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Integrative Parkinson’s Disease Care Part One

July 25, 2015 Written by JP    [Font too small?]

Parkinson’s disease (PD) is in the news on a weekly basis. According to the National Parkinson’s Foundation, there are approximately 50,000 to 60,00 new cases of PD diagnosed each year in the US alone. And, currently, it is estimated that up to 6,000,000 adults are living with PD worldwide. Thankfully, a significant amount of research is being directed at finding a cause and successful treatment for Parkinson’s. Still, it’s widely acknowledged that there’s a long way to go before a cure can be claimed.

In a recent interview, Dr. David Vallaincourt of the University of Florida admitted that, “The Parkinson’s drugs available today help reduce symptoms. They don’t slow the progression of the disease, which is the major unmet medical need.” Dr. Vallaincourt is part of a team of scientists looking for new biomarkers that will aid in the diagnosis and progression analysis of PD. However, these is reason for hope. Numerous studies now reveal that PD management can be enhanced by combining conventional treatment with alternative and complementary therapies.

Option #1: Integrative Acupuncture The September 2014 issue of BMC Complementary and Alternative Medicine reports that acupuncture stimulates areas of the brain (precentral gyrus and prefrontal cortex) affected by PD. Two other recent studies have found that integrating acupuncture with allopathic medicine reduces, “symptoms and signs of mind, behavior, mood, complications of therapy and depression in PD patients who received Western medicine.”

Option #2: Natural Caffeine and Gut Bacteria A protective association between coffee intake and PD has long been postulated. Now, a current trial has, likewise, found that yerba mate, a caffeinated herbal tea popular in South America, may decrease PD risk as well. This isn’t the only new development in the field of caffeine and PD research. An emerging hypothesis is that coffee and yerba mate may influence PD risk by beneficially altering gut bacteria in such a way so as to lower intestinal inflammation. Such inflammation may lead to changes in proteins that are linked to the type of neurodegeneration seen in PD.

Option #3: Dietary Fiber, Medication and Regularity – Psyllium husk fiber is sometimes recommended for PD patients who suffer from disease-related constipation. But, there are two other reasons why increasing dietary fiber may be of value. Firstly, fiber acts as a prebiotic – supporting the growth of good gut bacteria, the potential value of which is mentioned above. Secondly, using psyllium fiber along with levodopa, a common PD medication, may provide “more stable concentrations and final higher levels” of the drug that can result “in a great benefit for patients”. Having said that, any combining of supplemental fiber and levodopa should be carefully supervised by a medical professional.

Option #4: Move Your Body In a previous column, I presented a great deal of evidence showing that structured dance practice can be enormously helpful for those with PD. This line of study continues to show promise. I’ll list some of the latest studies on this topic in the “Comments & Updates” section at the bottom of the page. But, beyond that, I want to point out that more conventional forms of exercise, such as resistance or strength training, also aid cognitive functioning, mobility and slow disease progression. Furthermore, the effects of exercise can be bolstered by being physically active outside – in the sunshine. This may, in part, have to do with the noted connection between sun exposure and higher concentrations of Vitamin D.

Option #5: Move Your Mind-Body Parkinson’s disease is characterized by distinct changes in the brain. Namely, the brains of those with PD progressively stop producing dopamine, a neurotransmitter that regulates emotions and physical movement. But, the brain can also be used to counteract some of the effects of PD. For instance, a current trial discovered that an 8 week course of mindfulness training positively changed several neurobehavioral measures of PD. Other mind-body techniques including Tai Chi and yoga have demonstrated improvements in mood, postural stability, pulmonary function and tremor reduction.

In part two of this column, I’ll cover the most current data defining a link between diet, nutritional supplements and Parkinson’s disease. In the meantime, if you know anyone who has PD, please share the hopefulness in today’s blog with them. The groundbreaking research above only helps if it’s known by patients and physicians alike. So, help me spread the word!

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – UF Breakthrough Measures Parkinson’s Progression in the Brain (link)

Study 2 – Longitudinal Changes in Free-Water Within the Substantia Nigra (link)

Study 3 – Acupuncture on GB34 Activates the Precentral Gyrus and Prefrontal (link)

Study 4 – A Clinical Study of Integrating Acupuncture and Western Medicine (link)

Study 5 – Parkinson’s Disease Combined with Depression Treated with (link)

Study 6 – Inverse Association Between Yerba Mate Consumption and Idiopathic … (link)

Study 7 – Gut Feelings About Smoking and Coffee in Parkinson’s Disease (link)

Study 8 – Yerba Mate Enhances Probiotic Bacteria Growth in Vitro (link)

Study 9 – A Randomised Clinical Trial to Evaluate the Effects of Plantago Ovata (link)

Study 10 – Constipation in Parkinson’s Disease: Objective Assessment & Response (link)

Study 11 – Use of Probiotics for the Treatment of Constipation in Parkinson’s (link)

Study 12 – Exercise Improves Cognition in Parkinson’s Disease: The PRET-PD (link)

Study 13 – Systematic Review & Meta-Analysis of Strength Training in Individuals (link)

Study 14 – Associations Between Vitamin D Status, Supplementation, Outdoor (link)

Study 15 – Mindfulness Training Among Individuals with Parkinson’s Disease (link)

Study 16 – Randomized Controlled Pilot Study of the Therapeutic Effects of Yoga … (link)

Study 17 – Tai Chi Exercise Can Improve the Obstacle Negotiating Ability of (link)

The Effects of Acupuncture on Healthy and PD Brains

Source: BMC Complement Altern Med. 2014 Sep 15;14:336. (link)

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Posted in Alternative Therapies, Exercise, Mental Health

28 Comments & Updates to “Integrative Parkinson’s Disease Care Part One”

  1. JP Says:

    Updated 07/25/15:


    Front Neurol. 2015 May 27;6:122.

    Therapeutic Argentine Tango Dancing for People with Mild Parkinson’s Disease: A Feasibility Study.

    BACKGROUND: Individuals living with Parkinson’s disease (PD) can experience a range of movement disorders that affect mobility and balance and increase the risk of falls. Low health-related quality of life, depression, and anxiety are more common in people with PD than age-matched comparisons. Therapeutic dance is a form of physical activity believed to facilitate movement and therapy uptake. As well as being enjoyable, dancing is thought to improve mobility, balance, and well-being in some people living with PD. The primary objective of this study was to evaluate the feasibility and safety of a 4-week Argentine tango dance program for people with PD.

