Neuro Talk: How Does Basic Research Get Us Closer to a Cure?
How can understanding the basic biology of Parkinson’s disease (PD) help us prevent Parkinson’s altogether? In our latest Neuro Talk, Parkinson's Foundation Chief Scientific Officer James Beck, PhD, discusses what basic research is and how funding researchers early in their careers can lead to scientific breakthroughs. He also highlights the role that Parkinson’s Foundation initiatives like PD GENEration: Mapping the Future of Parkinson’s Disease and Reach Further play in furthering PD research.
New Survey Highlights Telehealth as Long-term Alternative To In-Person Visits
When the COVID-19 pandemic began in 2019, alternatives to in-person doctor visits became necessary. Many in-person visits were moved to telehealth. In fact, a previous Parkinson’s Foundation survey found that telehealth use increased from 10% prior to the pandemic to 64% during the pandemic among people with Parkinson’s disease (PD). However, little is known about the attitudes of people towards telehealth.
To better understand the attitudes of people living with PD on telehealth use and satisfaction, the Parkinson’s Foundation and Columbia University Parkinson’s Disease Center of Excellence administered a survey. The survey was titled: Attitudes towards telehealth services among people living with Parkinson’s disease: a survey study.
This survey is important as it helps to understand the use of telehealth and quality among the PD community.
Survey Results
The survey was sent to 16,026 email addresses from the Parkinson’s Foundation and Columbia University Parkinson’s Disease Center of Excellence mailing lists. There were 944 complete survey respondents.
The average age for respondents was 71.5 years old, and the average time they have lived with Parkinson’s is seven years.
Experiences with Using Telehealth
Of the 944 completed survey responses:
90% of participants were aware of telehealth
83% used it at least once
In the last 12 months, respondents reported using in-person visits most frequently
Experiences with Telehealth Satisfaction
Overall, people with PD were equally satisfied with most services via telehealth in comparison to in-person visits. Of those who had a positive telehealth experience:
The highest telehealth satisfaction was for speech and language pathology appointments (79%) and mental health appointments (70%)
The biggest reasons for telehealth satisfaction: reduced travel time (46%), ease and convenience (22%), and the option for follow-up appointments (19%)
The top reasons people preferred in-person visits include:
Health care professionals could notice symptom changes better in-person
Appointments were more thorough (20%)
Important of sight and touch in a physical examination (20%)
“It is difficult for my doctor to really see my gait, movement responses etc. when I am not there in person,” one survey participant said.
Experiences with Telehealth Quality
The quality between telehealth and in-person visits was similar. It seems that visits that require a physical exam were more preferrable to be in-person. However, people with PD expressed that telehealth saved time, reduced travel, was convenient, and a good option for follow-up appointments. Overall, people with PD saw telehealth video visits to offer the same quality of care as in-person visits.
Key Takeaways
Telehealth satisfaction and use is perceived be a good alternative to in-person visits among people living with PD.
Telehealth may help alleviate patient burden, especially by reducing travel with decreased mobility.
While most type of provider visits were equally satisfactory in-person vs over telehealth, speech language and pathology and mental health visits were preferred via telehealth.
Among the participants, appointments that required physical examinations were preferred to be in-person.
Telehealth should remain an option in the future.
Learn More
The Parkinson’s Foundation believes in empowering the Parkinson’s community through education. Learn more about telehealth and PD with the below Parkinson’s Foundation resources:
Reference
Feeney, M. P. et al. The impact of COVID-19 and social distancing on people with Parkinson’s disease: a survey study. NPJ Park. Dis. 7, 10 (2021).
How a Doctor is Removing Barriers Between Clinical Care and Research
William Dauer, MD, has had an impressive and impactful career in neuroscience. His groundbreaking research has focused on the molecular basis of dystonia (disabling, involuntary movements) and the mechanisms of neurodegeneration (lost brain cells) in Parkinson’s disease (PD).
We spoke with Dr. Dauer, who is also the inaugural Director of the Peter O’Donnell Jr. Brain Institute and Professor of Neurology and Neuroscience at the University of Texas Southwestern Medical Center, about his work, the early encouragement of the Parkinson’s Foundation funding, and his broader interests in breaking down silos between clinical care and research.
You began your career as a neurology resident and fellow in movement disorders at Columbia University more than two decades ago. How did the support from the Parkinson’s Foundation impact your early career?
