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Presence hallucinations early sign of Parkinson’s say scientists

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So-called ‘presence hallucinations’ where you have the strong feeling someone is standing behind you when they’re not, may be an early sign of Parkinson’s disease.

Scientists say the feeling is a common pointer to the progressive brain disorder that affects the nervous system.

But often patients and clinicians dismiss the hallucinations as a side effect of medication and not the symptoms of Parkinson’s disease itself.

Presence hallucinations may appear early on in the course of the disease, which affects around 10 million people globally, mostly in the 60-plus age group. But they are underreported.

Now, Ecole Polytechnique Fédérale de Lausanne (EPFL) scientists have warned they happen to around a third of Parkinson’s patients before the disease’s other more common symptoms, such as tremors, muscle stiffness, and slowness of movement, become evident.

Recognising the symptom is important because patients recently diagnosed with Parkinson’s disease who have early hallucinations are at greater risk of faster cognitive decline, the research team found.

Olaf Blanke, Bertarelli Chair in cognitive neuroprosthetics, who leads EPFL’s Laboratory of Cognitive Neuroscience, said: “We now know that early hallucinations are to be taken seriously in Parkinson’s disease.”

His colleague, Fosco Bernasconi of EPFL’s Laboratory of Cognitive Neuroscience and lead author of the study, added: “If you have Parkinson’s disease and experience hallucinations, even minor ones, then you should share this information with your doctor as soon as possible.

“So far, we only have evidence linking cognitive decline and early hallucinations for Parkinson’s disease, but it could also be valid for other neurodegenerative diseases.”

The EPFL team collaborated with medics at Sant Pau Hospital in Barcelona on the study, published in the journal Nature Mental Health.

Data was collected from 75 patients between the ages of 60 and 70 who were all diagnosed with Parkinson’s disease.

Early hallucinations in Parkinson’s disease are associated with frontal cognitive decline (triangles), and preceded by specific frontal neural oscillation (theta frequency band). Image: EPFL/Bernasconi

The clinicians and scientists at the hospital conducted a series of neuropsychological evaluations to assess the patients cognitive status, neuropsychiatric interviews about whether or not they were experiencing hallucinations, and electroencephalography (EEG) measurements of the brain’s activity at rest.

The scientists found that in patients with Parkinson’s disease, the cognitive decline was more rapid in the following five years for those who had suffered with early hallucinations.

The level of cognitive decline over those five years was further associated with frontal theta (4-8Hz) oscillatory activity as measured by the EEG during the first visit, but only if patients had hallucinations at the onset.  For clinically and demographically similar patients, the only difference at the outset was that one group had early hallucinations and the other did not.

Neurodegenerative diseases like Parkinson’s are often detected when it’s too late and the condition too advanced, limiting the impact of preventative measures and modifying therapies.

Dr Bernasconi, Professor Blanke and their collaborators want to change that, by looking for early signs – like minor hallucinations – and ways to promote intervention in good time for slowing down progression of cognitive and psychiatric symptoms of the disease.

Whilst hallucinations are among the lesser-known symptoms of Parkinson’s, they are highly prevalent early on in the disease, with one out of two individuals experiencing them regularly.

Parkinson’s disease is traditionally defined as a movement disorder, however, with the typical motor symptoms of resting tremor, rigidity, and slowness of movement. But it also leads to a wide variety of non-motor symptoms that appear early in the course of the disease.

Hallucinations can be described by a continuum of symptoms, from minor ones that usually occur early in the course of the disease, such as  presence hallucinations, to more severe indications like visual hallucinations that appear later.

It has also already been established that complex visual hallucinations, such as seeing someone who is not there, have been linked to cognitive decline and dementia in Parkinson’s disease and related neurodegenerative disorders like dementia with Lewy bodies.

However, complex visual hallucinations usually occur at a later stage of the disease, limiting their use as an early marker for cognitive decline, the research found.

Professor Blanke said: “Detecting the earliest signs of dementia means early management of the disease, allowing us to develop improved and personalised therapies that try to modify the course of the disease and improve cognitive function.”

Dr Bernasconi concluded: “We aim to have an early marker to identify individuals at risk of a more severe form of Parkinson’s disease, characterised by a more rapid cognitive decline and dementia, based on hallucinations proneness.”

Ideally, he said it was hoped to identify those individuals even before hallucinations actually occur. “We are therefore developing neurotechnology methods and procedures for that purpose.”

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On a mission to show that hearing loss is not inevitable

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The world’s largest investigation into the effectiveness of hearing training kicks off this week – as part of a movement to prove that hearing loss is not an inevitable part of ageing.

