The medications we have for Parkinson’s disease are very effective in controlling the symptoms of Parkinson’s disease. But wouldn’t it be great to have some medication that would slow the progression of Parkinson’s disease?
The process of slowing down Parkinson’s disease by preventing further death of Dopamine-producing cells is called “Neuroprotection”. There are no approved medications for neuroprotection. However there are many candidate drugs, and many things you can try to slow down Parkinson’s disease.
1. Stay Active:
Multiple studies have demonstrated that moderate levels of physical activity reduce the risk of Parkinson’s disease. The largest such study is a Swedish study that studied more than 43,000 patients over 12 years! (Yang 2015). Physical activity can improve many of the movement problems caused by Parkinson’s disease, especially balance (Dibble 2009). In addition, physical activity can improve many other non-movement symptoms related to Parkinson’s disease such as Thinking & Memory! (Tanaka 2008).
Although only a few studies have been listed here for reference, the evidence in support of exercise having a beneficial effect is extremely robust. Many prominent publications have highlighted physical activity as being an extremely important component of treatment in early Parkinson’s disease (Ahlskog 2011). Consider reading this article by Dr. Ahlskog in detail: Click here: Vigorous physical exercise may be neuroprotective (Alshkog 2011)
Now that, hopefully, I have convinced you that physical exercise can benefit you tremendously the next question is – what kind of exercise? I recommend that you exercise in two ways:
- Aerobic exercise – Walk for 30 minutes everyday. If possible, walk for 30-40 minutes everyday and make it brisk. Vigorous exercise – or aerobic physical activity for 20-30 minutes that increases the heart rate and the need for oxygen – is thought to be more protective than light exercise.
Therefore, brisk walking or a jog might be better than leisurely walking – Although both are infinitely more beneficial than doing nothing.
- Balance training – This is best learnt from a Physical therapist. Patients with Parkinson’s disease are at a high risk for falls, both because their feet get “stuck” to the ground, and because the normal postural reflexes that keep us from falling are impaired. Balance training is a set of exercises that can help you maintain better balance.
I will post a small video on balance training soon, but until that time you can meet your neighborhood physiotherapist to learn these exercises or follow the exercises posted on Mayo clinic’s website (click here) You may want to explore Yoga or Tai-Chi, many of the Yoga exercises emphasize balance. Remember: Only do the exercises you feel safe doing.
- Physical exercise reduces risk of Parkinson’s disease (Yang 2015)
- Exercise improves balance in Parkinson’s disease patients (Dibble 2009).
- Exercise improves thinking in Parkinson’s disease patients (Tanaka 2008).
- Vigorous physical exercise may be neuroprotective (Alshkog 2011)
- Balance exercises : Mayo Clinic website.
2. Prevent Injuries:
This one should be obvious. All measures should be taken to prevent Parkinson’s disease patients from falling down and breaking bones.
When it is hot outside, you wear a cap. When the ground is rough, you wear shoes. So if you are unsteady, you should use a cane, preferably one with multiple legs (picture below). There is no shame in using a leg, it should be as natural as wearing a cap in the hot sun.
Physical exercise & balance training (see above) can help a lot in preventing falls.
Patients with Parkinson’s disease should have their Vitamin D levels monitored, and if they are at high risk for falls, you should request your doctor to do a Bone density or DEXA test – these topics are covered in more detail below.
Drinking coffee may protect against Parkinson’s disease (Saaksjarvi 2007). It may also improve thinking, memory and mood in patients (Cho 2018). But this evidence is not definite. Drinking lots of coffee is not recommended if you have a heart condition or anxiety. Therefore, these studies need to be taken with a pinch of salt…. or read while drinking half a cup of coffee…
I refuse to discuss smoking and Parkinson’s disease. You can read about it yourself. After you read that material, take my advice, no matter what any other website on the internet says:
As a former smoker, all I can say is: STOP SMOKING AND NEVER START AGAIN. Better still, never start smoking at all. It is a vile habit that we enslave ourselves to, for absolutely no good reason. Most of the time when we are smoking, we are thinking about how we can stop smoking! The downsides of smoking outweigh any conceivable upside. If you need help to stop smoking, read Allen Carr’s book or better still – subscribe to the excellent videos on his website www.allencarr.com.
- Large Finnish study on Coffee drinking & Parkinson’s disease (Saaksjarvi 2007)
- Coffee may improve thinking, memory and mood in Parkinson’s disease (Cho 2018)
- Allen Carr’s website: Easyway to stop Smoking (Direct link to Online Program)
Please note that the effect of these medications on Parkinson’s disease is still under research. As of today (10 Nov 2019) none of these medications has been proven beyond doubt to work. Do not take any medication without a prescription of a registered doctor.
These work by suppressing an enzyme called “MAO-B” in the brain. There are two studies that suggest that these medications may be neuroprotective, at least in the very early stages of Parkinson’s disease.
