Unshakable: Living with Parkinson's Disease - LPSA & JPSA's Newsletter (April 2023)

Parkinson's Disease may be a challenging opponent, but it does not have to control your life. With the power of the 10 PWords, you can navigate the challenges and achieve success on your terms. Passionate, Patient, Perseverant, Persistent, Positive, Powerful, Prepared, Principled, Productive, and Purposeful, each P-Word contributes to your life’s symphony and helps you stay focused on your goals and live a purposeful and fulfilling life, regardless of the challenges that come your way.

DEFINITION

Dr. James Parkinson first reported Parkinson's Disease (PD) in 1817, referring to it as "shaking palsy."

Parkinson's Disease is a persistent and advancing neurodegenerative condition characterized by motor and non-motor traits such as tremors, muscle rigidity, and difficulty with balance and coordination in addition to cognitive impairment, mood disorders, trouble sleeping, and autonomic dysfunction.

The culprit? Dopamine. Dopamine, which is necessary for proper movement, is reduced in Parkinson's Disease due to the progressive death of dopamine-producing neurons in the substantia nigra, a region in the brain. Unfortunately, this disease cannot be cured, but treatments are available to control symptoms and enhance quality of life.

RISK FACTORS

Increased age is a risk factor for developing Parkinson's Disease. Young adults rarely experience the disease and people usually start to develop it around the age of 60 or older.

Men are more likely to develop Parkinson's Disease than women. Several gene variants are associated with an increased risk of developing Parkinson's Disease, suggesting that genetic factors may be at play. Environmental variables, such as exposure to chemicals including pesticides, herbicides, and heavy metals, also play a role.

SIGNS & SYMPTOMS

Speech alterations such as slurred or hesitant speech. Reduced ability to smell.

Mood disorders such as depression, anxiety and other mood swings.

Tremors is one of the cardinal signs of Parkinson's Disease. They typically begin in one hand or arm but might spread to the legs or other body parts. Muscle stiffness can make it difficult to walk or carry out regular tasks.

Bradykinesia, or slow movements, also involves decreased blinking and facial expression as well as trouble starting or stopping movements.

Postural instability can make it hard for patients to stay balanced and can increase their risk of falls. Coordination and balance difficulties can make it difficult for patients to stand, walk, or coordinate their motions.

PREVALENCE

Parkinson's Disease is the second most common type of neurodegenerative disorder after Alzheimer's Disease. Its prevalence has increased during the past 25 years and more than 8.5 million people worldwide are estimated to be affected by it.

PREVALENCE: 168 PER 100,000.

NUMBER OF DEATHS: 5114.

PREVALENCE: 83 PER 100,000.

NUMBER OF DEATHS: 2589.

OF PARKINSON'S DISEASE The Stages

Stage 1

Changes in Habits

Stage 1 is the mildest form of Parkinson’s Disease. At this stage, symptoms are not severe enough to interfere with daily tasks. In fact, symptoms are so subtle that they are often missed, but family and friends may notice changes in the patient’s posture, walking pattern, or facial expressions. For instance, patients' arms may not swing as freely when they walk, they may be unable to make facial expressions, and their legs may feel heavy. Posture may become slightly stooped and the handwriting may become smaller. Symptoms may be present on only one side of the body, such as a tremor in one arm.

At this stage, prescribed medications can effectively minimize and reduce symptoms.

Stage 2 Muscle Stiffness and Posture Problems

At this stage, the disease is moderate in severity and symptoms are more noticeable than those in stage 1. Stiffness, tremors and changes in facial expressions may be more noticeable. While muscle stiffness prolongs task completion, stage 2 does not impair balance. Difficulties walking may develop or increase, and the person’s posture may start to change. People at this stage feel symptoms on both sides of the body and sometimes experience speech difficulties.

The majority of people with stage 2 Parkinson’s Disease can still live alone, although they may find that some tasks take longer to complete. The progression from stage 1 to stage 2 can take months or even years and there is no way to predict individual progression.

