The Parkinson's Foundation, in collaboration with the American College of Sports Medicine, created new Parkinson’s disease (PD) exercise recommendations to ensure that people with Parkinson’s are receiving safe and effective exercise programs and instruction. The guidelines are the result of a convening including 34 exercise professionals and thought leaders who met in March 2020 to help develop the framework for these guidelines.

The new exercise guidelines include recommended frequency, intensity, time, type, volume and progression of exercises that are safe and effective for people with Parkinson’s across four domains: aerobic activity, strength training, balance, agility and multitasking and stretching. Each recommendation is paired with specific types of activity and special safety considerations for people with PD.

It is recommended that people with PD see a physical therapist specializing in Parkinson’s for full functional evaluation and recommends exercise during ‘on’ periods, when taking medication. The guidelines also recommend 150 minutes of moderate to vigorous exercise per week for people with Parkinson’s. Other key recommendations include:

• Aerobic activity: 3 days a week for at least 30 minute per session of continuous or intermittent movement at moderate or vigorous intensity
• Strength training: 2-3 non-consecutive days per week of at least 30 minutes per session for 10-15 repos for major muscle groups; resistance, speed, or power focus
• Balance, agility and multitasking: 2-3 days per week with daily integration if possible
• Stretching: 2-3 days per week with daily stretching being most effective

Research from the Parkinson’s Foundation Parkinson’s Outcomes Project, the largest-ever clinical study of Parkinson’s, suggests that people with PD do at least 2.5 hours of exercise a week for a better quality of life. The new Parkinson’s exercise guidelines aim to support the Parkinson’s community in staying active. The guidelines also provide an important framework for exercise professionals, who play a vital role in developing safe and effective programs to improve quality of life for the PD community. 

Learn more:

• Read the Parkinson’s Foundation exercise recommendations
• Read see the full Exercise Convening Summary Report
• Exercise professionals can review the professional version of these guidelines

Navigating Parkinson’s disease (PD) can feel like a never-ending learning curve. PD Conversations is a place to ask your Parkinson’s questions and connect with others living with the disease. In this blog series, we highlight a high-interest question answered by the Parkinson’s Foundation Helpline on PD Conversations.

Question: My father and his father both had Parkinson’s. I’m wondering if this is a disease that I and my children should be concerned about possibly inheriting? If so, is there a way or place we can get tested? None of us currently show any signs or symptoms.

Currently scientists find that genetics alone cause only 10% to 15% of all people's Parkinson’s. If through genetic testing a person is positive for a certain gene mutation associated with Parkinson’s (such as LRRK2, GBA and SNCA genes) then their risk may increase, but they may never develop Parkinson’s. Genetic testing for these and other genes can be done, but it will not be able to predict the probability for you or your kids to develop the disease.

Testing may be able to calculate your risk. A complicated interplay between environmental and genetic factors are thought to be the main reasons why the vast majority develop Parkinson’s.

I can understand your wish to know more about genetics and Parkinson’s because of your family history, it might be helpful to first talk with a genetic counselor about why you want the test and what impact the results will have on you and your family. If you want to read more about this, we have additional information on Parkinson.org/Genetics.

You can also learn more about the Parkinson’s Foundation PD GENEration study that offers genetic testing for Parkinson's-related genes and genetic counseling at no cost for people with Parkinson’s disease.

Do you have a question for the PD community? Join the PD Conversation in our discussion groups: Newly Diagnosed, Symptoms, Caregiving, Tips for Daily Living, Young-Onset and more.

Imagine being diagnosed with an incurable neurological disease, but afraid to reveal your identity because you might be denied care or enrollment in a clinical trial. Unfortunately, for many within the LGBTQ+ population living with Parkinson’s disease (PD), this is a common reality. Chi-Ying Roy Lin, MD, MPH, is an incoming neurologist at Baylor College of Medicine, a Parkinson’s Foundation Center of Excellence, who is advocating for the Lesbian, Gay, Bisexual, Transgender, Queer or Questioning plus other sexual identities (LGBTQ+) Parkinson’s community through research.

In his previous role as a Parkinson's Foundation Movement Disorders Fellow at New York-Presbyterian Hospital/Columbia University Medical Center, Dr. Lin noticed some life-altering issues his patients were grappling with. “Movement disorders is one of the least researched areas in the LGBTQ+ neuroscience field,” Dr. Lin said. The LGBTQ+ Parkinson’s community is so under-researched, there are currently no population estimates.  

Dr. Lin’s published study titled, “Expanding Sexual and Gender Minority Research In Movement Disorders: More Than Awareness and Acceptance” identifies the most urgent LGBTQ+-related Parkinson’s issues. 

