Tips for a Happy, Healthy Pregnancy After Age 35

Wednesday, June 05, 2013 12:42 PM comments (0)

pregnancyIncreasingly more women are waiting until later in life to start families. And while there are many benefits to postponing motherhood, there are some health risks that increase as a woman ages. 

What are the risks? Starting in their mid-30s, women face an increased risk for miscarriage, fetal chromosomal abnormalities, high blood pressure, gestational diabetes, placental abruption, preeclampsia, early labor and are more likely to require a cesarean. 

It’s important to remember that these are risks all women, no matter their age, face during pregnancy. While every woman’s pregnancy is unique, older moms-to-be often face some unique challenges. Knowing what challenges might arise and how to reduce your risk increases the likelihood you’ll enjoy a happy and healthy pregnancy.

Scott MacGregor, DO, Maternal-Fetal Medicine at NorthShore, shares his tips for staying healthy throughout your pregnancy: 

  • Talk to you doctor or midwife before getting pregnant. If you are older than 35 and thinking of starting a family, talk to your doctor or midwife about the current state of your health.  He or she can assess your personal risks and recommend certain lifestyle changes or evaluations to ensure you are at optimal health prior to getting pregnant. 
  • See your doctor or midwife early and regularly. As soon as you think you might be pregnant, see your doctor or midwife. The early stages are very important for any woman. Your doctor or midwife can assess your pregnancy and medical status in the early months and provide you with information to help guide you through the process.  Your doctor or midwife can also discuss your management plan and options during the pregnancy.
  • Take your vitamins. Again, this is important for any pregnant woman. Prenatal vitamins should contain at least 400 micrograms of folic acid. If you are not yet pregnant but are considering starting a family, start prenatal vitamins or folic acid now. Getting the recommended amount of folic acid before pregnancy and during the first trimester helps prevent birth defects. 
  • Make healthy lifestyle choices. Pregnancy is an excellent time to embark upon smart lifestyle choices. Moderate exercise—walking, swimming, yoga, stationary bike—for 30-45 minutes daily is encouraged. Make sure to maintain adequate hydration and avoid overexertion.  Cigarettes, alcohol and illicit drugs should be avoided.  Over-the-counter medications and herbal medicines should be avoided. 

Are you waiting until later to start your family? When did you have your first child?

Act FAST: Stroke Is a Medical Emergency

Thursday, May 30, 2013 11:00 AM comments (0)

There are two types of stroke: ischemic, which occur as the result of a blockage inside a blood vessel that supplies blood to the brain, and hemorrhagic, which occur when a blood vessel ruptures and causes bleeding in the brain. When the brain does not receive a continuous supply of blood, brain cells die. Time is of the utmost importance in the treatment of stroke, and yet many do not call 911 when stroke symptoms arise. Deborah Lynch, Advance Practice Nurse and Stroke Coordinator at NorthShore, answered our questions on stroke, including signs, risk factors, recovery and more, to raise awareness that stroke is a brain attack and a medical emergency. Don’t ignore the signs.

strokeWhat are the signs of a stroke? Are there early signs that might go unnoticed or ignored?
We teach the public to be F.A.S.T., which stands for facial droop, arm and/or leg weakness/numbness, speech/language difficulty and the T is for timing, which means getting medical attention as soon as possible. More subtle signs of stroke would be similar to the ones listed above but possibly not as pronounced. For instance, if a person notices sudden weakness of his arm and leg on the same side, though he is able to use them, that is still a sign of stroke and it warrants emergent medical attention. The real problem with stroke and public awareness is there usually is no pain associated with stroke so people wait and see if the symptoms will go away. Time is of essence!

Why is it so important to get medical attention fast?
Brain cells (neurons) die within seconds of not receiving oxygenated blood. The faster a person with stroke symptoms gets to the hospital the better. A person may be candidate for our only FDA-approved treatment for acute stroke: tPA (alteplase). But, this can only be administered if symptom onset is less than 3-4.5 hours from time of drug administration. Stroke is a medical emergency. Call 911.

