffness) who benefits from treatment with medication, the diagnosis is already made. Unless the disease progresses in a way that calls the diagnosis into question, DaTscan is likely unnecessary.”  (Okun, 2012)

The procedure is as follows: the patient receives an injection given via IV of the imaging agent, and will need to wait 3-6 hours for the body to absorb the compound.  “The substance “tags” a part of a neuron in the brain where dopamine attaches to it, something called the dopamine transporter (DaT), showing the density of healthy dopamine neurons” (Okun, 2012). Next, the compound is visualized by a gamma camera, and the areas of the images captured that then “light up” symbolize more surviving brain cells. If the parts of the brain where dopamine cells should be remains dark instead, an expert reader may diagnose early brain degeneration.  This could mean either Parkinson’s disease or parkinsonism. The side effects of a DaTscan are minimal (e.g. injection site pain, headache, dizziness, nausea, dry mouth, hives and skin rash).

“DaT/SPECT scans examine the “function” of the brain rather than its anatomy. This is an important point because unlike in strokes and tumors, the brain anatomy of a Parkinson’s disease patient is largely normal. These scans can show changes in brain chemistry, such as a decrease in dopamine, which identify Parkinson’s disease and other kinds of parkinsonism” (Okun, 2012).

Finally, a determination will be made as to the severity of the brain cell loss.  But patients and their families need to be aware that these scans cannot reliably separate Parkinson’s disease from parkinsonism (multiple system atrophy- MSA, corticobasal degeneration, progressive supranuclear palsy- PNP). “The DaTscan is presently being used as a tool to determine if dopamine degeneration is present, suggestive of a diagnosis of PD, MSA, PSP, or other variants,” (Seifert & Wiener, 2013). Interpretations are not clear cut, and once a scan is determined to be normal or abnormal, the expert will determine if the scan follows the pattern of Parkinson’s disease.

References

  1. https://movementdisorders.ufhealth.org/2012/04/11/should-i-get-a-dat-scan-to-confirm-my-parkinsons-disease/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601468/
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A note from Laurie | October 2019

Dear Facilitators,

Wisconsin is beginning to explode with the colors of autumn, and I hope you are jumping into the fall season full of excitement for the coming holidays, feeling thankful for all of the wonderful people in your lives, and looking forward to the new opportunities coming your way as a Parkinson’s community!

The WPA team is full of gratitude for the success we have had this past year in connecting with so many of you! Whether we have shared conversation through our events, or touched base during educational programs and site visits, you continue to inspire us with your positivity, sense of humor, dedication and perseverance. Support, partnerships and awareness are growing in Parkinson’s communities throughout the state, helping us to build stronger relationships that in turn bring more resources to more people.

As we continue to increase the number of outreach opportunities we offer, whether through additional educational programs or exciting new exercise programs in new areas, we value and appreciate our facilitators, who so willingly help to assure the information about these programs goes out to those in their area.

We had a very successful Facilitator Retreat back in July, with facilitator representation from across the state – it was so nice to visit with so many of you that day! We had terrific speakers all afternoon on the topics of Stress Management, the PD Self program and Art Therapy- and even got our hands a little messy as we completed a creative art project!

Each of these topics spoke to empowerment, quality of life and self-expression, all critical components for those managing PD and their caregivers. Here are links to each of the presenters notes and presentation slides so you can share this valuable information with members of your groups:

Stress Management
PD Self program
Art Therapy

We received very positive feedback on our speakers and the information they shared, as well as topic suggestions for next year, so we can start planning for the Facilitator Retreat in Appleton on June 18th, 2020 – Mark your calendars now!

Hope to see you soon – thank you for all you do!

-Laurie Couillard
Director of Group Engagement
[email protected]
414-386-2305

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Music & Stress Management

There is no question that music is a universal language that can evoke emotions and memories that span a lifetime. But music can also be a healing mechanism, and can affect every aspect of our development- social, emotional, physical, cognitive and spiritual.