Estrogen and Testosterone in Parkinson’s Research 

Estrogen and testosterone can be given as medically necessary gender-affirming hormones to match transgender people’s gender identity. How does this relate to Parkinson’s? At this point, testosterone was not found to affect Parkinson’s symptoms. On the other hand, the influence of estrogen on Parkinson’s symptoms remains inconclusive. Some research has shown that estrogen can play a role in providing protective benefits, such as lessening certain symptoms. Researchers also found that women with PD could have more motor fluctuations than men, challenging the idea of estrogen’s “protective effect” In PD.

What does this mean for trans women with PD who take estrogen therapy? “It is possible that trans women with Parkinson’s who take estrogen may see better or worse motor symptoms, which requires future research to tell us,” Dr. Lin said. “This is particularly important, as counseling about the stopping or altering of gender-affirming hormone for a transgender person, if necessary, is drastically different from that for postmenopausal or contraception purpose, considering the medical necessity of gender-affirming hormone to maintain mental health and life quality.”

Worse Parkinson’s Care Access and Experience

“There is a disparity in care among those in the sexual and gender minorities,” Dr. Lin said. “I have had patients who are reluctant to reveal their identity because of fear they will get denied healthcare.”

“We need to create a safe environment in healthcare institutions to disclose sexual orientation and gender identity to better impact care and access to resources,” Dr. Lin wrote in his study. Sex is a biological identifier generally determined at birth (male or female), while gender is a person’s identity (man, woman, transgender, non-binary). 

Unfortunately, there is no LGBTQ+ patient guidance for multidisciplinary teams or care facilities. This coupled with ongoing discrimination and stigma against LGBTQ+ patients in healthcare, many people do not feel comfortable telling their doctor they are in a same-sex marriage or they identify as transgender. Seniors within the LGBTQ+ are particularly vulnerable. “It is not uncommon to see higher rates of violence or verbal abuse in nursing homes aimed at LGBTQ+ residents,” Dr. Lin said.

Identity Issues

Research, education, and advocacy can help address all these issues. The biggest obstacle right now for the LGBTQ+ Parkinson’s community is data. On a national level, most medical records list sex (female or male), but not gender (how a person identifies). “This continues to limit our research,” Dr. Lin said. 

Knowing if a patient with Parkinson’s identifies as LGBTQ+ may help doctors provide customized treatments for movement and mood disorders. For instance, LGBTQ+ members typically experience higher rates of social isolation, so do people with Parkinson’s. If someone is LGBTQ+ and has Parkinson’s, they would be extremely prone to experience graver isolation issues that can lead to the worsening of non-movement PD symptoms, like depression or anxiety. To provide better evidence-based care, Dr. Lin would like to answer, “How does identity affect access to research and care?”

Helping the LGBTQ+ Parkinson’s Community

Policy-making and advocacy would change the course of treatment and care for the LGBTQ+ Parkinson’s community. “There are currently no guidelines at national or state level to help provide better care for the LGBTQ+ community,” Dr. Lin said. “There is a critical need for literature and best practices.” 

Once created, guidelines would begin to address the disparity of care experienced by the LGBTQ+ community along with providing more tailored treatment options and help healthcare professionals follow best practices when treating LGBTQ+, Parkinson’s patients. For example, a nation-wide LGBTQ+ Parkinson’s guidelines can include affirming terminology for healthcare workers, an LGBTQ+-friendly and culturally competent provider list and proven ways to help the LGBTQ+ population feel more comfortable speaking to their care team. 

“Do not be afraid to reveal your identity and community, said Dr. Lin when asked for his advice to the underrepresented LGBTQ+ Parkinson’s community. “I feel people in the medical community are relatively open-minded. If you are uncomfortable with your current specialist, reach out to other providers who may be able to give LGBTQ+ customized care. Telemedicine allows most people to find the right provider now. Also, try to be active in participating in clinical research and trials. Don’t be afraid to reveal who you are.” 

Learn more about the Foundation’s commitment to diversity, equity and inclusion at Parkinson.org/DEI.

Much of our understanding of Parkinson’s disease (PD) comes from genetic studies. The most common genetic changes linked to PD occur in the GBA gene. People with PD who have a change (known as a mutation) in their GBA gene have been found to be more likely to experience 1) a younger onset of PD, 2) a more intense disease course, 3) an increased risk of dementia, and 4) tend to have a shorter life span than those with PD who do not have the GBA gene mutation. 

The GBA gene, when functioning properly, provides instructions for toxic waste clean-up in a person’s cells. A GBA gene mutation may lead to a dangerous toxic build-up that can harm one’s brain, and other essential organs. 