The Stages

OF PARKINSON'S DISEASE

Stage 3

Poor Reflexes and Balance Issues

Stage 3 marks a major turning point in the progression of Parkinson's Disease. Many of the symptoms are the same as those in stage 2, but patients are now more likely to experience a loss of balance and decreased reflexes, slower movement and a higher risk of falls.

Parkinson’s Disease significantly affects daily tasks at this stage, but people are still able to complete them. Medications combined with occupational therapy may help decrease symptoms.

Stage 4 Poor Motor Skills

Independence separates people with stage 3 Parkinson’s Disease from those with stage 4 of the disease.

During stage 4, patients can stand without assistance, but their movement may require a walker or other type of assistive device. Many people are unable to live alone because of the significant decrease in movement and in reaction time. Living alone at stage 4 or later may make many daily tasks impossible, and can even be dangerous.

Stage 5 Poor Motor Skills

Stage 5 is the most advanced stage of Parkinson’s Disease and patients at this stage cannot live independently. Advanced stiffness in the legs can cause freezing upon standing and patients are often unable to stand on their own or walk without falling. Patients in this stage require around-the-clock assistance, may be confined to a bed or wheelchair and need help with daily tasks.

DIAGNOSIS

Diagnosing Parkinson’s Disease is not easy as no universal technique has been established. Not only that, but symptoms can be commonly confused with those of other diseases, leading to frequent misdiagnoses. Thus, physicians usually combine the results of multiple tests for a more accurate diagnosis.

Physicians usually start with a physical exam to find the most potent clinical features associated with Parkinson’s Disease:

Bradykinesia, or slowness of movement caused by weak muscle force.

Rest tremors, or shaking, involving usually the hands, lips, chin, and legs. It may not be experienced by all patients.

Rigidity and joint stiffness caused by increased resistance. It is often associated with shaking while moving a limb and pain might result. Shoulder pain is the first sign of the disease.

Postural instability is identified in later stages of the disease and patients often develop a fear of falling. The pull test, in which the patient is quickly pulled by the shoulders, aims to detect postural imbalance. A long latency before falling implies Parkinson’s Disease.

To complement those tests, neurological examinations are carried out by administering drugs such as Levodopa, and monitoring patients' response. Improvement of signs and symptoms confirms the diagnosis.

Various types of scans can also be used to track nervous system functions. The most efficient imaging method is the DaTscan, in which a radioactive tracer is injected into blood to track dopamine locations in the brain. A weak signal in the striatum confirms Parkinson's Disease.

RISK FACTORS

The early detection of Parkinson’s Disease, although challenging, significantly improves the patient’s quality of life.

Firstly, early treatment of Parkinson's Disease, with drugs such as Levodopa before irreversible neurological damage occurs ensures neuroprotection and delays the disease's progression. Moreover, early therapeutic procedures are significantly more cost-effective than those required in later stages.

Additionally, non-pharmacological approaches, such as speech therapy or exercise, are easier to perform in the early stages of the disease and decrease the severity of symptoms.

Detecting Parkinson’s Disease in its early stages enables the patient to slowly get accustomed to the disease, accept it, and cope with its challenges as it progresses.

PARKINSON'S DISEASE VS. MEDICATION-INDUCED PARKINSONISM

Drug-induced Parkinsonism is not a syndrome. It is a set of symptoms that mimic those of Parkinson’s Disease. In fact, some drugs including Antipsychotics, Anti-nausea drugs, Calcium Channel Blockers, and Antidepressants may cause Parkinsonism, as they block dopamine receptors in the brain. If this happens, these drugs should be substituted by others that do not have such side effects.

TREATMENT

The goal of managing Parkinson’s Disease is to minimize symptoms and disability while maintaining the patient's overall well-being. It is worth noting, however, that there is currently no established treatment that can halt or slow down the progression of the disease.

~ Physical Therapy

Helps control pain, increase mobility and release stiffness.

~ Dance and Music Therapy ~

Patients can express themselves freely, which improves their brain function and dancing can enhance mobility.

~

Massage and Yoga

~

Helps patients relax, reduces bone pain and improves posture and motility.

~ Surgery ~

Should be considered an adjunct to pharmacotherapy when patients are experiencing frequent motor fluctuations or disabling dyskinesia or tremor despite an optimized medical regimen.