However, many neurologists think these studies are not conclusive. Many neurologists feel this effect is minimal. In addition, these medications have many possible side-effects, some of which are bothersome. I call these medications “The brothers Karamazov” – Just like them, these have significant flaws and probably belong to another era.
Therefore, at this time they are not used very commonly. Sometimes they are used in patients with very early Parkinson’s disease.
2. CoQ-10 (Co-enzyme Q-10):
CoQ-10 is an antioxidant. In theory, it removes harmful oxygen radicals which can damage Dopamine-producing cells.
A small number of studies have been demonstrated some benefit in Parkinson’s patients. One study in Mice demonstrated CoQ-10 may prevent damage to Dopamine-cells by toxic substances (Beal 1998). One other large study seemed to indicated that CoQ-10, especially in large doses (upto 1200 mg/day) may slow the progression of patients with Parkinson’s disease (Shults 2002).
While CoQ-10 may slow the progression of Parkinson’s disease, it probably is not very useful in treatment of the patient’s current symptoms. A systematic analysis of all papers published upto 2017 concluded that there was no definite evidence of benefit (Zhu 2017).
Most doctors do not prescribe CoQ-10 for neuroprotection at this time, since conclusive data is not available.
- CoQ-10 study in Mice (Beal 1998)
- University of California study on neuroprotective effect of CoQ10 in humans (Shults 2002)
- CoQ-10 for treatment of existing symptoms (Zhu 2017)
3- Vitamin E:
Vitamin E is a strong antioxidant. Just like CoQ-10, the hope is that it will decrease damage to Dopamine-cells by harmful oxygen radicals.
But the data seems to indicate otherwise. In fact, Vitamin E has been studied more thoroughly than CoQ-10. A large study published in the most respected journal in medicine (NEJM) strongly indicates that Vitamin E does not slow the progression of Parkinson’s disease (Shoulson 1993).
However, in medical research, just one study, however big and well designed is not considered to be the final word. Recently, there have been studies that indicate that Vitamin E may be slightly beneficial (Schirinzi 2019). However, these are smaller and less thorough than the NEJM study.
Because of the very clear findings of the large study that Vitamin E is not beneficial for neuroprotection in Parkinson’s disease, it is hardly prescribed by any doctor for Parkinson’s disease.
Of note, Vitamin E is found in nuts including Almonds & Walnuts. Including a few nuts in your diet may not be a bad idea. If you have trouble swallowing, there is a risk of choking if you try to eat whole nuts. Instead crush them into a powder or incorporate them in your smoothie.
- Large multicentric study: Vitamin E is not helpful in Parkinson’s disease.
- Smaller questionnaire study published in a good journal (Zhang 2002)
- A very recent Italian study (Schirinzi 2019)
Selenium is an antioxidant as well. But there are no good studies that indicate whether it is useful in Parkinson’s disease.
Some researchers believe that low selenium levels may be one of the factors responsible for Parkinson’s disease. But most studies indicate that selenium levels are not low in patients with Parkinson’s disease. Some studies in rat/mice have provided weak evidence that selenium may be useful in Parkinon’s diseae, but much more research is needed.
Because of lack of any reliable data, almost no doctor uses selenium in the treatment of Parkinson’s disease. My advice: Don’t take it.
- Brain levels of Selenium in Parkinson’s disease patients (Aguilar 1998).
- A study in Rats which indicates Selenium may be useful (Nutr 2015)
- A thorough review of Selenium & Parkinson’s disease (Ellwanger 2016)
Minocycline is actually an antibiotic. It is a spectacularly effective antibiotic, disabling or killing many types of bacteria. One of the “by-stander” effects is that it also disable cells within our own body called microglia.
Microglia are powerful cells that help our body in destroying bacteria. But sometimes they can kill other cells in our body including Dopamine-producing cells! Therefore, scientists hope that Minocycline may protect Dopamine-cells by disabling Microglia.
Results in mice and rats have been very encouraging. However, this has not translated well into human benefits. The largest study of Minocycline in Parkinson’s disease conducted by the world renowned National Institute of Neurological Disorders & Stroke (NINDS) failed to show a beneficial effect (Galpern 2008). The same institute tried to explore this topic again in 2014, with similar results (Parashos 2014).
However, the chapter is not closed on Minocycline use in Parkinson’s disease. The evidence in animals is so strong, that researchers are still hopeful that minocycline may be helpful. Further research should clarify this topic.
As of now, Minocycline should not (and is not) being prescribed to Parkinson’s disease patients.
Dr. Kharkar is a Neurologist, Epilepsy specialist & Parkinson’s disease specialist in Mumbai, Maharashtra, India.
He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, University of California at San Francisco (UCSF), USA & Kings College in London.
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