Having a GBA gene mutation has been identified in upwards of 12% of PD cases of people from European descent and 15-20% of Ashkenazi Jewish cases. Despite how common this mutation is, there have been surprisingly few good studies comparing the motor and functional decline of those with and without the GBA gene mutation — particularly from early diagnosis. Fortunately, a just-published, seven-year study that followed a group of people with Parkinson’s over time, sought to tackle this important shortcoming.

A study titled, “Association of GBA Genotype with Motor and Functional Decline in Newly Diagnosed Patients with Parkinson’s Disease” (Maple-Grodem et al., 2021), drew from three large European population-based PD studies (the Norwegian ParkWest, the Swedish NYPUM, and the Scottish PINE). Participants in this study included 53 GBA mutation carriers (in their mid-50s to mid-70s; 64% male) and 387 without the GBA gene mutation (in their early 60s to their late 70s; 60% male). Then, each year for seven years, the study participants’ motor and functional impairments (difficulties in performing activities of daily living) were meticulously evaluated using well-established PD scales, along with other sophisticated models and tests. Researchers took into consideration age, sex and duration of motor symptoms for each participant. 

Results

At time of initial diagnosis:

• Participants with and without the GBA mutation did not differ in overall motor severity or activities to perform (or complete) activities of daily living, nor in severity of tremor, rigidity, bradykinesia or trouble with balance.
• GBA mutation carriers experienced their first motor signs of PD at an earlier age than non-carriers.
• GBA mutation carriers were younger than non-carriers when initially diagnosed with PD. 

Effects after seven years: 

• GBA mutation carriers had a more rapid motor decline than non-carriers.
• There was statistically significant worsening in both the PD rating scores for GBA carriers compared to non-carriers — mostly driven by a steep decline in their bradykinesia and rigidity scores.

What Does It Mean?

This study investigated how having a GBA mutation impacts the motor and functional decline of people with PD over time. In brief, study participants with a GBA mutation experienced their first symptoms younger and were also diagnosed at a younger age than participants without this mutation. Of note, at the time of initial diagnosis, there was no distinguishable difference in the level of motor and function decline between GBA carriers and non-carriers. 

Why is this study important? The speed of motor and function decline experienced by participants with a GBA mutation was faster compared to people without the genetic mutation. Such a profound decline impacts everything — from one’s independence to caregiver responsibility, and more. Having a better understanding — and armed with a reasonable predictability of PD progression — is essential for coordinating optimal health care for a significant proportion of the PD population. Better understanding these PD-related gene mutations and how they are linked to symptoms can help revolutionize PD research and future treatments.

While the study authors did not specifically advocate for genetic testing to become standard practice, they did suggest that knowledge of whether study participants are GBA mutation carriers would be valuable information, in terms of designing clinical trials and for interpreting the implications and applicability of study results. 

Genetic studies, such as PD GENEration, help arm people with Parkinson’s with the knowledge of their genetic mutations, which can help them qualify for enrollment in more specialized clinical trials that are currently testing and optimizing PD treatments and medications that respond to particular genetic mutations.

Learn More

The Parkinson’s Foundation believes in empowering the Parkinson’s community through education. Learn more about Parkinson’s and genetics by visiting the Parkinson’s Foundation resources below, or by calling our free Helpline at 1-800-4PD-INFO (473-4636) for answers to your Parkinson’s questions.

• Genetics and Parkinson’s
• PD GENEration: Mapping the Future of Parkinson’s Disease
• GBA Mutation May Lead to Novel Therapeutics 
• Episode 7: Genetics as a Guide to Neuroprotection in Parkinson’s Disease

On August 11, 2014 actor and comedic genius Robin Williams passed away. Williams not only amplified awareness of the life-changing, prevalent disease known as Lewy Body Dementia, but his passing brought much-needed attention to the importance of mental health and the non-movement symptoms of depression and anxiety that often accompany a neurodegenerative disease.

A decade after his passing, what do we know about Lewy Body Dementia? How can we help people with a neurological disease experiencing suicidal thoughts?  

What is Lewy Body Dementia? 

Lewy Body Dementia (LBD), also known as Dementia with Lewy Bodies, is a progressive brain disorder that is diagnosed when cognitive decline is an early symptom. It can also be diagnosed when cognitive decline and motor symptoms begin and develop together. 

“Lewy Body Dementia is a common type of dementia — it is the second most common neurodegenerative dementia behind Alzheimer’s,” said Jennifer G. Goldman, MD, MS, section chief of Parkinson’s Disease and Movement Disorders at Shirley Ryan AbilityLab and a Professor in Physical Medicine and Rehabilitation and Neurology at Northwestern University Feinberg School of Medicine, a Parkinson’s Foundation Center of Excellence. “It is thought to affect 1.4 million people in the U.S. but is not widely recognized. With greater education and awareness, with Lewy Body Dementia including both Dementia with Lewy Body and Parkinson’s disease (PD) dementia, we can start to change that landscape.”