    METHODS: Six community dwelling individuals with mild to moderate PD were recruited from Parkinson’s support groups, movement disorder clinics, and the PD association in Australia. To minimize falls risk, participants were required to be <75 years of age and physically independent (Hoehn and Yahr stages I-III). They were also required to speak English. Participants attended a 1-hour dance class at a dance studio twice per week for 4 weeks. A professional dance instructor led and choreographed the Argentine tango dance classes. Physiotherapists were present to assist participants during the class and served as dance partners as necessary. The primary outcome was feasibility, which was determined by measures of recruitment, adherence, attrition, safety (falls, near misses and adverse events), and resource requirements. Secondary measures included the Beck Depression Inventory and the Euroqol-5D, administered at baseline and post intervention. Therapy outcomes pre- and post-intervention were analyzed descriptively as medians and interquartile ranges and using Wilcoxon matched pair signed-rank tests.

    RESULTS: The Argentine tango dance intervention was shown to be safe, with no adverse events. Adherence to the dance program was 89%. Depression scores improved after intervention (p = 0.04). Some challenges were associated with the need to quickly recruit participants and physiotherapists to act as dance partners during classes and to monitor participants.

    CONCLUSION: The 4-week, twice weekly Argentine tango dancing program was shown to be feasible and safe for people with mild-to-moderately severe PD.

    Be well!


  2. JP Says:

    Updated 07/25/15:


    Complement Ther Med. 2015 Apr;23(2):175-84.

    Tango for treatment of motor and non-motor manifestations in Parkinson’s disease: a randomized control study.

    OBJECTIVE: To determine effects of Argentine tango on motor and non-motor manifestations of Parkinson’s disease.

    DESIGN: Randomized control trial.

    PARTICIPANTS: Forty patients with idiopathic Parkinson’s disease.

    SETTING: Movement disorder clinic and dance studio.

    INTERVENTION: Two randomized groups: group (N=18) with 24 partnered tango classes, and control self-directed exercise group (N=15).

    MAIN OUTCOMES MEASURES: The primary outcome was overall motor severity. Secondary outcomes included other motor measures, balance, cognition, fatigue, apathy, depression and quality of life.

    RESULTS: On the primary intention-to-treat analysis there was no difference in motor severity between groups MDS-UPDRS-3 (1.6 vs.1.2-point reduction, p=0.85). Patient-rated clinical global impression of change did not differ (p=0.33), however examiner rating improved in favor of tango (p=0.02). Mini-BESTest improved in the tango group compared to controls (0.7±2.2 vs. -2.7±5.9, p=0.032). Among individual items, tango improved in both simple TUG time (-1.3±1.6s vs. 0.1±2.3, p=0.042) and TUG Dual Task score (0.4±0.9 vs. -0.2±0.4, p=0.012), with borderline improvement in walk with pivot turns (0.2±0.5 vs. -0.1±0.5, p=0.066). MoCa (0.4±1.6 vs. -0.6±1.5, p=0.080) and FSS (-3.6±10.5 vs. 2.5±6.2, p=0.057) showed a non-significant trend toward improvement in the tango group. Tango participants found the activity more enjoyable (p<0.001) and felt more "overall" treatment satisfaction (p<0.001). We found no significant differences in other outcomes or adverse events.

    CONCLUSION: Argentine tango can improve balance, and functional mobility, and may have modest benefits upon cognition and fatigue inParkinson's disease. These findings must be confirmed in longer-term trials explicitly powered for cognition and fatigue.

    Be well!


  3. JP Says:

    Updated 07/25/15:


    Complement Ther Med. 2015 Apr;23(2):210-9.

    Effects of dance on motor functions, cognitive functions, and mental symptoms of Parkinson’s disease: a quasi-randomized pilot trial.

    OBJECTIVE: To examine the effectiveness of dance on motor functions, cognitive functions, and mental symptoms of Parkinson’s disease (PD).

    DESIGN: This study employed a quasi-randomised, between-group design.

    SETTING: Dance, PD exercise, and all assessments were performed in community halls in different regions of Japan.

    PARTICIPANTS: Forty-six mild-moderate PD patients participated.

    INTERVENTION: Six PD patient associations that agreed to participate in the study were randomly assigned to a dance group, PD exercise group, or non-intervention group. The dance and PD exercise groups performed one 60-min session per week for 12 weeks. Control group patients continued with their normal lives. All groups were assessed before and after the intervention.

    MAIN OUTCOME MEASURES: We used the Timed Up-and-Go Test (TUG) and Berg Balance Scale (BBS) to assess motor function, the Frontal Assessment Battery at bedside (FAB) and Mental Rotation Task (MRT) to assess cognitive function, and the Apathy Scale (AS) and Self-rating Depression Scale (SDS) to assess mental symptoms of PD. The Unified Parkinson’s Disease Rating Scale (UPDRS) was used for general assessment of PD.

    RESULTS: When comparing results before and after intervention, the dance group showed a large effect in TUG time (ES=0.65, p=0.006), TUG step number (ES=0.66, p=0.005), BBS (ES=0.75, p=0.001), FAB (ES=0.77, p=0.001), MRT response time (ES=0.79, p<0.001), AS (ES=0.78, p<0.001), SDS (ES=0.66, p=0.006) and UPDRS (ES=0.88, p<0.001).

    CONCLUSIONS: Dance was effective in improving motor function, cognitive function, and mental symptoms in PD patients. General symptoms in PD also improved. Dance is an effective method for rehabilitation in PD patients.

    Be well!


  4. JP Says:

    Updated 07/25/15:


    Complement Ther Clin Pract. 2015 Feb;21(1):47-51.

    Is Irish set dancing feasible for people with Parkinson’s disease in Ireland?

    OBJECTIVE: To investigate if community-based Irish set dancing is feasible in Irish adults with Parkinson’s disease.

    METHODS: Over an eight week period, ten participants attended one set dancing class per week and completed a home programme in parallel. Feasibility was assessed by monitoring adverse effects, participants’ verbal feedback, compliance rates and feedback from an exit questionnaire. Participants were assessed using the Berg balance scale, 6-min walk test, UPDRS-3 and PDQ-39, before and after the intervention.

