Animal models of Parkinson's disease have been widely used for investigating the mechanisms of neurodegenerative process and for discovering alternative strategies for treating the disease. Following 10 injections with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP, 25 mg/kg) and probenecid (250 mg/kg) over 5 weeks in mice, we have established and characterized a chronic mouse model of Parkinson's disease (MPD), which displays severe long-term neurological and pathological defects resembling that of the human Parkinson's disease in the advanced stage.

The behavioral manifestations in this chronic mouse model of Parkinson's syndrome remain uninvestigated. The health benefit of exercise in aging and in neurodegenerative disorders including the Parkinson's disease has been implicated; however, clinical and laboratory studies in this area are limited.

In this research with the chronic MPD, we first conducted a series of behavioral tests and then investigated the impact of endurance exercise on the identified Parkinsonian behavioral deficits.

Results: We report here that the severe chronic MPD mice showed significant deficits in their gait pattern consistency and in learning the cued version of the Morris water maze. Their performances on the challenging beam and walking grid were considerably attenuated suggesting the lack of balance and motor coordination.

Furthermore, their spontaneous and amphetamine-stimulated locomotor activities in the open field were significantly suppressed. The behavioral deficits in the chronic MPD lasted for at least 8 weeks after MPTP/probenecid treatment.

When the chronic MPD mice were exercise-trained on a motorized treadmill 1 week before, 5 weeks during, and 8-12 weeks after MPTP/probenecid treatment, the behavioral deficits in gait pattern, spontaneous ambulatory movement, and balance performance were reversed; whereas neuronal loss and impairment in cognitive skill, motor coordination, and amphetamine-stimulated locomotor activity were not altered when compared to the sedentary chronic MPD animals.

Conclusions: This study indicates that in spite of the drastic loss of dopaminergic neurons and depletion of dopamine in the severe chronic MPD, endurance exercise training effectively reverses the Parkinson's like behavioral deficits related to regular movement, balance and gait performance.

Despite the finding that Parkinson disease (PD) occurs in more than one in every 1000 people older than 60 years, there have been few attempts to quantify how deficits in impairments, activity, participation, and quality of life progress in this debilitating condition. It is unclear which tools are most appropriate for measuring change over time in PD.

Methods: This protocol describes a prospective analysis of changes in impairments, activity, participation, and quality of life over a 12 month period together with an economic analysis of costs associated with PD.

One-hundred participants will be included, provided they have idiopathic PD rated I-IV on the modified Hoehn &Yahr (1967) scale and fulfil the inclusion criteria. The study aims to determine which clinical and economic measures best quantify the natural history and progression of PD in a sample of people receiving services from the Victorian Comprehensive Parkinson's Program, Australia.

When the data become available, the results will be expressed as baseline scores and changes over 3 months and 12 months for impairment, activity, participation, and quality of life together with a cost analysis. DiscussionThis study has the potential to identify baseline characteristics of PD for different Hoehn &Yahr stages, to determine the influence of disease duration on performance, and to calculate the costs associated with idiopathic PD.

Valid clinical and economic measures for quantifying the natural history and progression of PD will also be identified.Trial Registration: ACTRN12609000008224

Author: Meg E Morris, Jennifer J Watts, Robert Iansek, Damien Jolley, Donald Campbell, Anna T Murphy and Clarissa L Martin
Credits/Source: BMC Geriatrics 2009, 9:2

Patients suffering from Parkinson’s disease are at an increased risk of developing osteoporosis, according to an expert.

While writing in Journal of the American Academy of Orthopaedic Surgeons, Dr Lee M. Zuckerman Chief Resident of orthopaedic surgery, Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Centre, in Brooklyn said that tremors, body rigidity, and problems with movement caused by PD may lead to complicated orthopaedic conditions.

People with Parkinson’s often move and walk less than non-suffers and generally stay indoors.

Decreased movement may lead to bone loss, and the reduced exposure to sunlight that generally occurs when patients spend little time outdoors is likely to generate a decrease in vitamin D, which is needed to keep bones strong.

This is particularly harmful to Parkinson’s patients, since the combination of decreased bone density and instability from tremors and rigidity caused by PD greatly increase a person’s risk of fallinga and breaking bones.

He said that involving family members in care could significantly improve a patient’s health.

“I recommend patients and their families read up on Parkinson’s disease so they can prepare themselves for the challenges that come with it,” said Zuckerman

This type of early education is important, because it can prevent these secondary problems from occurring. For instance checking bone mineral density and getting treatment for at-risk patients can help reduce the risk of fracture,” he added.

Although there are surgical treatments for orthopaedic conditions experienced by people with PD, the disease can have a negative effect on recovery.

For instance, the tremors associated with PD have been shown to interfere with the repair and rehabilitation of bone injuries. Those who have had a joint replacement are often relieved of pain and initially have improvements in mobility, but these improvements only last about a year.

“Whether this is because the disease is progressing or because the rehabilitation was insufficient is unclear. So patients now have to decide what they want to accomplish - more mobility or decreased pain.

They have to know that although their pain level should improve, their function may get worse after a year,” he added.