What is the difference between Lewy Body Dementia and Parkinson’s disease dementia?

Lewy Body Dementia is a term used for both Parkinson’s disease dementia and Lewy Body Dementia. They have some things in common, but their progression and treatment are different. 

While many people with Parkinson’s can experience cognitive changes, it is important to know that not everyone with Parkinson’s will develop dementia. “When we see more severe cognitive changes, particularly when they affect someone’s function or ability to act independently for activities of daily living, their work or hobbies, we think of that as being a form of dementia,” said Dr. Goldman.

“With Parkinson’s dementia, the motor symptoms precede the dementia. In dementia with Lewy Body the initial core symptom is dementia — cognitive changes are early, and motor features, if present, occur either after the onset of dementia or concurrently,” said Dr. Goldman. 

Fight For a Diagnosis

Before Robin Williams was diagnosed with Lewy Body Dementia, it was reported that he had been experiencing paranoia, confusion, insomnia, constipation and lacking the ability to smell. For many, the wide range of early symptoms — not all related to brain function — makes Lewy Body Dementia difficult to diagnose. 

Dr. Goldman urges patients to fight to find their diagnosis. “Continue to seek the answers and seek out a specialist to help identify the cause of the cognitive issues or type of dementia,” said Dr. Goldman. “The right doctor can change one’s management, prognosis, and eligibility for participating in research studies. It’s important to have the best understanding of the disease for the chance to have the best outcomes.”

Depression and Suicide

People with neurological conditions, like Parkinson’s, are at higher risk for suicide, according to a study published in in the Journal of the American Medical Association in February 2020. Depression can be a common symptom for both PD and LBD. 

People living with Parkinson's benefit most from a comprehensive, team-based healthcare approach that includes a mental health professional. With a team in place, should depression or suicidal thoughts occur, you have an established relationship with a professional you trust. However, it is never too late to add a mental health professional to your care team. 

If you or your loved one is having thoughts of suicide:

• Find the resource that works for you: 24-hour suicide prevention hotlines can help, such as the National Suicide Prevention Lifeline at 1-800-273-8255.
• Seek professional help: Find a psychologist, therapist, counselor, or social worker you can trust and lean on. 
• Stay engaged: It can be easy for people with Parkinson’s to distance themselves. Try to connect with family and friends, schedule regular phone calls and seek out a support group or wellness class. 
• Build your support crew: call the Parkinson's Foundation Helpline at 1-800-4PD-INFO (473-4636) for help finding a local or online support group. 

If you are a care partner or family member, learn about suicide warning signs and how you can help here.  

Ongoing Hope

There are treatment options for Lewy Body Dementia and Parkinson’s disease dementia. Healthcare teams are finding that the most effective approach is a combination of medication, physical and mental exercises, and incorporating a mental health professional as part of a care team. 

“There is quite a bit of research going on in Lewy Body Dementia,” said Dr. Goldman. “Researchers are trying to understand why it occurs, and whether there are differences between Parkinson’s disease dementia and Lewy Body despite the fact that they share many clinical symptoms and pathology. Ongoing research ranges from trying to predict or detect early changes in people who might go on to develop Lewy Body Dementia all the way to studying different treatments — from medications to newer trials starting to look at the roles of mental and physical exercises.”

More Resources

The Parkinson’s Foundation believes in empowering the Parkinson’s disease community through education. Learn more: 

• Podcast Episode 87: What is Lewy Body Dementia and How Does it Relate to Parkinson’s?
• Lewy Body Dementia Association
• Dementia with Lewy Bodies
• Caregiver Corner: Lewy What? Explaining Lewy Body Dementia
• Suicide and Parkinson’s

Contact the Parkinson's Foundation Helpline at 1-800-4PD-INFO (1-800-473-4636) for more information about any of these topics and Parkinson’s. 

Through its national study, PD GENEration: Mapping the Future of Parkinson’s Disease, the Parkinson’s Foundation is giving people with Parkinson’s disease (PD) insights into their PD and opportunities to take action, while accelerating PD treatments. Genetic counseling, offered in English and Spanish, is a critical and unique part of this study.

Licensed, board-certified genetic counselors Jeanine Schulze, MS, CGC, and Jennifer Verbrugge, MS, CGC, are with the Department of Medical and Molecular Genetics at the Indiana University School of Medicine, a Parkinson’s Foundation Center of Excellence. Both have taken part in several PD genetic testing research initiatives, including PD GENEration.

Their collaboration answers the following questions that highlight the importance of screening for biological Parkinson’s factors in those who live with PD and how genetic counseling is critical to navigating genetic test results.