    RESULTS: No adverse effects were detected. Attendance at classes was 86%. Compliance with the home programme was 67%. Findings from the exit questionnaire showed participants enjoyed participating and reported improvements in aspects of health including balance. Quality of life improved with the dance programme and there was a trend toward improvement on the UPDRS-3.

    CONCLUSION: These findings suggest community-based Irish set dancing is a feasible form of exercise that can positively influence quality of life.

    Be well!


  5. JP Says:

    Updated 07/25/15:


    J Altern Complement Med. 2014 Oct;20(10):757-63.

    Are the effects of community-based dance on Parkinson disease severity, balance, and functional mobility reduced with time? A 2-year prospective pilot study.

    OBJECTIVE: To determine the effects of participation in a 2-year community-based dance class on disease severity and functional mobility in people with Parkinson disease (PD).

    DESIGN: Randomized controlled trial.

    SETTINGS/LOCATION: Dance classes took place in a community-based location. Outcome measures were collected in a university laboratory.

    PATIENTS: Ten individuals with PD were randomly assigned to the Argentine tango (AT) group (n=5 [4 men]; mean age±standard deviation, 69.6±6.6 years) or the control group (n=5 [4 men]; mean age±standard deviation, 66±11.0 years).

    INTERVENTIONS: The AT group participated in a community-based AT class for 1 hour twice weekly for 2 years. Control group participants were given no prescribed exercise. Blinded assessments occurred at baseline and 12 and 24 months.

    OUTCOME MEASURES: Movement Disorder Society-Unified Parkinson Disease Rating Scale (MDS-UPDRS) III, Mini-Balance Evaluation Systems Test (Mini-BESTest), gait velocity (forward and backward), Timed Up and Go and dual-task Timed Up and Go, Six-Minute Walk Test (6MWT), MDS-UPDRS II, MDS-UPDRS I, and Freezing of Gait Questionnaire.

    RESULTS: There were no differences between groups at baseline. A significant group-by-time interaction (F [2,8]=17.59; p<0.0001) was noted for the MDS-UPDRS III, with the AT group having lower scores at 12 and 24 months than the controls. Significant interactions were also noted for the Mini-BESTest, MDS-UPDRS II and I, and 6MWT.

    CONCLUSION: This is believed to be one of the longest-duration studies to examine the effects of exercise on PD. Participation in community-based dance classes over 2 years was associated with improvements in motor and nonmotor symptom severity, performance on activities of daily living, and balance in a small group of people with PD. This is noteworthy given the progressive nature of PD and the fact that the control group declined on some outcome measures over 2 years.

    Be well!


  6. JP Says:

    Updated 07/25/15:


    Int J Neurosci. 2014 Oct 22.

    Qigong exercise may improve sleep quality and gait performance in Parkinson’s disease: a pilot study.

    Purpose: Parkinson’s disease (PD) involves a variety of motor and non-motor symptoms, several of which, including gait abnormalities and sleep disorders, are generally not adequately managed with standard therapy. This study aimed to determine the impact of Qigong as a potential complementary therapy in the management of gait and sleep-related symptoms in PD. Methods: Seven subjects (aged 66.9 ± 8.1 years) with PD participated in a six-week Qigong exercise intervention. Pre- and post-intervention testing was performed to assess sleep quality, cognitive function, fatigue, quality of life, gait performance (stride time, stride length, double support time, and velocity), and gait variability (stride time and length variability). Results: Following Qigong, subjects showed improvement in some aspects of sleep quality. Fatigue remained unchanged. Gait function was improved by a significant reduction of stride time and a slight increase in stride length. Together these changes resulted in significant improvements to gait velocity. In addition, time spent in double limb support was reduced following the intervention. Overall gait variability improved significantly, particularly in the reduction of stride time variability. Conclusions: These results suggest that Qigong may provide benefit for gait performance and sleep quality in PD patients. However, larger, controlled studies are required to determine the immediate and long-term benefits of Qigong for PD sleep and gait problems as well as the impact on other aspects of the disease.

    Be well!


  7. JP Says:

    Updated 07/25/15:


    Complement Ther Clin Pract. 2014 Nov;20(4):251-61.

    Effectiveness of Anma massage therapy in alleviating physical symptoms in outpatients with Parkinson’s disease: a before-after study.

    We aimed to confirm the physical effects of a single Anma massage session and continuous Anma massage therapy for outpatients with Parkinson’s disease (PD). Twenty-one PD outpatients (mean age, 64.43 ± 8.39 [SD] years; Hoehn and Yahr stage I-IV) received a single 40-min Anma massage session involving upper and lower limb exercises and some subsequently received seven weekly Anma massage sessions. After a single session, visual analogue scale scores were significantly lower for muscle stiffness, movement difficulties, pain, and fatigue; gait speed and pegboard test time were significantly shortened; stride length was significantly lengthened; and shoulder flexion and abduction were significantly improved. No significant changes occurred in controls. After continuous sessions, we found general improvements in the same outcomes. In conclusion, Anma massage might effectively alleviate various physical PD symptoms; furthermore, because it is given through clothing, Anma massage is accessible for PD patients with movement difficulties.

    Be well!


  8. JP Says:

    Updated 07/26/15:


    Disabil Rehabil. 2015 Jul 22:1-11.

    Choral singing therapy following stroke or Parkinson’s disease: an exploration of participants’ experiences.

    PURPOSE: People with stroke or Parkinson’s disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others.

    METHOD: Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (total N = 23).

    RESULTS: Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options. CST participation was described as an enjoyable social activity, and participation was perceived as improving mood, language, breathing and voice.

    CONCLUSIONS: Choral singing was perceived by people with stroke and PD to help them self-manage some of the consequences of their condition, including social isolation, low mood and communication difficulties. Implications for Rehabilitation Choral singing therapy (CST) is sought out by people with stroke and PD to help self-manage symptoms of their condition. Participation is perceived as an enjoyable activity which improves mood, voice and language symptoms. CST may enable access to specialist music therapy and speech language therapy protocols within community frameworks.

    Be well!


  9. JP Says:

    Updated 07/26/15:


    Altern Ther Health Med. 2015 Jan-Feb;21(1):8-14.

    Feldenkrais method-based exercise improves quality of life in individuals with Parkinson’s disease: a controlled, randomized clinical trial.

