Maintaining cognitive brain health is a high priority for both people with Parkinson’s disease (PD) and family members. Though many living with Parkinson’s will not develop dementia, mild cognitive issues may emerge in 20 to 50 percent. As a result of this survey, a working group of experts led by Jennifer Goldman, MD, MS, at Rush University, a Parkinson’s Foundation Center of Excellence, was assembled to address this issue. In this month’s What’s Hot in PD? column, we share practical results from the working group that may be useful for both people with PD and their families.

There are potential pharmacological and non-pharmacological interventions that may be useful in addressing cognition (thinking and memory) in PD. The working group divided the recommendations for maintaining PD cognitive health into early and more advanced Parkinson’s.

Early Parkinson’s Disease

• Exercise according to guidelines from American College of Sports Medicine and American Heart Association 
• Stay active socially; for example, spend time with friends or join a support group.
• Engage in cognitive training exercises.
• Learn coping strategies; for example, work with an occupational therapist or neuropsychologist on techniques for paying attention, remembering things or doing everyday tasks.
• Nutrition can affect cognition. Consider trying the Mediterranean diet.
• Take your time when doing tasks.
• Let your family and friends know if you are having trouble.

Seek help if feeling depressed or anxious 

Advanced Parkinson’s Disease

Follow the above recommendations, in addition to: 

• Develop and follow a highly structured daily routine 
• Consider the use of medication for cognitive impairment; common medications include cholinesterase inhibitors and memantine
• Have an advanced directive in place (living will, treatments) 
• For care partners: take care of your own health as well (see doctors as needed) 

For care partners: seek out support such as counseling 

Though more pharmacological treatments are needed, we advise people not to underestimate the value of implementing many of these techniques and considerations. You can have a happy life with PD but you need a winning strategy for brain health and cognition — and that strategy may not always include a pill.

All Science News articles summarize a research study and are not an official opinion, endorsement or position of the Parkinson’s Foundation’s.

For years, drinking coffee has been associated with having a reduced risk of developing Parkinson's disease (PD). In fact, a 1968 study suggested that coffee drinkers were less like to get PD (Nefzger, Quadfasel, & Karl, 1968). Since then, multiple epidemiologic studies have confirmed the PD/coffee connection (Ascherio et al., 2003; Ascherio et al., 2004; Fujimaki et al., 2018). Researchers have mostly attributed the protective effect to the caffeine component (Lee et al., 2013).

However, coffee is more than a caffeine delivery system. Coffee has more than 1,000 different compounds, including organic acids, sugars, amino acids and fatty acids. One such fatty acid called Eicosanoyl-5-hydroxytryptamide (EHT) has been getting quite a bit of buzz in the PD research community; and, for good reason. A recently published study titled, “Synergistic neuroprotection by coffee components eicosanoyl-5-hydroxytryptamide and caffeine in models of Parkinson’s disease and DLB” (Yan et al., 2018), provides some compelling insights into the possible biochemical protective mechanisms of our cup of joe.

A recently published study in the journal, Neuropsychopharmacology, sought to determine if having ADHD and/or its treatment, increases the risk of having basal ganglia and cerebellar diseases. In this 20-year follow-up retrospective cohort study, a total of 190,586 patient records (31,796 with ADHD and 158,790 without ADHD) from Utah were examined. People with no prior PD diagnosis or symptoms, no basal ganglia/cerebellar disease and those with a history of substance abuse were excluded from participating in the study.

Here’s what the researchers did: over a six-month period, they treated groups of two different PD model mice with various combinations of caffeine and EHT (caffeine alone, EHT alone, or caffeine and EHT together) to study their effects on both brain and behavior. There was also a group of mice that received no treatment. Then they performed several behavioral tests to study their movement, as well as study their brains for signs of alpha-synuclein clumps (which result in Lewy bodies, the pathological hallmark of PD), neurodegeneration and inflammation. The study found that the untreated mice had significant amounts of clumped α-synuclein in their brains, increased inflammation and loss of neurons, as well as significant deficits on three different behavioral tests. In general, the mice treated with EHT or caffeine alone showed either no or minimal improvement in any of these measures. However, the mice treated with the combination of EHT and caffeine together showed significant improvements in all of these measures.

