Parkinson's Q&A: October 10, 2001


Parkinson's Q&A was presented on October 10, 2001 from 1:00 to 2:00PM EST.

Dr. Côté is a renowned clinician-researcher who specializes in PD. His early research focused on the basic neurochemistry of the basal ganglia. While he has a strong clinical research background, he also works closely with patients and their families on a daily basis. His research is focused on
clinical pharmacology and clinical trials of new agents for Parkinson's Disease.


DrCote

Good Afternoon everyone.

RichOBoyle
Good afternoon Dr. Cote and welcome

DrCote
Thank you for allowing me this opportunity.

RichOBoyle
why don't we wait about 5 minutes until people start to enter the chatroom

DrCote
That is fine.

DrCote
Good afternoon MariaB and TerraMzu

scott
(This user has entered ElderCare Chatroom)

TerraMzu
Good Afternnon. Thank you for being here.

RichOBoyle
we had a handful of advance questions sent in by email. I will incorporate them throughout the chat session

DrCote
Good afternoon Scott.

RichOBoyle
Hello scott and welcome

scott
than you ! good morning.

RichOBoyle
we will get started in about 5 minutes

RichOBoyle
terramzu and scott, can you tell us about who you are, your caregiving situation, interest in Parkinsons?

scott
I live in Pasadena CA -- with parents in their 80's in Seattle. Dad has advanced alzheimers, my mom has parkinsons -- that is moderately well controlled by meds. They have live-in care in the home, but it has been a struggle (and a lot of frequent flyer miles ) this year achieving any sort of balance.

RichOBoyle
why don't we get started here. we will save a transcript and post it to the website in a day

RichOBoyle
Terra Mzu, you may ask the first question if you are ready

RichOBoyle
and then followed by Scott

RichOBoyle
otherwise, I will pose one of the advance questions

TerraMzu
What are the stages of Parkinson's and how does it affect one's lifespan?

DrCote
There are five stages. The first stage is unilateral involvement of an arm or a leg.

DrCote
The second stage involved one side of the body and the trunk of the body.

DrCote
The third stage is when PD patients begin to have slight balance difficulty and gait impairment.

DrCote
The fourth stage is when they begin to need assistance in order not to fall, or for walking.

DrCote
ANd the last stage is when they are wheelchair bound.

TerraMzu
I read these stages on the parkinson.org website, but got the impressio that they only dealt with mobility -- that there were other descriptions applying to tremors, and other kinesias, etc.

DrCote
At the present time it does not affect the life span significantly.

RichOBoyle
where do dementia and other mental effects occur?

DrCote
Well, there is a unified PD disease rating scale which evaluates the cognitive functions, as well as the motor functions.

DrCote
This scale is frequentlyused in assessing drug therapy. Doctors often use it to monitor their patients from visit to visit.

gmumsy
(This user has entered ElderCare Chatroom)

kiki
(This user has entered ElderCare Chatroom)

RichOBoyle
hello gmumsy and welcome

RichOBoyle
hello kiki and welcome

kiki
Hello Rich

RichOBoyle
Dr. Cote has just begun the session. Please hold your questions until I call on you

RichOBoyle
we have been diuscussing the stages of Parkinsons (PD)

DrCote
Well, PD disease presents in many different ways, usually the motor symptoms such as tremor, rigidity and bradykinesia. And subsequently the cognitive functions may be impaired.

DrCote
It is important to add that drug therapy can, in some patients, cause memory difficulties.

DrCote
Because PD patients now live a full life, the later chapters of the disease may bring on mental changes including memory impairment and other symptoms of dementia.

DrCote
Next question

RichOBoyle
scott you are next

scott
Actually you touched on my question. Can you discuss any relationship between Parkinson's & memory-loss, confusion.

RichOBoyle
and then kiki

gmumsy
(This user has entered ElderCare Chatroom)

DrCote
Yes - all drugs that are used for treating PD patients can contribute to confusion and other mental symptoms.

DrCote
More recently the newer "so called dopamine agonists" are prone to causing visual illusions and hallucinations.

RichOBoyle
Along those lines, what types pf pain medications can be used since some of them can cause hallucinations?

DrCote
Pain meds can contribute to hallucinations, especially narcotics.