Other biotherapies, such as stem cell and gene-based approaches, are currently under investigation and remain highly experimental.

PHARMACOLOGICAL APPROACH

Family Example Indication

Dopamine precursor combined witha peripherally actingLaminoacid decarboxylase (L-AAD) inhibitor

Levodopa+ Carbidopa Or Levodopa+ Benserazide

Side Effects Comments

Selective MAO-B Inhibitors

Rasagiline Selegiline

Levodopa is converted into dopamine by LAAD in the central nervous system and in theperiphery.

Carbidopa or benserazide can block L-AAD in the periphery, increasing the penetration of Levodopa into the central nervous system and reducing the adverse effects of dopamine.

On - off effect: transition from fluid state to complete immobility. Wearing-off: symptoms reoccur before the time of the next dose. Dyskinesia: involuntary movement of the neck, trunk and upperextremities.

Delusion

Dyskinesia

The usual initial maintenance dose is 25/100 mg Carbidopa / Levodopa 3 times daily. Controlled-release tabletsmaybeused. Orally disintegrating tablets or capsules containing beads can be sprinkled onto food and are available for patients with difficulty swallowing.

As monotherapy in early Parkinson's Disease, both Selegiline and Rasagiline provide a modest improvement inmotorfunction.

Gastrointestinal sideeffects

Delusions

Selegiline may cause insomnia; avoid administration in the late afternoon or at night.

Oral disintegrating tablets provide improved response and fewer side effects than conventional formulations.

Anticholinergic medications

Benztropine Diphenhydramine

They improve tremors and dystonic features in some patients but have a limited effect against bradykinesia andotherdisabilities.

Anticholinergic side effects: dry mouth, blurred vision, constipation and difficulty urinating. Cognitive side effects: confusion, sedation, depression and anxiety.

Used alone or in combination with other antiparkinsonian drugs. Avoid in patients aged above 65 and in those with cognitive deficits because they are at a higher risk of side effects.

Antiviral Amantadine

Itiscommonlyusedto manage dyskinesia causedbyLevodopa.

Sedation, hallucinations, dizziness and confusion

Drymouth

Livedo reticularis (reversible purple skindiscoloration)

Adjustment is needed inkidneyimpairment.

PHARMACOLOGICAL APPROACH

Family Example Indication

CatecholO-Methyl transferase

Inhibitors (COMT Inhibitors)

Tolcapone

Entacapone

Never used as monotherapy and always used in combination withLevodopa. Prevent the metabolism of Dopamine and L-dopa.

Side Effects Comments

Tolcapone use is limited because of the potential for fatal liver toxicity, which requires strict monitoring of liverfunction. Cause brownish orange urine discoloration and delayed diarrhea.

No need to titrate-up the dose.

Easy to administer.

Dopamine Agonists

Ergot derivative:

Bromocriptine

Non-Ergot derivatives:

Pramipexole

Rotigotine

Ropinirole

Apomorphine

Has Levodopa sparing effect (levodopa dose can be decreased). Can be used in patients with motor complications due to Levodopa. As combination or as monotherapy.

Non-ergot derivatives are safer than ergot derivatives. Cause drowsiness, nausea, vivid dreams, hallucinations anddelusions. Worsen dyskinesia.

Apomorphine: causes severe hypotension and severe nausea and vomiting; contraindicated with 5HT-3 receptor antagonists such as Ondansetron.

Titrate doses slowly to enhance tolerability.

Bromocriptine: risk of pulmonary fibrosis which limitsuse.

Rotigotine: exists as a patch that provides continuous release over 24 hours.

Apomorphine: given as a subcutaneous rescue injection if off symptoms occur despite optimal treatment.

Treatment is a must in stage 3 Parkinson's Disease, which is the stage where most patients are diagnosed. Upon diagnosis, patients are usually started on Rasagiline.

Stage 4 patients should be directly started on a combination therapy with either Levodopa/Carbidopa and a Dopamine Antagonist or Levodopa/Carbidopa and a COMT Inhibitor. Then, MAO Inhibitors, Amantadine, and Anticholinergics can be added according to the patient’s condition.