Q: Why is genetic testing important for people with Parkinson’s?

A: People with Parkinson’s may seek genetic testing for several reasons. Some people want a better understanding of why they developed Parkinson’s, or to learn more about their individual disease. Others are concerned about the risk to their family.

Genetic testing can identify if a change in a gene, or what we call a variant, contributed to Parkinson’s disease. If a genetic variant is identified it can give us information about inheritance in the family, if other family members might be at risk of Parkinson’s and what that level of risk may be. In some cases, genetic test results might give us information about potential symptoms, treatment or future progression.

Identifying a genetic variant in a person with Parkinson’s can also open the door to research studies such as clinical trials. People with Parkinson’s who carry genetic variants can play a critical role in helping researchers learn more about what causes Parkinson’s, and how we might be able to treat it. There are different types of research studies looking for people with specific genetic variants; some are evaluating new treatments while others are following people over time to learn more about how genetic variants impact Parkinson’s symptoms and progression.

Q: What does a genetic counselor do?

A: Genetic counselors empower people with Parkinson’s and their families with information, guidance and emotional support. Counselors help them understand biological history, evaluate genetic testing options and make informed choices based on test results.

Q: How is PD GENEration setting the bar for Parkinson’s-specific genetic reporting and counseling?

A: The study puts participants at its center, helping them understand their genetic test results and encourage them to partner in future PD research. PD GENEration provides genetic counseling to every participant. The high-level, comprehensive genetic test is designed to cover all seven of the major PD gene variants, including those important for clinical trials and other research participation.

Q: How is genetic counseling through PD GENEration unique?

A: This study enables access to genetic testing and counseling to people with PD across the U.S. at no cost. The new virtual option gives access to people who previously might have been too far from a study site or unable to travel. Participants can have their questions answered by genetic counselors who are highly specialized in Parkinson’s disease and PD genetics. Counseling is offered in Spanish and English.

Q: What should people know about at-home genetic tests?

A: There are many kinds of at-home genetic tests available. Some of these, called direct-to-consumer genetic tests, are performed without the involvement of a physician or a health care provider. These tests do not fall under the same guidelines as those ordered through a clinician, and often provide limited or incomplete information.

The PD GENEration at-home genetic testing is ordered through a PD GENEration healthcare provider. Staff mail a collection kit, and coordinators help explain how to collect the genetic sample during the video visit. The sample is mailed to the clinically-certified laboratory running the PD GENEration genetic testing panel. This test was carefully designed and results are carefully analyzed. Each participant’s genetic information is protected by the research study and the lab doing testing. Results are reported to participants by a genetic counselor or clinician who can answer questions and discuss any complexities.

Q: What should a person with PD expect when meeting with a genetic counselor?

A: A genetic counseling appointment may consist of a face-to-face, telephone or video discussion with a genetic counselor. Sessions may last anywhere from 20 to 60 minutes, but the length of the time depends on the type of visit, number of questions and complexity of testing or testing results.

During a genetic counseling session, a counselor may discuss how genetics plays a role in Parkinson’s disease, gather family history and explain how genetic factors and/or test results may impact family members.

To learn more about in-person or at-home PD GENEration participation, visit Parkinson.org/PDGENEration or call the Parkinson's Foundation Helpline 1-800-4PD-INFO.

We are 100+ years since the publication of James Parkinson’s essay the Shaking Palsy describing his eponymous disease. Yet, aside from a small number of individuals who have clear genetic causes to their disease, we still do not know the reason why the majority of people develop Parkinson’s disease (PD).

Based upon current research, scientists believe that Parkinson’s is most likely caused by a combination of genetic and environmental factors. The interactions between genes and the environment can be quite complex. Some environmental exposures may lower the risk of PD, while others may increase it. Learn more in our article, Pesticides and Parkinson’s: Time to Strengthen Epidemiology.

Specifically, as researchers, we need to better understand the predisposition to develop Parkinson’s based on a person’s genetics and environmental factors. One thing science has shown is that the exposure of certain chemicals in pesticides can lead to people having an increased risk developing Parkinson’s. However, it is important to note, that even when a pesticide is linked to Parkinson’s, not every person exposed to certain chemicals in pesticides will go on to develop this life-changing disease.

We understand there is a strong link to between Parkinson’s disease and pesticide and herbicide exposure and it is our responsibility as a leader in the Parkinson’s space to better understand what causes PD and to work to prevent it and help eliminate the risk of developing the disease.  Limiting exposure to chemicals known to cause PD is one way to reduce one’s overall risk of developing the disease.

What should people with Parkinson’s know about Paraquat?