Results

• More specifically, mice treated with both EHT and caffeine together:
• Had less alpha-synuclein clumping in the brain
• Maintained better neuron integrity and function
• Had less brain inflammation
• Displayed less movement symptoms

What Does This Mean?

In this study, a synergistic combination of EHT and caffeine was shown to slow down the progression of the neurodegeneration associated with PD in mice — which has potentially readily available therapeutic implications. In addition, previous research has demonstrated that caffeine enhances dopamine signaling in the brain (Volkow et al., 2015); and, it’s the death of dopamine-producing cells that results in movement symptoms of PD (and why dopamine replacement medication is the gold standard treating PD symptoms).

For years, coffee consumption has been suggested to play a protective role in developing PD. However, it was never clear what exactly in coffee had this effect. This study suggests that two compounds, caffeine and the fatty acid EHT, work together to protect against alpha- synuclein clumps and dopamine neuron loss in two different PD models of mice. Interestingly, these effects were seen even using very low doses of the compounds. If the results of this study can be replicated by other researchers, then identifying that delicate balance of safety and effectiveness for humans is likely an essential step that researchers will be investigating in the future.

Learn More

The Parkinson’s Foundation believes in empowering the Parkinson’s community through education. Learn more about the connection between dopamine, caffeine, Lewy bodies and alpha-synuclein and Parkinson’s in the below Parkinson’s Foundation resources or by calling our free Helpline at 1-800-4PD-INFO (473-4636).

• The Latest in Nutrition and Parkinson’s Disease

During Brain Awareness Week, taking place March 11 to 17, we join the global campaign to raise awareness about the progress and benefits of brain research, including research into the causes of Parkinson's disease (PD) and how to treat it.

Since Parkinson’s affects multiple parts of the brain, we wanted to provide you with an easy-to-understand introduction to the amazing things your brain does and how.

Ready to exercise your brain?

Check out Tips for Daily Living: 12 Ways to Boost Your Brain Power.

Parkinson’s disease (PD) is largely known for its motor symptoms, slow movement, tremor and stiffness, but other wide-ranging challenges, known as non-motor or non-movement symptoms — can often be most problematic. Treating these non-motor symptoms promotes optimal living.

The following article is part one of a two-part series based on a Parkinson’s Foundation Expert Briefings webinar exploring the latest research and treatments in PD-related non-motor symptoms, by Ronald Pfeiffer, MD, Oregon Health and Sciences University, a Parkinson’s Foundation Center of Excellence.

Early Parkinson’s Symptoms

Early signs of Parkinson’s can appear before a Parkinson’s diagnosis is ever made. Non-movement symptoms can begin decades before a diagnosis. Impaired sense of smell occurs in 70 to 90 percent of those living with PD, often precedes other PD symptoms. Licorice, coconut and banana are some smells people with PD have difficulty with, while scents like chocolate, strawberry and onion, are not impacted.

Another common early pre-movement symptom, constipation, can begin around age 40, sometimes preceding a PD diagnosis by 20 years. Erectile dysfunction, REM sleep behavior disorder, depression and anxiety are often also early non-motor PD symptoms. 

Vision Changes

About 14 percent of people with PD experience vision changes including tired eyes, blurred vision, intermittent double vision or difficulties reading and seeing in dim lighting. Optometrists who look closely may discover convergence insufficiency, impaired color perception, blinking irregularities or reduced contrast sensitivity (the capacity to pick out an object from its background). Playing video games may improve contrast sensitivity, but no PD-specific studies have been done. Fitting glasses with prisms can help PD-related double vision. Both blepharospasm (involuntary eye closure) or apraxia of lid opening (inability to open the eye) may benefit from botulinum toxin A (BOTOX®). At-home eye exercises called “pencil push-ups” may help with convergence insufficiency. Talk to your doctor or optometrist about how to perform these exercises, or to discuss vision treatments.