What happens after the hospital phase of stroke recovery?
Once the patient is medically stable, they will often go to either a sub-acute rehabilitation facility or an in-patient rehabilitation facility as the next level of care. Both include physical, occupational and speech therapy but in-patient requires that a patient can tolerate at least three hours of therapy in a given day. Often, patients who have a lot of deficits are unable to withstand this level of therapy at the beginning. In those cases, sub-acute rehab is the next best place. Patients will be able to get upwards of two hours of therapy a day but it is much more dependent on patient’s endurance. Typical length of stay times are variable and depend on how well or poorly a patient is doing.

After a stroke, how long can patients continue to improve?
Improvement can continue a year from the stroke but improvement is not as dramatic as during the first 3-12 months. That said, people who have language difficulties from stroke have been known to improve for years afterward.

Is a younger stroke patient likely to have a better recovery than someone who is older?
Stroke can happen at any age and when it comes to stroke age is relative. Someone can have a more severe stroke as a younger person than an older person. Usually the younger patients have fewer chronic health issues though. If you are in poor health before a stroke, it’s more difficult to recover primarily because there is less reserve. That said, I have seen quite large strokes in an elderly population with good outcomes. The brain is a very complex organ and everyone really recovers differently. On the whole, after a stroke, people improve. Where one can functionally get to remains unknown.

If there is a family history of stroke and high blood pressure, what can you to do prevent stroke.
Regular aerobic exercise and healthy eating are terrific approaches to what we refer to as "primary stroke prevention." Hypertension, or high blood pressure (typically greater than 130/85), is the number one risk factor for stroke. If you do have high blood pressure, make sure to treat it. Do not delay. Hypertension is a "silent killer.” People usually don't feel any different with high blood pressure.

What’s a “mini stroke”? Can it lead to a more severe stroke?
Mini stroke is a term we in the stroke field would like to do away with. It has been used in the past to refer to TIA (transient ischemic attack). This is an event with stroke-like symptoms that usually resolves itself within minutes. The problem with this term is that it sounds almost cute and harmless. In actuality, it carries the same risk of future stroke as an actual stroke. TIAs are definitely warning signs of stroke. We take these events very seriously with the hope of identifying a person's stroke risk factors and reduce them as much as possible to hopefully prevent a stroke in the future. These preventative measures include lifestyle changes like diet and exercise.

In addition to healthy eating and exercise, is an aspirin regimen recommended after a TIA?
We recommend at least aspirin 81mg (baby aspirin) or plavix 75mg after a person has had a TIA, especially if there is a history of diabetes, unless there is known contraindication.

The Importance of Sleep to a Healthier You

Friday, May 24, 2013 10:48 AM comments (0)

sleepThe importance of a good night’s sleep can’t be overstated and not getting enough can lead to more than simply waking up on the wrong side of the bed.  Prolonged sleep deprivation can raise your risk for serious health problems like heart disease, diabetes and high blood pressure. Sleep isn’t a waste of time; it’s an investment in your health.

The benefits of sleep are many. According to Thomas Freedom, MD, Neurologist and Program Director of Sleep Medicine at NorthShore, a good night’s rest can improve:

