Research

Longtime Antidepressant Could Slow Parkinson’s

Michigan State University scientists now have early proof that an antidepressant drug that’s been around for more than 50 years could slow the progression of Parkinson’s.

In a proof-of-concept study, published in the journal Neurobiology of Disease, the drug nortriptyline, which has been used to treat depression and nerve pain, stopped the growth of abnormal proteins that can build up in the brain and lead to the development of the disease.

“Depression is a very frequent condition associated with Parkinson’s, so we became interested in whether an antidepressant could modify how the disease progresses,” said Tim Collier, lead author of the federally funded study and a neuroscientist at MSU.

Collier and collaborator Katrina Paumier, an assistant professor of molecular medicine, began looking at previous patient data to see if individuals who were on antidepressants experienced any delay in their need to go on a standard Parkinson’s therapy called levodopa. This type of therapy increases levels of dopamine, a natural chemical in the body that sends signals to other nerve cells and can significantly decrease in cases of Parkinson’s.

The medication also treats many of the symptoms associated with the disease such as tremors and poor muscle control.

“We found that those on a certain class of antidepressant, called tricyclics, didn’t need the levodopa therapy until much later compared to those who weren’t on that type of antidepressant medication,” Collier said.

Collier then began testing rats with the tricyclic antidepressant nortriptyline and found that it indeed was able to decrease the amount of abnormal protein that can build up in the brain. This protein, known as alpha-synuclein, can cause the brain’s nerve cells to die when in a clustered state and is a hallmark sign of the disease.

To further back up his research, he enlisted the help of his colleague and co-author Lisa Lapidus, who in previous studies had already detected whether certain compounds could bind to alpha-synuclein and stop it from accumulating.

“Proteins are constantly moving and changing shape,” said Lapidus, a professor in the Department of Physics and Astronomy. “By using a test tube model, we found that by adding nortriptyline to the alpha-synuclein proteins, they began to move and change shape much faster, preventing the proteins from clumping together. The idea that this clustering effect is controlled by how fast or slow a protein reconfigures itself is typically not a standard way of thinking in research on proteins, but our work has been able to show these changes.”

Understanding how these proteins can clump together could point researchers in new directions and help them find other possible drugs that could potentially treat Parkinson’s.

“What we’ve essentially shown is that an already FDA-approved drug that’s been studied over 50 years and is relatively well tolerated could be a much simpler approach to treating the disease itself, not just the symptoms,” Collier said.

Collier is already looking for funding for the next phase of his research and hopes to lead a human clinical trial using the drug in the future.

The National Institutes of Health, as well as the Michael J. Fox and Saint Mary’s Foundations, funded the study.

 

Article from Michigan State University.

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Brain Rewiring in PD May Contribute to Abnormal Movement

The brain’s own mechanisms for dealing with the loss of dopamine neurons in Parkinson’s disease may be a source of the disorder’s abnormal movement, according to a Northwestern Medicine study published in Neuron.

The study suggests the loss of dopamine may cause the brain to rewire in a maladaptive manner, contributing to impaired movement in Parkinson’s disease. These findings also suggest that there are fundamental problems with scientists’ traditional model of Parkinson’s disease, said senior author Mark Bevan, PhD, professor of Physiology.

The prevailing consensus was that excessive patterning of the subthalamic nucleus (STN), a component of the basal ganglia, by the cerebral cortex was linked to the symptomatic expression of Parkinson’s disease, including muscle rigidity and slowness of movement, according to Bevan.

“When one saw a burst of activity in the cortex that was consistently followed by an abnormal burst of activity in the STN, scientists assumed that the direct connection between the two was responsible,” Bevan said.

Thus, Bevan and his colleagues, including lead author Hong-Yuan Chu, PhD, a post-doctoral fellow in the Bevan Lab, expected to see transmission in the cortex-to-STN pathway increase as dopamine levels dropped. Instead, they found the opposite: the strength of the pathway decreased massively.

“Like most scientists who come across something unexpected, we thought we’d done something wrong,” Bevan joked. “So, we used multiple, complementary approaches but everything pointed to the same conclusion.”