Paraquat is an herbicide that has been linked to Parkinson’s. It is a widely used commercial herbicide in the U.S. that is banned in 32 countries, including the European Union and China. In fact, paraquat along with another pesticide, rotenone, is routinely used in research as one of the ways to induce and study parkinsonism in animal models of PD.

The Parkinson’s Foundation, along with the Unified Parkinson’s Advocacy Council, signed two letters to the U.S. Environmental Protection Agency (EPA) encouraging them to cancel the registration of paraquat based on strong scientific research linking the herbicide to Parkinson’s disease.

In October 2020, the EPA re-approved paraquat for use in the U.S. Without additional action, paraquat will remain legal for sale and use in the U.S. for the next 15 years.

What should I know about Paraquat legal cases?

Currently, there are more than 300 lawsuits filed against Paraquat across the U.S. Due to the multitude of cases, a multidistrict litigation (commonly known as MDL) was passed to help accelerate the legal proceedings.

Talk to a lawyer — specifically a product liability attorney — if you are considering filing a lawsuit. For help locating an attorney contact your local Area Agency on Aging. The Parkinson’s Foundation is not directly involved with Paraquat lawsuits.

What’s Next?

We still need to understand the cause of PD for the majority of people living with Parkinson’s today.  The Parkinson’s Foundation is committed to fund the basic science research needed to reveal what might be the cause of PD, how does it progress, and how we can ultimately stop it.

The interactions between genes and the environment are intricate. The Parkinson’s Foundation is actively working to better understand the genetics underlying PD as well as prepare the community for the next generation of therapies through our PD GENEration: Mapping the Future of Parkinson’s study.

The three main goals of PD GENEration are to accelerate clinical trials for Parkinson’s, improve PD care and research, and empower people with Parkinson’s and their care team. By undergoing genetic testing and contributing their genetic data, people can better understand their disease and help scientists in their journey to advance understanding of it.

As part of our research strategy, we work to connect and understand the biology behind Parkinson’s — including genetics — neuroscience and all Parkinson’s symptoms. Evolving our understanding in these three areas will lead us to better Parkinson’s treatments and hopefully, a cure.

More Parkinson’s Foundation Resources:

• Environmental Factors
• Genetics and Parkinson’s

James Beck, PhD is the Senior Vice President and Chief Scientific Officer of the Parkinson's Foundation. Jim guides the Foundation’s research strategy and critical grants that support research centers, scientists and fellows.

The human body naturally produces antioxidants. These antioxidants have been shown to destroy excess free radicals (oxidative stress) which, in turn, helps protect brain cells (neurons) from their toxic effects, such as inflammation, DNA damage and cell tissue damage. Studies have also shown that long-term oxidative stress contributes to the development of many diseases such as diabetes, cancer and Parkinson’s disease (PD).

In the brains of people with PD, there’s a build-up of a protein called PARIS (Parkin Interacting Substrate), that inhibits the production of another protein called PGC-1α. One of the many important functions of PGC-1α in dopamine-producing cells is to fight off damaging oxidative stress – so that there’s plenty of healthy dopamine remaining to do its job. 

This begged the question: might there be an antioxidant that could block the PARIS accumulation – that leads to the PGC-1α not being able to protect the dopamine-producing cells?

A just-published study in the journal, Science Translational Medicine, titled “PARIS farnesylation prevents neurodegeneration in models of Parkinson's disease,” (Jo et al., 2021) screened over 230,000 compounds, and identified farnesol as a possible candidate. Farnesol is a natural compound found in berries (as well as other fruits and herbs) that has demonstrated impressive antioxidant capabilities. 

To accomplish this complex study, scientists created mice models with different genetic make-ups. For example, some of the mice models did not have the parkin protein, while others had an overproduction of PARIS, among others. The mice were then randomly selected to be fed either a farnesol-supplemented diet for one week, or a regular mouse diet. 

The following week, the mice were injected with alpha-synuclein, (a key protein involved in PD). Behavioral and chemical tests were conducted, in addition to robust statistical analyses. Next, multiple experiments were carried out on the mice brain tissue, such as measuring the concentration of farnesol in the mouse brain. The scientists also measured the levels of dopamine, PARIS and PGC-1α proteins in the mice brain tissue.

Results

• PD mice models fed the farnesol-supplemented diet demonstrated improvements in strength and coordination tests designed to measure the progression of PD symptoms. 
• PD mice models fed the farnesol-supplemented diet had twice as many healthy dopamine neurons than mice not fed the farnesol-enriched diet.
• PD mice models fed the farnesol-supplemented diet had approximately 55% more of the protective protein PGC-1alpha in their brains than the untreated mice.

What does this mean?