DrCote
Non-narcotic agents such as Celebrex or vioxx or any of the non-steroidal anti-inflammatory usually are not major contributors to confusion.

DrCote
Next.

kiki
the non narcotic agents NSAIDS you speak of would also include Ibuprofan?

DrCote
Yes

RichOBoyle
Any new research regarding alternative choices which are proving helpful in slowing down the progression of symptoms of AD, PD, or Lewy Body? (such as ginkgo, etc)

DrCote
All over the counter agents that are available are not thoroughly tested in a way that the pharmaceutical companies must do in order to obtain FDA approval before the drug is released. There is a lack of good studies on over thecounter drugs to see if they are effective in treating PD or dementia.

RichOBoyle
Are you aware of any research into using vitamin, hormone, or herbal therapies?

gmumsy
We came to see you on Sept 27,my husband and son you had recommended clozaril, but morty developed a bad cough and some congestion, now he has been sleeping all day monday and now off and on. we never started the clozaril. Should we be concerned or will he be better when he recovers

DrCote
I'm aware of several agents being used such as SAME, NADH, and glutathione.

DrCote
SAME is used in patients that are depressed.

DrCote
NADH is administered to PD patients to improve PD symptoms.

DrCote
glutathione is a natural substance in the brain that is reduced in patients with PD.

kiki
Please, be more specific. What exactly are all of those agents u mentioned? Which ones are hormones, vitamins, etc.?

DrCote
It is the main reducing agent in the brain. Since it is believed that PD may be caused by excessive oxidants, glucothione is suggested to neutralize the oxidants.

DrCote
SAME is a substance present in all of us and it is involved in the oxidation pathway in all organs, including the brain.

DrCote
NADH is also present in all organs and serves to reduce oxidized products.

RichOBoyle
is that enough kiki?

RichOBoyle
great explanation dr cote

TerraMzu
Is there a list of typical and atypical symptoms of PD that I may look at? And where would I find the unified PD rating scale that you mentioned earlier?

DrCote
Glutathione is a reducing agent that is present in all organs and particularly the brain. These are natural substances for the body. YOu cannot live without them.

DrCote
The $64.00 question is do these substances penetrate the brain barrier - i.e. can they get into the brain from the circulation

RichOBoyle
along with Terra's question... can some of these symptoms be used to distinguish between Alzheimer's Disease and Lewy Body dementias?

DrCote
I think we missed a prior question.

RichOBoyle
typical vs. atypical symptoms

DrCote
This is a specific question that I should answer. I would be happy to speak with you via telephone.

DrCote
That was for gmummsy.

DrCote
The list of typical and atypical symptoms of PD is extremely long, although the clasical symptoms are tremor, rigidity, bradykinesia, gait and balance difficulty.

DrCote
Terra - What are you specifically looking for?

TerraMzu
A list of symptoms. Perhaps you might direct me to a publication or site? Also, is dystonia a typical or atypical symptom in your opinion?

DrCote
As far as distinguishing between AD and Lewy body dementia (LBD), in PD disease Lewy bodies are always found in a very localized part of the brain that is called the extrapyramidal motor system "basal ganglia."

DrCote
In diffuse LBD, the lewy bodies are found in other areas of the brain, as well as in the part of the brain involving PD.

DrCote
The distribution of the Lewy bodies cause additional symptoms such as psychotic manifestations, orthostatic hypotension, etc.

DrCote
Patients with diffuse lewy body disease experience a great deal of visual illusions and hallucinations.

DrCote
However, many of the drugs we use to treat PD can cause similar problems. Therefore one has to very carefully assess the affect of these drugs on the symptoms.

RichOBoyle
Earlier this year I read a report of a surgery that implanted fetal cells into PD patients brains. Apparently the surgery was not successful and caused some very uncomfortable situations for the patients. What is the current thinking on implantation? Do the implantation surgeries hold any promise for Alzheimer's Patients?

DrCote
Terra - the textbook of Neurology, edited by Dr. Lewis P. Rowland (the original HOuston Merrit Textbook). There is a long list of symptoms listed. The PD foundation does have a web site. We can provide it to Rich later because I would need to look it up. Dystonia can be a symptom of PD especially if it starts very early in life. However, the most common cause of dystonia in PD are the drugs that are used to treat the illness - i.e. Sinemet.

