Tag Archives: Parkinson’s

The dope on Dopamine

I just finished reading Kelly McGonigal‘s The Willpower InstinctIt is a fascinating look at the psychology and physiology behind our ability to control our actions. In the book talk below, McGonigal discusses some of the research covered in her book.

But it isn’t willpower I want to write about; it’s what I learned about DOPAMINE. Dopamine is the culprit behind folks with Parkinson’s Disease having movement and balance issues. More precisely, it is the lack of dopamine that poses the problem. Back in  May, 2007, when I first began blogging about the brain in order to learn about how it functions, I wrote a post about dopamine.

McGonigal has added to my understanding of dopamine. She describes the neurotransmitter as kicking in in anticipation of a reward. That reward can be anything that makes you feel good.

Dopamine tells the rest of the brain what to pay attention to and what to get our greedy little hands on. A dopamine rush doesn’t create happiness itself–the feeling is more like arousal. We feel alert, awake, and captivated. We recognize the possibility of feeling good and are willing to work for that feeling.

When there is insufficient dopamine, besides impacting movement and balance, the brain’s natural reward system feels a sense of apathy, according to McGonigal. She goes on to say that in Parkinson’s patients, while this state may pass for peacefulness, it is actually depression.

What further fascinated me was her explanation of the potential negative effects of dopamine drug therapy on people with Parkinson’s.

The standard treatment for Parkinson’s disease is a two-drug combo: L-dopa, which helps the brain make dopamine, and a dopamine agonist, which stimulates dopamine receptors in the brain to mimic the action of dopamine. When patients begin drug therapy, their brains are flooded with way more dopamine than they’ve seen in a long time. This relieves the main symptoms of the disease, but also creates new problems that no one expected.

Medical journals are full of case studies documenting the unintended side effects of these drugs.

McGonigal then describes one person who “developed insatiable [food] cravings”, another person who “developed a daily gambling habit”, and yet another who “all of sudden found himself afflicted with an increased appetite, a taste for alcohol, and what his wife called ‘an excessive sex urge’…All of these cases were completely resolved by taking the patients off the dopamine-enhancing drug.”

Essentially, it seems that as with much in life, there needs to be a balance in the amount of dopamine your brain processes.

For more on Parkinson’s and dopamine, see my previous posts:

On Music, Dopamine, and Making Sense of Sound

Last week SharpBrains published part one of my two posts about Daniel Levitin’s This Is Your Brain On Music, and now part two is posted! On Music, Dopamine, and Making Sense of Sound explores how music impacts people who have Parkinson’s, dementia or Alzheimer’s.

If you know anyone with Parkinson’s, dementia or Alzheimer’s, and if they currently do not have music in their lives, I hope you will share my two posts with them and with their families. Thank you, on their behalf!

Music as Therapy: Music, Movement, Cognition!

A number of my posts have dealt with my foray into teaching yoga and facilitating movement for folks who are dealing with movement limitations, the normal process of aging, or changes in cognitive functioning due to dementia or Alzheimer’s. I have also mentioned Daniel Levitin, the author of This Is Your Brain On Music, related posts being available here.

I am delighted to share that yesterday part 1 of two posts furthering the above conversations has been posted on the SharpBrains blog. My post is Music as Therapy: Music, Movement, Cognition! I hope you’ll pop over to read it, and if you have any feedback, please feel free to share, especially if you have related experiences that we can all learn from. Thanks!

Commuting.

For this school year, I am commuting 62 miles each way to where I teach. That translates to an hour’s drive in the morning, and on the days of after school meetings, anywhere from 70 to 90 minutes for the drive home.

After 14 years of teaching just four miles from my home, and several times a year walking home from school, you can perhaps begin to imagine the impact this change of time spent sitting in a car has had on me – less time available for walking, poor air quality (though I recirculate the interior air while driving on I-95 so as to minimize the trucking fumes), muscle strain from sitting in one position, and stress from intense concentration so as to keep my drive safe.

The Hidden Toll of Traffic Jams, in the November 2011 Health & Wellness section of The Wall Street Journal, discusses the impact of traffic emissions on commuters, including this tidbit:

And older men and women long exposed to higher levels of traffic-related particles and ozone had memory and reasoning problems that effectively added five years to their mental age, other university researchers in Boston reported this year. The emissions may also heighten the risk of Alzheimer’s disease and speed the effects of Parkinson’s disease.

