Estrogen Therapy for Men? Maybe.

Men are more likely to develop Parkinson’s disease (PD) than women, and the onset of PD in men happens at a younger age. However, women with PD have a higher mortality rate, and once they have Parkinson’s, progression is faster. Research suggests that women get the disease at later in life when compared to men, at least in part, due to the natural protection estrogen provides. There are studies that have demonstrated that hormone replacement therapy (HRT) can provide dopaminergic neuroprotection in both young and menopausal female mice.

Could the female sex hormone, estrogen, be a therapeutic approach for delaying or reducing PD symptoms for men?

Recently published in the Journal of Neuroscience, a study titled, “Female Sex and Brain-Selective Estrogen Benefit α-Synuclein Tetramerization and the PD-like Motor Syndrome in 3K Transgenic Mice” (Rajsombath, Nam, Ericsson, & Nuber, 2019) investigated this possible therapeutic neuroprotective effect.

Using mice called 3K that show motor and neural changes associated with PD, researchers injected male mice under the skin with the hormone therapy DHED. What makes DHED so special is that it was designed to only activate estrogen in the brain. This matters because estrogen therapy has been associated with an increase in cancer in other parts of the human body.

The motor performance and brain health of the 3K male and female mice were compared along with whether DHED affects the progression of PD-like symptoms in males. The motor evaluations included their ability to clasp, climb down a pole, gait (walk) and balance on an accelerating rotarod, which is a lot like lumberjack logrolling. There were also highly sophisticated tests to determine possible changes in the build-up or clearing of protein clumping in the brain, along with the decline or increase in the health of dopamine neurons.

Results

Like the sex differences found in people with PD, 3K male mice developed PD-like symptoms faster than female mice. Furthermore, male mice treated with DHED had:

  • Improved clasping abilities
  • Improved downclimbing
  • Improved gait
  • Improved balance
  • Better clearing of risky alpha-synuclein (protein clumps in the brain)
  • Healthier dopamine neurons

What Does This Mean?

This study focused on the 3K male mice and how they responded to the estrogen therapy, DHED. When the male mice were treated with the DHED, they showed improvements in all the motor functions tested. They also showed significant improvements in the brain, including healthier dopamine neurons and lower amounts of alpha-synuclein at risk for clumping. Remember, clumped alpha-synuclein becomes Lewy Bodies ― a hallmark of PD.

It is also important to note that the successful development of the 3K model itself – which duplicates many differences in male and female PD at motor, cellular and molecular levels – is a significant step forward in closing the gender gap in PD research. Having a model that helps unravel how the pathology differently affects the two sexes informs new avenues of research that could lead to the development of tailored medications and interventions to meet the distinct needs of men and women with PD.

Read the study HERE. This article from parkinson.org.

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6 Ways to Be a Great Long-Distance Caregiver

At some point, you may end up being a caregiver for one of your senior loved ones. Whether your parent or your grandparent needs your assistance, you might be wondering if you can fulfill this role without moving them into your home or relocating to be closer to them. Today, it is easy to be a long-distance caregiver for a loved one who is still able to maintain a certain degree of independence but may have limited mobility or need someone to keep them on track with their medication schedule and regular doctor’s appointments.

Of course, some seniors with conditions like dementia or Alzheimer’s will need daily, in-home care, but for seniors with conditions like Parkinson’s, support from a long-distance caregiver can be extremely helpful. If you are about to take on long-distance caregiving responsibilities, here are a few tips to help you fulfill your loved one’s needs while living in another city or state.

Navigating Medicare

If you are becoming a long-distance caregiver for your senior loved one, it’s crucial for you to understand the Medicare system. You and your loved one should be aware that Medicare has an Annual Election Period from October 15 through December 7. If your loved one needs to make changes to their Medicare plan, this is the only time of year that they can do it, so make sure that you are prepared with all of the necessary paperwork before by mid-October. This checklist should include their Medicare card, their previous medical bills, and other documents.

Both you and your loved one should also discuss options for long-term care in an assisted living facility if it becomes necessary. Since Medicare does not cover extended stays in assisted living facilities, you should familiarize yourself with Medicaid and what kind of coverage your loved one would be eligible for.

Are you concerned that your loved one will not be able to advocate for their own healthcare needs in the future? Talk to them about naming a trusted relative as power of attorney.

Schedule Regular Check-Ins
Even if you have to travel to see your loved one, it’s important to visit them on a regular basis so that you can see how they’re doing. Yes, you can call them or video chat with them a few times each week to get an idea of how things are going, but when you spend time with them in person, you’ll be able to get a read on how they’re really feeling. If you can’t see them as often as you would like, ask another family member to check in on them sometimes.