It's exciting when you're just starting out to get funding. It's validating, important and so critical… those early career awards really can make a huge difference. The Parkinson's Foundation was a dominant force in enabling what my research would be, it would have been inconceivable without that support.
The Foundation funded an ecosystem of people: Bob Burke, Dave Sulzer, Serge Przedborski, Leo Stefanis. To us, as young investigators, knowing that there was some degree of support year after year and that people believed in you, it just made a world of difference. It made a lot of things possible and allowed me to do things I otherwise would not have done.
Many things in science don't work! That's part of becoming a scientist and for people who want to find the answer, that's their drive. Getting early career funding from the Foundation provides a degree of predictability and allows you to explore those ideas that are burning questions — which may be out-of-the-box thinking that wouldn’t necessarily be funded by the National Institutes of Health (NIH). It led to different things that we discovered that I think otherwise would not have been possible.
How did the Parkinson’s Foundation research grant help shape your investigations?
The Foundation was important in bolstering a basic scientific interest in PD research — it was important that they made that path possible. When I first received funding, it was the very beginning of what I would call the genetic discovery era for Parkinson's. Alpha synuclein was discovered as I was doing my fellowship: synuclein was really the first Parkinson-causing gene discovered.
The work we were able to pursue with Parkinson’s Foundation support enabled us to explore whether there was a relationship between that gene and the neurodegeneration caused by the Parkinson-related neurotoxin MPTP. These studies allowed us to discover that there is a relationship between environmental-type toxins and genetics, and that understanding provided a focus for future work. The Parkinson’s Foundation funding provided a set of questions that could be used to help guide research on synuclein itself.
All of that made a difference for me doing that work. There's a good chance I wouldn't have done that work had it not been for the early support of the Parkinson's Foundation. The Foundation support allowed me to pursue this work in an internationally recognized laboratory expert in the most cutting edge mouse genetic technologies needed to pursue these questions.
The grant fostered high quality work and the development of new science and young scientists, as I was at the time and increasing the degree of rigor and what's expected to advance the field. These things are related in ways that are hard to know. Encouraging scientists that do solid work, outstanding, rigorous work that engages and elevates the conversation, has impacts that are diffuse.
One of the most groundbreaking aspects of your career was learning about the causes of dystonia. Can you tell us about this?
Dystonia is an important symptom in Parkinson's, and it can be very disabling. It can, in some cases, be the cause for surgery and deep brain stimulation. My initial passion was dystonia for a variety of reasons, and it has been an enduring passion. The Foundation and the environment at Columbia very much contributed to this interest and, of course, also my clinical care.
The work that the Foundation initially funded was on a form of dystonia discovered at Columbia, together with researchers at Harvard, called DYT1 dystonia [a form of early onset dystonia]. The identification of a genetic form of “pure” dystonia allowed us to be able to look at this piece of the puzzle in isolation. The idea was if we can understand the mechanisms of what causes dystonia — that piece gives us a clearer picture of one of the pieces of the Parkinson disease puzzle.
What's become interesting is that by pursuing the DYT1 research we've developed evidence that dystonia is caused by abnormal functioning, and perhaps even some degree of degeneration, of a particular class of cells in the striatum [area of the brain]. The influence of that work contributed to a focus on these cells in a range of abnormal involuntary movements, including in dyskinesia and dystonia in Parkinson's. A lot of this was developed with that original funding. It's inspired others and influenced other Parkinson’s Foundation-funded investigators.
“Science and medicine are not separate, they are intertwined and nurturing that relationship, as the Parkinson’s Foundation is doing, is critical for the breakthroughs to which we all aspire.”
- William Dauer, MD.
What is next for you in terms of Parkinson’s research and care?
People with Parkinson’s face a series of unique challenges. My move to UT Southwestern to direct the O’Donnell Brain Institute is an incredible opportunity to take all the scientific and clinical knowledge and experience I was so fortunate to get through places like Columbia and Michigan. I will try to bring the lessons I've learned to bear on a larger scale to tackle these diseases.
I've had this parallel career: I've always seen patients and have had this passion for rigorous research that is informed by my understanding of the illness, and also the quality of care for those with neurodegenerative disease. Creating high-level clinical care connects to the research.