That last sentence is fascinating to me because my Dad commuted daily from New Hyde Park, NY to Hasbrouck Heights, NJ for upwards of 20 years. While his distance was half of my current commute, the time spent in the car was about equal due to the enormous volume of traffic crossing the George Washington Bridge.

And why is this fascinating? My Dad developed Alzheimer’s and Parkinson’s in his later years. To be sure, some of that was likely hard-wired into his DNA, but “heighten the risk” and “speed the effects” make me wonder about the commute’s impact. 

Bruce McEwen, in a March 2011 Dana Foundation article Effects of Stress on the Developing Brain, talks about the effects of stress on the brain and body. “Besides major life events, abuse and neglect, it is the ordinary day-to-day experiences in family, neighborhood, commuting and work, and school that affect brain and body function and promote those health damaging behaviors.

A recent acquaintance, who crafts infographics, sent me this infographic describing The Killer Commute. The graphic is provided by CollegeAtHome.com and it speaks volumes! She asked for my feedback, and this is what I had to say: 

The graphic is a killer! Okay, what I mean is, it depicts my experience – all the “yuck” parts of commuting. I had already determined to leave my job (and gave notice in January that I did not want another contract), but if I hadn’t already done that, the graphic would have convinced me to do so.
 
The parts covering health detriments are intense, (perhaps I can use them to drum up business for a “Yoga for Commuters” class….)
 
I only have two issues with an otherwise highly effective and convincing graphic – it is demoralizing! And the sources at the bottom were difficult for me to read.

This Is Your Brain On Music

This morning I was putting away the syrup that garnished the scrumptious french toast made by my husband, and as I closed the refrigerator door, some of the many tiles of magnetic poetry caught my eye. As our sons come and go on home visits, they alter the poetry, so I have no idea which one crafted this gem, but how appropriate given the book I am currently reading!

I am two-thirds of the way through Daniel J. Levitin’s This Is Your Brain On Music. When this book came out in 2007, I ordered a hard cover copy from amazon and eagerly awaited its delivery. When it arrived, I thumbed through the book and decided it wasn’t for me.

Rather than letting it languish on my book shelf, I gave it to a student – an accomplished high school musician who played (and still plays) clarinet and saxophone, who has studied at Julliard, and with who I had a close relationship developed over years of her assisting with faculty technology workshops and my being her advisor for her eleventh grade independent study project that resulted in her authoring and publishing this book. As her lulu.com bio states, she is “currently studying Music Education and Clarinet Performance at the University of Maryland, College Park.”

Now, five years later, guess what book I am reading? This time I have a paperback copy borrowed from my local library. And I am two-thirds of the way through Levitin’s book, absorbing his words and relating them back to my experience – in caring for my Dad, who had Parkinson’s and Alzheimers; in teaching yoga to people with mobility or other limitations; in teaching yoga to people who are at the upper realms of aging; in learning to teach dance to people with Parkinson’s. There will be much more about all of this as I continue to read, take notes, reflect and wonder, with a possibility of everything coming together in a blog post for SharpBrains.

But for now, I am just smiling at the magnetic poetry on my refrigerator door. Oh, and wouldn’t you know it – last night Levitin’s invitation to participate in a survey about music came across my Twitter feed. Of course, I participated! For those of you unfamiliar with Twitter, I do not know Levitin but I “follow” him, so everything he tweets about shows up in my timeline. How fitting that the magnetic poetry and Levitin’s tweet both deal with music and mood.

Last post – Music; this post – Dance

For me, they are linked – I hear music, I start to move. And if it’s a certain kind of music, my body starts to dance. The only thinking I do is split second, wondering if it is okay to start dancing in my current surroundings.

Music has an amazing impact on the brain, influencing neuronal impulses to cause movement. This Facebook wall post says it all. In fact, there are instances where dancing helps the brain to think.

Parkinson’s Disease – Dance for PD

I have been training, via Dance for PD, to teach dance to people with Parkinson’s. At some point, a person who has Parkinson’s winds up having difficulty controlling their movement. Their body parts function just fine, but the signal that is sent from their brain to their legs, for instance, gets lost in translation. The signal never arrives, or it arrives late or in a discombobulated form.