Pain

Pain related to PD is divided into five categories:

1. Musculoskeletal: pain that affects the bones, muscles, ligaments, tendons and nerves. It can occur suddenly and be short-lived or long lasting and can occur in one or several areas. Someone with PD may describe this as aching or burning in their muscles or skeleton.
2. Neuropathic/radicular: chronic pain condition where the body sends pain signals to the brain, not caused by an injury. This sharp pain comes from a nerve or nerve root.
3. Dystonic: sustained or repetitive muscle twisting, spasm or cramp that can occur at different times of day and in different stages of Parkinson’s. Can stem from rigidity and dystonia.
4. Akathisia: causes the feeling of restlessness or inability to be still. An example of this outside of Parkinson’s is Restless Leg Syndrome.
5. Central pain: neurological condition caused by a dysfunction that affects the central nervous system and is resistant to treatment. This pain is usually sharp and burning with no clear cause.

Though muscle relaxers are not usually effective, adjusting PD medications may help minimize “wearing off" episodes. Physical therapy or surgery can improve pinched nerve pain, while BOTOX® injections may improve dystonia.

Autonomic Dysfunctions

Non-motor problems include those with the autonomic nervous system, which controls bodily functions, such as heart rate, blood pressure, sweating, sexual function and both gastrointestinal and urinary function. These can be among the most serious problems for people with PD.

Oral Health Issues

Excess saliva: Experienced by up to 80 percent of people with Parkinson’s, it begins as nocturnal drooling and can progress to heavy saliva outpourings. Drooling isn’t caused by excess saliva; in PD it is due to decreased swallowing frequency and efficiency, as well as tendencies toward an open mouth and stooped posture. While surgery was used in treatment in the past, it is no longer advocated. Hard candy, medications, including sublingual atropine or glycopyrrolate, or BOTOX® injections have all been used in treatment. Discuss options with your doctor.

Dry mouth: Decreased saliva production in PD can cause dry mouth; medications can increase this dryness, raising the risks of cavities and periodontal disease. Artificial saliva products like Biotene®, which contains xylitol and glycerin, can help. Discuss treatments, including medications that increase saliva production, with your doctor or dentist.

Halitosis: Bad breath is common in PD, but rarely discussed. Many factors — dry mouth, inadequate brushing, gum disease, mouth bacteria and not drinking enough fluids — can contribute. Treatment includes adequate cleaning of teeth and mouth and alleviating dry mouth.

Recognizing and Addressing Symptoms

Non-motor PD features may also include sleep disorders, cognitive changes, hallucinations and delusions or weight changes. It’s important to stay abreast of all symptoms, and to discuss treatments with your doctor.

Read the second article in this series now: Non-motor Symptoms: What’s New? Part 2.

About 75 percent of people with Parkinson’s disease (PD) experience changes in speech and voice. These changes usually come on gradually and can vary from mild to severe. In the newest Parkinson’s Foundation educational book, Speech and Swallowing, we cover the symptoms, tools and exercises that can help you or a loved one better understand and manage speech, swallowing, voice, communication and cognitive problems in PD.

In addition to seeing a speech-language pathologist, there are some strategies that you, your family and your friends can use to improve communication.

About 75% of people with Parkinson’s experience changes in speech and voice.

Practice good “voice hygiene” with these tips:  

• Drink plenty of water or other liquids each day (non-caffeine and non-alcoholic).
• Do not strain your voice by shouting over loud noise when you talk.
• Rest your voice when it is tired. Like other muscles in your body, the muscles controlling your speech need a break sometimes.
• Reduce throat clearing or coughing.
• If the air is dry in your home, consider using a humidifier.

Posture

Posture is important for voice and speech. Keeping an upright posture and a straight neck (and slightly lifted chin) helps you to move air from your lungs through your vocal cords, which then vibrate to produce the sound waves that make your voice. Motor changes associated with PD (and aging) can make it more difficult to maintain an ideal posture. Exercise, stretching and yoga can help.

Keep Talking

The best way to practice talking is to talk! The saying “use it or lose it” applies to speech, too. If you don’t have a companion to talk to, talk out loud to yourself.

Singing and Voice

Singing uses the same muscles that are used for speech. Singing your favorite songs out loud is not only great exercise — it can help you feel good emotionally, too. Be careful not to strain or force your voice beyond what is comfortable.

TIP: To find a speech language pathologist or a speech-related program near you, call the Parkinson’s Foundation Helpline 1-800-4PD-INFO (473.4636).

Tips for Family and Friends

Remember a good conversation takes two (or more). Social engagement and maintaining social ties are important for both emotional and cognitive health. While there are steps that the person with PD can take, it is important that conversation partners also improve their conversation skills.

