Challenge Your Parkinson's Symptoms

Focus your attention and consciously control your habitual activities.


Check out these pages for more information:

[x]
Reduced dopamine, from aging or injury, changes the brain signals that maintain the body's normal functions.
  • Rangel-Barajas, C., Coronel, I., and Florán, B. (2015).
  • Dopamine Receptors and Neurodegeneration.
  • Aging and disease [electronic resource].
  • 6(5):349-68. doi: 10.14336/AD.2015.0330.
  • [PubMed]
  • Vance, D.E., Kaur, J., Fazeli, P.L., Talley, M.H., Yuen, H.K., Kitchin, B., et al. (2012).
  • Neuroplasticity and successful cognitive aging: a brief overview for nursing.
  • The Journal of Neuroscience Nursing : journal of the American Association of Neuroscience Nurses.
  • 44(4):218-27
  • [PubMed]
  • Bezard, E., Crossman, A.R., Gross, C.E., Brotchie, J.M. (2001).
  • Structures outside the basal ganglia may compensate for dopamine loss in the presymptomatic stages of Parkinson's disease.
  • The FASEB Journal
  • Published online February 26, 2001.
  • [PubMed]
  • Greenbaum, L., Lorberboym, M., Melamed, E., Rigbi, A., Barhum, Y., Kohn, Y., et al. (2012).
  • Perspective: Identification of genetic variants associated with dopaminergic compensatory mechanisms in early Parkinson's disease.
  • Frontiers in neuroscience [electronic resource].
  • 7:52. doi: 10.3389/fnins.2013.00052. .
  • [PubMed]
Your brain compensates naturally and when you switch
  • Scheller, E., Minkova, Leitner, L.M., and Klöppel, S. (2014).
  • Attempted and Successful Compensation in Preclinical and Early Manifest Neurodegeneration – A Review of Task fMRI Studies.
  • Frontiers in Psychiatry.
  • 5: 132.
  • [PubMed].
  • Zigmond, M,J, Berger, T.W., Grace, A.A., and Stricker, E.M. (1989).
  • Compensatory responses to nigrostriatal bundle injury. Studies with 6-hydroxydopamine in an animal model of parkinsonism.
  • Molecular and Chemical Neuropathology.
  • 10(3):185-200.
  • [PubMed];
  • Dreyer J.K. (2014).
  • Three mechanisms by which striatal denervation causes breakdown of dopamine signaling.
  • The Journal of Neuroscience : the official journal of the Society for Neuroscience.
  • 34(37):12444-56.
  • [PubMed];
  • Ullman, M.T. and Pullman, M.Y. (2015).
  • A compensatory role for declarative memory in neurodevelopmental disorders.
  • Neuroscience and Biobehavioral Reviews.
  • 51:205-22. doi: 10.1016/j.neubiorev.2015.01.008.
  • [PubMed];
to controlled pathways by focusing your attention.
  • Tard, C., Dujardin, K., Bourriez, J.L., Destée, A., Derambure, P., Defebvre, L., et al. (2014).
  • Attention modulates step initiation postural adjustments in Parkinson freezers.
  • The Journal of Neuroscience : the official journal of the Society for Neuroscience.
  • 20(3):284-9.
  • [PubMed]
  • Peterson, D.S. and Smulders, K. (2015).
  • Cues and Attention in Parkinsonian Gait: Potential Mechanisms and Future Directions.
  • Frontiers in Neurology.
  • 6: 255. doi: 10.3389/fneur.2015.00255.
  • [PubMed]
  • Lu C., Bharmal A., Kiss Z.H., Suchowersky O., and Haffenden, A.M. (2010).
  • Attention and reach-to-grasp movements in Parkinson's disease.
  • Experimental Brain Research.
  • 205(1):69-80.
  • [PubMed]
  • Nieuwboer, A,. Kwakkel, G., Rochester, L., Jones, D., van Wegen, E., Willems, A.M., et al. (2007).
  • Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial.
  • Journal of Neurology, Neurosurgery and Psychiatry.
  • 78:134–140
  • [PubMed];
Reduced dopamine affects your habitual and conscious mobility, but has its greatest effect on your habitual (automatic and autonomic) activities.
  • Beeler, J. (2011).
  • Preservation of function in Parkinson’s disease: What’s learning got to do with it?
  • Brain Research.
  • 1423: 96–113.
  • [PubMed].
  • Vyas, S., Rodrigues, A.J., Silva, J.M., Tronche, F., Osborne F. X. Almeida, O.F.X., et al. (2016).
  • Chronic Stress and Glucocorticoids: From Neuronal Plasticity to Neurodegeneration.
  • Neural Plasticity.
  • doi: 10.1155/2016/6391686.
  • [PubMed].
Learn to use controlled pathways.
  • Yan, L.R., Wu, Y.B., Zeng, X.H., and Gao, L.C. (2015).
  • Dysfunctional putamen modulation during bimanual finger-to-thumb movement in patients with Parkinson's disease.
  • Frontiers in human neuroscience [electronic resource].
  • 9:516. doi: 10.3389/fnhum.2015.00516.
  • [PubMed].
Learning and positive thinking builds helpful brain connections.
  • DeGutis, J., Grosso, M., VanVleet, T., Esterman, M., Pistorino, L., Cronin-Golomb, A. (2016).
  • Sustained attention training reduces spatial bias in Parkinson's disease: a pilot case series.
  • Neurocase.
  • 22(2):179-86.
  • [PubMed]
  • Conradsson, D., Löfgren, N., Nero, H., Hagströmer, M., Ståhle, A., Lökk, J., et al. (2015).
  • The Effects of Highly Challenging Balance Training in Elderly With Parkinson's Disease: A Randomized Controlled Trial.
  • Neurorehabilitation & Neural Repair
  • 29(9):827-36. doi: 10.1177/1545968314567150.
  • [PubMed]

