People with young onset forms of Parkinson’s disease (PD) face unique challenges – among them raising children and maintaining partnerships and relationships while coping with a progressive and chronic illness. Of course, these sorts of challenges also occur for older people with PD, but they may be more pressing for those with young onset PD. An older person with PD may not have a young child calling him ‘Dad’ or ‘Mom’ and may not be in the initial and building stages of a sexual and romantic relationship with a partner. People with young onset PD, however, often are just starting families or are still building families and so their challenges are different than those of older people with PD. Recent studies of sexual and relationship satisfaction in couples with young onset PD show that levels of dissatisfaction were prevalent among young onset PD patients. PD patients were similar to their partners in their level of sexual and relationship dissatisfaction. The degree of dissatisfaction did not correlate with disease characteristics. Instead, depression seemed to be fueling the dissatisfaction in sexual and romantic relationships. These findings underlie the importance of treating depression aggressively in people with young onset forms of PD.

_{Source: Wielinski, C. L., Varpness, S. C., Erickson-Davis, C., Paraschos, A. J., & Parashos, S. A. (2009). Sexual and relationship satisfaction among persons with young onset Parkinson’s disease. Journal of Sexual Medicine. [Epub ahead of print]}

The English philosopher, Thomas Hobbes (1588-1679), is best known for his political philosophy, although during his day he was more widely known as a scientist, a mathematician, a translator of the Greek classics (such as Thucydides’ History), and a fierce and passionate writer on religious questions. He developed the ‘shaking palsy’ sometime in his 50s or early 60s…sometime in the mid-1640s. By the 1650s or 1660s, we know he was using secretaries to do his writing as he had lost that ability. He would dictate his works to his secretaries. It is fascinating that Hobbes wrote his most influential works right before the estimated onset of his Parkinson’s disease (PD) and right after onset of the disease. For example, he wrote the De Cive [On the Citizen] (1642) right before the onset of his PD and he wrote his most famous work, Leviathan, in 1650-1651 right after onset of the disease. His disease onset and progression also coincided with some of the most momentous events in English history: The terrible Civil Wars of 1642-1646 and 1648-1651 occurred coincidently with the onset and early progression of his disease. Those civil wars involved the most fearsome forms of religious fanaticism and ended in the execution of the King. Through all of this and with his disease progressing, Hobbes was forced to leave the country for his personal safety and lived in France from 1640 to 1651. It is difficult to travel with PD now in the modern era. Imagine what it was like for Hobbes to travel with the disease in the 1650s – all while seeing his home country engulfed in religious fanaticism of the most extreme and deadliest kind. Did his PD influence his political philosophy? It is impossible to say. The disease, however, clearly did not slow him down intellectually. On the contrary, he produced his best most creative work just when the disease was trying to claim his body.

Some forms of familial Parkinson’s disease are linked to loss of function of the genes called Parkin, or PINK1, but, until recently, it was not understood why. Why did these genetic defects lead to PD in some families? Recent evidence suggests that these genes are important for normal functioning of the mitochondria. Mitochondria are those cellular processes in every cell of your body that produce energy for the body’s functions. The mitochondria produce energy in the form of adenosine triphosate. Cells, particularly cells that produce dopamine, need this energy molecule in order to perform their normal functions. Scientists have long suspected that damage to the mitochondria in your cells can contribute to the onset of PD. When mitochondria are damaged in animals, it can produce a form of parkinsonism. Now scientists have discovered that Parkinson-associated genes like PINK1 and Parkin functionally interact to maintain mitochondrial function. Loss of Parkin or PINK1 function impairs the morphology and activity of mitochondria, which then produce less adenosine triphosphate. Slowly, the pieces to the puzzle are being put together. Already scientists are talking about creating drugs or genetic products that can protect mitochondria and thus treat or ameliorate PD.

_{Source: Lutz, A.K., Exner, N., Fett, M.E., Schlehe, J.S., Kloos, K., Laemmermann, K., Brunner, B., Kurz-Drechsler, A., Vogel, F., Reichert, A.S., Bouman, L., Vogt-Weisenhorn, D., Wurst, W., Tatzelt, J., Haass, C., and Winkelhofer, K.F. Loss of parkin or PINK1 function increases DRP1-independent mitochondrial fragmentation. Journal of Biological Chemistry, 21. August 2009, Vol. 284, Issue 34, 22938-22951.}

One of the hardest symptoms to bear when you have Parkinson's disease is anxiety. Some forms of anxiety in PD are easy to understand. We are anxious over how the complications of PD will affect money and family life—not to mention our own well-being. But there are other forms of anxiety that seem to be an intrinsic part of the disease-not just a reaction to the disease. These intrinsic forms of anxiety can make you feel like you are going crazy. The fear seems irrational and yet uncontrollable. Something horrible is about to happen and I am powerless to do anything about it-or so it feels. Recent studies of anxiety in PD show that up to half of PD patients experience some form of anxiety at one point in their lives. The most common form of anxiety after diagnosis of PD appears to be “Anxiety disorder not otherwise specified”---in other words an anxiety disorder that is atypical and not well studied by the psychiatrists. In short, anxiety disorders of PD are not well understood and because of that they are probably not well treated either. If you are experiencing anxiety, talk to your doctor about it. When fears and worries are shared they lose their hold on us. Its time to bring anxiety disorders of PD out of the shadows and into the realm of rational understanding and treatment.

_{Source:
Gregory M. Pontone, James R. Williams, Karen E. Anderson, Gary Chase, Susanne A. Goldstein, Stephen Grill, Elaina S. Hirsch, Susan Lehmann, John T. Little, Russell L. Margolis, Peter V. Rabins, Howard D. Weiss, Laura MarshPrevalence of anxiety disorders and anxiety subtypes in patients with Parkinson's disease (p 1333-1338). Published Online: May 7 2009 Movement Disorders, Volume 24, Issue 9 (p 1333-1338)}