Further investigation suggested abnormal activity in a more indirect pathway from the cortex to the STN, involving the globus pallidus, was responsible. Abnormal activity in the indirect pathway leaves the STN vulnerable to excessive excitation, triggering compensatory plasticity that ultimately proved to be harmful, according to the study.

When the scientists prevented this maladaptive plasticity in late-stage Parkinson’s models, they found the symptoms improved, pointing to a link between compensation and motor dysfunction.

“According to the classic model, these adaptations should be homeostatic and preserve STN function,” Bevan said. “Preventing them should make the symptoms much worse — but it made them better instead.”

While the compensatory mechanisms may initially keep the brain operating normally under conditions of moderate dopamine neuron loss, as the disease progresses and more dopamine neurons die, the adaptations may become so extreme that they impair movement, according to the study.

These results suggest that there are fundamental flaws in our traditional understanding of brain dysfunction in Parkinson’s disease, Bevan said.

For Bevan, the unexpected results in this study served as a reminder that scientists must remain open-minded.

“It’s easy to be emotional and cling to your hypothesis,” Bevan said. “You have to be dispassionate, open-minded, and look at the data ­— if the data is not consistent with the hypothesis then you have to reject it and come up with a new one.”

This study was funded by the National Institutes of Health’s National Institute of Neurological Disorders and Stroke grants 2R37 NS041280, P50 NS047085, 5T32 NS041234, and F31 NS090845. Confocal imaging work was performed at the Northwestern University Center for Advanced Microscopy, which was supported by National Cancer Institute Cancer Center Support grant P30 CA060553.

 

Article from Northwestern.edu.

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Scratch-and-Sniff Test Could Predict Parkinson’s Even Earlier

A new study provides further evidence that a simple scratch-and-sniff test could predict Parkinson’s disease even earlier than previously thought.

According to Michigan State University researcher Honglei Chen, lead author and professor of epidemiology, the test could potentially identify certain people who are at an increased risk of developing the disease up to 10 years before they are actually diagnosed. Previous research has shown an association between sense of smell and disease progression of up to four to five years.

The federally funded study, now published online in Neurology, the official publication of the American Academy of Neurology, is also one of the first to follow black people.

“One of the key differences in our study was we followed older white and black participants for an average of about 10 years, much longer than any other previous study,” Chen said. “We found that there was a strong link between smell and disease risk for up to six years. After that, the link remained, but just wasn’t as strong.”

He added that the relationship between smell and Parkinson’s risk in black participants also appeared not as strong as in the white participant group.

“Previous studies have shown that black people are more likely to have a poor sense of smell than whites and yet may be less likely to develop Parkinson’s disease,” said Chen, who is part of MSU’s Global Impact Initiative, an effort to help accelerate research in key areas affecting the world such as health and energy.

“We found no statistical significance for a link between poor sense of smell and Parkinson’s disease in blacks, but that may have been due to the small sample size and more research is needed.”

The study also found that older men with a poor sense of smell were more likely to develop the disease compared to women.

The study included 1,510 white and 952 black participants with an average age of 75. The test asked people to smell 12 common odors including cinnamon, lemon, gasoline, soap and onion, and then select the correct answer from four choices.

Based on their scores, participants were divided into three groups – poor sense of smell, medium and good. Researchers then monitored participant health through clinical visits and phone interviews for more than a decade.

Overall, 42 people developed Parkinson’s during the study including 30 white people and 12 black people.

People with poor sense of smell were nearly five times more likely to develop the disease than people with a good sense of smell. Of the 764 people with a poor sense of smell, 26 people developed the disease, compared to just seven of the 835 people whose sense of smell was good and nine of the 863 people whose sense of smell was categorized as medium.

Researchers also discovered that the results stayed the same after adjusting for other factors that could affect risk including smoking, coffee intake and history of head injury.

“It’s important to note that not everyone with low scores on the smell test will develop Parkinson’s disease,” Chen said. “More research is needed before the smell test can be used as a screening tool for Parkinson’s, but we are definitely on to something and our goal now is to better characterize populations that are at higher risk for the disease and to identify other factors involved.”