• Have important or more challenging conversations when the person with PD is well-rested and at their ‘best’ time of day.
• Get face-to-face. Minimize having conversations between rooms. Make sure that the lighting is optimized so that you can see your partner’s face and mouth movements clearly. 
• Reduce background noise. Turn off the radio and TV, close car windows and shut doors to noisy areas.
• Learn to look for signals that your conversation partner is having difficulty engaging — requests for repetition, fidgeting or being distracted.
• Be aware that people with PD may not accurately express their emotions through facial expressions because of rigid facial muscles.
• Be patient. Allow ample time for the person with PD to communicate.
• Minimize talking ‘for’ the person with PD or filling in their responses unless they ask you to do so.
• Provide help and repeat or rephrase what you said (without elevating your volume or excessively slowing your speech rate).

Read our newest book Speech and Swallowing online now or order your free copy today.

• Watch our Expert Briefing: Communication Strategies for Optimal Success
• Listen to our Podcast episode: Alleviating Voice Challenges with PD
• Download our fact sheet: Swallowing Changes

First described as a common symptom of Parkinson’s disease (PD) more than 20 years ago, PD-related fatigue remains an under-recognized, clinically significant, disabling symptom that can diminish quality of life (Herlofson et al., 2018; Kluger et al., 2016). Often occurring prior to movement symptoms of PD — tremor, rigidity and bradykinesia — (Chong, Albor, Wakade, & Morgan, 2018), PD-related fatigue doesn’t go away over time and getting more rest does not help (APDA, 2017).

The 2014 Parkinson’s Foundation Conference on Fatigue found that half of all people with PD reported fatigue as a major problem, and one-third shared that fatigue is their single most disabling symptom. The conference brought together a multidisciplinary group of experts, including a scientist studying fatigue in breast cancer. Research in breast cancer has shown that inflammation plays a large role in fatigue, even years after treatment when patients are in remission. One of the questions that came out of the 2014 conference was whether inflammation also plays a role in fatigue in PD.

Recently published in the journal, Acta Neurologica Scandinavica, a study titled, “Inflammation and fatigue in early, untreated Parkinson’s” (Herlofson et al., 2018) sought to explore the possible association of proinflammatory cytokines (a type of substance released by a cell that promotes inflammation) and fatigue in PD. Considered the boss of the immune system, cytokines are chemical messengers responsible for up-regulating (initiating), as well as down-regulating (turning off) the immune response. Studies have found that proinflammatory cytokines may play a role in PD and have been proposed to be part of an immune response to tissue damage (Williams-Gray et al., 2016)

Funded by the Parkinson’s Foundation, Karen Herlofson, MD, led a study measuring 13 different inflammatory markers and adhesion molecules (helps cells stick to one another), obtained with a simple blood-draw in people with PD who had also been assessed for fatigue levels.

The study recruited 212 participants who were newly diagnosed with PD and untreated. They were initially recruited from the Norwegian ParkWest Project — a population-based prospective longitudinal cohort study of newly diagnosed, untreated people with PD. However, after excluding those with decreased cognitive function, symptoms of depression, excessive daytime sleepiness, apathy, other diseases or relevant medications, a total of 47 participated in this study; 24 had low fatigue scores and 23 had high fatigue scores.

Demographic data (age, years of education, weight, and height) were collected during a semi-structured interview. Disease severity was assessed by the Unified Parkinson’s Disease rating Scale part III (UPDRS III). Fatigue was assessed by the Fatigue Severity Scale (FSS), a self-administered questionnaire, which focuses upon the physical social, and mental aspects of fatigue. All 47 participants had their blood drawn the same day as the clinical assessment and all fasted the night before. The blood draw occurred between 8 and 10 a.m., to minimize confounding factors caused by circadian rhythm.

Results

Compared to the study participants without fatigue, participants with fatigue:

• Had significantly higher levels of the cytokine IL1-Ra and the adhesion molecule VCAM-1
• Had more advanced disease, as measured by the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score.
• Had lower cognitive function, as measured by the MMSE (Mini-Mental State Examination).
• Had more depression, as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS).
• Had less excessive daytime sleepiness, as measured by the Epworth Sleepiness Scale (ESS), showed no correlations between IL1-Ra or VCAM-1 with age, sex, years of education, BMI, UPDRS, MADRS, MMSE, apathy, or ESS.