Assist With Home Modifications
Although your loved one may be perfectly capable of managing most of their own daily tasks, they may not be able to move around their home as easily as they did in the past. For example, a senior who recently had a hip replacement might be unable to walk up the stairs, while someone with Parkinson’s may feel more comfortable bathing with a shower chair.

If you think that your loved one would benefit from certain home modifications, recommend a reputable contractor. This will give you peace of mind when you’re not physically around to help them.

Medical Alert System
A medical alert system is a must for any long-distance caregiver and their loved one. It will notify you if your loved one needs immediate medical attention.

According to PCMag, seniors can choose from several varieties of medical alert systems, including wearable devices like bracelets or necklaces, fitness trackers, cellular alert systems, and more. Choose one that works for your loved one’s lifestyle.

Digital Pill Dispenser
Many seniors take some kind of medication to manage a chronic medical condition. Whether your loved one takes medication for Parkinson’s or high cholesterol, you should make it a point to ensure that they are taking their pills on time.

You may want to set up a digital pill dispenser for your loved one. A digital pill dispenser will notify you when your loved one takes their medication, so you can get in touch with them if they forget. According to GlobalRPh, seniors who use these dispensers are more likely to take their medications as prescribed. If they frequently forget to take their medication, you can ask their doctor for help to remedy the situation.

Hire a House Call Service
Yes, you’ll want to stop by and visit your loved one when you have the chance. But what if they need medical attention, and you’re not there to assist them? Or what if they have a doctor’s appointment scheduled, but they’re not able to drive safely?

Hiring a house call service can fill in the gaps when you’re not around. On house calls, doctors can provide many beneficial services, and your loved one can receive care in the comfort of their own home.

Whether you are moving in with a loved one to help them or handling these responsibilities from afar, becoming a caregiver can be challenging. Thankfully, the technology we have today makes it possible to look out for your senior loved one’s best interests, even when you can’t see them every day.

Claire Wentz is a contributor to Caring from Afar. For more information, visit caringfromafar.com.

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Parkinson’s & Driving Safety

The topic of driving can be a sensitive subject for folks with Parkinson’s disease (PD) and their care partners. Fortunately, just because one has a PD diagnosis does NOT necessarily mean that the freedom to drive needs to be taken away. There are many people with PD who continue to drive safely, years after they have been diagnosed.

However, we know that PD progresses over time. Symptoms change. Medications may be added and others stopped. Side effects from medications can change. New health problems may arise that make controlling PD more difficult. Because of these things, driving safety is an issue that requires re-evaluation from time to time. Independence and safety are priorities that should both be honored, while recognizing that sometimes modifications may need to be considered.

Things to consider when deciding whether to drive
Driving plays an important role in an individual’s sense of independence, personal control, and self-reliance, so giving up driving can be very difficult. People living with PD should consider the following questions when deciding whether or not to drive:

  • How is my vision? Can I see well at night? Can I distinguish colors, such as in traffic lights?
  • Would I be putting my passenger (friend or loved one) at risk?
  • How fast is my reaction time? Could I safely avoid a surprise obstacle in the road?
  • Has anyone (friend or family member) commented negatively on my ability to drive?
  • Can I handle multiple activities at the same time (whether driving or not)?
  • Can I effectively and quickly turn the wheel or step on the brake with enough strength?
  • Do my medications for PD (or other conditions) cause side effects like sleepiness, dizziness, blurred vision, or confusion?

These are understandable and important questions to be considered, but often people struggle with how to discuss the issue with loved ones or care partners. Sharing concerns or observations with a trusted friend or family member might be a good place to start.

In some cases, speaking with a doctor or professional, such as an occupational therapist, might be helpful. The American Occupational Therapy Association maintains a searchable database to help locate a Driving Rehabilitation Specialist so you or a family member may receive an assessment (https://www.aota.org/Practice/ Productive-Aging/Driving/driving-specialistsdirectory-search.aspx).

Driver Rehabilitation Specialists work with people of all ages and abilities, evaluating, training, and exploring alternative transportation solutions. Another tool for rating driving ability is offered by AAA at https://seniordriving.aaa.com/evaluate-yourdriving-ability/self-rating-tool/. Local rehabilitation hospitals also sometimes offer assistance in driver evaluation and training.

When the time comes that a person with PD needs to give up driving, it is important to remember that there are options. Public transportation can be an option. Friends and family members are often happy to help, and it is important not to be afraid to ask. Also, look into special shuttle services through local organizations and community centers.

Socialization and staying active help manage Parkinson’s symptoms. You don’t have to stay home once you are no longer driving.

 

Article from February 2020 issue of Dallas Area Parkinsonism Society newsletter.

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