    CONTEXT: Longevity results in changes to patterns of health, with an increased prevalence of chronic diseases. Parkinson’s disease (PD) is described as a progressive neurodegenerative disease related to age that influences quality of life (QoL) and leads to depression.

    OBJECTIVE: The study intended to assess changes in QoL and depression in older adults with PD through use of Feldenkrais method-based exercise.

    DESIGN: The study was a controlled, blinded, and randomized clinical trial.

    SETTING: The study occurred at the University Hospital of the Federal University of Sergipe in Aracaju, Sergipe, Brazil.

    PARTICIPANTS: Participants were 30 patients, aged between 50 and 70 y, with idiopathic PD, who signed an informed consent form and were randomly assigned to 2 groups: treatment and control.

    INTERVENTION: The treatment group underwent 50 sessions of an exercise program based on the Feldenkrais method. The control group received educational lectures during this period. The treatment group’s 50 sessions, given 2 ×/wk on alternate days and lasting 60 min, were conducted in an appropriate room at the hospital.

    OUTCOME MEASURES: Two surveys, the Parkinson’s Disease Quality of Life (PDQL) questionnaire and the Beck Depression Inventory (BDI), were administered before and after the sessions for both groups.

    RESULTS: After the exercises based on the Feldenkrais method, the treated group showed improvement in QoL scores (P = .004) as well as a reduction in the level of depression (P = .05) compared with the control group.

    CONCLUSION: The findings in the current study indicate that it is likely that the practice of a program based on the Feldenkrais method can contribute greatly to the QoL of patients with PD, suggesting the importance of interventions that promote wellness for this population.

    Be well!


  10. JP Says:

    Updated 08/12/15:


    J Altern Complement Med. 2015 Jul 31.

    A Prospective Open-Label Study of Combined Treatment for Idiopathic Parkinson’s Disease Using Acupuncture and Bee Venom Acupuncture as an Adjunctive Treatment.

    OBJECTIVES: The purpose of this study was to examine the effectiveness and safety of combined treatment using acupuncture and bee venom acupuncture (BVA) as an adjunctive treatment for idiopathic Parkinson’s disease (PD).

    METHODS: Eleven patients (7 men and 4 women) with idiopathic PD who had been receiving a stable dose of anti-parkinsonian medication for at least 4 weeks. Participants received conventional treatment for 12 weeks. Subsequently, they received additional treatment with acupuncture and BVA twice weekly for 12 weeks while still maintaining conventional treatment. All participants were assessed at baseline, 12 weeks, and 24 weeks by using the Unified Parkinson’s Disease Rating Scale (UPDRS), the Parkinson’s Disease Quality of Life Questionnaire (PDQL), the speed and number of steps required to walk 20 m, and the Beck Depression Inventory (BDI). Maximum excursion and directional control, measured by computerized dynamic posturography (Balance Master® System, NeuroCom, San Carlos, CA), were used to assess postural stability.

    RESULTS: Patients who underwent 12 weeks of twice-weekly combined treatment with acupuncture and BVA showed significant improvements in gait speed, PDQL score, activities of daily living (UPDRS part II), motor symptoms (UPDRS part III), and combined UPDRS part II+III scores compared with assessments after conventional treatment.

    CONCLUSIONS: Combined treatment with acupuncture and BVA showed promising results as a safe adjunctive therapy for PD.

    Be well!


  11. JP Says:

    Updated 10/30/15:


    “For patients with Parkinson’s disease (PD), acupuncture is associated with improvement in gait function, according to a study published in the October issue of the Journal of the American Geriatrics Society.

    Shimpei Fukuda, Ph.D., from the Meiji University of Integrative Medicine in Kyoto, Japan, and colleagues examined the immediate effects of acupuncture on gait function in 27 outpatients with PD. The acupuncture points used were bilateral legs, bilateral arms, posterior region of neck, and back. Acupuncture needles were inserted perpendicular to the skin surface to a depth of 10 mm. A portable gait rhythmogram was used to measure gait function.

    The researchers observed significant increases in gait speed, step length, floor reaction force (all P < 0.001), and cadence (P = 0.007) after acupuncture. No adverse effects related to the therapy were reported." Be well! JP

  12. JP Says:

    Updated 1/31/16:


    Age Ageing. 2016 Jan 29.

    Abdominal massage for the alleviation of symptoms of constipation in people with Parkinson’s: a randomised controlled pilot study.

    BACKGROUND: constipation is one of the most common non-motor features of Parkinson’s affecting up to 90% of patients. In severe cases, it can lead to hospitalisation and is usually managed with laxatives which in themselves can lead to side effects. Abdominal massage has been used as adjunct in the management of constipation in various populations, but not in those with Parkinson’s.

    OBJECTIVE: the primary objective was to test the recruitment, retention and the appropriateness of the intervention methods and outcome measures.

    METHODS: thirty-two patients with Parkinson’s were recruited from three movement disorder clinics and were randomised to receive either 6 weeks of daily abdominal massage plus lifestyle advice on managing constipation (Intervention Group, n = 16) or lifestyle advice (Control Group, n = 16). Data were collected prior to group allocation (Baseline), at Week 6 (following intervention) and 4 weeks later (Week 10). Outcome tools included the Gastrointestinal Rating Scale and a bowel diary.

    RESULTS: constipation has a negative impact on quality of life. The study recruited to target, retention was high and adherence to the study processes was good. The massage was undertaken as recommended during the 6 weeks of intervention with 50% continuing with the massage at 10 weeks. Participants in both groups demonstrated an improvement in symptoms, although this was not significantly different between the groups.

    CONCLUSION: abdominal massage, as an adjunct to management of constipation, offers an acceptable and potentially beneficial intervention to patients with Parkinson’s.

    Be well!


  13. JP Says:

    Updated 03/28/16:


    Front Neurol. 2016 Mar 8;7:27.

    Espresso Coffee for the Treatment of Somnolence in Parkinson’s Disease: Results of n-of-1 Trials.