Music can improve mood, decrease stress levels and foster communication- it is truly a healing form of art, and one that should be a part of every treatment plan. Study after study shows the benefit of music in reducing pain, improving outcomes in patients with varying health issues and in promoting social engagement. In the following articles and links, you will see actual footage of music impacting the life of a man with Parkinson’s disease, learn about the neurological benefits of adding music to your life, and discover the many ways you can reduce stress by adding music as a regular part of your life.  The power point provided earlier from our Facilitator Retreat gives you some of the science behind the benefits of music, but just watch someone come alive to music they love and that will be all the proof you need!

“The main thing is that we hear and enjoy life’s music everywhere.” Theodor Fontane

Video: Man with Parkinson’s reacting to music
5 Reasons Music Therapy Works for Neurological and Neurodevelopmental Disorders

Brains Response to Music:

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Facilitator Success Tip: Support for Care Partners

Caregivers play a tremendous part in the care and support of those managing Parkinson’s. It is important when facilitating your support or exercise groups to assure they have a chance to share with other care partners the challenges, successes and hurdles of caring for a loved one with Parkinson disease. I have seen several models for this during my visits, and all work well, no one way is best – find the format that fits the needs of your caregivers in the group.

For some, this will be a regular meeting in addition to the loved one’s support group, as they often want and need to be a part of that as well. For others, it will be less frequent, maybe even quarterly, and more of a break-out session during the regular PD support group meeting, but in a separate room. Some care partners plan a social meeting at a restaurant while their loved one is at an exercise class or in the care of another for a short time.

Whatever the format, it is critical for care partners to be given an opportunity to share feelings about the caregiving role – positive and negative, so they do not feel alone or overwhelmed, and can learn from one another about a variety of topics, such as respite care, medication side effects, legal or financial issues etc.

I am happy to report that our WPA Caregiver Committee is working diligently with us on the development of a program to provide real-time, one-to-one peer support for care partners. We are looking forward to offering this as a resource, and will keep you posted on the progress over the next year as we refine the process for this program.

In the meantime, if you do not already have a care partner support group in place, consider talking with a caregiver in your group who you feel may be a good choice to help initiate this with you. There does not need to be a separate, formal facilitator if the group is comfortable just sharing discussion together, just someone to get the conversation going if necessary. If this is not a feasible option for your group, due to time, space or other issues, here are some valuable resources to help foster support for the PD care partners in your communities, so please feel free to share these with your groups.

Caregiver.com: This organization offers a fantastic newsletter, and focuses on common care partner questions, concerns and issues. I suggest encouraging your caregivers to check out the entire website, as they provide information on everything from driving assessments to building an effective care team:

Article: More Than a Hug: How Caregiver Peers Can Support Each Other 

Family Caregiver Alliance

Twenty Ways for Caregivers to Take Care of Themselves

Releasing Resentment

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Fall Prevention

In honor of the fall season, and the upcoming and not so welcome icy weather, I wanted to share some information on fall prevention!

We have had several speakers help address this topic at various support groups and educational programs, so I am passing on some of those tips for you to share with your groups. There are many precautions one can take when balance becomes an issue in managing Parkinson’s symptoms, and prevention is key- it is important to be proactive to avoid a fall in the first place!

But balance is not the only cause of falls, so it is important to take into consideration other factors that may add to the risk of a fall, such as issues with vision, hearing, environment (clutter), medication side effects like confusion, blurred vision and light-headedness, and more.

Here is some information to share with your group members, taking time to have some discussion about this important topic to help prevent unnecessary falls.

Prevent Falls & Fractures, from Today’s Caregiver
Safety & Mobility Presentation

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Linda Ronstadt on the sound of her life

This article from LA Times focuses on Linda Ronstadt, who was diagnosed with supranuclear palsy, a variant of Parkinson disease, in 2013.

READ THE ARTICLE HERE.