When you have engaged healthcare for patients, when you're doing the right thing, they come back because you're taking care of them and educating their families. That leads them to become advocates for research, and in some cases to participate directly in patient-centered research. Science and medicine are not separate, they are intertwined and nurturing that relationship, as the Parkinson’s Foundation is doing, is critical for the breakthroughs to which we all aspire.
Researchers are lasered in on slowing and someday stopping Parkinson's disease (PD) in its tracks. Explore what they've discovered, see what the future might hold and learn how some of the strongest weapons in the fight against Parkinson's progression are practices you can put in place today.
This article is based on Can We Put the Brakes on PD Progression, a Parkinson’s Foundation Expert Briefing webinar presented by Joash Lazarus, MD, Multiple Sclerosis Center of Atlanta.
PD symptoms stem from a protein, called alpha-synuclein, that clumps and accumulates in certain areas of the brain. This process depletes dopamine, which is critical to many body processes, including smooth, coordinated movements. Though dopamine declines for everyone who lives with Parkinson's, each person experiences disease symptoms differently.
But is there a way to slow Parkinson's progression? While scientists are evaluating everything from medications to mindfulness practice for clues, they've discovered some of the biggest benefits start at home.
Healthy Eating and Regular Exercise: A Powerful Combo
Making nutritious food the mainstay of your meals and enjoying regular exercise has countless proven benefits. Studies show targeted nutrition may slow Parkinson's advancement. Eating a whole-food, plant-based, Mediterranean-style diet — including fresh vegetables, fruit and berries, nuts, seeds, fish, olive and coconut oils and more — may be linked to slower PD progression.
When you live with PD, exercise is also critical to optimal health. In fact, the Parkinson’s Outcomes Project shows at least 2.5 hours a week of physical activity can slow PD symptom progression. Research reveals regular exercise also shows neuroprotective effects in animal models with Parkinson's.
Exercise benefits people of all ages. As people get older, their risk for falls increase. For people with PD, the chance of falls is two to three times higher. Up to half of these falls can result in major injury. Exercise is the only thing to notably minimize a person’s risk of falling. Regular physical activity can also boost balance, improve heart and lung function, increase memory, thinking and problem solving, minimize depression and more.
Here's how to make exercise work for you:
Maximize benefits by exercising moderately to vigorously 150 minutes a week.
Plan a weekly routine that includes aerobic activity, strength training, balance and stretching exercises.
Visit a physical therapist with Parkinson’s expertise for a functional evaluation and exercise recommendations.
Reference this Parkinson’s Exercise Recommendations PDF in English or Spanish to help guide your physical activity plan.
Specialized Parkinson's movement and speech therapies, such as the Lee Silverman Voice Treatment (LSVT) BIG and LOUD programs, have also shown potential to lessen symptoms and slow PD progression.
Exploring Therapy Advances
People with Parkinson's take a variety of medications to manage symptoms. PD researchers have spent decades working to discover therapies powerful enough to slow or stop Parkinson's. Some of these include:
Rasagiline
The 2009 ADAGIO study looked at whether rasagiline — a monoamine oxidase-B (MAO-B) inhibitor (these can minimize the enzyme MAO-B's breakdown of dopamine and ease movement symptoms) — could put the brakes on disease progression for people in early-stage Parkinson's. The results suggested the possibility that a 1 mg daily dose of rasagiline might hold disease-modifying potential, but a 2mg daily dose did not.
Despite the study's uncertainties, it still showed ample evidence that rasagiline better controlled symptoms for people with PD, which is why it's used in concert with levodopa, currently the most powerful medication for Parkinson's and a treatment mainstay since its discovery in the 1960s.
Levodopa
Levodopa is a proven effective therapy throughout the Parkinson's journey. In the past, people often delayed starting levodopa therapy based on the myth that it would stop working after a few years. A 2019 study looked at whether starting levodopa earlier or later could change the course of Parkinson's. While research showed levodopa didn't slow PD, it proved starting the medication early on in Parkinson's is safe.
Deep Brain Stimulation
When people who live with PD begin to experience severe motor fluctuations, tremors and dyskinesia, involuntary muscle movements that can't be controlled by optimal medication doses, a surgically implanted deep brain stimulation (DBS) device can deliver electrical pulses to the brain, easing symptoms and boosting quality of life.