Stage 5 patients do not respond well to treatment, so all treatments are usually discontinued, and the patient is started on palliative care.

FROM A PROFESSIONAL PERSPECTIVE With

FROM A PROFESSIONAL PERSPECTIVE

Currently, there is no therapeutic treatment directly targeting PD, so research into new and improved treatments is required. To improve the accuracy of diagnosis, develop novel treatments, and come closer to a cure for PD, many Parkinson’s clinical trials are being conducted throughout the world. The presence of these trials is important to find out a new treatment which is safe, beneficial to PD patients, more effective than available therapies, and most importantly improves the quality of life of patients.

In the context of clinical trials, a strict protocol or process is required to ensure that the new treatment is tested in a controlled way to minimize any risk to volunteers. Clinical trials not only study the effectiveness of the medication, but also involve data collection on safety aspects such as adverse reactions and drugdrug interactions.

ENDPOINTS

During the clinical trial, it is important to define what is meant by the drug being “effective” or having a significant clinical benefit. With the progress in the understanding of PD and other neurodegenerative disorders, there exist new insights on choosing the outcome measure that are used as endpoints in clinical trials.

In recent years, “ON” and “OFF” time changes were widely used as endpoints for measuring efficacy of symptomatic treatments of PD. “OFF” time is defined as a period when medication has worn off and is no longer providing benefit regarding mobility, slowness, and stiffness, and “ON” time can be classified as associated with or without troublesome dyskinesia that interfere with activities of daily living.

The current endpoint that is uniformly employed across PD clinical trials is the Movement Disorders Society Unified Parkinson‘s disease rating scale (MDSUPDRS). This scale represents a combination of clinical observed and patient reported assessments of motor and non-motor symptoms characteristic of Parkinson’s Disease including:

Part1: non-motor experiences of daily living

Part2: motor experiences of daily living

Part3: motor examination

Part4: motor complications.

FROM A PROFESSIONAL PERSPECTIVE

Other scores can be used as efficacy measuring endpoints include the 39-Item Parkinson’s Disease Questionnaire (PDQ-39) summary of index score, the Clinical Global Impression-Change (CGI-C) and Severity (CGI-S) scores, and the Numerical Rating Scale (NRS) score for pain.

As there remain an unmet need for endpoints that are clinically meaningful, being more objective and quantitative, measurable over a short period, and represent longer-term outcomes, potential novel endpoints are in development, including digital measures of signs and symptoms, as well a growing array of imaging and biospecimen biomarkers.

INCLUSION AND EXCLUSION CRITERIA

Every trial has its own inclusion and exclusion criteria describing the patients who are eligible to participate in the study. Common criteria used for Parkinson’s-related studies are age, time since diagnosis, current medications, pregnancy status, Unified Parkinson’s Disease Rating Scale (UPDRS) scores, Hoehn and Yahr scale, and whether the prospective participant has taken dopaminergic therapy like levodopa.

USE OF PLACEBO CONTROL GROUPS

The placebo arm of the clinical trial improves the quality of conclusions as it provides a way to compare the outcomes of using the treatments being investigated to the outcomes of the using it. Although there are some ethical concerns about the use of placebos and the possibility to compare the new drug with “best available therapy”, most of the trials go for the first option.

CHALLENGES

Despite the urgent need for new medications, clinical trials in Parkinson's have a relatively low rate of success due to several challenges including:

Restrictive inclusion and exclusion criteria

Financial Burden of participation

Medication adjustments/washout periods

Lack of ethnic and racial diversity

Limited pool of potential participants

THE ROLE OF SURGERIES

In the early stages of Parkinson's Disease, medications are used to manage symptoms nd minimize motor impairment. However, when patients no longer espond to medications, advanced reatments are considered. For instance, urgery is considered in patients who have xhausted the medications for tremors, are xperiencing profound motor fluctuations, or are suffering from medication-induced yskinesia.

