1. PARKINSON’S ADAM KREAMER

2. WHAT IS PARKINSON’S? *Parkinson’s disease, also called PD, is categorized as a motor system disorder, which is a result of the loss of dopamine producing brain cells. This disorder affects movement, muscle control and balance. *It is a neurodegenerative brain disorder that is found mostly in people ages 55-75. It progresses slowly in most people and symptoms may take years to develop. *Parkinson's itself is not fatal but complications from the disease rate Parkinson’s as the 14 th top cause of death in the United States *The main cause of Parkinson’s is due to a lack of Dopamine in the brain.

3. ROLE OF DOPAMINE *Dopamine is normally produced by neurons in the brain. These neurons are found in a specific part of the brain called the substantia nigra. *Dopamine is a chemical that relays messages between the substantia nigra and other parts of the brain that control movements of the body. *Dopamine helps humans have smooth coordinated muscle movements. *Dopamine is a catecholamine, a class of molecules that serve as neurotransmitters and hormones. - It is a monoamine, which means it contains nitrogen formed from ammonia by replacing one or more hydrogen atoms by hydrocarbon radicals. - Dopamine is a precursor of adrenaline and is formed by the decarboxylation from Dopa, which is used to try to cure this horrible disease.

4. DOPAMINE IN THE BRAIN

5. GENETICS OF PARKINSON’S * 10% of Parkinson’s cases have been linked to genetics but most is idiopathic or sporadic, which means the cause is unknown * More common in men than women * Mutation in the gene called SNCA, which encodes alpa-synuclein, has been common is families with a high prevalence of Parkinson’s * Mutation in the LRRK2 gene has caused PD in many families - Eastern Europeans, Jewish, and North African Arabs have a higher percentage of PK disease but it is not known why. Further research is needed.

6. SIGNS AND SYMPTOMS *Tremors (shaking) in the hands, arms, legs and face *Slowness of movement *Muscle rigidity *Difficulty with walking, balance, and coordination *Difficulty eating or swallowing *Digestive problems *Speech problems *Depression and difficulty with memory

8. DIAGNOSIS * NO DEFINITIVE TEST!!!! * Family history * Genetic testing (males) * Age (older individuals) * Environmental Factors * Neurological Exams (similar to many other diseases) -No objective test like brain scan or blood test but instead look at family history and for two or more signs to be present * FDA approved DaTscan which captures pictures of dopamine system in your brain

9. MEDICATION AND MANAGEMENT * There is NO cure for Parkinson’s disease * Medication: Levadopa, usually combined with carbidopa, helps incerease dopamine levels in the body * Physical Therapy: helps improve balance, mobility, speech, and functional abilities * Surgery: Very rare but for advanced stage Parkinson’s deep brain stimulation surgery can be done * The drug Neupro, a dopamine agonist drug, is applied as a patch on the skin and applied once a day

10. EFFECTS OF PARKINSON’S ON THE BODY Early Stage: -Tremors in just one arm or leg or one side of the body -Joint pain, weakness, and fatigue Moderate Stage: -Slow movement, stiff muscles, poor coordination -Trouble writing, shaving, or brushing teeth -Problems with posture; walk in stooped manner with shuffling steps Advanced: -Dementia -Unable to care for themselves and my be confined to wheelchair

11. EXERCISE AND PARKINSON’S Symptom management: -Improve gait, balance, tremor, flexibility, grip strength and motor coordination Slows disease progression: -Brain cells use dopamine more efficiently -Modifies area of brain where dopamine signals are released but doesn’t change the amount of dopamine produced

12. CASE STUDY * Heather is a 52 year old retired housewife who seems to be in good health. She is 5’4” and weighs 135lbs. No symptoms of CV disease but had been diagnosed with early stages of Parkinson’s disease. Her blood pressure was recorded at 148/98 mmHg on multiple occasions. She is non smoker and her family history is good. She has not been active in many years and has been been told to exercise by her family physician to help slow down the progression of Parkinson’s. * Risk Factors: -Hypertension -Sedentary lifestyle * Heather is at a moderate risk level

