Dementia/PD + role of nutrition 3

Question 1

Removal of …. and ….: Lower PD-risk in mice
Removal of …: no PD development

Answer 1

Lower PD-risk after truncal vagotomy: vagal nerve may be involved in pathophysiology
Appendix might also be involved (removing it: decrease PD risk)
Mice without microbiota: will not develop PD pathophysiology

Question 2

What are Two PD subtypes?

Answer 2

1. Body-first PD
   = Pathology starts in the gut, travels to the CNS, gives rise to RSB disorder (rem-sleep), then spread towards the cortex
2. Brain-first PD
   = Pathology starts in olfactory bulb, then to rest of brain, maybe even downwards to NS and gut

Question 3

Drugs: what is used against PD?

Answer 3

• Influence dopamine availability drugs (COMT inhibitors, DDC inhibitors, MAO-B)
• Dopamine agonists (dopamine-like effect on receptor)

Question 4

What is levodopa?

Answer 4

Levodopa
- Dopamine precursor
- Still most effective, least side-effects
- Effective until late in disease, but shorter + less predictable with progression
Levadopa is broken down by the body: actual amount of levodopa that reached the brain is reduced

Question 5

What is happening when levodopa is given after a while?

Answer 5

Nigral buffering capacity decreases
Duration of effect decreases:

Early >6 hr to days
Late: 2 hrs

Question 6

Dopamine agonists vs levodopa:

Answer 6

Dopamine agonists…
- Stimulate dopamine receptors more continuously
- Less effective than levodopa
- More side effects (difficulty controlling impulses)
- Delay response fluctuations
- May be considered in young-onset PD

Question 7

Later in disease: advanced treatment. A LCIG or apomorphine pump is used or deep brain stimulation. What does it do?

Answer 7

LCIG: infuse levodopa gel continuously in the stomach
Apomorphine pump: dopamine agonist, stable plasma levels
- Deep brain stimulation: electrode in brain, better motor symptoms: dopamine-like effect

Question 8

What are current guidelines with levodopa?

Answer 8

Protein rich meal: inhibits uptake levodopa
Therefore it needs to be ingested before or after meal and protein ingestion needs to be reduced

Question 9

X is likely in PD. Caused by
- Olfactory dysfunction
- Slower gastric emptying
- Constipation
- Depression

Answer 9

Weight loss

Question 10

Dementia: prevention food?

Answer 10

• mind diet, med diet (dietary patterns)
• vit D
• B-vitamins (6,12,folate)
• omega 3
• anti-oxidants (E, flavonoids)

Question 11

Dementia: treatment food?

Answer 11

• ketones
• Souvenaid
• Omega-3
• probiotica