    There is limited information available concerning the treatment of daytime somnolence associated with Parkinson’s disease (PD); the most frequently applied therapeutic strategies include decreasing the dose of dopamine agonists or adding potential wake-promoting agents. There is recent data from a placebo-controlled trial concluding on a non-significant trend in favor of caffeine. We aimed to evaluate the efficacy of espresso-coffee in the treatment of daytime somnolence in PD. To evaluate the efficacy of espresso-coffee in the treatment of daytime somnolence in PD, we have conducted multiple single-patient (n-of-1) clinical trials comparing regular espresso coffee to decaffeinated coffee in PD patients presenting moderate to severe daytime somnolence defined as an Epworth Sleepiness Scale score >9. Each single-patient (n-of-1) trial included a sequence of three crossovers (two treatment periods separated by two days of washout). Four patients were included in the studies and three completed the three pairs of treatment periods. In two of the four patients, espresso coffee was considered beneficial. This study concludes that multiple single patient trials are feasible in PD and suggests that espresso-coffee may have a beneficial effect on daytime somnolence in some patients. These results cannot be generalized beyond the patients included in these trials.

    Be well!


  14. JP Says:

    Updated 04/11/16:


    Explore (NY). 2016 Mar 3.

    Laughter Yoga, Adults Living With Parkinson׳s Disease, and Caregivers: A Pilot Study.

    OBJECTIVE: This study explored outcomes of Laughter Yoga in adults with Parkinson׳s disease (PD) and their caregivers. Laughter has been shown to generally improve mood in physically healthy adults, and specifically in adults with heart disease or cancer, but little research exists regarding the impact of laughter in adults with Parkinson׳s disease. Low mood is frequently a co-morbid condition for adults with Parkinson׳s disease, and can negatively affect their caregivers.

    DESIGN: Pre-experimental (O1 × O2) pretest-posttest design.

    SETTINGS/LOCATION: Data collection occurred at six unique PD support groups in Southern California.

    SUBJECTS: Participants (N = 85) comprised a convenience sample of adults diagnosed with Parkinson׳s disease (n = 47) and accompanying caregivers (n = 38).

    INTERVENTION: Subjects participated in a 45-min Laughter Yoga (LY) session conducted by a Certified Laughter Yoga Teacher.

    OUTCOME MEASURES: This study utilized the Laughter Yoga “How Do You Feel?” (HDYF) form. The form consists of a series of 10 scales labeled “well-being” measures including enthusiasm, energy level, mood, optimism, stress level, level of friendship with group members, level of awareness about breathing, level of muscle relaxation, level of mental relaxation, and ability to laugh without a reason.

    RESULTS AND CONCLUSION: Paired sample t-tests reveal statistically significant improvements in well-being for adults with PD and their caregivers after attending an LY session. Therapists and other clinicians should consider utilizing this unique technique with adults with PD to address co-morbid low-mood conditions and include caregivers in the LY sessions for support and their own benefit.

    Be well!


  15. JP Says:

    Updated 04/22/16:


    Complement Ther Med. 2016 Apr;25:126-31.

    Controlled pilot study of the effects of power yoga in Parkinson’s disease.

    OBJECTIVES: To evaluate the effects of a specially designed power yoga program (YOGA) on bradykinesia, rigidity, muscular performance and quality of life in older patients with PD.

    DESIGN: Randomized controlled trial.

    SETTING: University laboratory, US.

    INTERVENTION: Twenty-six patients with mild to moderate PD were randomly assigned to a YOGA or control group (CON). The YOGA program was three months, incorporating two sessions/wk of yoga classes.

    MAIN OUTCOME MEASURES: Upper and lower limb bradykinesia and rigidity scores from the Unified Parkinson’s Disease Rating Scale, one repetition maximums (1RM) and peak powers on biceps curl, chest press, leg press, hip abduction and seated calf, and quality of life (PDQ-39).

    RESULTS: The YOGA group produced significant improvement in both upper and lower limbs bradykinesia scores, rigidity score, 1RM for all 5 machines and leg press power (p<.05). Significant improvements were seen in the PDQ-39 overall score, mobility and activities of daily living domain for the YOGA group. CONCLUSION: The 3-month YOGA program significantly reduced bradykinesia and rigidity, and increased muscle strength and power in older patients with PD. Power training is an effective training modality to improve physical function and quality of life for PD. Be well! JP

  16. JP Says:

    Updated 05/27/16:


    PLoS One. 2016 May 26;11(5):e0155613.

    A Pilot Clinical Trial to Objectively Assess the Efficacy of Electroacupuncture on Gait in Patients with Parkinson’s Disease Using Body Worn Sensors.

    BACKGROUND: Gait disorder, a key contributor to fall and poor quality of life, represents a major therapeutic challenge in Parkinson’s disease (PD). The efficacy of acupuncture for PD remains unclear, largely due to methodological flaws and lack of studies using objective outcome measures.

    OBJECTIVE: To objectively assess the efficacy of electroacupuncture (EA) for gait disorders using body-worn sensor technology in patients with PD.

    METHODS: In this randomized pilot study, both the patients and assessors were masked. Fifteen PD patients were randomly assigned to an experimental group (n = 10) or to a control group (n = 5). Outcomes were assessed at baseline and after completion of three weekly EA treatments. Measurements included gait analysis during single-task habitual walking (STHW), dual-task habitual walking (DTHW), single-task fast walking (STFW), dual-task fast walking (DTFW). In addition, Unified Parkinson’s Disease Rating Scale (UPDRS), SF-12 health survey, short Falls Efficacy Scale-International (FES-I), and visual analog scale (VAS) for pain were utilized.

    RESULTS: All gait parameters were improved in the experimental group in response to EA treatment. After adjustment by age and BMI, the improvement achieved statistical significant level for gait speed under STHW, STFW, and DTFW (9%-19%, p<0.05) as well as stride length during DTFW (9%, p = 0.037) and midswing speed during STFW (6%, p = 0.033). No significant changes were observed in the control group (p>0.110). The highest correlation between gait parameters and UPRDS scores at baseline was observed between gait speed during STFW and UPDRS II (r = -0.888, p = 0.004). The change in this gait parameter in response to active intervention was positively correlated with baseline UPDRS (r = 0.595, p = 0.057). Finally, comparison of responses to treatment between groups showed significant improvement, prominently in gait speed (effect size 0.32-1.16, p = 0.001).

    CONCLUSIONS: This study provides the objective proof of concept for potential benefits of non-pharmaceutical based EA therapy on enhancing gait in patients with PD.

    Be well!


  17. JP Says:

    Updated 06/04/16:


    J Parkinsons Dis. 2016 Jun 3.