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Parkinson’s differences in women and men

There is growing evidence that Parkinson’s disease (PD) affects women and men differently. In this insightful review, published in the Journal of Parkinson’s Disease, scientists present the most recent knowledge about these sex-related differences and highlight the significance of estrogens, which play an important role in the sex differences in PD.

PD is a slowly progressive disorder that affects movement, muscle control, and balance. It is the second most common age-related, neurodegenerative disorder, affecting about 3% of the population by the age of 65 and up to 5% of individuals over 85 years of age. The risk of developing PD is twice as high in men than women, but women experience a more rapid disease progression and a lower survival rate.

“It is becoming increasingly evident that PD differs in women and men,” explained lead author Fabio Blandini, MD, Scientific Director of the IRCCS Mondino Foundation, National Institute of Neurology, Pavia, Italy. “Recent research findings suggest that biological sex also impacts on disease risk factors and, potentially, on molecular mechanisms involved in the pathogenesis of PD.”

This review meticulously examines the most recent knowledge concerning differences between women and men with PD including:

  • Motor and non-motor symptoms
  • Quality of life
  • Genetic and environmental risk factors
  • Pharmacological therapy of motor and non-motor symptoms
  • Surgical procedures
  • PD and steroids
  • Impact of biological sex on pathophysiology

Recent research has shown that women and men have distinctive motor and non-motor symptoms as their PD progresses. Motor symptoms emerge later in women: tremor is a common first presenting symptom associated with recurrent falls and more severe pain syndromes with specific characteristics such as reduced rigidity, a higher propensity to develop postural instability, and elevated risk for levodopa-related motor complications. Conversely, male PD patients show more serious postural problems and have worse general cognitive abilities: freezing of gait—the most disabling motor complication of PD—develops later in men; however, men have a higher risk of developing camptocormia (abnormal severe forward flexion of the trunk when standing or walking). An ongoing clinical trial is evaluating the prevalence in PD and the biological sex impact on other postural abnormalities, such as Pisa syndrome (a reversible lateral bending of the trunk with a tendency to lean to one side), antecollis (dystonia of the neck resulting in excessive forward flexion), scoliosis (a sideways curvature of the spine), and deformities related to hands and/or toes.

Non-motor symptoms have been the subject of a study of over 950 PD patients, which concluded that symptoms such as fatigue, depression, restless legs, constipation, pain, loss of taste or smell, weight change and excessive sweating are more common and severe in women. Other studies have demonstrated that male PD patients have worse general cognitive abilities and male sex is the primary predictive factor for mild cognitive impairment and its more rapid progression in the severe stage of the disease. A diagnosis of PD with dementia has a greater impact on life expectancy of women than men; in addition, women show distinctive symptoms as well as differences in the response to pharmacological therapies and deep brain stimulation, and in their personal evaluation of the quality of life compared to men.

The authors note that the distinctive clinical features as well as the contribution of different risk factors support the idea that PD development might involve distinct pathogenetic mechanisms (or the same mechanism but in a different way) in women and men. They highlight the significance of estrogens, which play an important role in the sex differences in PD, providing disease protection as demonstrated by the similar incidence of the disease in men and post-menopausal women.

“Sex hormones act throughout the entire brain of both males and females and sex differences are now highlighted in brain regions and functions not previously considered as subjected to such differences, opening the way to a better understanding of sex-related behavior and functions,” added Silvia Cerri, Ph.D., head of the Laboratory of Cellular and Molecular Neurobiology of the IRCCS Mondino Foundation and first author of the article. She commented: “Neuroinflammation is an important piece of the pathogenic puzzle of PD. Current evidence suggests that the physiological role exerted by microglial and astrocytic cells could become compromised during aging, thus contributing to PD onset and progression. Since estrogens have anti-inflammatory properties, their actions throughout the lifespan could partially account for sex-related risk and manifestation of PD.”