Today, the most commonly performed urgical procedures for Parkinson's Disease are:

DEEP BRAIN STIMULATION

Is a surgical procedure used to manage the motor symptoms of the disease such as tremors, stiffness, slowed movement and slowed walking. It consists of inserting electrodes into a targeted area of the brain then implanting an impulse generator battery (IPG) similar to a heart pacemaker. Patients are then given a controller to turn the device on or off and review basic parameters such as battery life.

DUOPA

Is a form of Carbidopa-Levodopa treatment that consists of delivering the drug directly to the small intestines in a gel form rather than in a pill. It works just like Levodopa pills, but it is designed to reduce "off periods" that are commonly seen with L-dopa compounds.

A small hole, or stoma, is made in the intestines and a tube is placed. After that, a pump delivers the drug directly to the intestines through the tube.

LEARNMOREATREALLYGREATSITE.COM

FOCUSED ULTRASOUND

Is a less common procedure in which the patient wears a helmet called a transducer that allows the focusing of ultrasound energy targeting certain areas in the brain. Then, an MRI is used to guide the waves to destroy the degenerated area in the brain responsible for tremors.

VITAMINS & NATURAL THERAPIES

Patients with Parkinson's Disease take many medications to treat the symptoms they experience, but are medications enough?

The answer is rather controversial: some healthcare providers consider that vitamins and natural therapies are not well-studied in this population of patients, so it is not clear whether their benefits outweigh their risks. On the other hand, other studies show the importance of these remedies in controlling symptoms of the disease.

Something is certain: a balanced diet rich in antioxidants from fruits, vegetables, nuts, and whole grains is essential for patients with Parkinson's Disease. Hence, some vitamins and supplements with evidence for managing Parkinson's Disease symptoms include:

VITAMIN C

Is an antioxidant that can enhance the brain function and immunity of patients with Parkinson’s Disease.

VITAMIN E

Also an antioxidant, Vitamin E was shown to be neuroprotective in patients with Parkinson's Disease.

VITAMIN D

Helps patients with Parkinson's Disease maintain their bone strength.

VITAMIN B

Especially Vitamin B12 increases patients' motility, brain function and nerve response.

OMEGA-3 FATTY ACIDS

Can raise dopamine levels, minimize inflammation, and help absorb calcium to increase mobility.

COENZYME Q10

Is an antioxidant that helps with brain performance and function.

Other therapies that may be attempted include Acupuncture and Tai Chi, but these are less backed by evidence.

PARKINSON'S DISEASE & BIOMARKER STUDIES

Biomarkers are biological molecules or other measurable indicators that can be used to diagnose or track the progression of a disease.

In recent years, there has been a number of studies investigating biomarkers for Parkinson's Disease focusing on a range of different biomarkers, including protein markers, imaging markers, and genetic markers.

PROTEIN BIOMARKERS

One promising area of research has been the identification of protein biomarkers in the blood or cerebrospinal fluid (CSF) of people with Parkinson's Disease. These biomarkers could be used to diagnose the condition or track its progression. For example, alpha-synuclein is a protein that plays a role in the development of Parkinson's Disease, and researchers have been exploring whether levels of this protein in the CSF could serve as a biomarker for the condition.

IMAGING BIOMARKERS

Imaging biomarkers can detect changes in the brain associated with Parkinson's Disease.

For example, researchers have been studying the use of Positron Emission Tomography (PET) imaging to detect changes in dopamine levels in the brain.

GENETIC BIOMARKERS

While the majority of Parkinson's Disease cases are not thought to be caused by a single gene, there are some rare forms of the condition that are associated with specific genetic mutations.

Researchers have been studying these mutations in order to better understand the underlying mechanisms of the disease and to develop new treatments.

THE OFF-LABEL USE OF MEDICATIONS

"Off-label" use refers to the use of a medication that has been approved but not as intended. This description may imply that the substance is:

Used to treat a disease or medical condition that it is not approved to treat.

Provided in a different method, for example when a medication is prescribed as an oral solution even if it has been approved for use as a capsule.

Given at a different dosage, such as when a patient is instructed to take two pills daily despite the fact that a drug's approved daily dose is one tablet.

When it comes to Parkinson's Disease, many medications are being use as "off-label":

Drug Approved Use Off-label Use Justification

Terazosin Used for the treatment of an enlarged prostate.