The National Institute on Aging, National Institute of Nursing Research and National Institute of Environmental Health Sciences funded the study.

 

Article from Michigan State University.

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First Drug Approved for Dyskinesia in Parkinson’s Disease

Adamas Pharmaceuticals recently announced U.S. Food and Drug Administration (FDA) approval of an extended-release formulation of amantadine (GOCOVRI) to treat dyskinesia in Parkinson’s disease. This is the first drug indicated specifically for dyskinesia — uncontrolled, involuntary movements that can develop with long-term levodopa use.

Extended-release amantadine is intended to be taken once daily at bedtime. In this way it can control dyskinesia during the day, when it typically is most prevalent. The new therapy’s approval is based on data from three placebo-controlled trials that demonstrated safety and efficacy. In addition to easing dyskinesia, the drug also may lessen total daily “off” time, when Parkinson’s symptoms return because medication is not working optimally.

The Michael J. Fox Foundation (MJFF) helped move this drug to market by supporting the creation and authentication of the Unified Dyskinesia Rating Scale, a tool that was used to measure the drug’s impact in trials.

“Dyskinesia can significantly compromise quality of life for people with Parkinson’s,” says Todd Sherer, MJFF CEO. “We are pleased that patients have another option to manage this aspect of the disease and glad the Unified Dyskinesia Rating Scale — a tool our support helped develop and validate — could show clinical efficacy of GOCOVRI for the treatment of dyskinesia.”

Extended-release amantadine is a reformulation of a currently available generic immediate-release version, which is approved to treat Parkinson’s symptoms.

 

Article from Michael J. Fox Foundation for Parkinson’s Research.

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Next Stop for PD Research: Outer Space

In an effort to find new treatments for Parkinson’s disease, researchers are sending their experiments to space.

On Monday Aug. 14, researchers launched a key Parkinson’s disease protein, called LRRK2, to the International Space Station (ISS). The microgravity conditions in space should offer a better test environment for their experiments with this protein, the researchers said.

The materials for their experiments will travel aboard the SpaceX Dragon capsule as part of a mission to send supplies and science experiments to the ISS.

The work is a collaboration between The Michael J. Fox Foundation for Parkinson’s Research and the Center for the Advancement of Science in Space (CASIS).

LRRK2 is a type of protein that modifies other proteins. Mutations in the gene that codes for LRRK2 are thought to cause Parkinson’s disease in some people. Researchers have hypothesized that developing drugs to inhibit LRRK2, or block its activity, could help prevent Parkinson’s or slow its progression.

But before scientists can develop a drug to inhibit LRRK2, they need to know the precise structure of this protein. One way to get a detailed view of its structure is by growing crystals of LRRK2 in lab dishes. However, on Earth, gravity can interfere with the growth of these crystals, and keep them small.

“The quality of our crystals is just not good enough [on Earth],” Sebastian Mathea, a researcher at the University of Oxford who is involved in the LRRK2 project, said during a news conference about the project Tuesday (Aug. 8).

This is where the ISS research comes in: Researchers hope that the microgravity conditions in space will allow the crystals to grow bigger with fewer defects. The scientists can then get a sharper view of the crystal structure.

Scientists will grow the LRRK2 crystals for about a month in space. Then, the crystals will be sent back to Earth, where they will be analyzed with high-energy X-rays, Mathea said.

Parkinson’s disease is a progressive neurological disorder that affects people’s movement abilities, and can result in symptoms such as tremors, slowed movements and muscle stiffness. There are currently no treatments to stop or reverse the progression of the disease, according to The Michael J. Fox Foundation.

Article from Live Science.

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Free Water Levels Provide a New Biomarker for PD Progression

According to a recent study, a newly discovered biomarker, free water, can track changes in the brain that are associated with Parkinson’s disease, which ultimately may aid in developing new drugs that could slow disease progression.

“This finding is a potential game changer as it could shift the way Parkinson’s disease clinical trials are designed and conducted,” said Michael S. Okun, MD, a professor and chair of neurology at the University of Florida and medical director for the Parkinson’s Foundation. “Free-water is a validated measurement that will likely decrease the number of patients required to demonstrate the slowing of clinical progression.”