DrCote
Unfortunately fetal substantia nigra implant did not prove to be a successful mode of therapy.

DrCote
Because in most cases the tissue did not grow.

DrCote
In a few patients "young patients" the tissue did develop but is now out of control. These patients experience severe involuntary movement, alternating with severe "off" periods.

DrCote
These patients are presently being treated with electrode implants into the subthalamic nucleus.

RichOBoyle
does someone else want to pose a question next?

TerraMzu
Given that PD does not shorten one's life, what percentage of PWPD develop Parkinsonian dementia?

TerraMzu
+/-

DrCote
As far as AD patients, fetal implant surgery has not been advocated.

DrCote
Terra - we are seeing several new chapters of this disease because of our better way of treating PD with the new medications that we have. Unfortunately these later chapters often show evidence of dementia.

DrCote
Next question

kiki
Dr Cote, my father seems to have more OFF periods than ON. His Dr. has given him more doses of meds/less doses of meds/changed the intervals & times he should take them, but nothing seems to be working. Any suggestions?

DrCote
Kiki - when one first develops PD it is one disease. However, after years of therapy one ends up with two diseases, PD and the side effects of the medications used to treat the disorder.

DrCote
In my experience I find that doctors in general tend to increase the dose of medication reaching a level that causes many of the side effects that become very difficult to control.

RichOBoyle
What are the risk factors for PD?

kiki
thank you Dr Cote, that makes a lot of sense to me.

DrCote
We know very little about the risk factors of PD. There are possibly gene abnormalities that can set the stage for developing PD, however environmental factors may very well play into this.

DrCote
In the past, it has been suggested that smoking may prevent patients from developing PD because very few PD patients smoke. However, I believe that the reason why PD patients don't smoke is because patients lose their addictive drives for smoking. Dopamine is well known to be at the heart of many addictive drives.

DrCote
Since dopamine is reduced in the brain, possibly years before we can recognize the onset of PD, it may be that the addictive drive for smoking is lost 5 or 10 years before they develop the disease.

DrCote
Kiki - your welcome.

TerraMzu
What environmental factors are your referring to as causes for PD?

Babs
(This user has entered ElderCare Chatroom)

RichOBoyle
hello Babs and welcome

DrCote
As far as smoking and PD we can provide Rich with a reference of a paper that I co-authored.

RichOBoyle
we are winding down the chat on Parkinson's Disease

RichOBoyle
the transcript will be posted tomorrow evening

DrCote
Terra - there is an increase incidence of PD in welders.

Babs
Dr. Cote, Is PD inherited?

DrCote
There have been increased reports of PD in lumberjacks. The notion is that maybe there is something about trees that could play into this. However, these are only notions and there is no convincing data about environmental factors, including insecticides.

DrCote
Babs - there is a small population of PD patients that show an abnormality in a gene called Parkin. This abnormal gene is most commonly seen in young onset PD.

DrCote
This suggests that there may be an inherited factor in PD.

kiki
can families be tested for the abnormal Parkin gene far in advance?

DrCote
Much research is needed to pursue this avenue.

RichOBoyle
let's wind down the chat now with these last questions. if anyone has typed a question in already, please post it now

DrCote
Although we are looking at patients in this young age group with PD, we are not allowed to give out the information until we have adequate data to support our notion.

TerraMzu
This has been an excellent chat. Thank you.

DrCote
Your very welcome TerraMzu

kiki
thank you very much Dr Cote

DrCote
Your welcome Kiki.

RichOBoyle
Thank yopu everyone for attending. As I said, the transcript will be posted tomorrow eveing

DrCote
Well I will sign off as well. Thank you Rich.

RichOBoyle
Thank you dr. Cote and the Taub Institute

RichOBoyle
Have a great day

ElderCare Online and the Taub Institute for Research on Alzheimer's Disease and the Aging Brain present a series of educational chat sessions throughout 2001. Our goal is to provide family caregivers with access to leading professionals in the field of Alzheimer's research and care. We believe that better-informed caregivers will be able to improve quality of life for themselves and their aging loved ones. Visit the Alzheimer's Answers Home Page for more information.

© 2001 Prism Innovations, Inc. All Rights Reserved.