1. Parkinson’s Disease Sheila Mulhern

2. Parkinson’s Disease Stats (PDF)  One million Americans live with Parkinson's disease, - more than the combined number diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrig's disease.  Approximately 60,000 Americans are diagnosed with PD each year,  Worldwide : an estimated seven to 10 million people are living with Parkinson's disease.  Men are 1.5 times more likely to have Parkinson's than women.

3. Healthcare Costs & PD  The combined direct and indirect cost of Parkinson’s, including treatment, social security payments and lost income from inability to work, is estimated to be nearly $25 billion per year in the United States alone.  Medication costs for an individual person with PD average $2,500 a year, and therapeutic surgery can cost up to $100,000 per patient.

4. Parkinson’s Disease  A degenerative disorder of the central nervous system as a result from the death of dopamine-generating cells in the substantia nigra, a region of the midbrain  Nerve cells can’t send signals properly causing loss of muscle function  In response the adjacent thalamus and globus pallidus interna become overactive resulting in a tremor  Most often develops after age 50 and one of the most common NS disorders of the elderly  Named after English doctor James Parkinson, who published the first detailed description in An Essay on the Shaking Palsy in 1817

5. Etiology of PD  Cause not officially known but genetic and environmental factors are linked  Genetic : modern research shows six genes have been identified as causing familial PD  alpha-synuclein, parkin, UCHL1, DJ1, PINK1, and LRRK2  Environmental : not direct but demonstrated to have the ability to cause nigrostriatal cell death appear to interact by interfering with mitochondrial function, inducing oxidative stress, and modifying proteasomal function.  DJ1 and PINK1 are mitochondrial proteins and overexpression of alpha-synuclein and parkin induce mitochondrial defects

7. Parkinson’s Disease Characteristics  Tremor at rest  Bradykinesia – slowness of movement  Rigidity and stiffness  Increased resistance to passive movement of limbs or trunk  Micrographia – small, constricted handwriting  Poor balance  Diminished arm swing  Dysphagia  Hypomimia – lack of facial expression - “Parkinson mask”  Dysarthria – diminished voice volume, stuttering  Depression  Dementia

8. PD & Nutritional Implications

9. Medical Interactions: Levodopa

10. PD & MNT  Focus on drug-nutrient interactions  Minimize dietary protein at breakfast/lunch  Recommend antioxidants and anti- inflammatory diet

11. Study #1: The Mediterranean diet and Parkinson's disease  Official Journal of the Movement Disorder Society – funding NIH & Parkinson's Disease Foundation (FEB 2012)  250 PD patients and 198 controls – diet questionnaire for past year  Higher Mediterranean-type diet adherence was associated with reduced odds for PD after adjustment.  Lower Mediterranean-type diet score was associated with earlier PD age at onset.  PD patients adhere less than controls to a Mediterranean-type diet. Dietary behavior may be associated with age at onset.  2009 study on 1,410 French adults showed higher adherence to Med-diet was associated with slower MMSE cognitive decline (not other tests or assoc. with dementia

12. Study #2

13. Study #3

14. Other study topics  Caffeine may improve motor PD symptoms  Flavonoids may aid PD risk  Concussions as contributing factor to later developing PD

15. Resources  Case study: The association between Mediterranean diet adherence and Parkinson's disease http://onlinelibrary.wiley.com/doi/10.1002/mds.24918/abstract?syst emMessage=Wiley+Online+Library+will+be+disrupted+on+8+Dece mber+from+10%3A00-12%3A00+GMT+%2805%3A00- 07%3A00+EST%29+for+essential+maintenance&userIsAuthenticated =false&deniedAccessCustomisedMessage=  Parkinson’s Disease Foundation http://www.pdf.org/en/parkinson_statistics http://www.pdf.org/en/parkinson_statistics  Dopamine signaling in PD http://www.cellsignal.com/reference/pathway/parkinsons_disease. html http://www.cellsignal.com/reference/pathway/parkinsons_disease. html  https://www.michaeljfox.org/ https://www.michaeljfox.org/  Etiology of PD http://www.ncbi.nlm.nih.gov/pubmed/16717248http://www.ncbi.nlm.nih.gov/pubmed/16717248  http://www.pdf.org/en/science_news/release/pr_1330379372 http://www.pdf.org/en/science_news/release/pr_1330379372