    Potential Benefit of Singing for People with Parkinson’s Disease: A Systematic Review.

    BACKGROUND: There is evidence that participation in performing arts brings psychosocial benefits in the general population and in recent years there has been substantial interest in the potential therapeutic benefit of performing arts, including singing, for people with chronic medical conditions including those of neurological aetiology.

    OBJECTIVE: To systematically review the existing body of evidence regarding the potential benefit of singing on clinical outcomes of people with PD.

    METHODS: Seven online bibliographic databases were systematically searched in January 2016 and supplementary searches were conducted. Full-text original peer-reviewed scientific papers that investigated the potential benefit of singing on at least one of speech, functional communication, cognitive status, motor function and quality of life in human participants with PD were eligible for inclusion.

    RESULTS: 449 unique records were identified, 25 full-text articles were screened and seven studies included in the review. All seven studies assessed the impact of singing on speech, five found partial evidence of benefit and two found no evidence of benefit. One study assessed each of functional communication and quality of life and no significant benefit was found. No included study assessed the impact of singing on motor function or cognitive status.

    CONCLUSIONS: Singing may benefit the speech of people with PD, although evidence is not unequivocal. Further research is required to assess wider benefits including on functional communication, cognitive status, motor function and quality of life. Substantial methodological limitations were identified in the existing literature. Recommendations are made for advancing the state of the literature.

    Be well!


  18. JP Says:

    Updated 06/16/16:


    J Bodyw Mov Ther. 2016 Apr;20(2):364-72.

    Anma massage (Japanese massage) therapy for patients with Parkinson’s disease in geriatric health services facilities: Effectiveness on limited range of motion of the shoulder joint.

    OBJECTIVE: To determine the efficacy of Anma massage therapy for patients with Parkinson’s disease (PD) in geriatric health services facilities.

    METHODS: (1) Immediate treatment effects: 10 PD patients, in the intervention period with Hoehn and Yahr (H&Y) scale at stage 5, received 30-40 min sessions of Anma massage therapy. In the non-intervention period, six PD patients did not undergo this therapy. The shoulder joint range of motion (ROM) was measured before and after each session. (2) Continuous treatment effects: Six PD patients in the intervention period received the same massage sessions once a week continuously for seven weeks. One week after the completion of the treatment, the ROM of the shoulder joints was measured.

    RESULTS: (1) Shoulder abduction on the more affected side showed immediate significant improvements. (2) Shoulder abduction on the more affected side and less affected side showed notable effects of continuous treatment procedure leading to significant improvement.

    CONCLUSION: The above results suggested the efficacy of successive Anma massage therapy.

    Be well!


  19. JP Says:

    Updated 08/31/16:


    Neurology. 2016 Aug 19.

    Probiotics and prebiotic fiber for constipation associated with Parkinson disease: An RCT.

    OBJECTIVES: Our objective was to evaluate the efficacy of probiotics and prebiotics in patients with Parkinson disease (PD) and constipation.

    METHODS: We conducted a tertiary setting, randomized, double-blind, placebo-controlled trial in patients with PD with Rome III-confirmed constipation based on 2-week stool diary data at baseline. Patients (n = 120) were randomly assigned (2:1) to either a fermented milk, containing multiple probiotic strains and prebiotic fiber, or placebo, once daily for 4 weeks. The primary efficacy endpoint was the increase in the number of complete bowel movements (CBMs) per week. The key secondary endpoints were 3 or more CBMs and an increase by one or more CBMs per week during weeks 3 and 4.

    RESULTS: For the primary endpoint, the consumption of a fermented milk containing probiotics and prebiotics resulted in a higher increase in the number of CBMs (mean 1.2, 95% confidence interval [CI] 0.8-1.6) than placebo (0.1, 95% CI -0.4% to 0.6%) (mean difference 1.1, 95% CI 0.4-1.8; p = 0.002). For the key secondary endpoints, a higher number of patients in the probiotics-prebiotics group vs the placebo group reported 3 or more CBMs (p = 0.030; 58.8% vs 37.5%; odds ratio = 2.4, 95% CI 1.1-5.2) and an increase by one or more CBMs (p = 0.004; 53.8% vs 25.0%; odds ratio = 3.5, 95% CI 1.8-8.1) during weeks 3 and 4.

    CONCLUSIONS: The consumption of a fermented milk containing multiple probiotic strains and prebiotic fiber was superior to placebo in improving constipation in patients with PD.

    Be well!


  20. JP Says:

    Updated 09/10/16:


    BMC Neurol. 2016 Sep 8;16:166.

    The effects of a mindfulness-based lifestyle program for adults with Parkinson’s disease: a mixed methods, wait list controlled randomised control study.

    BACKGROUND: Parkinson’s disease (PD) is the second commonest neurodegenerative disease in developed countries. Current treatment for PD is pharmacologically focused and can have significant side-effects. There is increasing interest in holistic approaches including mindfulness to help manage the challenges associated with living with PD. We hypothesised that there would be an improvement in PD associated function and wellbeing in participants after participating in a 6-week mindfulness-based lifestyle program, and that these improvements would be sustainable at 6 months. Our primary objective was to determine changes in function and wellbeing associated with PD.

    METHODS: An exploratory prospective, mixed-method, randomised control trial incorporating a before and after design with a waitlist control, with an embedded qualitative component was conducted in 2012-2013. Participants included community living adults with disability congruent to H&Y Stage 2 PD, aged 18-75, fluent in spoken and written English and able to attend at least four of six sessions of the program. Participants were randomised to the intervention or wait-list control groups at two locations. All participants in the wait-list control group eventually received the intervention. Two randomisation codes were created for each location. Allocation to the intervention or wait-list control was by random number generation. The program facilitator and participants were blinded to participant data.

    RESULTS: Group 1 included 35 participants and group 2 (the waitlist control), 37. Data was analysed from 24 (group 1) and 33 (group 2) participants. The intervention group, compared to the waitlist control, showed a small improvement in function and wellbeing associated with PD immediately after the program (t-score = -0.59) and at 6-month post intervention (t-score = -1.42) as reported by the PDQ-39 SI. However this finding was not significant (p = 0.56 and 0.16 respectively). A small yet significant effect size (β = 0.23) in PDQ-39 ADL was reported in group 1 after 6-months post-intervention. This showed a positive improvement in the ADL as reported by group 1 after 6-months (t-score -1.8, p = 0.04). Four secondary measures are reported.

