Neuro Talk: Strategies for Managing Parkinson’s Disease Symptoms
What are common Parkinson’s disease (PD) symptoms and what causes them? Each person’s experience with Parkinson’s is unique, as are their symptoms and management strategies.
In our latest Neuro Talk, Chief Scientific Officer James Beck, PhD, discusses common movement and non-movement symptoms of Parkinson’s, as well as available treatments and ongoing research. Learning how to navigate symptoms can take time, but ultimately helps empower you to live better with PD.
Veterans and PD: Managing Anxiety, Depression, and Apathy
August 31, 2023
For veteran’s living with Parkinson’s disease, non-motor challenges are not always easy to discuss. With a focus on mood changes, including anxiety, depression, and apathy, this program will provide strategies for coping and talking about it with healthcare providers or loved ones.
Megan Gomez, PhD, Clinical Psychologist
Tibor Rubin Medical Center
Long Beach, CA
Raise Awareness
How to Manage Bladder and Common Urinary Issues in Parkinson’s
Though bladder problems are one of the most common challenges in Parkinson’s disease (PD), they are rarely discussed with a doctor. Parkinson’s can impact bladder function in many ways, including urinary urgency, leakage and urinary tract infections. Untreated, some urinary issues can lead to cognitive problems. Discover why it’s important to discuss urinary difficulties with your healthcare provider and learn about the treatments that address challenges and improve quality of life.
This article is based on Parkinson's Disease and the Bladder, a Parkinson’s Foundation Expert Briefing webinar presented by Abhimanyu Mahajan, MD, MHS, Movement Disorders Neurologist and Assistant Professor of Neurology, University of Cincinnati and Ankita Gupta, MD, MPH, FACOG, Associate Fellowship Director, Female Pelvic Medicine & Reconstructive Surgery, University of Louisville Health.
PD and Pelvic Floor Health
In Parkinson's, the brain does not produce enough dopamine. The decrease in this feel-good brain chemical impacts more than movement and mood. Parkinson’s-related brain changes can lead to a host of symptoms in the pelvic floor region that can impact gastrointestinal and urinary systems, sexual health and more.
Constipation, common in PD, can begin as early as 20 years before the key movement symptoms that lead to a diagnosis. Urinary symptoms, however, often begin after someone has lived with Parkinson’s for 10 years or more.
Urinary and Bladder Issues
Parkinson’s impacts the autonomic nervous system (the system in charge of the body’s unconscious actions, such as pumping blood, blinking and breathing). When this system causes urinary issues, it’s known as neurogenic bladder dysfunction.
These urinary problems are widespread in Parkinson's and affect women and men. Whether doctors do not bring up urinary health or people are reluctant to mention issues, research shows that anywhere from 24% to 96% people with PD experience urinary symptoms.
Urinary challenges are also commonly associated with increased age and worsening cognitive function. The average age of a person receiving a Parkinson's diagnosis is 60 — around the same age people commonly experience:
Urinary urge incontinence: urgency accompanied by leakage
Stress incontinence: urine leakage when coughing, sneezing or exercising
Mixed incontinence: leakage after a sensation of urgency and with physical movement
Unless asked, women are far less likely to report urinary challenges compared to men. When asked, almost 50% of all women in the U.S. more than 80 years old report at least one relevant urinary symptom.
In Parkinson’s, the inability to delay urination can lead to falls.
Neurogenic orthostatic hypotension (nOH), when blood pressure drops when moving from sitting to standing, or from lying down to rising, can be common in people with PD and other nervous system disorders. Urinary urgency combined with nOH can increase a person’s fall risk.
PD-related balance difficulties (postural instability), trouble moving and walking and waking to use the bathroom at night — when Parkinson’s medications are not fully effective — can also increase the risk of falls connected to urinary urgency and bladder issues.
Sudden cognitive changes are unusual in PD. These should be urgently addressed and may be caused by a urinary tract or bladder infection, other infections, or a medication side effect.
Assess and Address Bladder Health
If you experience urinary issues, talk to your healthcare provider.To prepare:
Keep a 24-hour overactive bladder diary. This can help you keep track of urination timing and frequency and provide greater detail to your doctor.
Think about your treatment goals. Do you need enough relief to sleep better or are you hoping to get through an outing without overly frequent trips to the restroom?
Aim to take PD medication on time, every time. Most people with PD know medication timing is often essential to controlling PD symptoms. Staying on schedule can also impact bladder function.