Has a potential neuroprotective effect in Parkinson’s Disease.

The medication has stopped neuron loss in a variety of Parkinson's Disease model systems, including cell cultures, mice, rats, and flies.

Parkinson's Disease patients who use Terazosin experienced fewer Parkinson's Disease-related comorbidities and a slower disease progression.

Ambroxol

Glucagonlike peptide

1 (GLP1) agonists: Exenatide, Liraglutide and Lixisenatide

Is a Mucolytic that clears mucus from the respiratory system.

Pre-clinical research revealed that it supports the activity of glucocerebrosidase (GBA), an enzyme that eliminates waste products from cells.

Supporting healthy GBA function should be investigated because GBA mutation can trigger the onset of Parkinson's Disease.

Clinical trials for Ambroxol use in Parkinson's Disease are currently being conducted.

Used for the management of Diabetes Mellitus.

Preclinical evidence demonstrates that they have neuroprotective properties.

Exenatide revealed in clinical trials that it can moderately improve motor scores in patients with Parkinson's Disease. It has to be further studied in larger trials to assert this effect. Clinical trials are now being conducted on Lixisenatide and Liraglutide.

THE OFF-LABEL USE OF MEDICATIONS

Drug Approved Use Off-label Use Justification

Buspirone Used for the treatment of anxiety.

Shown to reduce Levodopa-related dyskinesia. Still under investigation.

Nilotinib Used for the treatment Chronic Myelogenous Leukemia.

Shown to reduce Levodopa-related dyskinesia.

According to preclinical research, it may cause the degradation of alpha-synuclein, a protein known to aggregate within neurons, thus preventing aberrant clumping and safeguarding neurons. Currently, a bigger placebocontrolled clinical trial is being conducted.

Deferiprone

Used to treat certain blood problems by eliminating excess iron from the body.

According to a phase II clinical trial, Deferiprone was well tolerated by Parkinson's Disease patients and linked to lower brain iron levels.

Parkinson's Disease-affected brain regions have higher iron levels. Too much iron can adversely affect dopamine brain cells. The removal of extra iron from the brain may stop the damage and halt the progression of Parkinson's Disease. The medication is currently being studied in a bigger Phase II trial.

Statins:

Simvastatin & Lovastatin

Used to lower cholesterol levels.

According to a preclinical study, statins may protect brain cells.

Statins may have neuroprotective effects by reducing oxidative stress, inflammation and alpha-synuclein in the brain.

Simvastatin and Lovastatin are being examined in Phase II trials for potential benefits in Parkinson's Disease.

WHAT'S NEW IN PARKINSON'S DISEASE?

While there is currently no cure for Parkinson's Disease, researchers are constantly exploring new technologies and treatments to help with early detection, symptom management, and improvement of patients' quality of life.

GENE THERAPY

Gene therapy has been investigated in the management of Parkinson's Disease. In a recent study, researchers were able to restore dopamine production in monkeys with Parkinson's Disease using a viral vector to deliver the gene for dopamine production directly to affected neurons. This approach can possibly provide a long-term solution to dopamine depletion in Parkinson's Disease patients.

NON-INVASIVE BRAIN STIMULATION

Non-invasive brain stimulation techniques like Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (DCS) have also shown promising results in improving motor and cognitive function in patients with Parkinson's Disease.

METABOLOMICS

Or the study of small molecules in biological samples, is being explored as a potential tool for the diagnosis of Parkinson's Disease. Changes in metabolite levels in the blood or cerebrospinal fluid may indicate Parkinson's Disease and metabolomics profiling could help identify candidate biomarkers for clinical detection and therapies of Parkinson's Disease.

Also, new medications targeting specific molecular pathways involved in Parkinson's Disease such as drugs that target the adenosine A2A receptor, are being developed. Researchers are also investigating the gut microbiome and its potential role in the disease.

While there is still much to learn about Parkinson's Disease, these developments offer hope for patients and their families that with continued research, we may one day be able to find a cure for this debilitating disease.