This study demonstrated that in mice models of Parkinson’s, eating farnesol not only prevented the loss of dopamine-producing neurons, it reversed behavioral deficits in mice, showing an improvement in strength and coordination. Thus, the process of the farnesol binding to the PARIS protein worked: PARIS was successfully deactivated and could no longer interfere with PGC-1α doing its job to protect dopamine-producing neurons. 

Of note, since this study was conducted in mice, it is not known if farnesol will act the same way in people. It is far too soon in this investigative process to know, but these findings are encouraging and warrant further study. 

Learn More

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

• Nutrition and PD
• Diet and Nutrition 
• Parkinson’s: Causes

For more than a decade, the Parkinson’s Outcomes Project has captured the experiences of people with Parkinson’s disease (PD) and care partners on topics such as medications, treatment, exercise and lifestyle. How has this essential data helped make life better for people with Parkinson’s?

When researchers analyze the experiences of more than 13,000 people living with PD who seek treatment within the Parkinson’s Foundation global Centers of Excellence network, they can identify new and better ways to provide care and manage Parkinson’s. The goal of this study is to improve health outcomes and quality of life for people with Parkinson’s and care partners.

Parkinson’s Outcomes Project research has led to several findings that have already improved care within the PD community. Four primary landmark findings include:  

Exercise and Physical Therapy

Increasing physical activity to at least 2.5 hours a week can slow the decline in quality of life and help people with Parkinson’s live fuller lives. At the same time, referrals to physical therapy during the early stage of disease can help prevent hospitalization and falls. These findings led to the establishment of the Exercise Initiative, partnering with physical therapists and exercise professionals nationally.

Mental Health 

Depression and anxiety are the top factors impacting the overall health of people with Parkinson’s. This understanding has led to greater supports across Parkinson’s Foundation Centers of Excellence as well as a dedicated sub-study looking at mental health.

Hospital Care

People with Parkinson’s are hospitalized 1.5 times more often than their peers without Parkinson’s, and these visits bring with them a host of complications. These findings resulted in the Foundation’s Hospitalization Initiative to drive culture and policy change at the hospital administration level. Learn more about the Parkinson’s Foundation hospitalization kit now.

Caregiving

The cost of caregiving increases 180% from early to advanced stages of Parkinson’s, with female care partners predominantly (72%) carrying the weight of care. Acknowledging these factors and how to best provide day-to-day care will help improve the quality of life for those with Parkinson’s and their care partners.

The Next Generation of Parkinson’s Research

The impact of the Parkinson’s Outcomes Project continues to direct the work of the Parkinson’s Foundation. Next, the study will next focus on recruiting more participants who are part of traditionally underrepresented populations in clinical research. The study will work to better understand the PD experiences of people with Young-Onset Parkinson’s, newly diagnosed, early and late-stage disease progression and broader ethnic and racial diversity.  

The Foundation is underway with the next phase of the study, genetic testing offered through PD GENEration: Mapping the Future of Parkinson’s Disease. Genetic testing is a powerful tool that can help people learn more about their own disease, uncover biological pathways that cause Parkinson’s and can accelerate the development of improved treatments and care for all people with Parkinson’s. 

“Together, the Parkinson’s Outcomes Project and PD GENEration will help researchers understand why and how Parkinson’s develops,” said James Beck, PhD, Parkinson’s Foundation Chief Scientific Officer. “These initiatives may also answer questions that researchers may never have asked, providing hope and a vision towards a cure for PD.”

For the full update from the field, read Parkinson’s Outcome Project: Improving the lives of people living with Parkinson’s through research. In this publication, we highlight landmark findings, how this research guides Foundation priorities, what’s next for the study and more. Read it now. 

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Learn more about the Parkinson’s Outcomes Project at Parkinson.org/Outcomes.

Every ethnic group across the globe is impacted by Parkinson’s disease (PD). However, most of the PD genetic information that is studied by scientists has primarily been collected from people of European and East Asian ancestry. In fact, as of 2018, only 1.3% of study participants in the genome-wide association study (GWAS) Catalog data are Latino. With Parkinson’s on the rise on a global scale, the importance of increasing the genetic diversity of research participants is of utmost importance.

A recently published study in the Annals of Neurology, titled “Characterizing the Genetic Architecture of Parkinson's Disease in Latinos” (Loesch et al., 2021) sought to address this lack of diversity in PD genetic research.

The senior author of this study, Ignacio Mata, PhD, is from the Cleveland Clinic Lerner College of Medicine, a Parkinson’s Foundation Center of Excellence. Dr. Mata serves as an advisor to the Parkinson’s Foundation’s Hispanic and Latino efforts and is a Stanley Fahn Junior Faculty Award recipient.