  • Your smarts. Sleep is essential to critical thinking and learning. Losing out a night’s rest impairs these processes, affecting attention span, problem-solving skills and alertness. Prolonged sleep deprivation takes a toll on long-term memory, too. It’s during your deepest sleep that the brain does its housekeeping, storing and consolidating learned information and long-term memories.
  • Your happiness. One sleepless night is depressing but multiple sleepless nights might be a symptom of depression. Insomnia and sleep disorders are strongly linked to depression and prolonged sleep deprivation can aggravate already existing symptoms of depression. Studies have shown that people diagnosed with depression were far more likely to sleep less than six hours a night.
  • Your looks. It turns out the fountain of youth isn’t a fountain at all. The key to healthy, youthful skin is plenty of rest. When you don’t get enough sleep, the body releases increased amounts of the stress hormone cortisol and excess cortisol can break down skin collagen— the protein responsible for supple, line-free skin. 
  • Your health. Chronic sleep deprivation is a contributing factor in a number of serious health problems, including heart disease, diabetes and high blood pressure. Those who regularly fail to get enough sleep are at a higher risk for heart attack, stroke and heart failure. Lack of sleep can also add to your waistline. Sleep loss is linked in an increase in appetite and cravings for high-carbohydrate and high-fat foods.
  • Your sex life. If the mood never strikes, your sleep schedule could be to blame. Sleep-deprived men and women often report less interest in sex. Lack of sleep leads to lower energy levels, higher stress levels and fatigue, which all have a negative effect on libido. To spend more time in the sack, spend more time in bed.

Remember that the amount of sleep required varies with each individual, but most adults need approximately 7-8 hours a night. 

Do you think you get enough sleep each night? Do you make sleep a priority?

 

Could It Be Skin Cancer? What to Look for During Your Self-Exam

Tuesday, May 21, 2013 3:08 PM comments (0)

skincancerSkin cancer is the most common kind of cancer, accounting for nearly half of all cancers in the U.S. And despite increased awareness of causes, risk factors and methods of prevention, the rates of skin cancer, including the three major types—basal cell carcinoma, squamous cell carcinoma and melanoma—continue to climb. Due in part to the use of tanning beds, rates of melanoma, the deadliest type of skin cancer, are especially high in young women in their 20s and 30s.

While prevention should be the priority—limiting exposure to sunlight, using sunscreen and avoiding the use of tanning beds—early detection is the next best thing. If detected early, skin cancer is almost always curable.

Britt Hanson, DO, medical oncology at NorthShore, shares some of her tips for identifying skin cancer, including what you should keep an eye out for during regular self-checks.

  • Have a full-body exam done by a physician. Your physician can ensure that your existing moles, spots or freckles are normal or recommend the precautionary removal of any suspicious ones. 
  • Perform monthly self-exams. After a skin examination by a physician, get in the habit of doing monthly self-exams. Use a full-length mirror to examine your moles and freckles, looking for any changes to existing moles or the development of new ones.
  • Remember your ABCDEs. If any of the moles on your body show signs of the ABCDEs, see a physician immediately.
  1. Asymmetry: One half does not mirror the other
  2. Border: Edges are jagged, blurred or irregular
  3. Color: Changes in color or if a mole is various shades of tan, brown, black, blue, white or red
  4. Diameter: If the diameter is larger than the eraser of a pencil
  5. Evolving: Any changes in size, color or shape 

 

What precautions do you take to reduce your risk of skin cancer?

 

The BRCA1 and BRCA2 Mutation: A Patient Faces Her Cancer Risk Head On [Video]

Thursday, May 16, 2013 3:44 PM comments (0)

A mutation found in the BRCA1 and BRCA2 genes puts women at an increased risk for developing breast and ovarian cancer. After learning that both her aunt and mother had the BRCA1 mutation, Sivan Schondorf was tested for the mutation at 24 years old and discovered that she was also positive. She began frequent surveillance for breast and ovarian cancer immediately. At 28, when she felt that surveillance was no longer enough, she opted to take control of her risk and undergo a preventative, nipple-sparing mastectomy with reconstruction at NorthShore.

brca1

With BRCA1 and BRCA2 in the news, she shares her story so that other women know how to find the correct information about their risks and options. 

What were your initial thoughts when you learned you tested positive for the BRCA1/BRCA2 gene mutation?

I was sad and worried to learn I had a BRCA 1 mutation, but I was able to push a lot of that fear aside because I was still years away from the recommended surgery time. I was 24 years old at the time.