    CONCLUSIONS: Our findings suggest mindfulness-based lifestyle programs have potential to assist participants in managing the ongoing difficulties associated with a neurological condition such as Parkinson’s disease. Importantly, our study shows promise for the long term benefits of such programs. Improvements to participant activities in daily living and mindfulness were retained at 6-months post intervention. A more definitive study should be conducted in a larger sample of PD patients to further explore these findings and their impact on reducing stress and anxiety in PD patients.

    Be well!


  21. JP Says:

    Updated 10/24/16:


    Contemp Clin Trials. 2016 Oct 17.

    A pilot study to evaluate multi-dimensional effects of dance for people with Parkinson’s disease.

    Parkinson’s disease (PD) is a progressive neurodegenerative disease associated with deficits in motor, cognitive, and emotion/quality of life (QOL) domains, yet most pharmacologic and behavioral interventions focus only on motor function. Our goal was to perform a pilot study of Dance for Parkinson’s-a community-based program that is growing in popularity-in order to compare effect sizes across multiple outcomes and to inform selection of primary and secondary outcomes for a larger trial. Study participants were people with PD who self-enrolled in either Dance for Parkinson’s classes (intervention group, N=8) or PD support groups (control group, N=7). Assessments of motor function (Timed-Up-and-Go, Gait Speed, Standing Balance Test), cognitive function (Test of Everyday Attention, Verbal Fluency, Alternate Uses, Digit Span Forward and Backward), and emotion/QOL (Geriatric Depression Scale, Falls Efficacy Scale-International, Parkinson’s Disease Questionnaire-39 (total score and Activities of Daily Living subscale)) were performed in both groups at baseline and follow-up. Standardized effect sizes were calculated within each group and between groups for all 12 measures. Effect sizes were positive (suggesting improvement) for all 12 measures within the intervention group and 7 of 12 measures within the control group. The largest between-group differences were observed for the Test of Everyday Attention (a measure of cognitive switching), gait speed and falls efficacy. Our findings suggest that dance has potential to improve multiple outcomes in people with PD. Future trials should consider co-primary outcomes given potential benefits in motor, cognitive and emotion/QOL domains.

    Be well!


  22. JP Says:

    Updated 11/20/16:


    J Exerc Rehabil. 2016 Oct 31;12(5):499-503.

    Effects of therapeutic Tai chi on functional fitness and activities of daily living in patients with Parkinson disease.

    The purpose of the study is to investigate the effects of therapeutic Tai chi (TTC) on the functional fitness status and activities of daily living (ADL) of patients with Parkinson disease (PD). The participants were clinically stable PDs in Hoehn and Yahr stage 1-2. These patients were randomly assigned to either the TTC group (n=11) or the control (CON) group (n=9). The TTC exercised at the clinic 2 times a week and performed home-based activity 1 time per week for 12 weeks. All the PDs were evaluated for functional fitness test and ADL screen before and after the 12-week trial. There was a significant Time × group interaction effect on the arm curl (P<0.01), functional reach (P<0.05), and stand on foot with eyes opened (P<0.05) of the functional fitness as compared to the CON. The results of the functional reach test in the CON worsened significantly during the 12-week intervention in comparison with those of the TTC (P<0.01). Also ADL showed significant changed in TCC (P<0.05). Tai chi training showed good effects on the functional fitness in PDs. This study suggests that further research into the based such as Tai chi intervention must be developed PD's quality of life in the future.

    Be well!


  23. JP Says:

    Updated 11/30/16:


    Evid Based Complement Alternat Med. 2016;2016:5935782.

    Effects of Health Qigong Exercises on Relieving Symptoms of Parkinson’s Disease.

    The purpose of this study was to investigate the effects of Health Qigong on the treatment and releasing symptoms of Parkinson’s disease (PD). Fifty-four moderate PD patients (N = 54) were randomly divided into experimental and control groups. Twenty-eight PD patients were placed in the experimental group in which the prescribed medication plus Health Qigong exercise will be used as intervention. The other 26 PD patients as the control group were treated only with regular medication. Ten-week intervention had been conducted for the study, and participants completed the scheduled exercises 5 times per week for 60 minutes each time (10 minutes for warm-up, 40 minutes for the exercise, and 10 minutes for cooldown). Data which included the muscle hardness, one-legged blind balance, physical coordination, and stability was collected before, during, and after the intervention. Comparisons were made between the experimental and control groups through the Repeated Measures ANOVA. The results showed that PD patients demonstrate a significant improvement in muscle hardness, the timed “up and go,” balance, and hand-eye coordination (the turn-over-jars test). There were no significant differences between the two groups in gender, age, and course of differences (P < 0.05). The study concluded that Health Qigong exercises could reduce the symptoms of Parkinson's disease and improve the body functions of PD patients in both the mild and moderate stages. It can be added as an effective treatment of rehabilitation therapy for PD. Be well! JP

  24. JP Says:

    Updated 06/26/17:


    Parkinsons Dis. 2017;2017:1902708.

    A Randomized Controlled Trial of Chinese Medicine on Nonmotor Symptoms in Parkinson’s Disease.

    Nonmotor symptoms (NMS) of Parkinson’s disease (PD) have devastating impacts on both patients and their caregivers. Jiawei-Liujunzi Tang (JLT) has been used to treat some NMS of PD based on the Chinese medicine theory since Qing dynasty. Here we report a double-blind, randomized, placebo-controlled, add-on clinical trial aiming at evaluating the efficacy and safety of the JLT in treating NMS in PD patients. We randomly assigned 111 patients with idiopathic PD to receive either JLT or placebo for 32 weeks. Outcome measures were baseline to week 32 changes in Movement Disorder Society-Sponsored Revision of Unified PD Rating Scale (MDS-UPDRS) Parts I-IV and in NMS assessment scale for PD (NMSS). We observed improvements in the NMSS total score (p = 0.019), mood/cognition (p = 0.005), and reduction in hallucinations (p = 0.024). In addition, post hoc analysis showed a significant reduction in constipation (p < 0.001). However, there was no evidence of improvement in MDS-UPDRS Part I total score (p = 0.216) at week 32. Adverse events (AEs) were mild and comparable between the two groups. In conclusion, long-term administration of JLT is well tolerated and shows significant benefits in improving NMS including mood, cognition, and constipation. Be well! JP

  25. JP Says:

    Updated 10/01/17:


    Medicines (Basel). 2017 Apr 23;4(2).

