Kren Harmon loves a good success story.

The licensed clinical social worker runs a neurological therapy group for older adults at OSF HealthCare in Alton, Illinois. Attendees might have short term memory loss due to a stroke, Parkinson’s disease or Alzheimer’s disease. Those challenges can also bring mental health concerns. But there is hope. Small group sessions like the ones Harmon runs have been proven to help not only with the seniors’ day-to-day life but also their sense of feeling alone.

“I had a new woman in group who said she had memory loss and was embarrassed. Another woman who’s a veteran of the group didn’t miss a beat. She reached over, touched the woman’s hand and said, ‘Honey we all have that’.” Harmon recalls. “The woman burst into tears and realized she’s not the only one dealing with this.

“That’s why I come to work every day,” Harmon says, beaming.

The fears, and how providers can help

Harmon has heard plenty of health concerns from older adults, and they’re all valid. The senior has moved out of their home and is worried about losing independence. They’re worried their health needs will be a burden on family. They might even be scared of dying.

Enter small group therapy. First, Harmon says, it’s a consistent thing on the senior’s schedule where they can look forward to getting out of the house and seeing people. Harmon says studies have shown more socialization for older adults means less confusion. But more importantly, the group connects attendees with others in their situation so they know they’re not alone. Harmon describes the concept in two terms: commonality of experience and installation of hope.

“We all have these same issues, but there’s hope,” Harmon says, restating what is said in a group session. “We can learn coping skills and accept what’s going on. We can support each other.

“Individual psychotherapy is great, but in group they get the benefit of having each other to lean on,” Harmon adds. “They say ‘This worked for me. You might want to try this at home.’”

A typical session might be a mix of camaraderie, memory tasks (medical term: cognitive stimulation therapy) and specialized topics like handling grief.

“We cover current events. What’s the date? What’s the weather?” Harmon outlines. “We do check-ins. Tell me something new in your life. People like that. They talk about their new great grandbaby.”

Harmon encourages her patients to expand on what they learn in group. The medical term for this is acceptance and commitment therapy. Find a way to exercise that works with your limitations. Explore a new hobby, such as puzzles or reading. Watching television all day won’t cut it, Harmon says.

“You’re never too old to learn a new skill,” she reminds.

Getting involved

If an older adult in your life could benefit from group therapy, Harmon says going through a physician might be the way to go. She’s found that seniors sometimes don’t listen to friends and family. But if their neurologist – someone they know and trust – recommends something, it might carry more weight.

“Having the doctor refer, I’ve found, makes a difference with that generation. When someone in a white coat says it, it’s the best idea ever,” Harmon chuckles.

You can also read more about healthy thoughts and behaviors on the OSF HealthCare website.

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This comes roughly five years after he announced he had been diagnosed with Parkinson's disease (PD).

Within 25 years, the world can expect to see a 112% increase in the number of people living with Parkinson’s since 2021.

A new report in the British Medical Journal (BMJ) links population growth and longer predicted lifespans as two main causes for an expected 25 million patients with Parkinson’s across the globe by 2050.

What is Parkinson's disease? 

“Parkinson’s disease is a movement disorder which causes a person to move less. It happens because the brain is not making enough dopamine, which is the neurotransmitter required for movement,” says Kavya Moravineni, a movement disorders neurologist with OSF HealthCare Illinois Neurological Institute (INI). “Our movement circuits in the brain use dopamine and cause voluntary movement.”

Dr. Moravineni wasn’t shocked to see the estimate in the BMJ. Parkinson's is a neurodegenerative disease, which coincides with natural aging. So, as life expectancy increases, the incidence naturally increases. Additionally, Dr. Moravineni believes there has been increased awareness, and in turn, increased diagnoses of Parkinson's. People are seeking out medical attention earlier as they recognize the symptoms, especially if they have a family history of PD.

Symptoms of Parkinson’s

“Tremor is the most common one. That’s what brings attention to see that something is wrong here,” Dr. Moravineni says. “Patients can have stiffness in their limbs, primarily in their muscles, and they can have problems walking. The typical dragging feet or not moving their arms as much when they’re walking. Stooped posture is another one.”

However, patients can have other symptoms which they don’t initially attribute to something like Parkinson’s disease. This can be the loss of sense of smell, dizziness upon standing or longstanding history of constipation. Sometimes anxiety or acting out your dreams at night can be longstanding symptoms.

