Dear Rosi!

The problem with this is that all these processes are under autoregulation and tight endogenous feedback control. So it may not that be as easy and "linear", i.e., more complex. However, having said that, yes - you are right, somehow, as it seems: Parkinson patients have become a focus, e.g., of placebo studies, since their dopamine regulation is deteriorated; however, they seem to respond quite well with dopamine releases upon interventions that include positive expectations, and conditioning (if physiologically still possible, i.e., enough dopamine producing cells still exist in the brain). Moreover, meditation studies have shown that dopamine release is involved, gets elicited, here too, at least in the beginning. Thus, yes, one could expect Parkinson's patients benefit from either meditation, or placebo, or positive psychology interventions, and this could (in a model!) be explained by neurobiological autoregulation! We already speculated on this in some of our recent papers.

Be good, Tobias

Here are some news articles on Parkinson and excercise:

http://www.eurekalert.org/pub_releases/2012-11/rson-err111612.php

http://www.nejm.org/doi/full/10.1056/NEJMoa1107911

http://medicalxpress.com/news/2011-09-symptom-specific-parkinson-disease.html

http://www.newscientist.com/article/dn21137-mind-control-key-to-improving-parkinsons-symptoms.html

Regards,

Joachim (not a medic)

Tobias,

Thank you for your response. When you say the problem is these processes are under autoregulation, do you mean they yield subjective experiences and are therefore hard to measure, hard to design research to validate, and yield qualitative data rather than sound quantitative data? Designing a larger trial to assess the validity of what I’m finding has been a puzzle for me. Perhaps this is why?

You mentioned positive expectations. I know the dopamine system has to do with rewards/motivation. And I know the PwP personality is typically cynical and has expectation of negative benefit, so much so that the lessebo response was named after them, when patients who knew they might be in the arm of a trial had substantially diminished response to the active medication, compared to responses to the same medication without a placebo arm. http://www.medscape.com/viewarticle/806549. And yet there are changes from anticipation of positive benefit, e.g. L-dopa in http://www.ncbi.nlm.nih.gov/pubmed/23630185.

What is the difference between the trials that have shown negative anticipation vs positive, lessebo vs placebo? Or do they show the same thing, that PwP can change their response by their expectations? You say it would then be theoretically possible to stimulate dopamine release by voluntary means such as meditation, mindfulness, somatic awareness, etc. I am so happy it could even be explained by neurobiological autoregulation, even though I am shaky in understanding what that is! I have started to look that up, and, once I understand it, I will cite it, since I have not had a plausible mechanism to explain results before! My question, why has this not been a more popular avenue to explore?

I have downloaded several of your papers and will see if some of these questions are answered there.

Thank you,

Rosi

Joachim,

Thank you for your response. I have looked at the links you provided. The last one was amazing, and I forwarded it to the three Parkinson’s support groups I have been attending. There are quite a few exercise programs that have shown benefit for Parkinson’s—TaiChi, boxing, Irish dance, tango, intensive PT, as well as the forced exercise cycling, and other dance. These all seem to require focused attention, and concentration on quality of movements, or sensory-based exercise, rather than mindless exercise. (http://www.ncbi.nlm.nih.gov/pubmed/19373930)

The other articles you linked were equally provocative. Neurorehabilitative exercise programs specifically for PD are very encouraging, and I hope they become easily available and prescribed for all people with Parkinson’s, with targeted exercises that are symptom specific, salient, graded to continue to challenge abilities, and adapted for age and disability. I was happy to read that one of the objectives is to establish the benefits so well that the programs will be covered by insurance.

Thank you,

Rosi