Men are more likely to develop Parkinson’s disease (PD) than women, and the onset of PD in men happens at a younger age. However, women with PD have a higher mortality rate, and once they have Parkinson’s, progression is faster. Research suggests that women get the disease at later in life when compared to men, at least in part, due to the natural protection estrogen provides. There are studies that have demonstrated that hormone replacement therapy (HRT) can provide dopaminergic neuroprotection in both young and menopausal female mice.

Could the female sex hormone, estrogen, be a therapeutic approach for delaying or reducing PD symptoms for men?

Recently published in the Journal of Neuroscience, a study titled, “Female Sex and Brain-Selective Estrogen Benefit α-Synuclein Tetramerization and the PD-like Motor Syndrome in 3K Transgenic Mice” (Rajsombath, Nam, Ericsson, & Nuber, 2019) investigated this possible therapeutic neuroprotective effect.

Using mice called 3K that show motor and neural changes associated with PD, researchers injected male mice under the skin with the hormone therapy DHED. What makes DHED so special is that it was designed to only activate estrogen in the brain. This matters because estrogen therapy has been associated with an increase in cancer in other parts of the human body.

The motor performance and brain health of the 3K male and female mice were compared along with whether DHED affects the progression of PD-like symptoms in males. The motor evaluations included their ability to clasp, climb down a pole, gait (walk) and balance on an accelerating rotarod, which is a lot like lumberjack logrolling. There were also highly sophisticated tests to determine possible changes in the build-up or clearing of protein clumping in the brain, along with the decline or increase in the health of dopamine neurons.

Results

Like the sex differences found in people with PD, 3K male mice developed PD-like symptoms faster than female mice. Furthermore, male mice treated with DHED had:

• Improved clasping abilities
• Improved downclimbing
• Improved gait
• Improved balance
• Better clearing of risky alpha-synuclein (protein clumps in the brain)
• Healthier dopamine neurons

What Does This Mean?

This study focused on the 3K male mice and how they responded to the estrogen therapy, DHED. When the male mice were treated with the DHED, they showed improvements in all the motor functions tested. They also showed significant improvements in the brain, including healthier dopamine neurons and lower amounts of alpha-synuclein at risk for clumping. Remember, clumped alpha-synuclein becomes Lewy Bodies ― a hallmark of PD.

It is also important to note that the successful development of the 3K model itself – which duplicates many differences in male and female PD at motor, cellular and molecular levels – is a significant step forward in closing the gender gap in PD research. Having a model that helps unravel how the pathology differently affects the two sexes informs new avenues of research that could lead to the development of tailored medications and interventions to meet the distinct needs of men and women with PD.

Learn More
The Parkinson’s Foundation believes in empowering the Parkinson’s community through education. Learn more about the Parkinson’s and Gender differences in the below Parkinson’s Foundation resources or by calling our free Helpline at 1-800-4PD-INFO (473-4636).

• Center of Excellence Series: University of Pennsylvania Movement Disorder Center Is a Leader in Women’s Parkinson’s Research
• Parkinson’s Foundation Identifies First Woman-Focused Parkinson’s Research Agenda
• Alpha-synuclein & DNA: The Ties that Bind

Over the next three years the Parkinson’s Foundation will invest more than $50 million to Parkinson’s disease (PD) research and clinical care. At the heart of our research initiatives are scientists and researchers who have received Foundation awards to improve our understanding of Parkinson’s, which will ultimately lead us to a cure.

While there is no known single cause for non-genetic (idiopathic) Parkinson’s disease, most cases are likely caused by interaction between a person’s genetics and their environment. Genetics cause about 10% to 15% of all Parkinson's. This is called familial PD. However, not everyone who carries PD gene mutations develop the disease.

Briana De Miranda, PhD, received a Postdoctoral Fellowship for Basic Scientists from the Parkinson’s Foundation to study the role environmental exposures play in the risk for both idiopathic and familial PD. Environmental factors that are linked to increased PD risk include pesticides, such as rotenone and paraquat, and the industrial solvent trichloroethylene (TCE).