Your doctor may refer you to a specialist. Urologists are doctors who focus on the urinary system, while urogynecologists specialize in treating pelvic floor disorders in women.
Urinary Issue Treatments
Your doctor will try to get to the root of any urinary issues, looking for reversible causes such as an infection or diuretics (water pills). It’s not uncommon for people with Parkinson’s to have bladder symptoms that predate their PD diagnosis.
A doctor might have you stand or sit and cough to assess for stress incontinence or use an ultrasound or catheter to confirm whether your bladder is fully emptying. Urodynamic testing can help your healthcare provider determine whether your bladder fills and empties at normal pressures and reveal urinary dysfunction.
Treatment is tailored to a person’s symptoms and goals. Non-surgical options include:
Kegel and pelvic floor muscle strengthening exercises, which can benefit men and women.
Referral to pelvic floor physical therapy.
Behavioral and lifestyle modifications, such as practicing urge suppression and urinating at fixed intervals to retrain the bladder and increase its holding capacity.
Botulinum toxin injections for overactive bladder.
For women, a continence-support pessary — a tailored, soft, vaginal device, typically removable, that can improve bladder control. This option may be challenging as Parkinson’s advances.
Medication therapy is also an option. Beta-3 agonists mirabegron (Moretti®) and vibegron (Gemtesa®) are once-a-day medications to control bladder urgency and frequency.
While anticholinergic drugs are often a first-line therapy for bladder issues, research finds cognitive slowing can be a side effect to these drugs. Use should be avoided in people older than 70, as there is a greater potential for anticholinergic-related hallucinations and confusion. Oxybutynin (Ditropan®), darifenacin (Enablex®), tolterodine (Detrol®), trospium (Sanctura®), phenoperidine fumarate (Toviaz®) and tofenacin succinate (VESIcare®) are among the anticholinergics used to manage overactive bladder.
Surgical options for bladder challenges include:
Injection of a hydrogel urethral bulking agent. This acts as a plug to stop urine leakage during coughing, exercise or other movement.
Sacral neuromodulation. Electrical stimulation through an implanted bladder pacemaker-like device, to improve urinary urgency, incontinence and retention.
Urethropexy to adjust and support the urethra for bladder control.
Retropubic colposuspension. Reinforcement for the bladder and urethra to improve urinary incontinence.
For men, bladder sling surgery, which supports the urethra to boost bladder control.
For women with stress incontinence, urethra-supporting synthetic midurethral sling surgery or autologous fascial sling surgery.
Learn More
Explore our resources about urinary issues and Parkinson’s:
Expert Briefing: Parkinson’s Disease and the Bladder
September 13, 2023
Many people with Parkinson’s disease (PD) experience urinary difficulties. Being aware that urinary problems, such as urinary tract infections, can be a symptom of Parkinson’s is the first step toward management. Learn more about common bladder problems in PD, why they occur and treatment options.
Abhimanyu Mahajan, MD, MHS, Movement Disorders Neurologist and Assistant Professor of Neurology
University of Cincinnati
Cincinnati, OH
Ankita Gupta, MD, MPH, FACOG, Associate Fellowship Director, Female Pelvic Medicine & Reconstructive Surgery
University of Louisville Health
Louisville, KY
Science News
New Study Finds Promise In Treatment for Parkinson’s-related Constipation
The most well-known Parkinson’s disease (PD) symptoms are movement-related — tremor, muscle stiffness, slow movement, trouble moving and walking. However, many people with Parkinson’s find non-movement symptoms — including sleep disturbances, depression, psychosis and constipation —more troublesome and disabling than movement symptoms.
In Parkinson’s, a protein found in the brain called alpha-synuclein accumulates abnormally in the nervous system, forming clumps. These clumps lead to changes in the normal function of brain cells. Interestingly, alpha-synuclein clumps within the nerves of the gastrointestinal (GI) tract have also been linked to a decrease in the strength and coordination of the bowels, resulting in constipation. More than 60% of people with Parkinson’s suffer from constipation, and for most of those people it can be chronic, severe, and unresponsive to standard treatments.
The results of a new clinical trial published in the Annals of Internal Medicine show a possible treatment for constipation in people with Parkinson’s. The biotech company Enterin has developed ENT-01, a compound designed to act on nerve cells in the GI tract and prevent alpha-synuclein from clumping. An earlier study found that ENT-01 is not absorbed into the body, suggesting it acts only in the gut.