What prompted you to get tested for this mutation? And then why did you decide to undergo a risk-reducing, nipple-sparing mastectomy with reconstruction.
My maternal aunt had what is now known as a triple negative BRCA1 breast cancer that metastasized and resulted in her passing before she was 50 years old. Our family OBGYN, Dr. Lapata, had good instincts and recommended that she test for the BRCA mutation. The red flags being that she had a cancer that was premenopausal and aggressive, and that she was of Ashkenazi Jewish descent. 

This was in 2000, so it wasn't something any of us had heard of. Once my aunt tested positive for the mutation, my mother found out she had the mutation as well. I was subsequently tested in 2005 and with a positive result, I opted for surveillance. At 24, I thought I was years away from any possible surgical interventions; however, after only after three years of surveillance, I felt the threat of cancer looming. I realized that surveillance wasn't protecting me; it was only enabling me to discover it at an early stage. The only way to significantly lower my risk was mastectomy, so I scheduled my surgery for the next year, which was around my 28th birthday.

The nipple-sparing one-step was the best option for me because it required less surgery than having expansion over time. I was also comfortable keeping my nipples because, aside from the more natural, aesthetic result, research shows that keeping one's nipples is safe as long as the surgery is done preventatively rather than when cancer is present.

How has this decision impacted your life?
In the very short-term, I felt different from my friends because I was thinking about things that women my age don’t normally have to think about. My thoughts were often on my situation. Five years later, as a working mother and wife, I hardly ever think about it, except at my yearly clinical exam. It's something from my past that I faced head on.

I’m so much more comfortable now that my risk for breast cancer is so much lower. I do still monitor my ovaries at least twice a year. I have not yet pursued surgical intervention because I’m not done having children and do no feel the cost-benefit of beginning menopause at 31 is worthwhile. I’m looking at having an oopherectomy by age 40.

It’s been a few years since you had this surgery. How are you doing?
I'm great! Having a baby (and now expecting my second) has done far more to change my body than the mastectomy did. I don't regret it for a second. I would do anything to improve my chances of being around to see my children grow. I want to be there for them as long as I possibly can. Clearly, Angelina Jolie felt the same way, and I’m proud to have been one of her trail blazers!

What advice would give to women who are at an increased risk of developing breast cancer?
Every woman comes to a decision and place of acceptance differently. We all have different perceptions of our bodies and what we can and can't live without. Some have lost mothers due to this mutation and some find out about BRCA unexpectedly, without even knowing about the elevated risk of cancer in their families.

Each woman must decide what level of risk she can live with. After watching my Aunt Linda die so quickly from this insidious disease, and also having my mother as a role model for me when she had her surgery, I decided that surgery at an early age was right for me. It doesn't mean its right for everyone. 

The most important thing is for women to have the most accurate information, which they can get from genetic counselors and doctors. They should also seek support from the local BRCA community so they can make informed decisions and have the emotional support that a community can provide. FORCE (Facing our Risk of Cancer Empowered) has provided my family with that support, and we try to give back to our community as much as possible.

Is there any other information you’d like to share?
I filmed my surgery process at NorthShore’s Evanston Hospital and at home in order to help empower other women and to make the experience more meaningful for myself. Because I'm not a filmmaker, I have not yet been able to edit the hours of footage. Seeing Angelina Jolie come out to the public has reignited my passion to finish this short film, which I hope will help other women.

Stress Management for Caregivers

Wednesday, May 15, 2013 11:05 AM comments (0)

palliativecareThere are many rewards but also many responsibilities that come with palliative caregiving. And while many caregivers say that those rewards make the effort worth it, there is no denying that the responsibilities caregivers shoulder on a daily basis can be stressful. Studies show that between 40-70% of caregivers suffer significant levels of stress and about half of significantly stressed caregivers meet the criteria for major depression. 

Recognizing and celebrating those rewards and learning to acknowledge when stress levels are too high are essential for the physical and mental well-being of all caregivers, both familial and professional. 