By drawing attention to sex-related differences and disparities in PD, Dr. Blandini and colleagues hope this will further encourage the scientific community and policy makers to foster the development of tailored interventions and the design of innovative programs—for example in care practices—that meet the distinct requirements of women and men with PD. “Women diagnosed with PD are a sizable portion of the PD population, but their specific needs are still partially overlooked. The differences between women and men strongly suggest the need for a personalized (sex-related) therapy in PD,” concluded Dr. Blandini and Dr. Cerri.

Article from MedicalXpress.

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Parkinson’s and depression: it’s not all in your mind

Depression is a very real and debilitating condition that many Parkinson’s disease sufferers experience. ParkinsonsLife guest writer Dr Nicola Davies explores the causes of and treatments for depression and Parkinson’s.


It’s well-documented that people who have been diagnosed with a chronic illness such as Parkinson’s are at higher risk of developing depression as well. Indeed, it’s estimated that 50% of people diagnosed with Parkinson’s will experience depression.

As Suma Surendranath, professional engagement and education manager at Parkinson’s UK, says: “Parkinson’s is a long-term progressive condition for which there is currently no cure, therefore a diagnosis can be a psychological blow for a person and those around them as they may well be concerned about what the future might hold.”

The following scenario is a common experience among many newly diagnosed Parkinson’s sufferers. First there is confusion: ‘What does this mean?’, ‘What can I do?’, ‘How will this impact me?’ Then the shock comes as the reality of the disease sets in and the impact that it will have on the rest of your life is realised. The shock gives way to grief and depression. The feeling that your life has ended and your hopes and aspirations have been shattered is less time than it takes to make a cup of tea. As one person with Parkinson’s told us, “When I was diagnosed, I came home and cried. I thought it was the end of my life.”

“There is evidence that suggests depression is an early symptom of Parkinson’s”

However, receiving a diagnosis for Parkinson’s isn’t the only factor that can cause depression in people with this condition – the very course of the disease changes the brain chemistry that usually keeps depression at bay.

Surendranath says: “Depression may occur amongst people with Parkinson’s as a result of the condition as dopamine, the neurotransmitter that becomes depleted with Parkinson’s, is [also] involved in motivation and a sense of reward.”

Experiencing depression after receiving a diagnosis of Parkinson’s isn’t a sign of emotional weakness or a flaw in character. Depression is caused by an imbalance of chemicals in the brain, which is what Parkinson’s is all about: low levels of chemicals in the brain.

There is evidence that suggests depression is an early symptom of Parkinson’s. Despite this, people with Parkinson’s aren’t routinely tested for depression and therefore might not receive treatment for the condition.

It remains unclear whether the medications prescribed to reduce the physical symptoms of Parkinson’s contribute or worsen symptoms of depression. It is also unclear how Parkinson’s affects pre-existing depression or how medication prescribed for Parkinson’s impacts pre-existing depression.

Surendranath says: “While medication, in the form of anti-depressants, can be beneficial to people with Parkinson’s it is still important to ensure that there are no adverse effects from medications interacting with each other.”

Words of hope

Depression is treatable even if it co-exists with other conditions. Depression is also limited in duration. Often, finding the right mixture and combination of drug therapy can improve both the physical symptoms of Parkinson’s and the symptoms of depression. However, it is important to know that the treatment of Parkinson’s must be comprehensive and include both the physical as well as the emotional symptoms.

Reaching out can also ease the depressive symptoms associated with Parkinson’s. As one patient told us, “I started meeting other people with Parkinson’s and it helped all of us to talk to someone who had the same condition.” There are many physical and online communities where other people with Parkinson’s can meet up virtually, or in person, and share their experiences with others who are feeling the same and suffering from similar symptoms.

Most importantly, you have to set a goal in for your life. Unless you have something to aim for, or something that drives you to get up every morning and face the day fighting, you will find yourself drifting through life. It is best to accept that you have Parkinson’s and move on.


Dr Nicola Davies holds a Master’s and a PhD in Health Psychology. She is a member of the British Psychological Society and the Division of Health Psychology. Article from ParkinsonsLife.

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