These chemicals disrupt the functioning of the mitochondria, the “powerhouse” of the cell. In addition, Dr. De Miranda has found that rotenone, paraquat and TCE cause activation of the protein affected by one of the most commonly inherited PD genetic mutations, LRRK2.

Her goal is to investigate whether mutations in LRRK2 increase susceptibility to the damaging effects of these chemicals, even when a person is exposed to low levels. She will also assess whether inhibiting the LRRK2 protein protects against these effects.

To achieve this goal, she will study the interactions of these environmental toxicants with LRRK2 in brain nerve cells. She will also use an animal model to study LRRK2 activation following exposure to these toxicants.

Clinical trials are currently underway for LRRK2 inhibitors for use in inherited PD cases. Our hope is this research may provide evidence that these drugs may help prevent PD induced by environmental toxicant exposure and lead to expanded use of LRRK2 inhibitors to treat those with idiopathic PD who have been exposed to these chemicals.

Parkinson's Foundation Postdoctoral Fellowships for Basic Scientists are two-year fellowships for young scientists, fresh from their PhD training, to study at major research institutions. Postdoctoral Fellowships for Clinical Neurologists are awarded to young clinicians who have completed their neurology residency and want research experience.

What's Next: Reporting Our Findings

Parkinson’s Foundation research awards fund Parkinson’s studies than can span up to three years. Scientists submit yearly progress reports to the Parkinson’s Foundation, and we report findings once the studies have concluded. Stay up to date with our latest research findings at Parkinson.org/Blog.

One of the only facts we know about Parkinson’s disease (PD) and medical marijuana is that more research is needed to understand the utility of marijuana or cannabis to treat Parkinson’s symptoms. In its latest research endeavor, the Parkinson’s Foundation has launched a survey to identify themes in cannabis and marijuana use and perceived benefits and risks to inform the design and priorities of future PD clinical trials.

The Parkinson’s community has looked to marijuana or cannabis to provide some relief from PD-related movement and non-movement symptoms. However, little is known about the effects of marijuana or cannabis for Parkinson’s. Unknown information includes benefit to symptoms, potential side effects and safety issues.

The Parkinson’s Foundation “Cannabis and Parkinson’s disease” survey will hear directly from people with Parkinson’s about their:

• Reasons for or against marijuana or cannabis use
• Methods and frequency of marijuana or cannabis use
• Benefits or risks of marijuana or cannabis use

“We exist to help the PD community, and right now they are interested in knowing if and how cannabis can be beneficial or if it can lead to a better quality of life. We want to help answer that question,” said James Beck, PhD, Parkinson’s Foundation Chief Scientific Officer. “When it comes to research, this is an unexplored area that has the potential to treat Parkinson’s symptoms.”

The Parkinson’s Foundation plans to administer the anonymous survey to both men and women with Parkinson’s, across all racial and ethnic groups. The Foundation hopes to reach 10,000 people with Parkinson’s. The survey has received Institutional Review Board (IRB) approval ― a high research standard approved by an independent oversight committee and governed by Federal Regulations. 

The survey will be administered in January and February 2020. The Foundation will publish survey results in early fall 2020.

How the Foundation Has Addressed Medical Marijuana and Parkinson’s

Few clinical studies have enrolled people with Parkinson’s to investigate the effects of medical marijuana on PD symptoms. As part of its research initiatives, the Foundation remains committed to addressing the needs and priorities of the Parkinson’s community.

In July 2019, Dr. Beck provided testimony to the U.S. Food & Drug Administration (FDA) regarding the agency’s proposed rule concerning scientific data and information about the safety, manufacturing, product quality, marketing, labeling and sale of products containing cannabis or cannabis-derived compounds. “Special warnings to consumers with neurologic disease such as PD, should be included in the labeling of cannabis-derived products,” said Dr. Beck during the FDA session. “Information is key for consumers to make decisions that are appropriate to their health needs.” 

