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Potential neuroprotective agents

Anti-oxidants

Over recent years there has been much interest in the role of free-radical damage in Parkinson’s and other conditions.  Free-radicals in moderation are normal but if there are more than the body can cope with oxidative stress occurs which results in disease. 

Anti-oxidants, both as supplements and in naturally occurring forms, have the ability to scavenge and neutralise free-radicals.  Most scientists agree that the brains of people with Parkinson’s have too many free-radicals and not enough anti-oxidants to balance them out.  Whilst anti-oxidants are no cure for the condition, many believe that they can help to slow the progression of the illness. However, in a number of cases, concrete scientific data to back up claims is lacking and you should always discuss with your doctor before taking any supplements.  

It is thought that certain Parkinson’s medications may have anti-oxidant properties and more research is underway to establish if this is the case.

MAO-B inhibitors

Perhaps the simplest and most important theory relating to neuroprotection is that dopaminergic treatment, which supports the degenerating cells, can provide significant long term neuroprotective benefits if started in the early stages of living with Parkinson’s.

A study on the MAO-B inhibitor rasagiline1 indicates that people with Parkinson’s who received early treatment had a better outcome than those whose treatment was delayed.   It appears that starting soon after diagnosis provides some long term neuroprotection by a compensatory mechanism of the remaining dopaminergic neurons. Further research is needed to understand the workings of the compensatory mechanism, together with exploration of neuroprotective strategies.

Several studies concerning selegiline, another MAO-B inhibitor, indicate that it too might have neuroprotective actions, but this theory has yet to proven (DATATOP2 ).


 

References


  1. A randomized, double-blind, placebo-controlled, delayed start study to assess rasagiline as a disease modifying therapy in Parkinson's disease (the ADAGIO study): Rationale, design, and baseline characteristics http://www3.interscience.wiley.com/journal/121461969/abstract
  2. The Parkinson’s Study Group (1993) ‘Effects of Tocopherol and Deprenyl on the Progression of Disability in Parkinson’s Disease’ New England Journal of Medicine; 328: 176–183 http://www.nejm.org/doi/full/10.1056/NEJM199301213280305

Dopamine agonists

Results of some studies on dopamine agonists, such as the PET/SPECT controlled studies for ropinirole1 and pramipexole2, suggest that they may have some neuroprotective benefits in Parkinson’s.  However, not all the studies reveal the neuroprotective qualities of medication, so no clear conclusions can yet be drawn.

The PROUD study3, which concluded in 2009, was the first to combine early versus delayed pramipexole treatment to investigate the potential clinical benefits of early treatment.  However, although pramipexole is an effective medication in relieving Parkinson’s symptoms, the results of the study were not conclusive and did not show that early treatment modifies the progression of Parkinson’s.


 

References


  1. Slower progression of Parkinson's disease with ropinirole versus levodopa: The REAL-PET study  http://onlinelibrary.wiley.com/doi/10.1002/ana.10609/abstract

  2. Dopamine transporter brain imaging to assess the effects of pramipexole vs levodopa on Parkinson disease progression  http://jama.ama-assn.org/cgi/content/abstract/287/13/1653

  3. Rationale for delayed-start study of pramipexole in Parkinson's disease: the PROUD study http://onlinelibrary.wiley.com/doi/10.1002/mds.23143/abstract


Vitamin C and E

For some time it has been suggested that the anti-oxidants Vitamin C and Vitamin E may have some neuroprotective properties for people with Parkinson’s, although current evidence suggests that the benefits are probably quite small.  The same benefits from the vitamins found in natural foodstuffs may not however always be derived from the vitamins in dietary supplements1. Further research and studies into this are needed in order to establish any links.


DId you know?

The following foods contain high levels of vitamin E: milk, eggs, nuts, seeds, avocado, asparagus, spinach and wholegrain.

 

 

References


  1. Intakes of vitamins E and C, carotenoids, vitamin supplements, and PD risk, Neurology; 59(8): 1161–1169 http://www.neurology.org/cgi/content/abstract/59/8/1161?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Zhang&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=59&firstpage=1161&resourcetype=HWCIT

Creatine

Creatine is a dietary supplement which is often taken by athletes to improve their performance.  It is thought that creatine may act as an indirect anti-oxidant by storing energy and protecting against neuronal cell death.  Additional studies and research into this are required to better understand if creatine can play a role in neuroprotection.

Co-enzyme Q10

Coenzyme Q10 (CoQ) is a fat-soluble anti-oxidant compound found in every cell of the body as well as in a number of foods.  Brain levels of CoQ fall with age and are likely to be significantly lower in people with Parkinson’s.  Small studies have suggested that CoQ scavenges free-radicals more effectively than vitamin E but further large scale trials using varied dosages are being carried out to establish the true extent, if any, of this compound.

Levodopa

The ELLDOPA1 study assessed the effect of levodopa on the rate of progression of Parkinson’s but the results were conflicting.  So the long term effects of levodopa treatment and any possible neuroprotective qualities are as yet unclear.


 

References


  1. Levodopa and the Progression of Parkinson's Disease (New England Journal of Medicine, volume 351:2498-2508 - 09 December, 2004) http://www.nejm.org/doi/full/10.1056/NEJMoa033447

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory medication, such as ibuprofen and aspirin, are thought to have some neuroprotective benefits.  NSAIDs are also naturally present in certain foodstuffs, including turmeric and curcumin.  Curcumin is the main active ingredient of turmeric, the most important compound in most curry powders.  Like green tea, it belongs to a group of compounds called polyphenols, many of which we now know have health benefits in humans.

Curcumin is the subject of various research studies into its potential benefits, including anti-oxidant and anti-inflammatory properties. These are thought to reduce oxidative damage in the brain, and therefore slow or reverse the progression of Parkinson's, with reduced side effects and toxicity compared to other NSAIDs.  It has been estimated that in the US and UK 280 out of 100,000 people develop Parkinson’s whilst in India the rate is as low as 14 per 100,000, leading to speculation that curcumin may be a factor in reducing brain cell damage.  Some hypothesise that if turmeric can protect foodstuffs from oxidative degradation, it can perhaps act in a similar way for our bodies, as may other natural NSAID.  Again, this is an area of ongoing research.

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