The research project aims to attract a minimum of 10,000 participants to better understand how hearing training impacts auditory processing skills like speech comprehension and the ability to locate where sounds are coming from.

Researchers are interested in the impact of hearing training on users who start training with different hearing ability levels, as well as training adherence in groups with different attitudes to smartphone technology.

Their aim is to find new ways to deliver and improve auditory training at scale and for a wider range of hearing skills; and to measure factors which influence training engagement.

The research is led by health tech firm Eargym. Co-founder Andy Shanks says:  Contrary to popular belief, hearing loss is not an inevitable consequence of ageing. We can take steps to improve and protect our hearing throughout our lives, yet preventative measures like hearing training have traditionally been under-researched.

“Our data shows the transformative impact hearing training can have on our ability to process sounds. Now, we want to deepen and widen our research and use our platform to make hearing training even more effective and accessible. Imagine improving and maintaining your hearing by up to 20% or more: it could make a big difference to the lives of so many people.”

The games on the Eargym app include a “busy barista” exercise, where users must discern speech over a cafe’s bustling background noise; and a “sound seeking” exercise, where users make their way through forests, jungles and oceans to locate the sources of different sounds. Each game is designed to be immersive and to help users practise specific auditory processing skills regularly.

Eargym was set up by former NHS CEO Amanda Philpott and DJ Andy Shanks in 2020, after they were both diagnosed with hearing loss. Amanda has moderate age related hearing loss, whilst Andy has “notch” or noise-induced hearing loss due to DJ-ing. Both found hearing loss isolating and it impacted their ability to socialise and communicate. They created eargym to empower others to better understand their hearing health and take proactive steps to protect it.

Hearing loss currently affects 18 million adults in the UK, with around one billion young people at risk of developing hearing loss due to increased use of headphones. Hearing loss is closely associated with increased dementia risk. Despite this, people wait an average ten years before seeking help for hearing loss.

Eargym plans to publish the findings of its research in early 2025.

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Interview: Exploring electrical stimulation for Parkinson’s disease

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The STEPS II study is investigating functional electrical stimulation (FES) in people with Parkinson’s disease to help improve their walking. Dr Paul Taylor, co-founder and Clinical Director of Odstock Medical Ltd (OML), spoke to Agetech World to tell us more.

Bradykinesia – slowness of movement which can lead to difficulty walking – affects many people living with Parkinson’s disease. The symptom can cause Parkinson’s patients to walk or move slowly, increasing the risk of falls, leading to a reduced quality of life and an increased dependence on others. 

Funded by the National Institute for Health and Care Research, sponsored by Salisbury NHS Foundation Trust, and managed by the University of Plymouth’s Peninsula Clinical Trials Unit, the STEPS II study is exploring the use of an FES device in Parkinson’s patients to help improve bradykinesia. 

The FES device, which has been pioneered by Salisbury researchers as a drop foot treatment for stroke and MS patients, is attached to the patient’s leg and produces small electrical impulses that improve movement.

“If you have Bradykinesia you’re moving slowly. The predominant treatment for Parkinson’s is medication and these can be very effective, but they have the problem of not working all the time,” explains Taylor, co-founder of Odstock Medical Ltd, a company owned by Salisbury NHS Foundation Trust.

”The effects of the drugs will wear off and after a period of time they become less effective, so, there’s a need for improvement.”

Taylor explains that deep brain stimulators are currently available, however, they are very invasive, expensive and can be risky. 

“We’re trying to do something which is a bit simpler and cheaper, which may possibly be able to help people at an earlier stage of Parkinson’s,” Taylor says.

“We’re stimulating the common peroneal nerve, which is the nerve that goes down the leg to the muscles, using a device called a drop foot stimulator. The device is commonly used for stroke and multiple sclerosis.”

A small feasibility study has already been conducted, which showed that FES can help patients walk faster and reduce some symptoms of Parkinson’s. 

In the STEPS II study, researchers hope to confirm the long-term effects of FES on walking speed and daily life with 234 participants at sites across Salisbury, Birmingham, Prestwick, Leeds, Swansea and Carlisle.

Taylor continues: “Our original idea was that we could use electrical stimulation to overcome freezing – which is the effect where people with Parkinson’s will stop walking, particularly when they come to doorways or very narrow areas. It’s to do with the processing of information from the outside world. 