The Foundation held its first-ever medical marijuana research conference in March 2019. At the conference PD experts and people with Parkinson’s discussed the evidence for use of medical cannabis in PD, including gaps in knowledge, potential health effects and safety concerns in an effort to establish a consensus to guide the patient community and future research efforts.

In 2016, the Foundation, in partnership with Danny Bega, MD, from Northwestern University and other researchers, published the attitudes about cannabis at 40 Centers of Excellence. This is the Foundation’s first study to provide data on the practices, beliefs and attitudes of expert PD physicians concerning cannabis use. While there is no general agreement on what the benefits might be for people with PD, the survey confirmed that cannabis is a popular subject within Parkinson’s Foundation centers as 95 percent of neurologists reported having been asked to prescribe cannabis.

Learn More

Check out the below Parkinson’s Foundation marijuana and Parkinson’s resources:

• Marijuana and Parkinson’s: What Do We Really Know?
• Expert Briefing webinar: Marijuana & PD: What Do We Really Know?
• Ask the Experts: The Challenges of Using Marijuana as a Parkinson’s Treatment, Part 1
• Podcast: Episode 26: Medical Marijuana: Going Green for PD?

The Parkinson’s Foundation has provided funding to more than 550 researchers since 2010. These scientists and researchers receive Foundation awards to improve our understanding of Parkinson’s disease (PD), which will ultimately lead us to better treatments and a cure. We recently sat down with nine of them to get the latest highlights of their ongoing PD research:

Stay up-to-date on the latest Parkinson’s research:

1. Join our email list at Parkinson.org
2. Follow us on Facebook, Twitter and Instagram.
3. Watch the latest Parkinson’s disease videos on our YouTube channel.

Stephanie De Santiago, DNP, AGNP-C, has a doctorate in nursing (DNP) and is an adult-gerontology nurse practitioner at Banner Sun Health Research Institute, where she specializes in movement disorders and cognitive neurology. She is also a faculty associate for the Doctor of Nursing Practice program at Arizona State University. In this Q&A, Stephanie highlights the Nurse Navigation Program, a program she created at a community wellness center where nurses conduct discussion sessions with members and their care partners to address Parkinson’s disease (PD) management strategies.

How did the Nurse Faculty Award help further the Nurse Navigation Program?

The Parkinson’s Foundation award funded the addition of a Nurse Navigation Program to a Parkinson-specific community wellness center. The 12-week program ― available to wellness center members and their care partners ― was conducted by nurse navigators who held weekly 45-minute individual sessions to discuss critical PD management topics.

Each week, the 24 participants discussed topics such as motor and non-motor symptoms, medication management, hospital preparedness, fall prevention and more. Participants were encouraged to talk about their questions and concerns. The entire plan will soon be published in a scholarly journal.

What self-management tips can you recommend for someone with Parkinson’s?

1. Education. An important aspect of improving self-management of any disease. The more you understand the disease and what to expect, the more confident you will feel in your own ability to manage new symptoms or challenges.

2. Social support. Finding the support from others in a similar situation is a key factor in self-management of any chronic, progressive disease. Have a support system in place to problem-solve with and open up to without fear of judgement.
3. Exercise. People often feel powerless over PD which can decrease self-management ability. Daily exercise is not only great for the body, but it can also restore a sense of control over PD that may have been lost upon diagnosis.

What role do nurses play in community wellness for people with Parkinson’s?

Nurses play an important role in creating and sustaining an interdisciplinary approach to wellness for people with PD. Often there is little communication between members of the healthcare team and visits with movement disorder neurologist. Having a nurse readily available in the community wellness setting can be a great added resource for addressing any issues that come up between neurologist visits.