Constipation impacts more than 60% of people with Parkinson’s.
Study Results
The clinical trial enrolled 150 people with Parkinson’s and constipation, who were randomly given either ENT-01 or a placebo for 25 days. The results of the study showed:
People with Parkinson’s and constipation who received ENT-01 had a significant increase in the number of daily bowel movements and had better stool consistency as well as ease of stool passage.
There were no serious adverse effects of ENT-01. The most common side effects were nausea (experienced by a third of participants) and diarrhea (experienced by 20% of participants).
A small number of participants with psychosis also saw improvements in their symptoms; however, researchers note that the study was not designed to examine improvements in cognitive symptoms.
What does this mean?
In this trial, ENT-01 was shown to help people with Parkinson’s who experience constipation. The compound will undergo further clinical testing to examine the safety and effectiveness of long-term use before it can become available.
What do these findings mean to the people with PD right now?
People with Parkinson’s who experience constipation will not yet have access to ENT-01 and should talk to their doctor about current treatment options. Depending on the clinical trial process, ENT-01 may be a treatment option for the PD community in the next few years.
Can this drug also help with cognitive issues?
A small number of participants in this study who experience psychosis saw improvements in their cognitive symptoms. However, this study was not designed to examine these symptoms, so the Parkinson’s Virtual Biotech has designed a study that is. This new project will assess the potential of ENT-01 and how it may impact people with Parkinson’s who experience memory problems.
Through our collaboration with the Parkinson’s UK, the Parkinson’s Virtual Biotech, is fast-tracking the development of new therapies that could treat, and ultimately cure, Parkinson’s. ENT-01 is one of these new therapies.
Learn More
The Parkinson’s Foundation believes in empowering the Parkinson’s community through education. Learn more about PD and the topics in this article through our below resources, or by calling our free Helpline at 1-800-4PD-INFO (1-800-473-4636) for answers to your Parkinson’s questions.
Episodio 27: Los efectos del Parkinson sobre el sueño
Existen diversas causas de los problemas del sueño que pueden experimentar las personas con Parkinson. Entre los trastornos del sueño más comunes están la apnea del sueño (asociada normalmente a un ronquido fuerte), el insomnio y el trastorno donde las personas actúan los sueños mientras duermen.
También sabemos que los problemas emocionales, que son síntomas no motores del Parkinson, pueden estar ligados a los problemas del sueño. Por ejemplo, si uno tiene depresión o ansiedad, puede llevarlo a dormir mal en general.
En este episodio de podcast, escuchamos al doctor Alberto Ramos, profesor de neurología clínica y director de investigación del Programa de Trastornos del Sueño en la University of Miami Miller School of Medicine acerca de los efectos del Parkinson sobre el sueño. El doctor Ramos comparte formas de mejorar el sueño, tratamientos que existen para estos problemas y consejos para las personas con la EP que están experimentando estos problemas, así como para las parejas que experimentan interrupciones debido a estos trastornos del sueño.
Publicado: 1 de agosto de 2023
El doctor Alberto Ramos es profesor adjunto de neurología clínica y director investigador del programa de trastornos del sueño en la University of Miami, Miller School of Medicine. La investigación del doctor Ramos se enfoca en la intersección de los trastornos del sueño con la enfermedad cerebrovascular y el envejecimiento neurocognitivo en estudios basados en la población. El doctor Ramos completó una subvención complementaria de diversidad del Instituto Nacional de la Salud/ Instituto Nacional de Enfermedades Neurológicas y Apoplejía, (NIH/NINDS por sus siglas en inglés), diseñada para determinar los trastornos del sueño asociados con los factores de riesgo de embolia y deterioro cognitivo en el estudio Northern Manhattan Study. También es investigador del Estudio de la Salud de la Comunidad Hispana/Estudio de los Latinos (Hispanic Community Health Study/Study of Latinos, HCHS/SOL, por sus siglas en inglés), donde se desempeña como consultor principal de investigación del sueño en la sede de campo de Miami. El doctor Ramos es Miembro de la American Academy of Sleep Medicine y fue presidente del Foro de Investigación de Jóvenes Investigadores (Young Investigator Research Forum) de la American Academy of Sleep Medicine Foundation en 2019.