Results of a 2020 study proved people with Parkinson's disease can also get long-term symptom relief with DBS. The research shows people who have DBS therapy early on — coupled with optimal medication — generally do better with dyskinesia control. Despite the profound benefits of DBS, it's not proven to delay disease progression.
As researchers work to solve the Parkinson's puzzle, empower yourself by prioritizing your well-being. Wholesome food paired with regular exercise habits and comprehensive team-based treatment are the building blocks of a better life with PD.
I first met Jon Lessin in October of 2012. Jon is an accomplished doctor, published author, father, husband, cyclist, yogi, jokester and now, addicted climber. Jon also has Parkinson's disease (PD).
When Jon started taking lessons with me, I knew very little about PD other than a couple of generalized symptoms. Working with Jon was a huge learning experience and he seemed eager to answer every little question I asked.
With the help of Sportrock and Jon, we started a free climbing session for people with Parkinson’s disease and have grown the group tremendously. Sportrock Climbing Centers has even partnered with the capital area’s PFNCA to undertake the first-ever study in the U.S. on Parkinson’s and climbing with George Washington University. You can read the results of that study here: Impact of Rock Climbing on Complex Tasks in Persons with Parkinson’s Disease.
I have devoted much of my time to learning the ins and outs of this disease and the Parkinson’s Foundation website is where I started my online educational journey.
I believe that rock climbing is an amazing activity for those living with PD. While there is no cure for this neurodegenerative disease, unquestionably helps slow the progress, gives relief to some of the symptoms and creates a social network. There is much debate as to which exercise is the absolute best for Parkinson’s but working at a high level of intensity is fairly universal in its importance.
According to Lisa Ebb, a movement disorder Physical Therapist who has joined in climbing with a couple of the climbers, “Challenge and variation are the two most important principles of exercise in Parkinson’s disease.
Not only does climbing force you to work at a high level, but it also challenges participants with varied movements, repetitive movements, big dynamic movements, small, controlled movements as well as flexibility, balance and stability. Perhaps most importantly though, are the cognitive skills acquired through climbing and neuroplasticity changes that can occur.
While I do not have PD myself, I have learned through many of my friends at Sportrock that being proactive in your treatment is paramount. I have seen firsthand what exercising regularly, eating the right foods, eliminating stress and keeping a good support system can do for you over the years. I am a firm believer in whatever exercise program you can stick with is the best one for you.
For anyone newly diagnosed, let the beautiful words of Ijeoma Umebinyuo be your mantra.
Start now. Start where you are. Start with fear. Start with pain. Start with doubt. Start with hands shaking. Start with voice trembling but start. Start and don’t stop. Start where you are, with what you have. Just...start.
Find a Parkinson’s-tailored exercise class near you at Parkinson.org/InYourArea or call the Parkinson’s Foundation Helpline at 1-800-4PD-INFO (473-4636).
I was diagnosed with Parkinson's disease (PD) at 45. I went in for a simple treatment for a tremor in my hand, but that led to series of investigations. I'm not too sure I was ready to accept the diagnosis, but my husband and son on the other hand were supportive from day one and undoubtedly have been my pillar of strength. They keep me motivated and feeling appreciated.
I was in denial for a couple of years. I was not so comfortable talking about it and tried to keep it under wraps. One fine day, I woke up with a different perspective towards life. I trained my mind to accept that sooner or later my ability to work or mobility will get affected. Why not live life fully?
All this did not happen overnight. It required every ounce of courage to overcome my inhibitions. That's actually when I started loving myself more than ever before. The moment you accept yourself half the battle is won.
Age, I believe, is just a number. I enjoy doing small things and derive happiness out of it. This makes me kid at heart but not immature. Embracing what life has to offer in a fearless manner, I decided to be unstoppable. That's the new ME. To live, love and lead a carefree life; to continue to ‘be me’ in my own unique way.
It's not easy to wear a smile and battle the chaos inside of me at the same time. I have a busy lifestyle working full-time for a diplomatic mission in London. After work, I have my hobbies to pursue. Though PD hasn't affected my work schedule so far, it definitely has affected my reflex actions, so, planning work is a key factor for me.
As brutal as it sounds, the fact is that we all know death is certain and life is uncertain. Fear doesn't help; it just stops life. Why stop living life before we actually do?
So, my journey of daring adventures started. I ran a 10K to beat cancer and raise funds for Cancer Research UK back in 2016. For me it was not only to crush cancer with my every step, but it was also to crush all those dead cells inside me that trapped my confidence that I wanted to set free.