Nurses can trouble-shoot issues or communicate the situation to the appropriate healthcare team members, taking the burden off the already overwhelmed person with PD or care partner. Additionally, nurses can support patients and families by giving them valuable education and guiding them through the course of the disease. Ultimately, this can instill in people a sense of control over PD.

How did being an Edmond J. Safra Visiting Nurse Faculty Scholar influence this project?

My experience as an Edmond J. Safra Visiting Nurse Faculty Scholar was pivotal to the development and execution of this project. My Safra mentor, Edie Simpson, helped me formulate the premise of this project.

Preparing for the project, I learned about PD management, which helped me create nurse navigation program topics. Lastly, during the clinical experience I gained through the Safra program, I was able to work directly with patients and I met many great movement disorder specialists who I collaborated with not only during the project, but also now, professionally, as a nurse practitioner.

What changes did you see in participants after they completed the nurse navigation program?

Our results showed that after a year of progression of Parkinson’s resulting in an expected decline in quality of life, nurse navigation was able to improve self-efficacy for managing PD. This means that having a nurse navigator as an additional resource for people with PD can improve their confidence in their own ability to manage their PD despite the known progressive nature of the disease.

What is the “Self-efficacy for Managing Chronic Disease 6-item Scale”?

It is a simple scale for researchers to evaluate how much confidence a person has in their own ability to manage a chronic disease, such as Parkinson’s. It is useful to track changes over time. Other wellness centers and programs that evaluate self-efficacy changes can utilize this scale.

What Parkinson’s Foundation resources do you, your team or patients utilize?

Parkinson’s Foundation resources were crucial for this nurse navigation program. We used the Foundation fact sheets and handouts that are available online at Parkinson.org/Library for all of the patient education involved in the program. These are a great reference for people with PD because they are easy to read and understand and they cover almost any topic relating to PD.

Another extremely beneficial resource is the Aware in Care kit. These kits help keep people with PD prepare for possible hospitalization. Everyone with a PD diagnosis needs to have an Aware in Care kit that is appropriately packed in order to advocate for themselves in the hospital setting.

Learn more about the Edmond J. Safra Visiting Nurse Faculty Program.

One of the major genetic risk factors believed to contribute to the development of Parkinson’s disease (PD) is having a mutation in the gene called GBA1 (glucocerebrosidase). Unable to do its job correctly, this damaged gene leads to the build-up of unhealthy, misfolded clumps of alpha-synuclein in the brain. These clumps, called Lewy bodies, impact dopamine production and are the hallmark of PD. What if there was a way to prevent the build-up of Lewy bodies in the first place?

A 2020 study published in JAMA Neurology, titled, “Ambroxol for the Treatment of Patients with Parkinson Disease with and Without Glucocerebrosidase Gene Mutations: A Nonrandomized, Noncontrolled Trial” (Mullin et al., 2020), investigated whether an over-the-counter cough syrup, called Ambroxol, may be the key. The cough syrup, specifically, an expectorant, is used to break up phlegm.

Shown in previous studies to improve GBA1 function in neurons, this 2a study (known as a proof-of-concept study) set to find out if Ambroxol could cross the blood/brain barrier, and function as a molecular chaperone (in other words, physically help the GBA1 protein function properly).

This 186-day clinical trial of 17 people with PD ― with and without the GBA1 mutation ― involved participants taking progressively increasing doses of Ambroxol in the form of an oral tablet. Baseline measurements included physical and neurological examination, an electrocardiogram, blood sampling and spinal fluid examination obtained by lumbar puncture. Three additional in-person clinical visits were held on day 11, day 93, and day 186. Of note, at baseline, Ambroxol was undetectable in both the blood serum and spinal fluid. All study participants continued their normal L-dopa therapy throughout the trial.

Results

In study participants both with and without the gene mutation:

• Ambroxol successfully crossed the blood-brain barrier.
• Ambroxol was safe and well-tolerated at the administered dose. 
• Ambroxol successfully bound to the mutated genes’ protein, which physically helped the protein function properly.
• Healthy levels of alpha-synuclein increased in the spinal fluid. 