What Does This Mean?

PD-associated fatigue can have a detrimental impact on quality of life; yet, the underlying biological cause remains unknown. This study found that having higher blood levels of the inflammatory markers IL1-Ra and VCAM-1 were associated with higher fatigue levels in newly diagnosed, untreated participants with PD. If true, and an altered immune response is indeed a factor, this finding may offer new targets to explore for future treatment — as the immune system is a promising therapeutic target for disease modification.

Additionally, these findings may, if correct, offer some future early PD diagnostic potential — as fatigue commonly presents before the classic hallmark symptoms of PD. We know that inflammation contributes to neurodegeneration in the brain. Whether or not cytokines are increased as a result of the stress and tissue damage that are a consequence of PD — or whether the inflammation happens prior to the fatigue — is a question that must be answered. This study brings us one step closer

Learn More

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

• Fatigue
• Fatigue & Parkinson's

Just as exercise keeps your body strong, mental activity keeps the mind sharp and agile. Challenging the brain and continuous learning not only keeps the mind healthy, but they also impact our entire physical well-being. New dendrites (the connections between nerve ells that allow cells to communicate with each other) are produced throughout your entire life. These new connections help you store and retrieve information more easily.

At any age the brain continues to absorb information, make new connections, acquire new skills and enhance memory. Mental decline is NOT a part of normal aging and there are ways you can train your brain. 

Tips for maintaining a healthy mind:

• Stay physically active to reduce the risk of Alzheimer's stroke and osteoporosis.
• Exercise every day for 30 minutes to improve blood flow to the brain.
• Seek positive social interaction by staying involved with friends and family. Social interaction is key to keeping the mind sharp.
• Get Involved. It gets you out of the house and involved with others.
• Reduce stress. Normal aging can make the mind less efficient, but don't stress about it.
• Exercise and challenge your mind daily with puzzles games and mental exercises.
• Practice good nutrition and a balanced diet with fruits, vegetables, breads and cereals which contain folic acid, Vitamin B12 and thiamine to keep the memory healthy.
• Drink water. Water is an essential part of humans and needed for good memory. Lack of water leads to dehydration. Choose water over soda as it can lead to dehydration and fatigue.
• Try to have a a positive attitude, which leads to more focus, increased memory and alertness.
• Vary your activity to keep the mind strong and healthy. Creativity in everyday life provides excellent mental stimulation.

To learn more about cognition and memory, download our free educational book "Cognition: A Mind Guide to Parkinson’s Disease."

Whether you’re planning your next beach escape or gearing up for a road trip, the need for entertainment is key, and what better way to tune out than tuning into our podcast?

Featuring the latest treatments and techniques in the Parkinson’s disease (PD) field, our Substantial Matters: Life and Science of Parkinson’s podcast features the experts in the Parkinson’s community who cover a series of PD topics including employee dynamics, the benefits of exercise, alleviating voice challenges and more!

We’ve made it easy for you by picking out our top recommended podcast episodes for the summer― think of this as your curated PD podcast playlist. Just a click away, these episodes will transport you into the labs, offices and meeting spaces of PD health professionals who are eager to share more about your PD topic of interest.

1. The Benefits of Music Therapy for Parkinson’s

The benefits of music therapy for Parkinson’s have been well established. Rhythm and rhythmic cuing can help with initiation, coordination and maintenance of movement. Benefits can extend to cognitive functions, communications abilities and mood. Some music therapists have furthered their education as academically trained professionals specifically in working with people with Parkinson’s.

Listen Now

2. Parenting and Parkinson’s: Raising Children While Living with Parkinson’s

Parenting has its challenges and surprises under the best of circumstances, but when a parent has Parkinson’s, it can put added stresses on the family. As parents’ abilities and roles change, children should understand the disease, how it may change their routines and the potential need to take on additional responsibilities. 

Listen Now

3. More than a Movement Disorder: Addressing Mood and Coping

Parkinson’s is more than a movement disorder. While movement symptoms may be a prominent outward symptom of PD, mood and other emotional changes are also common ― and not just for the person with PD. Care partners may also experience these changes. Often, the best way to recognize these problems and figure out coping strategies may involve other health professionals. 

