1. Innovations in Parkinson’s Diagnosis & Treatment: A Personal Story Dr. Kenneth E. Keirstead Excellence in Aging Care Symposium September 25-27, 2013

2. Why Me?  72 year old Stage I diagnosed nine months ago  Born in South Africa overdosing on DDT!  No direct family history, but have outlived most of my forebears  Biggest first issue – denial  “Symptoms are mostly all in your head” “You’re not kidding!”

3. What is Parkinson’s Disease?  A neurodegenerative disease with progressive loss of motor neuron cells  First described in 1817 as “Shaking Palsy”  “Idiopathic” condition or syndrome  Some indication of hereditary genetic factors (5- 10%)  Recently about ten genes have been identified that link to PD  External chemical influence? Pesticides and insecticides

4. Symptoms  Problems with walking and balance  Muscle aches and pain  Movement problems – difficulty starting movement such as walking or getting out of a chair  Slowed movement  Rigid or stiff muscles often beginning in legs  Anxiety, stress, depression and tremor  Truly idiopathic!

5. Diagnosis  Medical history  Thorough neurological examination  No screening or lab tests to confirm diagnosis  MRI detection of Lewy Bodies  Response to replacement medication

6. Progression of Disease Stage I: Slight tremor in one limb, often a hand. Walk may be a little unstable, slight stoop, some differences in facial expression. Stage II: Tremors spread to both sides of body. Increasing difficulty walking because of unsteady gait. Difficulty completing tasks. Stage III: Marked increase in symptoms (tremors, jerking). Movement visibly slowed. Difficulty standing upright or walking steadily.

7. Progression of Disease (continued) Stage IV: Walking very difficult, increasingly slow responses, rigidity and stiffness that impair movement, difficulty swallowing. Living alone not advised. Stage V: Signs of increasing dementia, difficulty swallowing and speaking, unable to live alone – probably chair or bed-bound.

8. Insidious Symptoms Anxiety Depression FearFatigue

9. Frontal Lobe Theory  Command Center Challenges  Affected processing  A possible precursor to more definitive diagnosis  “It’s all in the head”  Understanding brain plasticity  A new opportunity

10. Bring on the Dopamine!  Carbidopa-levodopa – drug of choice  Other agents  Need for precise control (dosage, timing, etc)  Alleve (naproxen sodium)  Self medication hypothesis  Rehabilitation and exercise

11. Other Treatments  Research pipeline  Deep brain stimulation  Stem cells  Accurate assessments of disease state