Michael Marschke, MD, palliative care physician at NorthShore, shares his recommendations on how caregivers can best cope with and manage stress:

  • Pay attention to your own health needs. A healthy, balanced diet, plenty of sleep and regular checkups are just as important for the person providing care as they are for the person receiving it. A well-rested, healthy caregiver is a happier caregiver.
  • Exercise! There’s no better natural stress-reliever than regular exercise. Physical activity loosens tight muscles, and fills the body and brain with endorphins, helping to produce a feeling of well-being.
  • Live your own life. Don’t put your life on hold while caring for another. Maintain your ties to friends and family and don’t abandon your own daily routines. Protect this time for yourself outside your caregiver role. If Friday night was always set aside for happy hour with friends, keep that on your calendar.
  • Create your own space. For caregivers taking care of family members at home, it might be difficult to do but try. This space should be separate from your caregiver role. Make it into a retreat where you can do things you enjoy or a place that makes you feel calm. 
  • Ask for help. You can’t do everything on your own and you shouldn’t be ashamed to admit it. When someone offers to help, don’t say no. Many hands make light work. Delegate tasks like laundry and grocery shopping to those willing to help.
  • Don’t ignore your own mental health. Have someone you can talk to about any stresses or fears—a physician or a friend. Also consider joining a support group. They can be a safe and supportive setting where you can freely and without judgment share your fears and frustrations with others who are dealing with many of the same issues.

Remember that in order to provide quality care to a family member or a client you have to care for yourself too. Once you do, the rewards of caregiving will be that much richer.

Have you ever cared for an elderly or disabled family member? Are you currently employed as a palliative caregiver? If so, how did you cope with stress?

 

Gearing up for Motherhood: Pregnancy Checklist from Beginning to Baby [Infographic]

Thursday, May 09, 2013 9:23 AM comments (0)

Mother's Day might have passed but every day can be a celebration of moms, moms-to-be and the many adventures of motherhood. For expectant mothers, the experts at NorthShore University HealthSystem have created a checklist for the stages of pregnancy, week by week. Every mommy-to-be can learn how to take care of herself during each and every stage of pregnancy and track her baby’s developments along the way.

Click on the infographic to learn more about the stages of pregnancy and how a mommy-to-be can prepare for baby.

motherhood

Skin Care: Is Natural Better?

Friday, May 03, 2013 12:08 PM comments (0)

natural skin care

They are everywhere, from drugstores to dedicated brands. It’s impossible to miss all the makeup, moisturizers, anti-aging serums and cleansers with the words “natural” and “chemical-free” written in bold on their packaging. But are these “natural” options any better for your skin than more conventional skincare products? The only way to find out is to ask your skin.

When it comes to skincare, it’s what your skin wants and how it reacts to what you put on it that should matter most. Certain skin types are just as likely to react to natural ingredients as they are to non-natural ingredients. Natural also doesn’t necessarily mean the product is safer for your skin or that it will produce more impressive results.

Give any product a month or more to determine its effectiveness. If you like what you see, you might have found a good match. If you react poorly, discontinue use and try all over again with something new.

If using natural products is important to you, Sarah Kasprowicz, MD, dermatologist at NorthShore University HealthSystem, shares some tips how to find the best product for your skin and what to look out for before buying:

1. Read the ingredients. Make sure to read the ingredient label on all skincare products like you would a food label. It will help you get to know the ingredients you are putting on your skin. The word “natural” doesn’t necessarily mean the product contains only “all natural” ingredients. In fact, it might contain some of the same ingredients as its non-natural counterparts.