What Does This Mean?

This study showed that Ambroxol is safe to use as a treatment in people with Parkinson’s. Ambroxol may slow the progression of Parkinson’s disease. How? Taking Ambroxol as a medication can prevent the negative effects of the GBA mutation ― including possibly reducing the formation Lewy bodies at the source. Ambroxol shows promise, and warrants further investigation ― including conducting larger, placebo-controlled trials.

Of note, while Ambroxol has been used as a safe and effective over the counter expectorant for adults and children in more than 50 countries for 30-plus years, the administered dose in this trial was approximately 10 times the specified dosage. Additionally, Ambroxol is currently not approved for prescription or over the counter use by the U.S. Food and Drug Administration (FDA) for any indication, at this time.

Learn More

The Parkinson’s Foundation believes in empowering the Parkinson’s community through education. Learn more about the Parkinson’s and the GBA mutation in the below Parkinson’s Foundation resources or by calling our free Helpline at 1-800-4PD-INFO (473-4636).

• GBA Mutation May Lead to Novel Therapeutics
• Genetic Testing

As the Parkinson’s Foundation celebrates the distribution of our 100,000th Aware in Care kit, we check in with our Aware in Care Ambassador, Myra Hirschhorn, to learn about her work educating health professionals and people with Parkinson’s about the Aware in Care kit and the importance of advocating for oneself through education in order to achieve safety across hospital care.

1.  Why did you become an Aware in Care Ambassador?

The Aware in Care kit is such a great solution to what has been a tremendous concern to folks living with Parkinson’s disease (PD). I am pleased to be a part of bringing this excellent resource to folks who can benefit from having the kit ready and available to them, should it be needed for a planned or emergency hospital visit. Hats off to the Edmond J Safra Philanthropic Foundation and the Parkinson’s Foundation for developing this!

2.  How has your role as an Aware in Care Ambassador helped you connect with larger organizations to educate the community about the hospitalization kit?

The Lee Silverman Voice Therapy Global (LSVT Global) holds a two-day program for the purpose of educating physical therapists, occupational therapists and speech-language pathologists on valuable information and techniques to assist folks with Parkinson’s. On the second day, folks with PD attend to learn about the program. Several years ago, I began sharing Parkinson’s information at these programs held near my home in South Jersey and included details on the Aware in Care kit as a way to engage with both health professionals and people with PD while educating them on this incredible resource.

Recently, representatives of both the Aware in Care program and LSVT directors agreed to have Aware in Care Ambassadors attend the LSVT Global Seminars throughout the country to share the information in a similar manner.  In addition, the kit information cards will be added to the welcome bags given to therapists and people with Parkinson’s. With participating health professionals better informed about the Aware in Care campaign, our hope is that they will return to their clinics better equipped to provide safer hospital care!

3.  Can you explain the doctor letters you use as Ambassadors and how they can be used by others with PD?

The new doctor’s letter shares important information about PD to further inform the medical staff during a planned hospitalization. I hope to share this with movement disorder specialists in my area as they may want to provide them to their patients to distribute. I will also share the letter with those in my support group and my email distribution list. I will encourage patients to have it signed by their movement disorder specialist and place it in their Aware in Care kits to be used if/when they are hospitalized. Our goal is for the letter to complement the Aware in Care kit to facilitate safe visits to the hospital.

4.  What advice would you give someone who is hesitant to share the kit with hospital staff?

Understandably, you may feel uncomfortable with the need to inform the nurses and staff members about Parkinson’s, but it is important to remember that by doing so, you are making the best situation possible for yourself or for your loved one. Certainly, we want you or your loved one to improve rather than have a setback due to a lack of knowledge on the part of the hospital staff. 

My advice is to review the information in the Aware in Care kit with a particular emphasis on the nurse fact sheet, the medications with the dosing times and the special considerations. Be open to any questions from the staff member.