Listen Now

4. Talking to Your Employer About PD: Disability Inclusion and Accommodation at Work

Many people with Parkinson’s want to continue to work. Sometimes all it takes is recognition of their condition by their employer and accommodations to compensate for disabilities. In fact, the Americans with Disabilities Act provides certain protections in the workplace for people with disabilities once they reveal their situation to their employers, who are then required to make reasonable accommodations to do the job. 

Listen Now

5. Alleviating Voice Challenges with PD

Just as Parkinson’s affects movement, it can affect muscles of the face, mouth and throat, leading to problems with speech and swallowing. People with PD may experience voice problems during the course of their disease. The problems tend to increase as the disease progresses but may occur at any stage.

Listen Now

6. Changing the Hospital Experience Through Aware in Care

People with Parkinson’s need their medications on time, every time. Getting them too soon or too late can cause problems. So when a person with PD enters the hospital, which happens 50 percent more often than their peers, the staff often needs to be educated on the importance of delivering medications at the right dose and at the right times ― times that may differ from the usual times that medications are dispensed.

Listen Now

7. Encountering Gender Differences: Women and PD Initiative

Given the differences women may encounter when dealing with their Parkinson’s, the Parkinson’s Foundation is leading the first national effort to address gender disparities in Parkinson’s research and care as part of an overall Women and PD Initiative. The Foundation has developed new patient-centered recommendations to improve the health of women living with PD.

Listen Now

If you like what you hear, be sure to subscribe, rate and review the series on Apple podcasts or wherever you get your podcasts. We want to hear what you think about our podcast! Share your feedback here.

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.

Many cellular components are involved in the development and progression of Parkinson’s disease. One component is the “energy factory” of the cell, called mitochondria. Certain genetic changes are known to impair the function of mitochondria.

Jannik Prasuhn, MD, of the Institute of Neurogenetics, University of Luebeck in Germany, has received a Clinical Research Award from the Parkinson’s Foundation to investigate the use of vitamin K2 in people with Parkinson’s whose disease is caused by genetic mutations that affect the mitochondria.

Vitamin K2 has been shown to be safe in previous studies of people with PD with osteoporosis. The vitamin is known to play a role in supplying cells with energy.

Dr. Prasuhn’s goal is to determine if vitamin K2 can increase energy levels and improve symptoms in people with mitochondrial-related Parkinson’s.

To achieve this goal, he will study 130 people: 26 people with PD who have mitochondrial mutations; 52 people with PD with idiopathic PD, and 52 people without Parkinson’s. They will be randomly assigned to receive vitamin K2 or a placebo for six months. All participants will undergo brain imaging before and after the study, and they will undergo medical exams five times throughout the study.

If this research suggests K2 could be helpful to people with Parkinson’s who have mitochondrial mutations, our hope is that larger, longer-term studies will be conducted that could ultimately lead to using K2 as a PD treatment.

Parkinson’s Foundation Clinical Research Awards help facilitate the development of clinician scientists, ensuring that promising early career scientists stay in the PD research to help us solve, treat and end this disease. These scientists are vital, as they apply research to the real-world as well as applying real-world issues to research. 

What’s Next: Reporting Our Findings

Parkinson’s Foundation research awards fund Parkinson’s studies than can span up to three years. We report findings once the studies have concluded. Stay up to date with our latest research findings at Parkinson.org/Blog.

Medical marijuana, or cannabis, is one of the most popular topics among the Parkinson’s disease (PD) community ― for people with PD, health professionals and researchers, alike. Earlier this year, the Parkinson’s Foundation hosted its first-ever convening on marijuana and Parkinson’s. Among the 46 attendees, of which 17 gave presentations, there was a reoccurring theme: what are the biggest hurdles the PD community faces when it comes to medical marijuana?  

This is the first article in a two-part series. Read part two here.

Treating Parkinson’s Symptoms with Cannabis

There is not enough evidence yet to support that medical marijuana can help manage Parkinson’s symptoms, however there are studies on the topic. Unfortunately, they have mixed results. Generally, the studies have been small and some with no control groups. The effects of medical marijuana are not completely understood, especially in the PD population. The bottom line is that more studies are needed, specifically larger and more rigorously conducted studies.