Train your brain to compensate for your deteriorating automaticity.

[x]


HOMEOSTASIS -- It's the brain protecting itself.


Early on, your brain compensates without your conscious help. You may not be aware of subtle changes in movements or thinking or feeling. It is thought that pathways within the brain are changing to maintain connections between different parts of the brain.
  • Navntoft, C.A. and Dreyer, J.K. (2016).
  • How compensation breaks down in Parkinson's disease: Insights from modeling of denervated striatum
  • Movement Disorders : official journal of the Movement Disorder Society.
  • 31(3):280-9.
  • [PubMed];
  • Beavan, M., McNeill, A., Proukakis, C., Derralynn A Hughes, D.A., Metha, A., et al. (2015).
  • Evolution of prodromal clinical markers of Parkinson disease in a glucocerebrosidase mutation positive cohort.
  • JAMA Neurology.
  • 72(2): 201–208
  • [PubMed];
  • Mahlknecht, P., Seppi, K., Poewe, W. (2015).
  • The Concept of Prodromal Parkinson's Disease.
  • Journal of Parkinson's disease.
  • 5(4):681-97.
  • [PubMed];

Perhaps the communication system is becoming overwhelmed?
  • Greenbaum, L., Lorberboym, M., Melamed, E., Rigbi, A., Barhum, Y., Kohn, Y., et al. (2013).
  • Perspective: Identification of genetic variants associated with dopaminergic compensatory mechanisms in early Parkinson's disease.
  • Frontiers in neuroscience [electronic resource].
  • 7:52. doi: 10.3389/fnins.2013.00052.
  • [PubMed]
  • Bezard, E., Crossman, A.R., Gross, C.E., Brotchie, J.M. (2001).
  • Structures outside the basal ganglia may compensate for dopamine loss in the presymptomatic stages of Parkinson's disease.
  • FASEB journal : official publication of the Federation of American Societies for Experimental Biology.
  • 15(6):1092-4.
  • [PubMed]
  • van Nuenen, B.F., Helmich, R.C., Buenen, N., van de Warrenburg, B.P., Bloem, B.R., and Toni I. (2012).
  • Compensatory activity in the extrastriate body area of Parkinson's disease patients.
  • The Journal of Neuroscience : the official journal of the Society for Neuroscience.
  • 32(28):9546-53. doi: 10.1523/JNEUROSCI.0335-12.
  • [PubMed]
  • Pont-Sunyer, C., Hotter, A., Gaig, C., Seppi, K., Compta, Y., Katzenschlager, R., et al. (2015).
  • The onset of nonmotor symptoms in Parkinson's disease (the ONSET PD study).
  • Movement Disorders : official journal of the Movement Disorder Society.
  • 30(2):229-37. doi: 10.1002/mds.26077. Epub 2014 Dec 1.
  • [PubMed]
Slight tremor, slower walking, forgetfulness may go unnoticed. Things that may or may not suggest the onset of Parkinson's,
  • Schwartze, M., Kotz, S.A. (2016).
  • Regional Interplay for Temporal Processing in Parkinson's Disease: Possibilities and Challenges.
  • Frontiers in neurology [electronic resource].
  • 6:270.
  • [PubMed]
such as:
  • Constipation.
  • Loss of the sense of smell (called hyposmia).
  • Certain sleep disorders.

