Andrea Malsom

@jonny_acheson I would be curious if a difference in Eye Contact suggests an ADHD diagnosis. Here's a research article suggesting a link (causation or association?) with ADHD and PD: pmc.ncbi.nlm.nih.gov/articles/PMC77…

Has anyone ever noticed that when you talk to people with #Parkinsons they don’t always make eye contact. I am aware that I do this but have no idea why? Perhaps it helps me to concentrate on what I am saying or about to say. Would welcome your thoughts and experiences.

This looks so amazing! Well done!

What is the recommended protocol for instrumental swallow assessments for those with Parkinson's? PD diagnosis = instrumental swallow assessment, no symptoms required as a prerequisite? I say yes. I also support the plan of a swallow study every 18 months, regardless of Sx.

@MichaelOkun Love that they discussed dysphagia! We need to make sure the SLPs understand the whole picture, too. PD is so very different compared to the other conditions we support.

Are you doing these 5 things? This is such an important paper about hospitalization and so nice to see this in the Joint Commission journal. Parkinson's hospitalization related issues we are coming for you! BRAVO! There is growing consensus on effective and sustainable solutions that hospitals can implement to avoid preventable harm among PD patients. The Parkinson's Foundation Hospital Care Recommendations establish five hospital care standards: -All PD medications are ordered in a custom fashion according to patients' at-home regimen. - All PD medications are administered within 15 minutes of patients' at-home regimen, 100% of the time. -Potentially harmful medication events are eliminated, particularly for dopamine-blocking medications, agents for pain and sedatives. -All people with PD should mobilize three times a day if clinically appropriate and under professional supervision if necessary. -All people with PD should undergo screening for dysphagia within 24 hours, with measures taken to minimize the risk of aspiration pneumonia, as needed.

DBS in pregnancy, is it possible? YES. Is it safe. LIKELY. Are there guidelines? NO. How do you manage if pregnant w/ existing DBS? Smilowska and colleagues in @journal_PD take on this topic w/ nice survey from OB's, 3 cases and discussion. content.iospress.com/articles/journ… #Parkinsons

Watching @coldplay playing ‘Fix You’ with Michael J Fox was iconic The lyrics are a poignant reminder of a journey with #Parkinsons. A call to governments to invest in more research so the scientific community to fix us. Thanks for the shout out at the end, I’m being good #cancer

@MyParkinsonsLif Medical teams are starting to add Video Swallowing Studies to the long list of tests recommended for those with PD - even before symptoms are obvious - due to the high prevalence of dysphagia with PD and the fact that trouble swallowing can be "silent." Have you completed one?

@MichaelOkun @NEJM What a thoughtful review! Thank you for your insights and guidance!

Big news with positive result announced for a randomized study of a GLP-1 agonist for Parkinson's just released @NEJM. A new era for Parkinson's or alternatively, more questions than answers raised by Meissner and colleagues. Key Points: - This multi-center French trial studied Lixisenatide which is a glucagon-like peptide-1 receptor agonist used for in diabetes. - The trial was a phase 2 double-blind randomized and placebo-controlled. - The authors wanted to know whether this drug would affect the progression of motor disability. - Who did they study? Parkinson's treated and with symptoms less than 3 years. - If you enrolled, you received daily subcutaneous lixisenatide or a placebo. - The primary outcome was a change in the motor PD scale called the MDS UPDRS when on dopamine medication after one year. - There were 78 people in each group. - The motor scores slightly improved in lixisenatide and worsened by 3 points in the placebo group. - There was a very short 2 month washout period where those getting the active drug stopped it and the benefit persisted. - Nausea was the most common side effect and occurred in about 1/2. My take: We have continued our multiple year love affair with various diabetes drugs and their potential links to Parkinson's disease, however the current study results are the most promising. Interpret with caution: there is a number called the 'clinically meaningful threshold' and those reading this study should appreciate that the results 'fell short' of this important metric. There will certainly be many arguments among experts as to whether this study met a minimum threshold for neuroprotection, and my personal opinion is that it did not. Here is an important message: In my view do not rush to prescribe this drug or try to creatively acquire it. We have been down this road many times including leukemia drugs, cough syrups and lithium. The data is not yet there to proceed to prescribing. More importantly, the weight loss associated with GLP-1’s is not desirable in the majority of cases of Parkinson’s disease and the nausea and vomiting will not be a welcome symptom. We must ask the important questions as to why the non-motor outcomes did not change, and why the other GLP-1 studies have been negative? Is there a blind spot here we are missing? Please appreciate this was trialed in only very early Parkinson's disease and thus there may be 'generalizablility' concerns. I do not want to diminish a great paper with a randomized design and encouraging data, however let's not rush to the drug store counter. Perhaps we should consider ad augusta per angusta – to glory through narrow spaces by continuing to follow the data with diabetes drugs and see where it leads and what it teaches us. nejm.org/doi/full/10.10… #Parkinsons #OZEMPIC #diabetes #GLP1