Relax

THE PSYCHOLOGICAL OUTCOMES OF PARKINSON'S DISEASE

Parkinson's Disease can affect both patients and their families psychologically. Emotions that are often encountered are anxiety, stress, and depression, and here are some ways to overcome them:

Relaxation can be found in things as simple as enjoying a cup of tea, listening to music, or having weekend getaway.

Adopt a Positive Outlook

A positive outlook on the condition and its implications on life can help improve many Parkinson's Disease symptoms.

Identify Triggers

Look for patterns of stress and try to work around them. Be aware of particular triggers, or particular times of day when you are more likely to get stressed.

Plan the Day

Planning the day can help reduce stress. Try not to schedule too many activities in any one day.

Seek Peer Support

Peer Support provides the opportunity to talk to other people who understand exactly what a Parkinson's Disease patient is going through, which can relieve stress.

Seek a Psychologist

A psychologist may help the patient or his/her family better manage some mood disorders and may even refer them to a psychiatrist for medications.

THE PHYSICAL OUTCOMES OF PARKINSON'S DISEASE

Parkinson's Disease is also associated with a number of physical outcomes.

Insomnia may be caused by certain medications that patients are taking or by the stress they are experiencing because of their condition.

To manage insomnia, health care providers must make sure that medication regimens are optimized by advising patients to take their insomniacausing medications in the morning, setting fixed sleeping times, avoiding naps, and taking some safe sleeping pills such as melatonin.

Some patients may experience dehydration caused by some of their medications.

Dehydration causes tiredness, confusion, balance issues, weakness, and kidney problems, so patients must be counseled on the importance of drinking an adequate volume of water and of other fluids per day.

Insomnia

Lastly, Parkinson's Disease patients may suffer from constipation caused by their sedentary lifestyle and medications. Therefore, exercising and maintaining a healthy diet are a must. The diet should be rich in fibers that can be obtained from sources such as fresh fruits and vegetables, whole grains, vegetables, legumes, and whole-grain bread and cereal.

Dehydration

Constipation

THE MYTHS ABOUT PARKINSON'S DISEASE

Parkinson's Disease is much more than just trembling and shaking. Non-motor symptoms such as dementia or cognitive impairment, which often occur in later stages, as well as depression, exhaustion and restless nights can often be more incapacitating.

The primary medication used to treat Parkinson's Disease is Levodopa. Many people, however, believe that it accelerates the disease's progression over time. Years ago, a clinical trial dispelled this myth, but many individuals still hold on to it.

As discussed above, there are other approaches to Parkinson's Disease than the pharmacological approach, and all approaches can be used to reduce the severity of symptoms and improve patients' quality of life. According to a recent study, patients who participated in weekly, hour-long exercise sessions were able to perform a higher number of daily tasks than those who did not.

DO NOT LET IT DEFINE YOU

"Parkinson's Disease may take away some of your physical abilities, but it can never take away your spirit."

- Karen Duffy

"Parkinson's Disease is a journey that can be traveled with hope if we choose."

- Sherri Woodbridge

"Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, 'I will try again tomorrow."

- Mary Anne Radmacher

"Parkinson's Disease is not a death sentence, it's a life sentence, forcing you to live life to the fullest."

Niall McGahan

-

"Living with Parkinson's Disease is not a death sentence, but rather a call to action."

- Davis Phinney

"Don't let Parkinson's Disease define you. Define yourself by how you live with Parkinson's Disease."

- David Leventhal

FROM JPSA

Maria Habash

Haya Hani

Deema Abudalhoum

Maha Mabrouk Public Health Chairperson

Ahmad Abu Arrah Public Health Local Coordinator Public Health Local Coordinator Public Health Local Coordinator

JPSA Contact Person

FROM LPSA

Maria Al Ounsi Rêve Khaddaj Ali Assi

Dimitra Al Hourani

Jenny Elia

Lina Haidar

Malak Rida

Mariam Khalili

Pharmacy Education Chairperson Newsletter Coordinator

FROM LPSA

Nour Chidiac

Cyrielle Saba

Media and Publications Chairperson

Social Media Coordinator

Alaa Amer

Sarah Ayache

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