It turns out, though, that when someone with Parkinson’s participates in these Dance for PD dance classes, something magical happens. The music permeates their minds and provides rhythmic accompaniment for their movement signals to traverse from the brain to the body part. Feet and legs can move, indeed, dance, often gracefully and fluidly, facilitated by the music.

Dementia and Alzheimer’s Disease

Very powerful it is, this dance! Especially in a social setting. Bringing people together to touch hands, figure out who leads, who follows, and how to create movement through music and footwork – all of this requires thought, concentration, focus and quick planning ahead. According to this article by Richard Powers, a dance instructor and presenter at Stanford University, dancing makes you smarterIt’s not just about the physical exercise provided by dance or the release of endorphins that ultimately makes a person feel good, it’s the social aspects that benefit cognition.

Frequent dancing apparently makes us smarter. A major study added to the growing evidence that stimulating one’s mind can ward off Alzheimer’s disease and other dementia, much as physical exercise can keep the body fit.

Fact is, when dancing with a partner, you have to pay attention and be one step (always figuratively and sometimes literally!) ahead of what they will do next. This causes your brain to build synapses and continually rewire itself the more you dance. All of this synaptical building is creating cognitive reserve, a mental buffer. The more neuronal connections you have, the better, so that if one portion of your brain malfunctions, the other portions of your brain can co-opt some of that cognitive reserve.

Dance is FUN and HEALTHY and SOCIAL and just plain GOOD FOR YOU!

The Nickelodeon…Music, Music, Music!

Put another nickel in
In the nickelodeon
All I want is having you
And music, music, music

It’s those last three words that tickle my fancy: music, music, music!

Posts about music have appeared on this blog seven times, usually relating to Parkinson’s, Alzheimer’s or dementia. The most recent post, from last October, included a quote by Daniel J. Levitin, a neuroscientist who is also a musician, and it is Levitin who led me – via Twitter – to a post by Diana Hereld about Autism, Gabrielle Giffords and the Neuroscience Behind “The Singing Therapy”. Hereld shares about her insights from the Second World Congress of Clinical Neuromusicology and mentions a specific type of music therapy, Melodic Intonation Therapy. As Hereld writes:

What this means for the whole of this ‘Singing Therapy’ is that by being able to work with brain regions such as Broca’s area which may facilitate the mapping of sound to action, all kinds of different strides may be made linguistically in patients with left-hemisphere brain damage. People who suffer from neurological impairments or disorders that would otherwise be completely unable to communicate verbally may now have that chance.

 

I have been volunteering at The Pavilion at The Osborne on Sunday mornings, facilitating movement to music. This began as a yoga session, but it is more a seated Sunday songfest of movement to music. Everyone has some mobility issue and everyone fits somewhere on the dementia –> Alzheimer’s spectrum. (You can read more about these sessions here.)

What I do know, from these sessions and from caring for my Dad, who coexisted with Alzheimer’s and who loved music, singing and dancing, is that music stays with people long after their ability for coherent conversation has taken leave. The music is the blessing.

What is Parkinson’s Disease?

The first day of the Dance for PD workshop included an informative overview of Parkinson’s Disease by neuropsychiatrist Melissa Frumin of Brigham and Women’s Hospital in Boston, MA. She spoke to us not just as a doctor, but also as a caretaker who had first hand experience after caring for her father who had Parkinson’s. Melissa’s talk was illuminating, as it was the first time I had an understanding of some of what was going on inside my Dad’s brain and body, and I began to have a medical understanding of what he must have dealt with.

Everything that follows is from Melissa’s talk, and I was so intent on taking down the information that much of the medical description is her exact wording.

Primary Symptoms
It turns out that the cardinal symptom of PD is the tremor, which typically begins on one side in one hand with the fingers rolling in towards the palm. The tremor is a resting tremor, which means when the hand is engaged in movement the tremor seems to disappear. While asymmetrical at the start, the tremor can become bilateral, impacting the other side.

Another symptom is the slowness of movement, often manifested by a dragging of the feet and resulting in a shuffling gait. Rigidity can set in, causing a stooped posture. And the final major symptom is postural instability, making it difficult to self-respond to imbalance.