@MayhemMonza @MichaelOkun @NEJM This article popped up for me just before reading your question: nytimes.com/2024/04/03/hea…

Never thought I would say thank goodness for X #facebookdown

@MyParkinsonsLif Are you handwriting them? You could post pictures of them or read them out loud for a podcast, social media video or reel. Good voice practice, too 🗣️

I asked people at the 'Parkinson's Summit' yesterday to raise their hands if their neurologist or general doc have talked to them about the 2X risk of melanoma in Parkinson's? To my disappointment only three hands shot up in a packed house of hundreds of people. Let's 'be the change.' See dermatology once a year, re-apply sunscreen every 2-3 hours and wear protective hats and clothing. #Parkinsons #Melanoma #NeurologyOne

@MichaelOkun I haven't heard "shrink" in ages! Psychiatrist and also psychology/therapy (but not my kind of therapy 😅) comes up a lot more nowadays in sessions which is so refreshing and helpful! Interesting to read the etiology!

Why do people refer to psychiatrists as 'shrinks?' Today in my clinic I overheard the term and it triggered engagement of many of my colleagues in a rich dialogue. In the end it turns out there are 'many schools of thought' on this topic.' Key points: - One theory is that when indigenous tribes-people would conquer an enemy they would follow an ancient practice called 'head shrinking.' This head shrinking was to denote they had conquered another people. So, this theory would hold that the psychiatrist conquers your brain. - Another theory is that psychiatrists shrink people's problems, challenges or burdens. - A 3rd idea which is close to the 2nd is that the duty of a psychiatrist is to provide insights into the mind and thereby shrink the distress. - The 4th theory is phrenology based. Phrenology is an old theory linking the shape and the size of your skull bones to your personality, behavior and character. This theory holds that by shrinking an undesirable phrenological area through use of a psychiatrist this will improve outcome. This theory was most recently written about in @TheAtlantic My take: I think this discussion is a lot of fun, however we should keep in mind that many psychiatrists do not appreciate being reduced to a 'shrink' no matter which school of thought (schola cogitationis) you subscribe to. Maybe we should leave this debate for the history books and just recognize the brilliance of our psychiatry colleagues.

@EnriqueZenitram @MichaelOkun I was going to ask if it was truly him doing all these amazing posts! Good to have the evidence! 😅

@MichaelOkun Meta-tweet of Dr. Okun writing that tweet.

'Beacon Of Hope' by Steve Williams: "The digital art piece, featuring a silhouetted lighthouse in warm colors, mirrors the hope for a Parkinson's cure. The sunset backdrop, depicted with thick lines, signifies the ongoing journey and progress in finding a solution." #SparkArt

Please help us get the word out -Parkinson's #SparkArt is back! Draw, Paint, Photograph, etc how PD impacts you, tag us, and post on social media! #PDAvengers Powered by @AbbottNews "Disco-Knee-Ja" (Dyskinesia) below. DETAILS: sparkthenight.org

@jonny_acheson @Procreate Love it! I've always wanted to learn how to do this!

For new followers I sometimes posted drawings about a brain called ‘Basil Ganglia’ to help to educate about #Parkinsons. Very excited to tell you that thanks to ⁦@Procreate⁩ Dreams I can now #animate and actually get Basil to move… #procreatedreams #firstattempttowalk

@MichaelOkun @PdAvengers Thank you!!! Speech and swallowing are so prevalent and important!

What is the most important symptom(s) to folks with Parkinson's at 5 years or more after the diagnosis? Tremor, stiffness, slowness? Nope, guess again and recalibrate your management focus. …mentdisorders.onlinelibrary.wiley.com/doi/10.1002/md… #Parkinsons @PdAvengers

Today is @michaeljfoxorg’s National Day of Action for #PD! Recently I helped secure @billhuizenga co-sponsorship in supporting The National Plan to End Parkinson’s Act. You can do the same with the click of a button! #Act4PD bit.ly/3Rt47pB

@MichaelOkun @ParkinsonDotOrg Specially trained Speech Language Pathologists have a role in cognitive education (for PwP and care partners) and cognitive rehabilitation for PwP 💪🧠 We know the is and outs of thinking clearly and, with our PD training, we can be super helpful in this respect!

What can you do besides 'drugs' to address memory and cognitive Parkinson's symptoms. There are things to consider and I love this page from the Cognition: A Mind Guide Book free download from @ParkinsonDotOrg Cognitive feedback and restructuring are important.