13. EXERCISE TESTING * Informed consent and par-q ( listen to doctors recommendation) * Exercises that test your range of motion and work on balance to help with mobility and stiffness in joints and muscles * Swimming in a pool puts less strain on the joints and helps with mobility (good to start) For Heather: Submaximal test - Warm – Up (10 min) -Swimming laps -Start with 10 minutes sessions until Heather builds up her CV system -Dry off and take heart rate, blood pressure, and RPE

14. EXERCISE PRESCRIPTION Getting Started: * Talk with your health care provider before starting an exercise program and ask for specific programming recommendations. * Take all medications as recommended by your physician. * The goals of your program should be to improve your functional capacity and ability to perform activities of daily living, increase muscle strength and endurance, improve range of motion, and reduce your risk of injury. * Choose activities that you enjoy and will do regularly. If walking is too difficult, cycling, swimming and chair activities are good alternatives. Group classes can also provide a social element to your workouts. * If your fitness level is low, start with shorter sessions (10 to 15 minutes) and gradually build up to 30 minutes, five days per week. * Perform low-level strength-training exercises using light weights. Incorporate flexibility, eye- hand coordination, reflex training, and fall prevention activities. * Take frequent breaks during activity if needed. Your workouts should be comfortable and not strained

15. CONCLUSION * There is no cure for Parkinson’s Disease * Exercise and physical activity have been shown to slow down the progression of the disease * Parkinson’s is a terrible disease and the cause is not fully known. My uncle was diagnosed with Parkinson’s over 4 years ago and it has been progressing very rapidly. Lets keep the public informed about this terrible disease and fight to find a treatment for Parkinson’s.

16. CITATION Dopamine. (2015, November 10). Retrieved 11 November 2015, from http://www.medicinenet.com/script/main/art.asp?articlekey=14345 http://www.medicinenet.com/script/main/art.asp?articlekey=14345 Genetics and Parkinson’s disease | Parkinson’s disease information. (n.d.). Retrieved 11 November 2015, from https://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?genetics&smcid=ag- a30U00000004hTT&gclid=Cj0KEQiAyIayBRDo4vjdqJrgxZ0BEiQAhOYCYHNlxAQsVzkoa_RutpuoHll_V0- 9RQikN1nZtgREQQYaAqo98P8HAQ https://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?genetics&smcid=ag- a30U00000004hTT&gclid=Cj0KEQiAyIayBRDo4vjdqJrgxZ0BEiQAhOYCYHNlxAQsVzkoa_RutpuoHll_V0- 9RQikN1nZtgREQQYaAqo98P8HAQ Medscape log in. (2010, March 29). Retrieved 11 November 2015, from http://www.medscape.com/viewarticle/719179http://www.medscape.com/viewarticle/719179 National Parkinson foundation: Believe in better. (2015). Retrieved 11 November 2015, from http://www.parkinson.org/understanding- parkinsons/treatment/Exercise/Neuroprotective-Benefits-of-Exercise National Parkinson foundation: Believe in better. (2015). Retrieved 11 November 2015, from http://www.parkinson.org/understanding- parkinsons/what-is-parkinsons/The-Stages-of-Parkinsons-Disease Parkinson’s disease information page: National institute of neurological disorders and stroke (NINDS). (2015, November 2). Retrieved 11 November 2015, from http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htmhttp://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm Parkinson’s disease. (2012, September 10). Retrieved 11 November 2015, from https://umm.edu/health/medical/reports/articles/parkinsons-disease https://umm.edu/health/medical/reports/articles/parkinsons-disease Parkinson’s diagnosis questions: The Michael J. Fox foundation | Parkinson’s disease information. (n.d.). Retrieved 11 November 2015, from https://www.michaeljfox.org/understanding-parkinsons/i-have-got-what.php?smcid=ag- a30U00000004da9&gclid=Cj0KEQiAyIayBRDo4vjdqJrgxZ0BEiQAhOYCYKMeWep3tUB8NMTfaGfa63J4sfZcpMd5Vw9l9SXFeAwaAly s8P8HAQ thakkar. (2014). Google+ badge. Retrieved 11 November 2015, from http://ktthebest4u.blogspot.com/2014/11/parkinsons- disease.html