All of these symptoms are neurological. The body part is still fully functional; it is the brain’s messaging system that is no longer sending the appropriate signals to the body part. In other words, the hands and the legs could still work just fine if the brain were able to get the messages out to those body parts.

Motor Symptoms
There are a number of motor symptoms, in addition to the tremor and movement issues. Faces begin to no longer exhibit expression, causing a disconnect between what a person says they feel and what their face displays. Handwriting can become  very tiny, resulting in what is called micrographia. Vision can become blurred due to contrasts no longer being discernible. Therefore, large print does not help but books on tape could be quite useful. Constipation and difficulty swallowing are other motor issues that are due, as with all the previous symptoms, to a lack of internal coordination.

Non-motor Symptoms
Imagine how you might feel if these symptoms began to invade your existence. Now add to the mix the non-motor component of Parkinson’s – cognitive dysfunction resulting in dementia that impacts executive functioning. I have written a number of posts about executive functioning, which has to do with decision making, organization, and self-management functions. With Parkinson’s, the dementia takes a toll on the ability to multitask – the ability to tend to more than one item or activity at a time, in other words, the ability to rapidly switch between multiple activities.

The result of all of these symptoms is typically depression, though not because the person has Parkinson’s and feels bad about it (though they may, indeed, feel badly), but rather because Parkinson’s is a brain disorder that effects the ability to initiate activity. The inability to initiate can cause anxiety. Additionally, there can by psychosis manifested by hallucinations that are usually visual or auditory or smell-based, but can also be paranoid.

Couple this with sleep disturbance due to getting up in the middle of a dream to act out that dream (which can lead to falls in the night), genuine fatigue (as opposed to fatigue from depression), and drooling, and you have a sense of the toll that Parkinson’s symptoms takes on a human body.

What is happening in the brain?
The basal ganglia, a compilation of neurons that function as a unit and assists with coordinating movement, contains the substantia nigra, an area of the brain that produces dopamine. With Parkinson’s, 50 to 60 percent of the neurons in the substantia nigra begin to deteriorate, resulting in a loss of dopamine. This loss of dopamine impacts the balance of excitation and inhibition of neurons. And this loss of balance in neuron firing means that signals sent from the brain are not being executed properly. Since the basal ganglia deals with movement, sure signs of Parkinson’s are the primary symptoms detailed at the start of this post.

Statistics
In general, Parkinson’s is not a genetic disorder and is rare before the age of 40, though Michael J. Fox was an exception at age thirty-two. Worldwide some five million people are diagnosed with Parkinson’s, for which the largest risk factor is old age. And I found out just this afternoon, from a new acquaintance who is active in local and national Parkinson’s organizations, two-thirds of PD individuals are men, one-third are women.

Additional Resources

The PD Partnership – words of wisdom, from a caregiver, for caregivers and the people they care for

What is Parkinson’s Disease – includes links to numerous information resources in both print and digital format, including the Second Edition of the Parkinson’s Disease Resource List

Dance for PD – where I was last weekend

This is where I was last weekend – attending the Dance for PD (Parkinson’s Disease) workshop in Waltham, Massachusetts. I had the wonderful opportunity to take this workshop with two of the founding teachers, David Leventhal and Misty Owens. Immersed in the workshop, I felt as much a student of dance as a student of learning how to teach dance to a specific population of people, those folks with Parkinson’s Disease.

Some 40 of us gathered Saturday and Sunday at the Jewish Family & Children’s Service center, an inviting two story complex that hosts a vibrant Family Support group coordinated by Nancy Mazonson for individuals with Parksinson’s, their families and caretakers. Of the many services provided, one is an ongoing series of dance classes that were begun in 2006.

The details of the workshop are on my yogajournal posterous blog. For now I want to focus on the benefits of dance for folks with Parkinson’s, and I would add that those same benefits accrue to just about anyone with limited mobility or dementia in its early stages.

Research into the impact of dance on people with Parkinson’s is ongoing, most recently noted in this November 11, 2011 article on Dr Sara Houston’s work examining “the benefits to quality of life for people with Parkinson’s taking part in dance classes run by English National Ballet.” The Dance for PD listserv provided a link to Study explores benefits of dance for people with Parkinson’s, a summary of Dr Houston’s research.