“We wanted to see if we could use electrical stimulation to overcome that freezing and, to a certain extent, we did find that is the case for some patients, but more commonly and with a greater number of patients FES affected bradykinesia – speeding up their movement and helping with more effective walking.”

For the STEPS II study, participants will be randomised into a care as normal group, or a care as normal plus FES group. They will use the stimulator if they are in the FES group for 18 weeks, then the stimulator is taken away, with patients followed up one month later to see if the effects are continued.

Measurements of walking speed and movement will be analysed, along with sensory perception, balance, coordination, muscle strength, as well as secondary effects such as how the device impacts daily living and quality of life.

OML has established clinics around the country with trained therapists where the device will be used if the study is successful. 

“There’s a network of clinics already experienced in using the treatment so we plan to reach those clinics to include Parkinson’s patients in their cohorts,” says Taylor. “Then we’ll work with our contacts to see if we can get it overseas as well.”

OML is currently recruiting participants for the study, to find out more please visit: https://www.plymouth.ac.uk/research/penctu/steps-2 

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Quit Googling to stave off dementia onset, expert urges

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Resisting the temptation to search the web for information that could otherwise be recalled be exercising your brain could help to reduce the risk of dementia.

That is according to Canadian academic Professor Mohamed I. Elmasry who believes simple daily habits such as afternoon naps, memory ‘workouts’ and not reaching for a smartphone can increase the odds of healthy aging.

His new book, iMind: Artificial and Real Intelligence, says the focus has shifted too far away from RI (natural, or real) intelligence in favour of AI (machine, or artificial) intelligence. Elmasry instead calls us to nurture our human mind which, like smartphones, has ‘hardware’, ‘software’ and ‘apps’ but is many times more powerful – and will last much longer with the right care.

Professor Elmasry, an internationally recognised expert in microchip design and AI, was inspired to write the book after the death of his brother-in-law from Alzheimer’s and others very close to him, including his mother, from other forms of dementia.

Although he says that smart devices are ‘getting smarter all the time’, he argues in iMind that none comes close to ‘duplicating the capacity, storage, longevity, energy efficiency, or self-healing capabilities of the original human brain-mind’.

He writes that: “The useful life expectancy for current smartphones is around 10 years, while a healthy brain-mind inside a healthy human body can live for 100 years or longer.

“Your brain-mind is the highest-value asset you have, or will ever have. Increase its potential and longevity by caring for it early in life, keeping it and your body healthy so it can continue to develop.

“Humans can intentionally develop and test their memories by playing ‘brain games,’ or performing daily brain exercises. You can’t exercise your smartphone’s memory to make it last longer or encourage it to perform at a higher level.”

In iMind: Artificial and Real Intelligence Professor Elmasry shares an anecdote about his grandchildren having to use the search engine on their smartphones to name Cuba’s capital—they had just spent a week in the country with their parents.

The story illustrates how young people have come to rely on AI smartphone apps instead of using their real intelligence (RI), he says, adding: “A healthy memory goes hand-in-hand with real intelligence. Our memory simply can’t reach its full potential without RI.”

Published by Routledge, iMind: Artificial and Real Intelligence includes extensive background on the history of microchip design, machine learning and AI and their role in smartphones and other technology.

The book also explains how both AI and human intelligence really work, and how brain function links the mind and memory. It compares the human mind and brain function with that of smartphones, ChatGPT and other AI-based systems.

Drawing on comprehensive existing research, iMind aims to narrow the knowledge gap between real and artificial intelligence, to address the current controversy around AI, and to inspire researchers to find new treatments for Alzheimer’s, other neurodegenerative conditions and cancer.

It argues that current or even planned AI cannot match the capabilities of the human brain-mind for speed, accuracy, storage capacity and other functions. Healthy aging, Professor Elmasry notes, is as important as climate change but doesn’t attract a fraction of the publicity.

He calls for policymakers to adopt a series of key reforms to promote healthy aging. Among such changes, he suggests that bingo halls could transition from their sedentary entertainment function to become active and stimulating learning centers.

As well as napping to refresh our memories and other brain and body functions, he also outlines a series of practical tips to boost brain power and enhance our RI (Real Intelligence).

These include building up ‘associative’ memory – the brain’s ‘dictionary of meaning’ where it attaches new information to what it already knows. Try reading a book aloud, using all of your senses instead of going on autopilot and turning daily encounters into fully-lived experiences.

Other techniques include integrating a day for true rest into the week, reviewing your lifestyle as early as your 20s or 30s, adopting a healthy diet, and eliminating or radically moderating alcohol consumption to reduce the risk of dementia.

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