2.2 other treatment options, diagnostic imaging, brain control and

2.2 Research Areas on Parkinson’s Disease:

Some of the research areas associated with
Parkinson’s disease: 84

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Parkinson’s Disease Clinical Studies offer an opportunity to help researchers find
better ways to safely detect, treat, or prevent PD and therefore hope for
individuals now and in the future.  National Institute of Neurological
Disorders and Stroke (NINDS) conducts clinical studies on Parkinson’s disease
at the NIH research campus in Bethesda, Maryland, and supports PD studies at
medical research centers throughout the United States.  But studies can be
completed only if people volunteer to participate.  By participating in a
clinical study, healthy individuals and people living with Parkinson’s disease
can greatly benefit the lives of those affected by this disorder. Current
studies include genetics and PD, search for PD biomarkers, experimental
therapies and other treatment options, diagnostic imaging, brain control and
movement disorders, DBS, and exercise and PD.

 

Animal
models: These are valuable tools for
scientists studying disease mechanisms to develop new treatments for people
with PD.  For example, a study of the drug isradipine-which had been shown
in animal models to have a protective effect on dopaminergic neurons-is being
tested for a similar neuroprotective effect in humans.

Cognition
and Dementia:  Mild cognitive
impairment is common in PD, sometimes in its early stages, and some people
develop dementia in the disease’s later stages.  The NINDS has funded
research using neuroimaging to predict which individuals with PD might develop
cognitive impairment.

Deep
Brain Stimulation (DBS):  NINDS
has been a pioneer in the study and development of DBS, which is now considered
a standard treatment option for some people living with PD whose symptoms no
longer respond to PD medications.  Researchers are continuing to study DBS
and to develop ways of improving it. A two-part study funded by the NINDS and
the Department of Veterans Affairs first compared bilateral DBS to best medical
therapy, including medication adjustment and physical therapy.  Bilateral
DBS showed overall superiority to best medical therapy at improving motor
symptoms and quality of life.  The second part of the study, involving
nearly 300 patients, compared sub thalamic nucleus (STN) DBS to globus pallidus
interna (GPI) DBS.  The two groups reported similar improvements in motor
control and quality of life in scores on the Unified Parkinson’s Disease Rating
Scale.  On a variety of neuropsychological tests, there were no
significant differences between the two groups.  However, the STN DBS
group experienced a greater decline on a test of vasomotor processing speed,
which measures how quickly someone thinks and acts on information. Also, the
STN DBS group had slight worsening on a standard assessment of depression,
while the GPI DBS group had slight improvement on the same test.

Other
clinical studies hope to determine the best part of the brain to receive
stimulation and to determine the long-term effects of this therapy.  In
addition, researchers are developing and testing improved implantable pulse
generators and conducting studies to better understand the therapeutic effect
of neurostimulation on the brain.

Environmental
studies:  Risk factors include
repeated occupational exposure to certain pesticides and chemical solvents may
influence who develops PD.  Researchers analyzed the occupational
histories of twins in which one of the pair developed PD.  Based on
estimates of exposure to six chemicals previously linked to PD,
the researchers concluded that two of the common solvents were significantly
linked to development of PD. 

Exercise:  Exercise routines are often recommended to
help individuals with PD maintain movement and balance necessary for everyday
living.  A recent study evaluated three different forms of
exercise—resistance training, stretching, and tai chi—and found that tai chi
led to the greatest overall improvements in balance and stability for people
with mild to moderate PD.  A current trial is studying the effects of two
levels of exercise in people who have been recently diagnosed with PD. 

Genetic
studies:  A better understanding
of genetic risk factors is playing a critical role in elucidating PD disease
mechanisms.  Current clinical studies include the genetic connection to
memory and motor behavior, the search for genes that may increase the risk of
PD and related neurodegenerative disorders, and identifying biomarkers for
PD. 

Mitochondria:  These cellular energy factories may play a
central role in PD.  Scientists have found that hundreds of genes involved
in mitochondrial function are less active in people with PD.  Drugs that
target genes involved in mitochondrial function could perhaps slow progression
of the disease.

Nerve
growth factors:  Growth factors
are proteins involved in nervous system formation and are of interest to
researchers studying neurodegenerative diseases.  One small clinical trial
will assess the safety, tolerability, and potential clinical effects of gene therapy
with Glial Derived Neurotrophic Factor (GDNF)—a protein that may help protect
dopamine-producing nerve cells.  This trial for individuals with advanced
PD is based on research showing that an advanced viral technique for delivery
of the GDNF gene into the brain improves the health and function of the
dopamine neurons in animal models of PD. 

Neuroprotective
Drugs:   Basic, clinical,
and translational research aimed at protecting nerve cells from the damage
caused by PD.  The NINDS-funded NeuroNext Network is designed to test new
therapies and to validate biomarkers in a number of neurological disorders,
including Parkinson’s disease

Stem
cells:   Scientists are exploring various types of cells,
including induced pluripotent stem cells (iPSCs), as opportunities for PD drug
discovery.  iPSC technology is used to define disease mechanisms and
discover the most promising treatments for sporadic PD.  To pursue this
area of research, NINDS established a PD cell research consortium in 2009 in
collaboration with the Michael J. Fox Foundation and the Parkinson’s disease
Foundation

 

CONCLUSION

 

              Parkinson’s
Disease a common neurodegenerative illness. A combination of genetic and
environmental factors is likely to be important in producing abnormal protein
aggregation within select groups of neurons, leading to cell dysfunction and
then death. The diagnosis remains a clinical one, and there should be a high
index of suspicion to exclude other causes of Parkinsonism. A large number of
agents together with surgical interventions are now available to treat early
and late complications of PD. Increasing attention is being given to the
diagnosis and treatment of non-motor complications in PD. Future developments
in PD are likely to focus on the concept of disease modifying drugs which offer
neuroprotection.