Dr. Mata and colleagues performed the first-ever genome-wide association study (GWAS) of Latinos with PD in South America. GWAS is an approach used to identify associations between genetic variants and risk for particular diseases.

“There are many reasons this study gives me hope for Parkinson’s research. We want to make sure the progress we are achieving in understanding the role of genetics in PD is applicable to all individuals, and right now that is not possible because of our Euro-centric research, however, this research is making a little dent on that front for the Latino community.”

- Dr. Mata

Dr. Mata’s team utilized the data from the Latin American Research Consortium on the Genetics of Parkinson’s Disease (LARGE-PD) — the world’s largest PD case-control group of Latinos. They then scanned for 8.7 million DNA variants using a genotyping array (a test that checks for changes in specific areas of a person’s chromosomes). After a careful quality control process, the genetics of 1,497 people (807 participants with and 690 without PD) from Uruguay, Brazil, Colombia, Peru, and Chile were included.

The participants with PD consisted of 53% men, with an average age of 61.7 years, and an average age of PD onset of 54.1 years. The group without PD consisted of 33% men with an average age of 56.5 years. Participant numbers are reflective of the fact that Parkinson’s affects more men than women.

Additionally, as the gold standard of GWAS studies requires independent evidence that genetic study findings are reliable, a group of 1,234 Latinos with self-reported PD and 439,522 people without PD were tested for genetic variants by the consumer genetics and ancestry company, 23andMe. Researchers also utilized genetic admixture (when people from genetically distinguishable groups have children together) analyses, which uses DNA to help determine ancestry. In this case, Latino populations tend to have a three-way DNA admixture of African, European, and Native American ancestry.

Results

• The role of the SNCA gene (a common Parkinson’s gene mutation) in the development of PD in the Latino population is substantial. In both the LARGE-PD group and the replication group of 23andMe, only the Synuclein Alpha (SNCA gene) was found to have genome-wide significance in the GWAS.
  • Of note, the SNCA gene, which produces the protein alpha-synuclein, is associated with familial PD, and has been previously linked to PD in people of European and East Asian descent.
• Variants near the NRROS gene approached genome-wide significance but were not replicated in 23andMe.
  • NRROS findings were prominent in Peruvians of primarily Amerindian ancestry.
  • NRROS is biologically possible as a potential PD risk gene, as NRROS knockout mice display neurological abnormalities including defects in motor functions.
• In the admixture analyses, there was evidence that having African ancestry was protective against PD risk, which appeared to be associated with the RPS6KA2 gene.

What Does It Mean?

Genetics cause between 10% to 15% of all Parkinson’s disease. In some families, genetic changes (or mutations) are inherited or are passed down from generation to generation. Scientists have identified certain groups of genes that are known to be associated with family-linked Parkinson’s, including the genes SNCA, PRKN and DJ-1. Genetic research has made great strides to help scientists better understand the biology of Parkinson's and guide the development of treatments for all people with PD.

This study is groundbreaking: this is the most comprehensive examination of PD genetics throughout South America increasing the diversity in PD genome-wide association (GWAS) data in PD.

Of note in the study findings, the SNCA gene, which produces alpha-synuclein, was found to be clinically significant in the Latino population. This confirms that there is substantial overlap in the genetics of PD in Latinos as comparable to those of European-ancestry and warrants further study.

The NRROS gene, which is known for being associated with problems in motor functions and is critical for the development of microglia (immune cells of the brain responsible for maintenance of brain tissue) is another key finding, despite it not being replicated in 23andMe. The difference in findings may be because of the higher proportion of Native American ancestry present in the LARGE-PD group compared with the 23andMe group (47% vs. 19%), thus replication in another independent group with high Native American ancestry is needed.

Additionally, the authors found several other regions of potential significance that could not be confirmed with certainty because of the limited number of participants in this study. In short, this is an excellent first step towards proactively addressing the lack of diversity in Parkinson’s disease genetic research. Additional studies with even larger number of Latino participants are needed to reliably uncover additional genetic causes. Diversity in research studies is essential for optimizing our understanding of PD and potential future treatments.

“Our results show that there is some overlap in the genetic architecture of PD between populations, although the variants involved may be slightly different,” said Dr. Mata. “However, we need larger cohorts to really identify those population-specific components. We are working on more than doubling LARGE-PD in the next two years to help with this effort.”

The Parkinson’s Foundation believes in diversifying research, which is why its PD GENEration: Mapping the Future of Parkinson’s Disease is conducted in English and Spanish. Help further Parkinson’s research by enrolling today in English or Spanish.

Learn More

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

Spanish Resources: Genetics and Parkinson’s

• PD GENEration: Trazando el futuro de la enfermedad de Parkinson
• Episodio 6: La representación hispana en la comunidad del Parkinson
• Participando en la investigación