The therapies recommended to prevent orthopaedic problems in Parkinson’s disease include bone density treatment, physical therapy, vitamin therapy medication to increase bone density and optimizing therapies for gait and rigidity. (ANI)

Updated 6:29 PM EST, Thu, Jan 8, 2009

"Parkinson's is on the rise; affecting millions of Americans with tremors, muscle stiffness and an inability to move. This new study compares two widely accepted forms of treatment for the disease, and measures the benefits and risks of each, even for older patients," Dr. Bruce Hensel said.

Since Richard Seeger was diagnosed with Parkinson's in 1991, his movement ability has rapidly deteriorated.

"I couldn't get up from the seat. I'd have to bounce and bounce and bounce until I finally got my legs, my knees locked," Seeger said.

He volunteered to participate in a study comparing a surgical procedure called deep brain stimulation and "best medical therapy," defined as treatment by a movement disorders specialist, including a combination of medication and therapies.

Richard was chosen at random to undergo surgery, in which very small electrodes were placed in his brain. The electric stimulation was then adjusted to best control his symptoms.

"They turned it on and, I tell you what, they couldn't hardly believe it, I was walking around, not shaking," Seeger said.

The study, featured in this week's issue of the Journal of the American Medical Association, found that at six months, patients who received deep brain stimulation increased the amount of time per day that they were able to function normally by 4.6 hours compared with patients receiving best medical therapy.

Significant improvements in most movement functions and quality of life were also measured and it was found that the extent of benefit was roughly the same for all surgical patients, regardless of age.

"The fact that our older patients did almost as well was a very surprising and positive finding for us," said Frances M. Weaver, Ph.D.

However, the study also found a higher rate of complications for patients who underwent deep brain stimulation.

"The take-home message from this study is that each patient should weigh the benefits and risks of undergoing deep brain stimulation but that being older and having Parkinson's does not exclude a person from being appropriate for receiving this treatment," Weaver said.

Phase two of this study will focus on the placement of the deep brain stimulation implant, and compare which of two different sites provides better control of symptoms of parkinson disease.

"All surgeries carry risk but this procedure is relatively simple; and the results are often strikingly good. The choice of treatment depends on hsitory and condition and all options should be discussed with an expert," Dr. Hensel said.

ROSEMONT, Ill., Jan. 2 /PRNewswire-USNewswire/ -- Although Parkinson's disease (PD) is a neurological disorder, according to an article in the January 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons, the disease also increases a person's risk of experiencing complicated orthopaedic conditions. The author recommends that all Parkinson's treatment plans include a multidisciplinary approach in order to address additional accompanying musculoskeletal health issues.

According to the author Lee M. Zuckerman, M.D., Chief Resident of orthopaedic surgery, Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center in Brooklyn, New York, tremors, body rigidity, and problems with movement caused by PD may lead to other secondary, medical issues. One often-noted example relates to the fact that people with Parkinson's often move and walk less than non-suffers and generally stay indoors. Decreased movement may lead to bone loss, and the reduced exposure to sunlight that generally occurs when patients spend little time outdoors is likely to generate a decrease in vitamin D, which is needed to keep bones strong. This is particularly harmful to Parkinson's patients, since the combination of decreased bone density and instability from tremors and rigidity caused by PD greatly increase a person's risk of:

* Falling
* Breaking bones
* Osteoporosis (http://orthoinfo.aaos.org/topic.cfm?topic=A00227)

Ensuring family members are involved in care can have a positive impact on patient health. Dr. Zuckerman says, "I recommend patients and their families read up on Parkinson's disease so they can prepare themselves for the challenges that come with it. This type of early education is important, because it can prevent these secondary problems from occurring. For instance checking bone mineral density and getting treatment for at-risk patients can help reduce the risk of fracture."

Recommended actions to prevent orthopaedic problems in Parkinson's disease include:

* Bone density treatment (http://orthoinfo.org/topic.cfm?topic=A00110)
* Physical therapy
* Vitamin therapy
* Medication to increase bone density
* Optimizing therapies for gait and rigidity

The author recommends that patients with PD who are being treated by an orthopaedic surgeon should also be treated by a medical team that includes a neurologist, a neurosurgeon, a primary care physician, a physical medicine and rehabilitation physician, and a social worker. Including family members can ease the complexity of care by ensuring the patient is seeing the correct doctors while getting referrals to other members of the multidisciplinary team.

Although there are surgical treatments for orthopaedic conditions experienced by people with PD, the disease can have a negative effect on recovery. In one example, the tremors associated with PD have been shown to interfere with the repair and rehabilitation of bone injuries. Those who have had a joint replacement are often relieved of pain and initially have improvements in mobility, but these improvements only last about a year.

Dr. Zuckerman comments: "Whether this is because the disease is progressing or because the rehabilitation was insufficient is unclear. So patients now have to decide what they want to accomplish -- more mobility or decreased pain. They have to know that although their pain level should improve, their function may get worse after a year."

Treatments for PD patients have allowed them to live longer lives with improved quality of life. As these patients age, there are strong predictions that there will be an increased need for medical and surgical interventions for complicated orthopaedic issues.

Disclosure: Neither Dr. Zuckerman nor a member of his immediate family, has received anything of value from, or owns stock in, a commercial company or institution related directly or indirectly to the subject of this article.