In 2018, I did my first zipline and then, again, in Dubai the following year. That same year (2019), I went skydiving in Dubai from 13,000 feet. All of this gave me the confidence to fight back. I firmly believe there's nothing that can stop you as long as you firmly believe in yourself.
I took part in Shaimak Dawar Summer Funk stage dance - performed to the moves of Govinda - at Wembley Auditorium in 2017, which helped me fight my anxiety.
This past year wasn't easy. Lockdown took toll on all of us. Still, I didn't let it affect my morale. I joined online sketching classes that helped me strengthen my motor skills.
I always remind myself that faith is bigger than fear and that helps me move forward.
During the recent lockdown, I started my culinary YouTube channel by the name of Deez Culinary Delights. I am currently working on another culinary project that keeps me occupied apart from my regular full-time job.
All these activities were never on my bucket list, but I have decided to live life with positivity and optimism. I am a warrior and my struggle to find opportunities amongst difficulties continues. That is precisely what I call a blessing in disguise, and I'm not going to give up so easily.
If you have questions about Parkinson's disease symptoms, call our free Helpline at 1-800-4PD-INFO (473-4636).
Jay, whose infantry service in Vietnam exposed him to Agent Orange, talks about the importance of receiving expert care for his PD and the availability of that care for veterans, including medications, through the Veterans Health Administration. He also points out the outstanding resources available through the Parkinson’s Foundation and the key role exercise plays in Parkinson’s care.
Jay has been an advocate for Parkinson’s patient care and research since 2012 and was the Parkinson’s Foundation 2020 Volunteer of the Year. He currently serves as an Aware in Care Ambassador, Moving Day Captain and is also a support group leader.
The VA estimates that 110,000 veterans have Parkinson’s disease. If you or your loved are a veteran living with Parkinson's, check out our resources for Veterans. You are not alone.
A Physical Therapist specializing in Parkinson’s disease (PD) changed … saved my life as I know it.
I was diagnosed with PD a year ago after experiencing symptoms for a couple of years. I am lucky. I seem to be on a slow progression, currently on two medications, both agonists.
From a time before my formal diagnosis, I have understood that exercise is critically important therapy. I was exercising more, but humans are not good at connecting future consequences with immediate actions. I was thinking of exercise today as an investment in a delay in being wheelchair-bound in 15 to 20 years.
Then I got an email introducing me to the MIND (Movement Initiative for the Newly Diagnosed) program, a Parkinson’s Foundation community grant recipient. The initial evaluation and therapy sessions were at no cost, covered by a grant. The email came from Valerie Johnson, PT, DPT, a physical therapist specializing in PD. I had nothing to lose. There were still spots open under the grant, so I signed up. It was perhaps the best decision of my life.
Dr. Johnson through her practice, Balance Therapy LLC, proved to be fantastic in many ways. She is extremely knowledgeable regarding movement exercises specifically useful for Parkinson’s. Like all great physical therapists, Dr. Johnson is a great motivator and a hard taskmaster.
But the most important gift she gave me was a different understanding, on an emotional level, of the value and importance of the exercise in which she was training me. I had many questions regarding the specific benefits of the individual movements and why and how they provided those benefits. She answered those questions in an accessible and useful way. For instance, she summarized that she was “retraining my brain.”
Dr. Johnson’s credibility made her persuasive, and she persuaded me that there were both long-term and immediate short-term benefits to these exercises. The short-term perspective is critically important because it is much more likely to motive action today. Having been “converted” to believing in the benefits of physical therapy across the arc of my Parkinson’s progression, I threw myself into learning the exercises and improving my form, which is critically important.
The results have been immediate. I feel better (more free in my movements) than I have since my diagnosis and will be discussing dropping one of my medications at my next neurological appointment. I cannot be strong enough in my recommendation to seek out physical therapy. The education in exercise techniques is immensely valuable. The gift of a transformed mindset regarding real engagement in that exercise is priceless.
For a physical therapist referral or to learn more, call our Helpline at 1-800-4PD-INFO (473-4636).
It was in my teen’s when I was diagnosed with Juvenile Rheumatoid Arthritis, in my 20’s Colon Cancer and in my 30’s Parkinson’s disease. I was used to having a medical challenged life, but I had no way to anticipate what challenges were ahead of me. Parkinson’s impacts so many facets of your life.