5.  What is your favorite component of the kit?

Each part really is so helpful and all materials together provide the pertinent information that is needed. If I had to choose, I feel that the Nurse Fact Sheet pad because it provides valuable points to be aware of in addition to the vital information regarding medications. There are plenty of copies to share with all the medical staff assisting the person with Parkinson’s so that each person can have an individual copy, which is key!

Unfortunately, I have heard too many issues that have come up with folks being provided drugs like Haldol and the horrible reaction that follows it. I hope those days will be behind us now as we take the step to advocate for ourselves and educate those who are caring for us!

At the Parkinson's Foundation, one of the ways we make life better for people living with Parkinson’s disease (PD) is through research. Every day, your generous donations help us fund cutting-edge PD research initiatives and support scientists working on the causes and treatments for Parkinson’s that could one day lead to a breakthrough.

In this Neuro Talk, our Chief Scientific Officer, James Beck, PhD, walks us through the research we’re supporting right now and how your support goes a long way at the Parkinson's Foundation. 

Learn more about the research you fund.

Does Parkinson’s disease (PD) only affect movement? Can doctors predict its progression? Can stem cells cure Parkinson’s? In this Neuro Talk, our Chief Scientific Officer, James Beck, PhD, debunks seven common myths about Parkinson's disease.

Watch the latest Parkinson’s disease videos on our YouTube channel.

As coronavirus continues to impact our daily life, we are committed to providing you with the latest updates and ways you can stay engaged with the Parkinson’s community. While you practice social and physical distancing, exercise your brain with our podcast playlist.

With the most downloads, these Substantial Matters: Life and Science of Parkinson’s podcast episodes are YOUR favorites:

1. The Benefits of Exercise for People with Parkinson’s

The Parkinson’s disease (PD) community often hears that exercise is crucial to living a healthy live with PD, but why does fitness make such an impact? Bas Bloem, MD, breaks down the science behind its benefits to those with PD and how to get started. 

2. Early Warning Signs of Parkinson’s

In our first podcast episode, Michael Okun, MD, discusses the early signs of Parkinson’s and practical steps to take after the life-changing diagnosis.

3. How to Manage Parkinson’s “Off” Time

Finding the right PD medication balance is often an unpredictable and sometimes frustrating. Irene Malaty, MD, discusses “off” time, what causes it and how it can be managed.

4. The Importance of Good Nutrition for People with Parkinson’s

What we put into our bodies is always important, but especially when it comes to people with PD. Can symptoms be managed through what we eat? Can our diet improve the effects of our medications?

5. Medical Marijuana – Going Green for Parkinson’s?

Medical marijuana is a hot topic in the PD community for its possible effect on easing PD symptoms such as pain, anxiety, sleep and nausea. Danny Bega, MD, sheds light on the subject.

6. Swallowing Issues and Oral Care with Parkinson's

Learn the “Dreaded D’s” and how taking care of your oral health can keep PD symptoms at bay and keep you feeling better in the long run.  

7. Keys to Driving with Parkinson’s

Driving and Parkinson’s can be a difficult conversation. Lissa Kapust, creator of DriveWise, speaks about driving with Parkinson’s, assessments and making the complicated decision.

8. New Levodopa Delivery Methods for Parkinson’s

Levodopa has been around for a while. Find out the new delivery methods researchers are currently exploring for the go-to PD medication.

9. Addressing Sleep Discomfort with Parkinson’s

Sleep is often a big problem for people with Parkinson’s and their care partners. How can you sleep better despite PD symptoms?

10. Autonomic Problems

Parkinson’s is more than movement symptoms. Non-movement symptoms often go under-reported because many find them too embarrassing to discuss. Tanya Gurevich, MD, discusses sexual health and common solutions to autonomic problems.

Subscribe and review our podcast wherever you get your podcasts.

We are devoted to the health and wellbeing of the PD community. For our latest information on the coronavirus and Parkinson’s visit Parkinson.org/Coronavirus.