Parkinson’s: What’s the latest?

Exciting new developments are helping Parkinson’s disease patients enjoy a better quality of life – and may even mean faster diagnosis and more effective treatment

Last year, Nintendo became the first games company to be endorsed by the Department of Health. The NHS recognised the ability of the virtual fitness game Wii Fit Plus to help improve the nation’s fitness levels, giving permission for use of its Change4Life logo. But the game has not only been found to help improve general health for the masses – it has also been proven to specifically help sufferers of Parkinson’s disease, a neurological condition which damages nerve cells in the part of the brain that controls movement. It is one of a number of recent breakthroughs in helping people with Parkinson’s manage their condition and enhance the quality of their everyday lives.

Living with Parkinson’s
Parkinson’s disease is a progressive condition that affects one in 500 people in the UK – 120,000 in total. People affected by the disease don’t have enough of a chemical called dopamine because specific nerve cells inside their brain have died. Without dopamine, people can find that their movements become slower and balance is impaired – which affects basic activities such as walking, talking and, in more advanced stages, controlling facial expressions and swallowing. Dr Kieran Breen, director of research and development at Parkinson’s UK, describes Parkinson’s as not so much a single disease but as a syndrome, or set of symptoms: ‘If you have a heart attack, there is a specific reason for it. With Parkinson’s it is a much broader spectrum, with many symptoms – and this something people often don’t understand.’ There are three classic ‘motor’ symptoms of the disease, relating to muscle activity. ‘These are slowness of movement, muscle tremor (or trembling) and rigidity (a stiffness of the muscles) – but sufferers don’t always have all three,’ explains Dr Breen. ‘No two people with Parkinson’s have exactly the same symptoms.’ The disease also varies from person to person in terms of how fast it progresses, and different symptoms may come and go in different people.
People with the disease can also experience a range of ‘non-motor’ symptoms, including disturbed sleep, constipation, muscular pain, tiredness, sexual problems and depression.
One of the biggest myths surrounding Parkinson’s disease is that the condition only affects older people. As Dr Breen explains: ‘Yes, you are more likely to get Parkinson’s as you get older, because age is a risk factor – but one in 20 people who get Parkinson’s are under the age of 40.’ Canadian actor Michael J Fox was diagnosed in 1991, aged just 30.
It is generally thought that people develop Parkinson’s disease due to a combination of genes that increase its possibility and environmental factors, such as exposure to pesticides. It is rare for the disease to be passed on from parent to child, with Parkinson’s UK estimating that the disease may have a genetic cause for five in every 100 people with the condition.

Improving movement
While medication to mimic or replace dopamine is used to manage Parkinson’s, and surgery to implant electrodes in the brain can also be carried out in severe cases, there are a number of ways that have recently been discovered to help people enhance their quality of life.
Last year, doctors at the Medical College of Georgia, USA, piloted an eight-week study that saw 18 people with Parkinson’s spend an hour playing Wii Sports three times a week, for four weeks. The patients – all affected by the disease on both sides of their bodies – played two games each of tennis and bowling, and one game of boxing. The games required whole body movements, balance and speed. Participants showed significant improvements in rigidity, movement and energy levels, and most participants’ depression levels decreased. But it’s not just virtual games that help – getting active in the traditional sense is encouraged, too. ‘Keeping active helps “oil” joints and muscles,’ says Dr Breen. ‘There is no need to run a marathon every day, but people with Parkinson’s should keep active to a level they are comfortable with – whether that means a 20-minute walk or a 10-minute jog.’
A study in The Cochrane Library this year supports this theory, finding that treadmill training can help Parkinson’s sufferers overcome difficulty walking – showing improved speed, stride length and distance covered. It may be the rhythmic nature of walking on a treadmill that helps sufferers. ‘People with Parkinson’s are often good at dancing because they move to a rhythm,’ says Dr Breen. ‘When someone with advanced Parkinson’s “freezes”, they can often start moving again by counting in their head “one, two, one, two” – they’ll start walking to that rhythm. The ticking of a metronome can also help to get people moving again.’
Indeed, a study by researchers at Washington University School of Medicine in 2008 showed that patients with Parkinson’s disease who took part in 20 regular tango dance classes showed significant improvements in balance and mobility, compared to patients who did conventional exercise. The tango classes included stretches, balance exercises, tango-style walking, footwork patterns and timing steps to music.
The Chinese martial art t‘ai chi – which is based on slow, controlled movements, developing strength, balance, posture and calm – has also shown encouraging results in helping Parkinson’s sufferers to overcome their symptoms. A study by the Washington University School of Medicine, published in 2008, found that people with mild to moderately severe Parkinson’s disease showed improved balance, walking ability and overall wellbeing after 20 t’ai chi sessions.

Mind matters
As well as motor symptoms affecting movement, Parkinson’s disease can cause non-motor symptoms including muscular pain and depression. Professor K Ray Chaudhuri, co-director of the National Parkinson Foundation Centre of Excellence, believes this is one area where Parkinson’s research and treatment has moved on: ‘The traditional way of looking at Parkinson’s disease is to address the motor symptoms, such as tremors, rigidity and balance. But we have started looking much more at the non-motor problems, as they tend to be what puts people in hospital – and what carers are most worried about. So far we have been quite blind to that.’
One Parkinson’s sufferer, Bob Taylor, has set up an art group for people with the disease. After tutoring recovering stroke and brain injury patients at a local hospital, Taylor realised the healing potential art therapy could have for people with Parkinson’s – helping them articulate their feelings and enhancing their emotional wellbeing. ‘People get so much out of it – it’s a release,’ he says.
Taylor also runs laughter therapy courses. ‘Laughter releases endorphins, which improve mood and relieve pain,’ says Taylor. Because 30 to 40 per cent of people with Parkinson’s experience depression during the course of the condition, mood-enhancing activities that encourage laughter can help.

Better diagnosis
It is not only in managing the condition that there have been strides forward, but in diagnosis too. Currently the condition is only diagnosed when sufferers start exhibiting motor symptoms, which occur after 70 per cent of the nerve cells in a specific part of the brain have died.
However, in April this year researchers at the University of Haifa in Israel found a way of using software to measure speech patterns and test if apparently healthy people have the condition. Because Parkinson’s damages muscles in the neck and mouth, it can also give sufferers a husky voice. The researchers claim that diagnosing patients earlier could prevent the damage of up to 60 per cent of the nerve cells in question.
Parkinson’s UK is also working towards earlier diagnosis. ‘We’re trying to build up a picture of what happens before people develop motor symptoms,’ says Dr Breen. ‘The earlier we can make a diagnosis, the more effective their treatment can be.’

Visit Parkinson’s UK at www.parkinsons.org.uk for more information.