The tremor, slowness, or balance issues may be mild, but hard to ignore.
  • Kojovic, M., Bologna, M., Kassavetis, P., Murase, N., Palomar, F.J., Berardelli, A., et al., (2012).
  • Functional reorganization of sensorimotor cortex in early Parkinson disease.
  • Neurobilolgy.
  • 78(18):1441-8.
  • [PubMed];
  • Kojovic M., Kassavetis P., Bologna M., Pareés I., Rubio-Agusti I., Beraredelli A., et al., (2015).
  • Transcranial magnetic stimulation follow-up study in early Parkinson's disease: A decline in compensation with disease progression?
  • Movement Disorders.
  • 30(8):1098-106.
  • [PubMed];
  • Boonstra, T.A., Schouten, A.C., van Vugt,J. P. P., Bloem, B. R., van der Kooij, H., (2014).
  • Parkinson's disease patients compensate for balance control asymmetry.
  • Journal of Neurophysiology.
  • 112(12), 3227-3239.
  • [PubMed];
  • Hwang, S., Agada, P., Kiemel, T., and Jeka, J.J. (2016).
  • Identification of the Unstable Human Postural Control System.
  • Frontiers in Systems Neuroscience [electronic resource].
  • 10:22. doi: 10.3389/fnsys.2016.00022.
  • [PubMed]
Stiffness can be overcome by conscious stretching movements. Eventually, drugs may be needed to help compensate for the reduced dopamine. Cognitive difficulties (e.g. focusing attention, memory issues, planning) may become noticeable. Focused attention and conscious control training should start now.
  • King, L.A. and Horak, F.B. (2009).
  • Delaying Mobility Disability in People With Parkinson Disease Using a Sensorimotor Agility Exercise Program.
  • Physical Therapy.
  • 89(4): 384–393.
  • [PubMed];
At this stage cuing works very well.

Learn to actively override faulty activities.


[x]
  • Pros:
  • This is the easiest way to get some relief.
  • Simply taking medications as directed and exercising conforms to current recommendations.
  • Drugs do help compensate for reduced dopamine in the striatum.
  • Cons:
  • Drugs can't do everything; they need help - from YOU.
  • The drugs that enter the brain flood needed and unneeded areas.
    • Michely, J., Volz, L.J., Barbe, M.T., Hoffstaedter, F., Viswanathan, S., Timmermann, L., et al. (2015).
    • Dopaminergic modulation of motor network dynamics in Parkinson's disease.
    • Brain.
    • 138(Pt 3):664-78.
    • [PubMed];
    • Simon, D.K., Wu, C., Tilley, B.C., Wills, A.M., Aminoff, M.J., Bainbridge, J., et al. (2015).
    • Caffeine and Progression of Parkinson Disease: A Deleterious Interaction With Creatine.
    • Clinical Neuropharmacology.
    • 38(5):163-9.
    • [PubMed];
  • The drugs can interact adversely with other neurotransmitters.
  • Eventually, the drugs become less effective or higher doses may cause abnormal involuntary movements (dyskinesia).
    • Jenner, P. (2015).
    • Treatment of the later stages of Parkinson’s disease – pharmacological approaches now and in the future.
    • Translational Neurodegeneration.
    • 4:3.
    • [PubMed];
    • Herz, D.M., Haagensen, B.N., Mark S. Christensen, M.S., Kristoffer H. Madsen, K.H., Rowe,J.B., Løkkegaard, A . (2015).
    • Abnormal dopaminergic modulation of striato-cortical networks underlies levodopa-induced dyskinesias in humans.
    • Brain.
    • 138: 1658–1666.
    • [PubMed].
  • Anti-parkinson's drugs don't help autonomic and cognitive symptoms much.
    • Dashtipour, K., Johnson, E., Kani, C., Kani, K., Hadi, E., Ghamsary, M., et al. (2015).
    • Effect of exercise on motor and nonmotor symptoms of Parkinson's disease.
    • Parkinson's disease [electronic resource].
    • 2015:586378. doi: 10.1155/2015/586378.
    • [PubMed];
    • Yalcin, A., Atmis, V., Cengiz, O.K., Cinar, E., Aras, S., Varli, M., et al. (2016).
    • Evaluation of Cardiac Autonomic Functions in Older Parkinson's Disease Patients: a Cross-Sectional Study.
    • Aging and Disease [electronic resource].
    • 7(1):28-35.
    • [PubMed]
    • Ruonala V, Tarvainen MP, Karjalainen PA, Pekkonen E, and Rissanen SM. (2015).
    • Autonomic nervous system response to L-dopa in patients with advanced Parkinson's disease.
    • Conference proceedings : Annual International Conference of the IEEE Engineering in Medicine and Biology Society.
    • 6162-5. doi: 10.1109/EMBC.2015.7319799.
    • [PubMed];
  • The long-term risks:
  • With relief comes short-sighted thinking.
  • Why think about the side-effects? Get another drug.
  • Don't think about being ready when the drugs no longer work.
  • Don't consider the risks of aspiration pneumonia. That may be years away.
  • Shallow breathing? Slow heart rate? Balance issues? Deal with them later.