The study titled, “Progression marker of Parkinson’s disease: a 4-year multi-site imaging study,” was published in the journal Brain.

One of the issues in developing disease-modifying therapies for Parkinson’s disease has been a lack of an accurate biomarker that can detect changes in the brain as the disease progresses. Recently, a new imaging technique was developed that can accurately detect the volume of water in brain tissue and separate that measurement from the water outside the brain tissue. The latter type of water is known as free water and has been known to increase in neurodegenerative disorders.

In 2015, researchers demonstrated that free water levels were increased in the posterior substantia nigra (PSN) of patients with Parkinson’s disease. The motor symptoms that accompany a diagnosis of Parkinson’s disease tend to emanate from the area of the brain that includes the nigrostriatal pathway, which is part of PSN.

In another study, researchers discovered that the free water levels in the PSN increased over one year in newly diagnosed Parkinson’s disease patients, but not in control groups. However, no studies have investigated how free water in the PSN changes over an extended period of time.

Therefore, researchers at the University of Florida conducted a multicenter international longitudinal study to determine the pattern of change in free water in patients with Parkinson’s disease over four years.

Results from this study showed that free water levels in PSN increased over one year in newly diagnosed Parkinson’s disease patients. Furthermore, free water levels continuously increased over four years. The research team also showed that sex and baseline free water predicted four-year changes in free water levels. Additionally, researchers showed that free water increasing over one or two years leads to worsening stages on the Hoehn and Yahr scale over a four-year period.

One of the most important things to result from this study has been the discovery of a biomarker that determines the progression of Parkinson’s disease and one that can potentially be used in future clinical trials as an endpoint.

“This means if you want to start designing studies to slow the progression of Parkinson’s disease, testing a drug on that measurement in the substantia nigra might be a good way to go,” said David Vaillancourt, PhD, professor of applied physiology and kinesiology at the University of Florida in a press release. “If the measurement in the substantia nigra is increasing year after year after year, and if you can stop that from occurring, you’re likely to slow or possibly stop the progression of the disease. This could change the way studies are conducted for disease-modifying trials in Parkinson’s disease.”

 

Article from Parkinson’s News Today.

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UW Otolaryngology Research Study

Have you been diagnosed with Parkinson’s disease within the last 5 years, and are your motor symptoms mild? Dr. Timothy McCulloch’s research lab at the University of Wisconsin Hospital is recruiting subjects for a study evaluating changes to chewing, swallowing, voice, fine motor, and walking function in the early stages of Parkinson’s disease, as well as healthy controls.

Participation in this study lasts about 2 hours and participants are paid $60. Contact study coordinator Dr. Suzan Abdelhalim at 608-265- 2470 or [email protected] for more information.

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People with Parkinson’s should be monitored for melanoma, study finds

People with the movement disorder Parkinson’s disease have a much higher risk of the skin cancer melanoma, and vice versa, a Mayo Clinic study finds. While further research is needed into the connection, physicians treating one disease should be vigilant for signs of the other and counsel those patients about risk, the authors say. The findings are published in Mayo Clinic Proceedings.

Overall, patients with Parkinson’s were roughly four times likelier to have had a history of melanoma than those without Parkinson’s, and people with melanoma had a fourfold higher risk of developing Parkinson’s, the research found.

Medical experts have speculated about the relationship between Parkinson’s and melanoma for decades, with varying conclusions, the Mayo researchers note. Several studies have suggested levodopa, a drug for Parkinson’s, may be implicated in malignant melanoma, but others have found an association between the two diseases regardless of levodopa treatment, they add.

“Future research should focus on identifying common genes, immune responses and environmental exposures that may link these two diseases,” says first author Lauren Dalvin, M.D., a Mayo Foundation Scholar in Ocular Oncology. “If we can pinpoint the cause of the association between Parkinson’s disease and melanoma, we will be better able to counsel patients and families about their risk of developing one disease in the setting of the other.”