I can remember the day that my fear became a reality. I sat in an uncomfortable flower-print chair in my neurologist's office. The nurses in the front office were talking to each other about what type of sandwiches they would order for lunch. The background was filled with traces of annoying soft-rock music and an overpowering smell of coffee. It was apparent that someone put much effort into creating a calm and relaxing environment, but at the moment it felt as irritating as wearing an itchy sweater in the desert.
A nurse came into the waiting area and called my name. I followed the nurse as she guided me to the exam room. Hearing the diagnosis — "You have Parkinson's disease. There is no cure, and you will struggle with this the rest of your life." — was like being punched in the stomach. I felt cheated out of a life that held so much promise. I looked down at my rigid left arm, resting lifeless on my lap. It felt alien. This was not the same arm that helped me make the cheerleading squad. These were not the fingers that I used to play the flute in my high school band.
After the shock wore off from learning about my neurological decline. I knew I had to stop thinking about “Why me?” but shift my way of viewing my diagnosis to “Try me.” I would use the same method of coping that I had so heavily relied on with past medical challenges. I focused on being happy, taking it one day at a time and use humor to get me though the difficult times.
I thought about what type of support I saw that was missing in the community, and what I would find useful being a patient myself. Just like many other illnesses, the mental health aspect was completely neglected. It was just not spoken about. No one asked me how I was doing emotionally, and no referrals were offered to seek support. It appeared that I was to just handle any emotional pain that I had on my own. Every medical professional was phenomenal in their area of expertise, but no one was looking at the continuation of care.
I completed my graduate program and became a licensed Marital and Family Therapist in the state of California. Then I got hired by my neurologist’s office to work with their Parkinson’s patients. I partner with individuals, couples and families who are faced with health challenges and chronic pain. It’s a unique experience to see both perspectives from being a patient and also a clinician. In 2013, I extended my reach into the world of Parkinson’s by launching The Perky Parkie Blog, with my sense of humor, I share stories of life with Parkinson’s disease. It’s a great feeling to know that my blog has led to interactions between my readers and provided a few giggles... I mean, really, you’ve gotta be able to laugh at yourself.
After 11 years of having Parkinson’s disease, I can’t really remember what my life was like without it. All the people who I have met, all the friends I’ve made who have become a part of my wolfpack, I wouldn’t change it for the world. I’m not saying my life is easy, not even close, but without Parkinson’s, my life wouldn’t have meaning.
My dad, John Morton, was a college athlete and maintained a very active lifestyle. He was a swimmer, golfer, runner, biker in addition to a very successful lawyer. He loved continuing education and after his Parkinson’s disease (PD) diagnosis, devoted endless hours to researching and learning about different treatments, studies and activities related to Parkinson’s. He even attended the 2018 Parkinson’s Policy Forum in Washington D.C. in an effort to learn more about PD and share his story.
His PD diagnosis came in 2008 after a wrist injury in a bike accident while training for a full marathon. The tremors began and so did his progression. After several years he underwent Deep Brain Stimulation (DBS) surgery. While the surgery initially slowed his progression, the disease began to take control and more symptoms began occurring including gate issues and many falls. Unfortunately, he passed away after a fall last spring as a result of Parkinson’s.
In the last few months for my dad, I was able to experience his progression firsthand as my parents moved to Texas to be closer to family (including myself). As his wife and main caregiver, my mom played an integral part in my dad’s health and helping him get the right treatments and help he needed. As a result, he was able to maintain an active lifestyle as best he could ― continuing to swim when he could and play golf as much as possible.
Throughout the 11 years he lived with Parkinson’s, my dad never let PD define who he was. He was incredibly smart and motivated me and my sisters to always strive for the best. His inquisitive nature and motivating personality moved me to continue learning about Parkinson’s and contribute where I could to the ongoing research and development, including hosting a small, local “Pedal for a Purpose” event to raise money for the Parkinson’s Foundation in 2017.
This disease is not easy for anyone involved ― the person living with it, family members or caregivers ― and my dad’s passing really put that into perspective. There is so much additional research and information we need to find a cure for this terrible disease and I hope that this can be done sooner rather than later.
Raise Parkinson's awareness on Instagram with social media GIFs that Natalie donated to our digital PD community.