Based on some observational studies, cannabinoids (the active molecules in marijuana) may potentially benefit some non-motor symptoms of PD including pain, anxiety, sleep problems (insomnia, RBD, RLS), weight loss and nausea. Potential adverse effects include dizziness, blurring of vision, loss of balance, mood and behavioral changes, hallucinations, and impaired cognition and motivation. Better studies are necessary to confirm these benefit and adverse effects for people with PD.

Controlled clinical trials of cannabinoids (where some people receive the drug and some do not) have  reported mixed results for treating motor symptoms and levodopa-induced dyskinesia as well as improving quality of life.

While stories and videos exist showing that marijuana can treat PD symptoms, the challenge is showing that cannabis is better and safer than treatments that are currently available. A recent survey shows that the health community does not have a consensus on using cannabis as a treatment. This reflects lack of data, knowledge and training on the subject.

Future studies about medical marijuana and Parkinson’s should follow the highest standards of clinical trials to focus on:

• Delivery type: do specific strains, soft gels, tinctures (alcohol-based cannabis extract), e-liquid (vapor), topicals, infused food, flower products, inhalers and patches treat symptoms differently and have different side effect profiles?
• Dosage: what is the minimum dosage to guarantee effectiveness, what is the maximum dose tolerated and what dose will have a sustained benefit? Furthermore, how does this differ by strain and formulation?
• Effect on motor vs non-motor symptoms: which symptoms can improve, worsen or stay the same with cannabis use?
• Interaction with PD medications: how does cannabis interact with medications taken for PD symptoms?
• Key component: What components of cannabis/marijuana provide the best response in PD with the least risk of side effects?  What is the optimal CBD (Cannabidiol) to THC ratio?
• PD-specific side effects: are people with PD uniquely susceptible to certain side effects that are not seen in the general population?
• Population: studies that involve participants in difference stages of the disease.

Lastly, there needs to be a widespread physician education on using cannabis as a treatment ― almost all physicians surveyed agreed that medical school curriculums should include education on cannabis.

→ Danny Bega, MD, MSCI, from Northwestern University Feinberg School of Medicine; Joseph Jankovic, MD, from Baylor College of Medicine; and Karl Kieburtz, MD, MPH, from the University of Rochester, spoke about this topic at the marijuana convening.

Potential Drug Interactions

One surprising fact shared at the meeting is that cannabis-based products have the potential to interact with other medications. Given that people with Parkinson’s may be on multiple medications for other conditions, it is important to be aware of these interactions to avoid complications.

Epidiolex® is the first FDA-approved cannabinoid prescription drug. It is an oral solution of cannabidiol most commonly used to treat rare forms of epilepsy. It has been shown to have interactions with many anti-seizure medications, some antibiotics and medications for lowering cholesterol, pain, anxiety, depression and blood pressure. In some cases, Epidiolex can make these medications more or less potent. In other cases, these medications can make Epidiolex more or less potent. Because Epidiolex largely contains cannabidiol, there is the possibility that other cannabis-based products may also interact with medications in a similar way.

Delta-9-tetrahydrocannibinol (THC) is the primary psychoactive component of marijuana (the part that gives a “high”). It can take a long time to take effect and cannot be easily measured for a therapeutic or medicinal dose. THC can also interact with certain medications such as valproic acid (for bipolar disorder, seizures, and migraines) and can result in increased psychoactive effects of marijuana.

Medical marijuana can be taken in an edible form. Care should be taken with this form, as it takes longer to feel an effect and lasts longer (4-8 hours as opposed to 2-3 hours for smoking or vaporizing). Often, because the effects are slow, people increase their dose, eating more, which can be dangerous. Edibles may also have more toxicity than smoked marijuana, because they are broken down by the liver into more toxic chemicals.

→ Jacqueline Bainbridge, PharmD, FCCP, MSCS, from the University of Colorado, spoke about this topic at the marijuana convening.

The medical marijuana convening brought together a diverse group of experts from academia, clinics, industry, government and the Parkinson's community to establish a consensus on medical marijuana use in PD. The Parkinson’s Foundation will publish its findings on the convening in summer 2020. 

Learn more about Parkinson’s and marijuana at Parkinson.org/Marijuana.