2. Keep an eye out for these natural ingredients:

  • Green Tea Extract – Green tea contains antioxidants that help prevent and treat UV damage to the skin.
  • Soy – In studies, soy has been shown to be a good natural alternative to prescription creams aimed at correcting darkening and discoloration of the skin.
  • Oats – Studies show that oats can help maintain and protect the skin barrier in conditions like eczema.
  • Feverfew – This flower extract has been shown to effectively counteract the redness from conditions like rosacea. 
  • Vitamin C – It’s a powerful topical antioxidant that can help regulate oil production for people prone to acne.

3. Use sunscreen. Always include a sunscreen in your skincare routine. Look for a sunscreen that is labeled as “broad spectrum,” which means the product has been tested and proven to protect against deeply penetrating UVA rays and shorter-waved UVB rays. Zinc oxide, a physical blocker, is considered more “natural” than many of the other ingredients found in sunscreen.

Have you gone natural with your skincare regimen? Why or why not? What’s worked for you?

Bariatric Surgery: Is It Right for You?

Wednesday, May 01, 2013 2:38 PM comments (0)

weight lossObesity is a condition that affects nearly one third of men and women in the United States, and its risk factors can cause severe and often life-threatening illnesses, such as diabetes, heart disease, stroke and an increased risk for developing breast, prostate and colon cancers.  While a healthy diet and consistent exercise routine are the best ways to stay fit, that combination might not be enough for everyone to maintain a healthy weight.

For those who struggle with severe weight loss problems, bariatric surgery, or weight loss surgery, can offer life-changing solutions. The procedures that fall under the category of bariatric surgery reduce the size of the stomach in various ways, restricting the amount of food patients can eat and increasing their ability to lose weight rapidly.

These procedures include:

  • Gastric Bypass—the most common bariatric procedure where the smaller, upper portion of the stomach is stapled, separating it from the rest of the stomach.
  • Gastric Banding, or Lap-Band—a silicone rubber band is used to separate the top of the stomach from the bottom of the stomach.
  • Gastric Sleeve, or Vertical Sleeve Gastrectomy —85% of the stomach is laparoscopically removed, leaving a smaller, sleeve-shaped portion.

Woody Denham, MD, bariatric surgeon at NorthShore, shares some of the basic criteria one must meet for weight loss surgery:

  1. Your BMI (body mass index) is higher than 40. A BMI of over 40 is the equivalent of being 100 pounds overweight for men and 80 pounds overweight for women. Those with BMIs between 35 and 39 might also be good candidates.
  2. You have an obesity-related illness. Obesity-related illnesses and health problems include: diabetes, high blood pressure, high cholesterol and sleep apnea.  Almost 90% of those newly diagnosed with diabetes are also overweight or obese. Patients who underwent bariatric surgery for their diabetes have often achieved complete remission of the disease.
  3. Your attempts to lose weight have been repeatedly unsuccessful. Your physician will review your weight losses and gains, and eating and exercise habits, to determine if you have exhausted more traditional weight loss strategies. This will also help your physician determine if there is another medical condition preventing weight loss.

As with any surgery, it is important to discuss what treatment options would be best for you with your physician. The weight loss journey doesn’t end with surgery. Losing weight will still require basic lifestyle changes, including diet and exercise.

To learn more about bariatric surgery and to determine if you’d be a good candidate, attend one of NorthShore’s Bariatric Information Sessions. This free session is offered the 3rd Tuesday of every month from 6-7p.m. at 501 Skokie Blvd. in Northbrook.

What do you do control your weight? Have you had weight loss surgery?

Parkinson's Disease: Symptoms and Progression

Thursday, April 25, 2013 11:32 AM comments (0)

April is National Parkinson’s Disease Awareness Month. All this month, we will feature a series of posts addressing Parkinson’s disease symptoms, genetics, treatment options and more from NorthShore neurologists—Demetrius Maraganore, MD, Aikaterini Markopoulou, MD, and Ashvini Premkumar, MD— to raise awareness about this common and often disabling neurological disorder.

by Demetrius Maraganore, MD, and Ashvini Premkumar, MD

symptomsIs it possible to detect PD before symptoms begin?