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Episode 154: Sexuality from the Care Partner Perspective
Intimacy is a significant part of any relationship, and sexuality is an important aspect of intimacy. Parkinson’s disease (PD) can present challenges for both intimacy and sexuality, both for the person with PD and for the care partner. The Parkinson’s Foundation Helpline can be a good resource for coping with these issues. In this episode, Anna Moreno, MSW, a Senior Parkinson’s Information Specialist at the Parkinson’s Foundation, highlights some of the more common questions that care partners pose about sexuality to the Helpline.
Although she herself is not a therapist, she can direct callers to appropriate resources. Gila Bronner, MPH, MSW is a Certified Sex Therapist and Supervisor of the Sex Therapy Services at the Tel-Aviv Sourasky Medical Center in Israel. In this episode, she provides insight into these typical problems that care partners report, and she offers some recommendations to help overcome them. For many years, she has researched and provided therapy and advice about intimacy and sexuality relating to PD in Israel and around the world.
Released: July 11, 2023
Gila Bronner, MPH, MSW is a senior sex therapist at Tel-Aviv Sourasky Medical Center in Israel and is an expert in sexual-neuro-rehabilitation (Parkinson’s disease, Multiple Sclerosis, Stroke, Dementia). She has published over 30 scientific papers, 13 chapters in neurological books, and sex-education books for children, adolescents and elders. Her life goal was dedicated to sexual health promotion, by training health care professionals in Israel and all over the world (Europe, USA, Canada, Asia and Australia). She is a member of the MDS Task Force on Wellness and of the MDS Health Professional leaders group.
Anna Moreno, MSW received a Bachelors of Arts at Louisiana State University and a Master of Social Work from Washington University in St. Louis. She is a Senior Parkinson Foundation Information Specialist and has had the honor of speaking with and answering questions from people with Parkinson's, care partners, family, friends and health care professionals on the Parkinson's Foundation Helpline for 13 years. She has also worked on developing educational materials and webinars. She previously worked for the National Cancer Institute Helpline.
Neuro Talk: Strategies for Managing Parkinson’s Disease Symptoms
Each person’s experience with Parkinson’s disease (PD) is unique. Understanding how to manage symptoms can take time, but will ultimately empower you to live better with PD.
In our latest Neuro Talk, Chief Scientific Officer James Beck, PhD, discusses common movement and non-movement symptoms of Parkinson’s. Dr. Beck also explains available treatments and ongoing research related to both types of symptoms.
Episode 152: The Link Between Art and Parkinson’s Disease
There’s a new and greater understanding of the relationship of Parkinson’s disease (PD) and art. Engaging in artistic practices can enhance mood, cognitive function, and enjoyment of life for people with PD. Importantly, how art causes these effects is giving greater insight into the neurobiological basis of how people in general create and respond to art. Central to this insight is the role of the neurotransmitter dopamine. In this episode, Prof. Bas Bloem, Director of the Parkinson’s Foundation’s Center of Excellence at Radboud University Medical Center in Nijmegen, the Netherlands, explores the emerging importance of incorporating art in the treatment of PD and the role of dopamine for enhancing people’s enjoyment and creativity. Dopamine has been called the “happiness hormone,” but it may also be the creativity hormone.
Released: June 13, 2023
Professor Bas Bloem is a neurologist at the Radboud University Medical Centre, Nijmegen, The Netherlands. He received his medical degree, with honours, at Leiden University Medical Centre in 1993 and obtained his PhD degree in 1994. He trained as a neurologist between 1994 and 2000. He received additional training as specialist in movement disorders during fellowships at The Parkinson's Institute, Sunnyvale, California, and the Institute of Neurology, Queen Square, London. In September 2008, he was appointed professor of neurology, with movement disorders as special area of interest.
Professor Bloem is on the editorial board of leading national and international (scientific) journals and has over 800 publications to his credit. Since 2020 he serves as Co-Editor in Chief of the Journal of Parkinson's Disease. In 2002, Professor Bloem founded the Radboudumc Center of Expertise for Parkinson's & Movement Disorders and, together with Dr. Marten Munneke, developed ParkinsonNet, an innovative care concept for Parkinson's patients consisting of 70 professional regional networks. In 2018, he won the Tom Isaacs award in recognition of his long-standing achievements in the field of Parkinson's disease. In 2022 he received the Stevin Award, the highest recognition for a Dutch scientist who has had greatest impact on society.
PD in the Feces: Stool Samples Could Detect Early Parkinson’s
New research finds a Parkinson’s-related biomarker in stool samples from individuals with a sleep disorder linked to later developing Parkinson’s.