    Qigong Exercise May Reduce Serum TNF-α Levels and Improve Sleep in People with Parkinson’s Disease: A Pilot Study.

    Background: Inflammatory cytokine levels are often elevated in people with Parkinson’s disease (PD). People with PD often experience sleep disturbances that significantly impact quality of life. Past studies suggest inflammatory cytokines may be associated with various symptoms of PD. Benefits of Qigong, a mind-body exercise, have been shown in different neurological conditions, but there is still a lack of clinical evidence in the PD population.

    Methods: Ten people with PD were recruited and randomly assigned into two groups receiving six weeks of Qigong (experimental group) or sham Qigong (control group) intervention. The levels of TNF-α, IL-1β, and IL-6 in subjects’ serum and sleep quality were measured before and after the intervention.

    Results: After the intervention, the serum level of TNF-α in the experimental group was significantly decreased in all subjects, while the level in the control group showed a trend to increase. Qigong exercise significantly improved sleep quality at night. There was a strong correlation between changes in the level of TNF-α and sleep quality.

    Conclusion: Qigong exercise decreased TNF-α level in people with PD and helped improve sleep quality. TNF-α may have a potential to influence the sleep quality in people with PD.

    Be well!


  26. JP Says:

    Updated 04/11/18:


    J Evid Based Integr Med. 2018 Jan-Dec;23:2515690X18765943.

    The Applied Effectiveness of Clay Art Therapy for Patients With Parkinson’s Disease.

    This study investigates how clay art therapy affects Parkinson’s disease patients’ overall mental and physical condition as well as future treatment potentiality. The research was nonequivalent control groups pre and post study. A total of 54 patients with Parkinson’s disease (control = 28, experimental = 26) were recruited from 3 setting locations in South Korea. Test measures were completed before and after the 16 sessions. The experimental group received two 80-minute evaluations per week for 8 weeks. Demographic information: hand dexterity, self-expression, mood depression, and quality of life measurements. There were significant differences in hand dexterity ( t = 4.96, P < .001), self-expression ( t = 3.74, P < .001), mood depression ( t = -11.85, P < .001), and quality of life ( t = 8.07, P < .001) between the 2 groups. Further research and development of clay art therapy can advocate the benefits, highlight practicality and demonstrate the possibility for its usage as a treatment methodology. Be well! JP

  27. JP Says:

    Updated 08/14/18:


    Mov Disord. 2018 Aug 11.

    Low-fat versus ketogenic diet in Parkinson’s disease: A pilot randomized controlled trial.

    BACKGROUND: Preliminary evidence suggests that diet manipulation may influence motor and nonmotor symptoms in PD, but conflict exists regarding the ideal fat to carbohydrate ratio.

    OBJECTIVES: We designed a pilot randomized, controlled trial to compare the plausibility, safety, and efficacy of a low-fat, high-carbohydrate diet versus a ketogenic diet in a hospital clinic of PD patients.

    METHODS: We developed a protocol to support PD patients in a diet study and randomly assigned patients to a low-fat or ketogenic diet. Primary outcomes were within- and between-group changes in MDS-UPDRS Parts 1 to 4 over 8 weeks.

    RESULTS: We randomized 47 patients, of which 44 commenced the diets and 38 completed the study (86% completion rate for patients commencing the diets). The ketogenic diet group maintained physiological ketosis. Both groups significantly decreased their MDS-UPDRS scores, but the ketogenic group decreased more in Part 1 (low-fat group: -0.99 ± 3.63 points vs. ketogenic group: -4.58 ± 2.17 points; P < 0.001), representing a 41% improvement in baseline Part 1 scores compared to 11% in the low-fat group, with the largest between-group decreases observed for urinary problems, pain and other sensations, fatigue, daytime sleepiness, and cognitive impairment; there were no between-group differences in the magnitude of decrease for Parts 2 to 4. The most common adverse effects were excessive hunger in the low-fat group and intermittent exacerbation of the PD tremor and/or rigidity in the ketogenic group. CONCLUSIONS: It is plausible and safe for PD patients to maintain a low-fat or ketogenic diet for 8 weeks. Both diet groups significantly improved in motor and nonmotor symptoms; however, the ketogenic group showed greater improvements in nonmotor symptoms. Be well! JP

  28. JP Says:

    Updated 12/01/18:


    J Nutr Health Aging. 2018;22(10):1211-1215.

    MIND Diet Associated with Reduced Incidence and Delayed Progression of Parkinsonism in Old Age.

    BACKGROUND: In old age, motor impairments including parkinsonian signs are common, but treatment is lacking for many older adults. In this study, we examined the association of a diet specifically developed to promote brain health, called MIND (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay), to the incidence and progression of parkinsonism in older adults.

    METHODS: A total of 706 Memory and Aging Project participants aged 59 -97 years and without parkinsonism at baseline were assessed annually for the presence of four parkinsonian signs using a 26-item modified version of the United Parkinson’s Disease Rating Scale. Incident parkinsonism was defined as the first occurrence over 4.6 years of follow-up of two or more parkinsonian signs. The progression of parkinsonism was assessed by change in a global parkinsonian score (range: 0-100). MIND, Mediterranean, and DASH diet pattern scores were computed based on a validated food frequency questionnaire including 144 food items. We employed Cox-Proportional Hazard models and linear mixed models, to examine the associations of baseline diet scores with incident parkinsonism and the annual rate of change in global parkinsonian score, respectively.

    RESULTS: In models adjusted for age, sex, smoking, total energy intake, BMI and depressive symptoms, higher MIND diet scores were associated with a decreased risk of parkinsonism [(HR=0.89, 95% CI 0.83-0.96)]; and a slower rate of parkinsonism progression [(β= -0.008; SE=0.0037; p=0.04)]. The Mediterranean diet was marginally associated with reduced parkinsonism progression (β= -0.002; SE=0.0014; p=0.06). The DASH diet, by contrast, was not associated with either outcome.

    CONCLUSION: The MIND diet created for brain health may be a associated with decreased risk and slower progression of parkinsonism in older adults.

    Be well!


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