There is no established method of detecting Parkinson’s disease before symptoms begin.  Because patients with Parkinson’s disease may lose their sense of smell decades before the onset of their movement disorder, some investigators have explored the use of smell testing as a method of detecting Parkinson’s disease in at-risk subjects (e.g., persons who carry a rare gene mutation known to cause Parkinson’s disease). Persons can lose their sense of smell for many unrelated reasons though (e.g., following an upper respiratory infection, head trauma, or if they smoke). Loss of smell can precede other brain degenerations such as Alzheimer’s disease, so smell testing lacks the specificity needed for a predictive test.

A more promising approach is brain imaging using a radiopharmaceutical called DATSCAN. This is a compound that is injected into a vein and that binds to the endings of dopamine nerve cells in the brain. In Parkinson’s disease, dopamine nerve cells degenerate; hence, there is less binding of DATSCAN. The uptake and binding of DATSCAN can be measured using a single photon emission computerized tomogram or “SPECT” camera.  We are currently conducting a study at NorthShore to determine if persons with mild to moderate traumatic brain injury, who are at an 11-fold increased risk for Parkinson’s disease, have lower DATSCAN binding than persons without a history of brain injury. This study would demonstrate that it’s possible to detect Parkinson’s disease in at-risk subjects before symptoms begin. 

DATSCAN could prove useful as a method to develop asymptomatic Parkinson’s disease in at-risk subjects who could then be prescribed treatments or lifestyle changes that might delay or possibly even prevent the onset of Parkinson’s disease symptoms.  My research associate Dr. Ying Wu is also exploring the use of automated MRI brain measurements in the same brain injury population to see whether MRI may prove effective in detecting preclinical Parkinson’s disease changes in at-risk subjects.

Are PD symptoms or outcomes different between men and women? Between races?

My research collaborators and I have conducted several studies of gender differences in Parkinson’s disease. At every age men are 1.5 times more likely to develop Parkinson’s disease than women. We observed no convincing difference in survival for men and women with Parkinson’s disease. While there was no difference in motor outcomes, we observed that the risk for dementia was greater in men than in women with Parkinson’s disease. It's possible that estrogen protects against dementia in women.

My collaborators and I observed no important differences in the rates of Parkinson’s disease worldwide, and I’m not aware of any convincing data to suggest that symptoms of Parkinson’s disease or its outcomes differ according to race or ethnicity.

What are some of the later complications of Parkinson’s disease?

Typically we associate Parkinson’s disease with movement disorders. As the disease progresses, patients may develop balance difficulties that result in falls. As a result, patients become increasingly dependent on assistance in walking. For example, they may need a cane or a walker or someone to walk with them.  As the movement disorder progresses more, patients may be entirely unable to stand or walk even with assistance

Parkinson’s disease is not just a movement disorder though. About one in three patients develop a significant decline in memory and mental faculties, or what we call dementia.  Both falls and dementia are dreaded late complications of Parkinson’s disease because they are resistant to medical or surgical treatments and because they carry an increased risk for nursing home placement and even death. Predicting falls and dementia as late complications of Parkinson’s disease is a research priority of the Department of Neurology at NorthShore and a current focus of my research.

Is there a way to slow or halt the progression of PD?

There is no proven method of slowing or halting the progression of Parkinson's disease. Treatments that have been studied and that failed to provide evidence of neuroprotection are: selegiline, vitamins E and C, pramipexole, ropinerole, and COQ10.  There is some statistical evidence that carbidopa/levodopa therapy may slow motor progression in Parkinson's disease, but the benefits are trivial.

Azilect is being promoted as a neuroprotective agent, but it’s dubious because the beneficial effects were observed at smaller and not higher doses. The drug is also very expensive and prone to multiple drug-diet and drug-drug interactions. At best, the benefits are nominal. A recent medical advisory panel to the FDA voted 17 to 0 that Azilect should not be approved as a neuroprotective therapy in Parkinson's disease.