[x]
  • Pros:
  • During the early years, when the drugs work best, is the best time to get ready for the later, more difficult years.
  • You can use this "honeymoon period" to forestall later difficulties.
  • You can safely control your mobility when the automatic pathways no longer work well.
    • Cavanaugh JT1, Ellis TD2, Earhart GM3, Ford MP4, Foreman KB5, Dibble LE6. (2015).
    • Toward Understanding Ambulatory Activity Decline in Parkinson Disease.
    • Physical therapy.
    • 95(8):1142-50.
    • [PubMed]
  • You CAN compensate by focusing attention on safe movements, like catching a ball, blowing up a balloon, speaking loud, swallowing safely and, especially, walking safely.
    • Wu, T., Liu, J., Zhang, H., Hallett, M., Zheng, Z., and Chan, P. (2015).
    • Attention to Automatic Movements in Parkinson's Disease: Modified Automatic Mode in the Striatum.
    • Cerebral Cortex.
    • 25(10):3330-42.
    • [PubMed];
  • You compensate better when you are motivated to do so (so fight apathy - see the Barriers section).
    • McDonald, L.M., Griffin, H.J., Angeli, A., Torkamani, M., Georgiev, D., Jahanshahi, M. (2015).
    • Motivational Modulation of Self-Initiated and Externally Triggered Movement Speed Induced by Threat of Shock: Experimental Evidence for Paradoxical Kinesis in Parkinson’s Disease.
    • PLoS ONE.
    • 10(8): e0135149. doi:10.1371/journal.pone.0135149
    • [PubMed];
    • Renfroe, J.B., Bradley, M.M., Okun, M.S., and Bowers, D. (2016).
    • Motivational engagement in Parkinson's disease: Preparation for motivated action.
    • International journal of psychophysiology : official journal of the International Organization of Psychophysiology.
    • 99:24-32.
    • [PubMed];
  • Focused attention and conscious control may be able to fight freezing of gait or difficulty in initiating a sit to stand movement.
    • Lieberman, A., Deep, A., Dhall, R., Tran, A., and Ming-Jai Liu, M-J. (2015).
    • Early Freezing of Gait: Atypical versus Typical Parkinson Disorders.
    • Hindawi Publishing Corporation: Parkinson’s Disease.
    • Volume 2015, Article ID 951645, 5 pages.
    • [PubMed]
    • Kelly, N.A., Ford, M.P., Standaert, D.G., Watts, R.L., Bickel, C.S., Moellering, D.R., et al. (2014).
    • Novel, high-intensity exercise prescription improves muscle mass, mitochondrial function, and physical capacity in individuals with Parkinson's disease.
    • Journal of Applied Physiology.
    • 116(5):582-92.
    • [PubMed].
    • Fling, B.W., Cohen, R.G., Mancini, M., Carpenter, S.D., Fair, D.A., Nutt, J.G., et al. (2014).
    • Functional reorganization of the locomotor network in Parkinson patients with freezing of gait.
    • PloS one [electronic resource].
    • 9(6):e100291. doi: 10.1371/journal.pone.0100291.
    • [PubMed].
  • Cons:
  • Learning to consciously compensate for mobility dysfunctions is difficult.
  • The training is lifelong -- it will never end.
  • Note: This author has found no long-term (i.e. 20+ years) studies which have examined the effect of attentional endurance on motor or non-motor symptoms.
[x]
[x]
  • Get advice from a speech therapist who knows Parkinson's.
    • Jones, C.A. and Ciucci, M.R. (2016).
    • Multimodal Swallowing Evaluation with High-Resolution Manometry Reveals Subtle Swallowing Changes in Early and Mid-Stage Parkinson Disease.
