Parkinson’s Disease: Diagnostic Studies-Part II

(3/27/07)- The National Institute of Health announced that it would begin a 5-year to 7-year study of the nutritional supplement creatine to see if it can slow down the progression of Parkinson's disease. The supplement is popular with athletes, since they feel it can give them short bursts of extra strength. It is supposedly the nutritional supplement that Mark McGwire used when he broke Roger Maris' home run record.

This new study will involve about 1,720 early stage Parkinson's patients at 51 medical centers in the U.S. and Canada. Researchers at the University of Rochester, N.Y., and the Medical University of South Carolina will lead the study. It is part of a NIH Parkinson's research program that is expected to cost $40 million.

The patients will take either five grams of creatine powder mixed with 8-ounces of liquid twice daily, or a fake powder, or placebo.

Creatine is an amino acid that occurs naturally in the body. The supplement is sold in various formulations by retailers such as GNC Corp.'s General Nutrition Centers for about $35 a bottle for a four-week supply.

Avicena Group Inc., Palo Alto, CA will provide the creatine for the study. It calls it version of the supplement "PD-02", and it hopes to apply to the FDA for approval of it as a prescription drug if the trial is successful. In previous animal models and human studies, creatine has been shown to be well tolerated and may have some ability to protect the brain cells.

Although some drugs, such as Bristol-Myers Squibb Co.'s Sinemet can alleviate Parkinson's symptoms, none has proven to be able to slow or reverse the progress of the underlying disease.

Side effects of creatine can include muscle cramps, vomiting and diarrhea, and there have been reports of damage to the kidneys and livers.

Avicena currently sells an over-the-counter creatine supplement called Neotine for about $22.90 for a four-week supply.

(6/24/06)- The Honolulu-Asia Aging Study (HAAS) began in 1991 as part of the Honolulu Heart Program. The latter was a prospective study of heart disease and stroke that followed 8,000 Japanese American men born between 1900 and 1919. The HAAS component was looking for dementia and Parkinson’s disease.

Cases were identified in 1994, 1997, 1999, 2001, and 2003. They were looking for preclinical symptoms that could be precursors for the disease. They have found that excessive daytime sleepiness is 2.5 times more prevalent in those who had Parkinson’s disease.

They also showed that olfactory dysfunction was common with Parkinson patients. They used the Pennsylvania Smell Identification Test to measure this factor. Olfactory dysfunction correlates with dopamine transporter density in early Parkinson’s on single-photon emission CT imaging.

Further findings indicate that constipation occurs in 80% of Parkinson’s disease patients, with the incidence of PD highest in men who reported less than one bowel movement per day. This constipation appears related to loss of dopaminergic neurons in the colon. Slow reaction time is the other factor that proved significant for preclinical signs of PD. This reflects the akinesia and bradykinesia of the disease.

The preferred method for confirming PD is autopsy. Classic PD starts on one side of the body unrelated to hand dominance. It now is clear that not everyone has the classic resting tremor, but many do, and this improves with movement. Essential tremor that has been lasting for years is usually not an indication of PD.

You will also find that essential tremor is temporarily alleviated in 60% of the cases with a small amount of alcohol. This is not true of the Parkinson patient. The handwriting in PD patients tends to be micrographic, but not tremulous. PD is progressive, and symptoms become worse from year to year. Initial responses to levodopa are not sustained.

Certain medications can bring on Parkinson-like symptoms. These drugs include the antipsychotics, metoclompramide or dopamine depleters such as reserpine.

Autopsy studies have indicated that the false-positive rate for a Parkinson disease diagnosis is about 35% at the initial diagnosis and 24% at the final diagnosis. It behooves physicians to be careful in their diagnosing elderly patients as having PD.

Please see our article on Parkinson Disease- Part I


Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated March 27, 2007

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