The Mayo study used the Rochester Epidemiology Project medical records database to identify all neurologist-confirmed Parkinson’s cases from January 1976 through December 2013 among Olmsted County, Minn., residents. The study examined the prevalence of melanoma in those 974 patients compared with 2,922 residents without Parkinson’s. They also identified 1,544 cases of melanoma over that period and determined the 35-year risk of Parkinson’s in those patients compared with the risk in the same number of people without melanoma.

The results support an association between Parkinson’s disease and melanoma, but argue against levodopa as the cause, the researchers conclude. It is likelier that common environmental, genetic or immune system abnormalities underlie both conditions in patients who have both, but more research is needed to confirm that and refine screening recommendations, they say.

In the meantime, patients with one of the two diseases should be monitored for the other to help achieve early diagnosis and treatment, and they should be educated about the risk of developing the other illness, the researchers say.

The study’s senior author is Jose Pulido, M.D., an ophthalmologist at Mayo Clinic in Rochester, Minnesota, who treats eye melanoma.

 

Article from Science Daily.

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Predicting cognitive deficits in people with Parkinson’s disease

NIH-funded tool may improve clinical trial design and aid in treatment development.

Parkinson’s disease is commonly thought of as a movement disorder, but after years of living with the disease, approximately 25 percent of patients also experience deficits in cognition that impair function. A newly developed research tool may help predict a patient’s risk for developing dementia and could enable clinical trials aimed at finding treatments to prevent the cognitive effects of the disease. The research was published in Lancet Neurology and was partially funded by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.

“This study includes both genetic and clinical assessments from multiple groups of patients, and it represents a significant step forward in our ability to effectively model one of the most troublesome non-motor aspects of Parkinson’s disease,” said Margaret Sutherland, Ph.D., program director at the NINDS.

For the study, a team of researchers led by Clemens Scherzer, M.D., combined data from 3,200 people with Parkinson’s disease, representing more than 25,000 individual clinical assessments and evaluated seven known clinical and genetic risk factors associated with developing dementia. From this information, they built a computer-based risk calculator that may predict the chance that an individual with Parkinson’s will develop cognitive deficits. Dr. Scherzer is head of the Neurogenomics Lab and Parkinson Personalized Medicine Program at Harvard Medical School and a member of the Ann Romney Center for Neurologic Diseases at Brigham and Women’s Hospital, Boston.

Currently available Parkinson’s medications are only effective in improving motor deficits caused by the disease. However, the loss of cognitive abilities severely affects the individual’s quality of life and independence. One barrier to developing treatments for the cognitive effects of Parkinson’s disease is the considerable variability among patients. As a result, researchers must enroll several hundred patients when designing clinical trials to test treatments.

“By allowing clinical researchers to identify and select only patients at high-risk for developing dementia, this tool could help in the design of ‘smarter’ trials that require a manageable number of participating patients,” said Dr. Scherzer.

Dr. Scherzer and team also noted that a patient’s education appeared to have a powerful impact on the risk of memory loss. The more years of formal education patients in the study had, the greater was their protection against cognitive decline.

“This fits with the theory that education might provide your brain with a ‘cognitive reserve,’ which is the capacity to potentially compensate for some disease-related effects,” said Dr. Scherzer. “I hope researchers will take a closer look at this. It would be amazing, if this simple observation could be turned into a useful therapeutic intervention.”

Moving forward, Dr. Scherzer and his colleagues from the International Genetics of Parkinson’s Disease Progression (IGPP) Consortium plan to further improve the cognitive risk score calculator. The team is scanning the genome of patients to hunt for new progression genes. Ultimately, it is their hope that the tool can be used in the clinic in addition to helping with clinical trial design. However, considerable research remains to be done before that will be possible.

One complication for the use of this calculator in the clinic is the lack of available treatments for Parkinson’s-related cognitive deficits. Doctors face ethical issues concerning whether patients should be informed of their risk when there is little available to help them. It is hoped that by improving clinical trial design, the risk calculator can first aid in the discovery of new treatments and determine which patients would benefit most from the new treatments.

“Prediction is the first step,” said Dr. Scherzer. “Prevention is the ultimate goal, preventing a dismal prognosis from ever happening.”