    • Journal of Parkinson's disease.
    • 6(1):197-208.
    • [PubMed]
  • Swallow consciously (pay special attention to the back of your mouth).
  • Before drinking, inhale to create reserve in the lungs.
  • Practice loud, forceful coughs.
[x]
  • Get advice from a physical therapist.
    • Hubble, R.P., Naughton, G.A., Silburn, P.A., and Cole, M.H. (2015).
    • Wearable sensor use for assessing standing balance and walking stability in people with Parkinson's disease: a systematic review.
    • PLoS One.
    • 10(4):e0123705. doi: 10.1371/journal.pone.0123705.
    • [PubMed]
  • Perform all practice in a safe place - prevent falls.
  • Practice keeping your feet hip-width apart.
  • Transfer your weight from one foot to the other before stepping forward.
[x]
  • Learn how to keep yourself safe while walking.
  • Get advice from a knowledgeable exercise trainer.
  • Again, practice in a safe place and see above on balance.
  • Before taking a step, remember to transfer your weight to prevent freezing.
  • Focus your attention on walking - count steps, use cues, walking stick, etc.
  • Do not look at your feet.
  • Lamont, R.M., Morris, M.E., Woollacott, M.H., and Brauer, S.G. (2012).
  • Community walking in people with Parkinson's disease.
  • Parkinson's disease [electronic resource].
  • doi: 10.1155/2012/856237.
  • [PubMed]
[x]
  • Get advice from a physical therapist.
  • It is uncertain whether DRT actually improves breathing.
    • Monteiro, L., Souza-Machado, A., Valderramas, S., and Melo, A. (2012).
    • The effect of levodopa on pulmonary function in Parkinson's disease: a systematic review and meta-analysis.
    • Clinical Therapeutics.
    • 34(5):1049-55.
    • [PubMed].
    • Guedes, L.U., Rodrigues, J.M., Fernandes, A.A., Cardoso, F.E., and Parreira, V.F. (2012).
    • Respiratory changes in Parkinson's disease may be unrelated to dopaminergic dysfunction.
    • Arquivos de neuro-psiquiatria.
    • 70(11):847-51.
    • [PubMed].
  • Blow up balloons or purchase a breathing exercise device.
  • Join a singing class and sing loudly and vary your pitch to strengthen your vocal folds.
[x]
  • Get advice from a speech therapist.
  • Focus on slow, clear enunciation.
  • Invest in LSVT - LOUD.
  • Obtain a sound-level monitor: use it to train your voice volume.
  • Soft voice? - Read a book LOUD to someone.
  • Talk too fast, garbled? - read a list of unrelated syllables to force you to slow down.
  • Focus on clear enunciation by exaggerating the movements of your mouth.
[x]
  • Research on dementia prevention is sparse.
    • Mitchell, S., Ridley, S.H., Sancho, R.M., and Norton, M. (2016).
    • The future of dementia risk reduction research: barriers and solutions.
    • Journal of public health (Oxford, England).
    • [Epub ahead of print].
    • [PubMed].
  • Most important! Use safe exercise to increase your heart rate and the flow of oxygen to your brain.
  • Check this [WebMD] site for prevention advice.
  • Learn something unfamiliar to you. Keep your brain active.
  • Socialize often. Discuss a subject important to you.
  • Avoid mind-deadening TV programs.

Start practicing now!

Check out the Attentional Endurance page.

Helpless? You can choose!