Inosine dietary supplementation, to increase blood uric acid levels, may be neuroprotective; however, it may also increase the risk for heart disease, stroke or dementia. There is some evidence that vitamin D deficiency is a risk factor for Parkinson's disease; however, there are no clinical trials to suggest that vitamin D therapy slows the progression of Parkinson's disease. Similarly, observational studies have suggested that non-steroidal anti-inflammatory drugs (NSAIDs) or cholesterol lowering medications (statins) are associated with a reduced risk for Parkinson’s disease, but clinical trials evidence of neuroprotection is lacking. There are some early clinical trials of the calcium channel blocker isradipine, which may have neuroprotective effects in animal models of Parkinson's disease. Though, the animal models of Parkinson's disease are not always informative, and some calcium channel blockers can actually cause reversible parkinsonism.

One big hope on the near horizon is therapies targeting the alpha-synuclein protein in Parkinson's disease, including a vaccine that is in early phase clinical trials.  However, while genetic studies have indicated that alpha-synuclein is neurotoxic prior to the onset of Parkinson’s disease symptoms, my research team recently provided genetic evidence that alpha-synuclein may be neuroprotective late in the disease process. So it’s unclear if therapies targeting alpha-synuclein in Parkinson’s disease will be effective and safe. 

Recent studies have suggested that exercise might slow the progression of Parkinson’s disease. Apart from exercise, I have no recommendations regarding neuroprotection at this time.

Once dementia starts is there anything that can be done to reduce the loss of memory?

There are certain “cognitive enhancing” medications that may be useful in improving cognitive symptoms and slowing the progression of dementia in patients with Parkinson’s disease. These include a class of drugs entitled cholinesterase inhibitors (rivastigmine, galantamine, donepezil). The Exelon patch in particular was specifically studied in Parkinson’s patients and obtained FDA approval for treatment of Parkinson’s related dementia. Memantine, an NMDA receptor antagonist, has been FDA approved for treatment of Alzheimer’s dementia; however, in clinical practice, it has also been found to be helpful in certain patients with Parkinson’s disease related dementia. In addition, nonpharmacological interventions including exercise, social stimulation, and cognitive rehabilitation can be helpful in the treatment of dementia in Parkinson’s disease.

Apart from genes, are there any environmental risk factors for PD? 

My research team was funded by the National Institute for Environmental Health Sciences for more than ten years to study both genetic and environmental risk factors for Parkinson’s disease. We found that pesticide exposure, both occupational and gardening-related, was associated with a two-fold increased risk for Parkinson’s disease. In particular, exposure to herbicides carried an increased risk. Of the herbicides recalled by our study subjects, the one most significantly associated with Parkinson’s disease was 2,4-Dichlorophenoxyacetic acid, a major component of Agent Orange. There have been reports that Vietnam War veterans are at an increased risk for Parkinson’s disease. Pesticides may contribute to an increased risk for Parkinson’s disease by causing the alpha-synuclein protein to misfold and form toxic accumulations within vulnerable nerve cell regions.

My research team also observed that head trauma may be a risk factor for Parkinson’s disease. A closed head injury that produced loss of consciousness or that required hospitalization was associated with an 11-fold increased risk for Parkinson’s disease.  Head trauma may contribute to an increased risk for Parkinson’s disease by causing an acute spike in alpha-synuclein levels.

While my research team observed no evidence for an interaction of pesticide exposures and alpha-synuclein gene variants, a research team from California recently reported an interaction of head trauma and alpha-synuclein gene variants in Parkinson’s disease. Currently, my research team at NorthShore is conducting a brain imaging study of mild traumatic brain injury to determine if there are Parkinson’s disease-like abnormalities in the brain scans of persons exposed to head trauma, even in the absence of symptoms of Parkinson’s disease. We will also consider the interaction of traumatic brain injury and alpha-synuclein gene variations in that study.

× Alternate Text