My father had Alzheimer’s for many years. He also had a never-ending love of music and dance, with a heavy dose of Broadway musicals, music of the 40s and 50s, and folks like the Gershwins, Sinatra, Ella Fitzgerald, as well as Big Band tunes and songs from both world wars. He attended ballet and Broadway shows for the better part of his life, and danced up a storm (often with me) at family gatherings. Turns out, my Dad also had Parkinson’s Disease, something we did not find out until he died and it showed up on his death certificate. To be sure, I had an inkling, for he had the tremors in his hands, the arms that eventually stopped swinging when he walked, and a walk that turned to a shuffle (also common with Alzheimer’s).  But no matter his physical state, he LOVED the music, he loved singing along to songs, he loved dancing. When the words left him, he sang along with humming or the requisite “heh” in a well-known WWII ditty or Columbia College (his alma mater) song.

Among the many resources provided by Dance for PD is this list of ten points (noted below) extolling the benefits of dance for people with Parkinson’s. Reading them over, and having seen the impact of music and dance on my Dad, it’s difficult to say that only folks with Parkinson’s benefit from dancing! All of the Dance for PD classes have musical accompaniment, and the Brooklyn based home of Dance for PD has the benefit of live piano playing by William Wade.

  1. Dance develops flexibility and instills confidence.
  2. Dance is first and foremost a stimulating mental activity that connects mind to body.
  3. Dance breaks isolation.
  4. Dance invokes imagery in the service of graceful movement.
  5. Dance focuses attention on eyes, ears and touch as tools to assist in movement and balance.
  6. Dance increases awareness of where all parts of the body are in space.
  7. Dance tells stories.
  8. Dance sparks creativity.
  9. The basis of dance is rhythm.
  10. The essence of dance is joy.

A former student (who has written a book for other students that, like her, have a learning difference) tweeted a link to Cellist Memory Wiped Out From Virus, Doctors Stunned By Musical Memory. I read the article just after returning from the Dance for PD workshop. Towards the end of the article there are several references to “the link between memory and music”, specifically noting the impact of music on people with Alzheimer’s.

Music! Dance! What a combo this can be for anyone, and especially those whose bodies are no longer as resilient as they once were. For more about Dance for PD, read or listen to this 2008 NPR story, Parkinson’s Patients Find Grace In Dance.

The Love Affair between Music & Movement and Mind & Body

Listening to music with others causes the release of oxytocin, a chemical associated with feelings of trust and bonding. … Plus the nucleus accumbens – the brain’s well-known pleasure center – modulates levels of dopamine, the so called feel-good hormone.
Daniel J. Levitin, neuroscientist 

My Dad loved music, especially Broadway tunes, Sinatra songs, and Ella Fitzgerald, plus Columbia University ditties and tunes from World War II. My Dad also loved to move – dancing to music, shuffling and running to tennis and, when younger, sprinting short distances as well as longer cross country running. In his waning years, my Dad co-existed with Alzheimer’s and Parkinson’s. While he lost the ability to move, his love of music and his ability to mimic a tune never left him. Indeed, I believe that music and song provided sustenance for him as he navigated those last five years of his life.

My Mom also loved music, being an avid and accomplished pianist, with a Masters of Music Composition earned when she was in her forties. She composed the music for our wedding ceremony. She nourished her Steinway piano until the last months of her life, playing magnificently up till a few weeks before a stroke left her paralyzed on her right side, taking away her ability to nourish herself through piano playing.

No surprise, then, that I, too, love music and dancing and playing the piano. And perhaps no surprise that the yoga I most want to teach is yoga that incorporates music, the marrying of movement and music.

Dance for PD is based upon the premise that dancers are skilled at understanding the fluidity with which their bodies move through space, and this is exactly the issue that people with Parkinson’s are trying to deal with – maintaing their balance and coordination despite their brains lessening lack of bodily control. Let Your Yoga Dance is an approach to yoga that meshes music with movement, and when doing this form with special populations, massages the two Ms to bring smiles and sensory stimulation to folks with Parkinson’s or folks needing to participate from the vantage point of sitting in a chair.

In Happy Birthday iPod!, an article in today’s Sunday Times, Daniel Levitin speaks of the positive impact that music has on the brain. Music, like exercise, causes good things to happen in our brains, which often translates to good things happening in our bodies!