This work was supported by the NINDS (NS082157, NS095736), the U.S. Department of Defense, M.E.M.O. Hoffman Foundation, and Brigham & Women’s Hospital.

 

The NINDS is the nation’s leading funder of research on the brain and nervous system. The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Article

Liu et al. Prediction of cognition in Parkinson’s disease with a clinical-genetic score: longitudinal analysis of nine cohorts. Lancet Neurology June 16, 2017; DOI: 10.1016/S1474-4422(17)30122-9
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Statins may not be used for protection against Parkinson’s disease

Use of statins may speed up the onset of Parkinson’s disease symptoms in people who are susceptible to the disease, according to Penn State College of Medicine researchers.

Some previous research has suggested that statins, used to treat high cholesterol, may protect against Parkinson’s disease. Research findings have been inconsistent, however, with some studies showing a lower risk, some showing no difference and some showing a higher risk of Parkinson’s disease in statin users.

“One of the reasons that may have explained these prior inconsistent results is that higher cholesterol, the main indication to use statins, has been related to lower occurrence of Parkinson’s disease,” said Xuemei Huang, professor of neurology. “This made it hard to know if the statin protective effect was due to the drug or preexisting cholesterol status.”

Another reason for the inconsistent results is that there are two types of statins. Water-soluble statins cannot get into the brain, while fat-soluble statins, called lipophilic, can. Since people with high cholesterol are treated for both kinds, the interpretation of results as it relates to Parkinson’s disease is not easy.

The researchers analyzed data in a commercially-available database of insurance claims for more than 50 million people. They identified nearly 22,000 people with Parkinson’s disease, and narrowed the number to 2,322 patients with newly diagnosed Parkinson’s disease. They paired each Parkinson’s patient with a person in the database who did not have Parkinson’s — called a control group. Researchers then determined which patients had been taking a statin and for how long before Parkinson’s disease symptoms appeared. Researchers reported their results in the journal Movement Disorders.

After analyzing the data, researchers found that prior statin use was associated with higher risk of Parkinson’s disease and was more noticeable during the start of the drug use.

“Statin use was associated with higher, not lower, Parkinson’s disease risk, and the association was more noticeable for lipophilic statins, an observation inconsistent with the current hypothesis that these statins protect nerve cells,” Huang said. “In addition, this association was most robust for use of statins less than two-and-a-half years, suggesting that statins may facilitate the onset of Parkinson’s disease.”

Guodong Liu, assistant professor of public health sciences, said, “Our analysis also showed that a diagnosis of hyperlipidemia, a marker of high cholesterol, was associated with lower Parkinson’s disease prevalence, consistent with prior research. We made sure to account for this factor in our analysis.”

A recent study reported that people who stopped using statins were more likely to be diagnosed with Parkinson’s disease, a finding interpreted as evidence that statins protect against Parkinson’s disease.

“Our new data suggests a different explanation,” Huang said. “Use of statins may lead to new Parkinson’s disease-related symptoms, thus causing patients to stop using statins.”

Huang stressed that more research needs to be completed and that those on statins should continue to take the medication their health care provider recommends.

“We are not saying that statins cause Parkinson’s disease, but rather that our study suggests that statins should not be used based on the idea that they will protect against Parkinson’s,” Huang said. “People have individual levels of risk for heart problems or Parkinson’s disease. If your mom has Parkinson’s disease and your grandmother has Parkinson’s disease, and you don’t have a family history of heart attacks or strokes, then you might want to ask your physician more questions to understand the reasons and risks of taking statins.”

One limitation of this study was that the MarketScan data did not include Medicare patients, Medicaid patients or the uninsured. Also, because it was a private insurance sample, the patients were all under 65 years old, so the findings cannot be generalized to those who are older.

Other researchers on this study are Lan Kong and Douglas Leslie, Department of Public Health Sciences; Nicholas Sterling, Medical Scientist Training Program student; and Mechelle Lewis and Richard Mailman, Departments of Neurology and Pharmacology, all of Penn State College of Medicine; and Honglei Chen, Michigan State University.

The Center for Applied Studies in Health Economics and Penn State College of Medicine funded this research.

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