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Parkinson’s disease is a neurological disorder with cardinal motor signs of resting tremor, bradykinesia and lead-pipe rigidity. In addition, many patients display non-motor symptoms, including a diminished sensation of smell, gastrointestinal problems, various disorders of sleep and some cognitive impairment. These clinical features – particularly the motor signs – manifest after a progressive death of many dopaminergic neurones in the brain. Conventional therapies can reduce the signs of the disease, however, the progression of this neuronal demise has proved difficult to slow or stop, and the condition is relentlessly progressive. Hence, there is a real need to develop a treatment that is neuroprotective and slows the pathology of the disease effectively.
At present, there are several neuroprotective therapies in the experimental pipeline, but these are for the patients of tomorrow. This book focuses on two therapies that are readily available for the patients of today. They involve the use of exercise and light (i.e. photobiomodulation: the use of red to infrared light therapy on body tissues). Given the heterogeneity of Parkinson's disease in humans, tackling the condition from a range of different angles – with several different therapies – would only serve to enhance the positive outcomes. This book considers the use of exercise and light therapies, proposing that they have the potential to make a powerful "dynamic duo", offering a most effective neuroprotective treatment option to patients.
acknowledgements
abbreviations
preface
chapter 1 Parkinson's disease
general
signs and symptoms
the basal ganglia
basic structure, neurochemistry and connections
striatum: caudate and putamen 8 globus pallidus
subthalamic nucleus
substantia nigra
zona incerta
pedunculopontine tegmental nucleus
overall functions of basal ganglia
the loops
the direct and indirect pathways
summary
pathophysiology
zones of neuronal pathology
Lewy bodies and α-synuclein
gliosis
growth factors
other pathological changes
mechanisms of neuronal death
neural circuits behind the signs and symptoms
predictive tests
risk factors
age
environmental toxin
vascular
head injury
gender and race
genetics
summary
animal models
toxin-induced models
transgenic models
summary
current treatments
dopamine replacement drug therapy
surgical treatment: deep brain stimulation at high frequency
neuroprotection and future treatments
neuroprotection basics
neuroprotection versus symptomatic treatments?
why no neuroprotective treatment for patients?
future treatments
summary
chapter 2 the run is exercise
general
why should exercise work?
how much exercise do you need?
methods of exercise: how do you do it?
exercise-induced neuroprotection: a matter of survival
evidence for exercise-induced neuroprotection in animal models of Parkinson's disease
exercise-induced changes to the dopaminergic system
exercise-induced changes to the non-dopaminergic system
exercise stimulates growth factors
exercise-induced changes in mitochondrial function, neurogenesis and other cellular features
exercise reduces gliosis
key features of exercise-induced neuroprotection
is there exercise-induced neuroprotection in Parkinson's disease patients?
how does exercise neuroprotect: the mechanisms
exercise-induced symptomatic effects: a matter of function
evidence for exercise-induced changes in function in the brain
how does exercise influence neuronal function
exercise-induced functional and behavioural improvements
evidence for functional and behavioural changes in animal models of Parkinson's disease
evidence for clinical effects in Parkinson's disease patients
safety of exercise
factors that generate exercise-induced functional and behavioural changes: neuroprotective or symptomatic?
summary and a working hypothesis of the trigger
what is the trigger
chapter 3 the light is photobiomodulation
general: what is light?
the light (photobiomodulation) and its history
neural applications of light
light sources, wavelengths, powers and modes
how far does light travel?
is light safe?
other light wavelengths
light-induced neuroprotection: a matter of survival
evidence for light-induced neuroprotection in animal models of Parkinson's disease
light-induced neuroprotection in the dish
light-induced neuroprotection in the whole animal
light reduces gliosis
light stimulates growth factors
effects of light on encephalopsin expression?
how does light neuroprotect: the mechanisms
direct light stimulation of neurones
indirect light stimulation of neurones using the circulation: the abscopal effect
summary
light-induced symptomatic effects: a matter of function
evidence for light-induced changes in brain function
how does light influence neuronal function?
light-induced functional and behavioural improvements in animal models of Parkinson's disease
evidence for functional and behavioural changes in animal models of Parkinson's disease
factors that generate light-induced functional and behavioural changes: neuroprotective or symptomatic?
how will light work in humans?
light-induced changes in Parkinson's disease patients
light application in other diseases and systems
the road to a therapeutic option for light treatment in patients
why should light work?
summary
chapter 4 the run and the light: the "dynamic duo"
they are so similar
animal models
patients
do exercise and light use common mechanisms for two outcomes
potential benefits of a combined therapy: a cocktail
is there a precedent?
exercise plus light therapy in animal studies
exercise plus light therapy in humans
summary
a combined therapy protocol for Parkinson's disease patients?
light wavelength, dosage and application site
exercise programme
timing of light application in relation to exercise
what about eating more vegetables
summary
conclusions
bibliography