Making an accurate Parkinson’s disease (PD) diagnosis is complicated because there is no single test. Doctors look at symptoms such as tremor, rigidity and difficulty walking to make a diagnosis. As a result, it can take years after the onset of early symptoms to get an accurate diagnosis. And while there are treatments available to alleviate symptoms, they can’t slow down or stop the disease.
A new study suggests that a stool sample could help detect Parkinson’s before movement symptoms start. Detecting Parkinson’s early can help researchers better understand how Parkinson’s works and ultimately, develop treatments that can slow disease progression.
What is alpha synuclein?
When it comes to Parkinson’s, the protein called alpha synuclein plays a critical role. This protein, believed to be important for normal neuronal function, begins to form sticky clumps in neurons (cells in the brain) in PD. Over time, the clumping kills neurons and impairs the brain’s ability to produce dopamine, leading to Parkinson’s symptoms and ultimately a diagnosis.
To develop a test for a disease, researchers often rely on a biological indicator (called a biomarker). A potential biomarker of Parkinson’s is a protein called alpha-synuclein, which is involved in normal brain cell function but accumulates abnormally in Parkinson's. The presence and increase in alpha-synuclein clumping levels in the cerebrospinal fluid (CSF) in Parkinson’s has been well documented; however, collecting the CSF is invasive and challenging. Alpha-synuclein aggregates have also been detected in the saliva, tears, urine, and blood of people with Parkinson’s. However, to this date, no method has been developed to reliably predict or diagnose Parkinson’s using these samples.
A recent study published in Nature Parkinson’s Disease and funded by the Parkinson’s Foundation, describes how alpha-synuclein levels detected in stool samples could predict Parkinson’s disease onset. Gültekin Tamgüney, PhD, a Parkinson’s Foundation Impact Award recipient, led the research team.
The study is based on recent research that indicated that it might be possible for alpha-synuclein to be shed in the gut, and therefore found in feces. The amounts of alpha-synuclein shed by the body are too small for standard lab techniques to detect them. Thus, a team of researchers studied whether they could use a special technique called sFIDA (surface-based fluorescence intensity distribution analysis) to accurately detect alpha-synuclein in stool samples.
The researchers used sFIDA in stool samples from people with Parkinson’s, healthy people, and people who have a sleep disorder called isolated rapid eye movement sleep behavior disorder (iRBD). Past research indicates that 80% of individuals with iRBD — which can lead people to act out their dreams through movements such as kicking, punching, or getting out of bed and walking around — later develop Parkinson’s or dementia. Importantly, individuals with iRBD also display many of the non-movement symptoms observed in people with Parkinson’s and have high amounts of alpha-synuclein aggregates in their nervous system.
Study Results
The sFIDA technique was successful at detecting alpha-synuclein aggregates in stool samples.
Stool from individuals with iRBD showed significantly higher levels of alpha-synuclein aggregates than healthy individuals — the researchers were able to distinguish 76% of people with iRBD from healthy individuals.
Unexpectedly, alpha-synuclein aggregate levels were similar between healthy people and people with Parkinson’s.
The researchers were surprised that alpha-synuclein aggregates are found in the stool of people with iRBD, but not in people with a Parkinson’s diagnosis. They speculated that the presence of alpha-synuclein in the stool may be related with disease progression — the more advanced the disease is, the less alpha synuclein aggregates are shed through stool.
What does this mean?
With further improvement, this method of detecting alpha-synuclein in the stool could be a noninvasive way to detect Parkinson’s many years before the movement symptoms appear. Earlier detection would allow for earlier treatment once researchers identify a successful disease-modifying drug.
Additionally, researchers could use this method to monitor the effectiveness of treatments in clinical studies. For example, if a drug treatment reduces alpha-synuclein aggregate levels in stool over time, it could indicate that the treatment is having an effect.
What do these findings mean to the people with PD right now?
Currently, this method cannot be used to diagnose Parkinson’s. Studies like this one are an exciting step toward allowing the medical research field to find a biomarker that can help doctors diagnose and track disease progression.
Learn More
The Parkinson’s Foundation believes in empowering the Parkinson’s community through education. Learn more about PD and the topics in this article through our below resources, or by calling our free Helpline at 1-800-4PD-INFO (1-800-473-4636) for answers to your Parkinson’s questions.