The first step, Dr. Moravineni says, is to get a diagnosis. Next would be to decide how to manage the disease. The medical team at OSF INI offers different medication options, as well as discussing different surgical options. One example is deep brain stimulation (DBS).

What is deep brain stimulation? 

"It's an implant that's going into your brain. The idea is that we're using electricity to help with symptoms," Dr. Moravineni says. "To put it simply, the leads that go into the brain will pass electricity into the tissue and neurons. This negates abnormal signaling causing symptoms, so it improves symptoms."

Why deep brain stimulation can replace medication:

"As the disease progresses, the need for medication dosage increases. With that comes side effects. In those situations where the patients are still responding to medications, but experiencing a lot of side effects, deep brain stimulation can help. It's replacing medication while still providing the same benefit," Dr. Moravineni says. 

It can be increased or decreased based on what the symptoms are doing. Younger patients are often "better" candidates for deep brain stimulation. Patients cannot be candidates if they have severe dementia or underlying psychiatric illness that has not been managed. Of if they don't have solid family support. Dr. Moravineni calls deep brain stimulation one of the "next steps" in the process. It is recommended patients have proof of responding well to medication. 

Supportive therapies (speech and/or physical therapy) are beneficial parts of the care journey. 

The Michael J. Fox Foundation says while the BMJ article does not fully articulate the growth of PD, it does shine a light on the need for a cure.

There's no great list of health tips out there that can prevent Parkinson's. However, Dr. Moravineni says a well-rounded exercise regimen can help slow down progression in Parkinson's patients.

Dr. Moravineni adds that there have been increasing amounts of evidence indicating a connection between neurologic diseases and gut microbiome. The Mediterranean diet focuses on healthy habits like drinking less alcohol, eating more plant-based foods and fewer red meats, encouraging a strong and diverse microbiome. In turn, this may help in prevention and/or reduce the severity of certain neurologic conditions.

OSF INI has two physicians, one nurse practitioner and therapists caring for patients in the Peoria area. This multi-disciplinary approach to care helps INI be the go-to destination for patients in the community. 

For more information, visit the OSF INI website.

Video Interview Clips

• Dysarthria (pronounced diss-ARR-three-ah): Brim says this common voice disorder could be brought on by a neurological issue, such as the effects of a stroke, Parkinson’s disease or a traumatic brain injury. Muscle issues and medication side effects can also play a role. It all leads to the most common symptom: slurred speech. Brim says to picture trying to talk with a mouth full of marbles. The person’s speech could also be a different volume (too quiet or too loud) and speed (too slow or too fast).
  
  “There’s a restorative approach where we do different types of [vocal] exercises. Try to get that voice to where it sounds better and clearer,” Brim explains. “Then there’s a compensatory approach. For a person with Parkinson’s or amyotrophic lateral sclerosis [ALS] where their voice probably isn’t going to improve in the long run, we might look at an alternative communication device. Or, do we need environmental assistance to help them communicate?”
  
  A communication device could include a voice box to amplify speech or, if someone has lost their voice entirely, a speech generating tablet.
  
  “The [speech generating device] has a bunch of communication presets on it,” such as common phrases conveying hunger or pain, Brim says. “They can have it pre-programmed with their actual voice before they lose it.”

• Dysphonia (pronounced diss-PHONE-ee-ah): This is a general term to describe a voice abnormality, Brim says. Neurological issues and brain injuries are common causes.
  
  “The most common dysphonia people know is spasmodic dysphonia. We really don’t know a specific cause. We assume it’s neurological,” Brim says. “This brings voice tremors. The vocal cords are not abducting or adducting correctly.

“When they’re adducting, the vocal cords are coming together. If you have an adductor-type spasmodic dysphonia, the vocal cords aren’t wanting to go away from each other. They’re wanting to stay together. So there’s a really strained voice. It sounds very harsh, almost like people are trying to force the voice out,” Brim outlines.

“Or you have abductor dysphonia, where the vocal cords are pulling away. The person has a breathy voice because the vocal cords are open all the time. Speech comes out very quiet and whispery. They’re losing all their air in one go,” Brim adds.

Treatment could include voice exercises or Botox injections. Or, if the person has a nodule or polyp on the vocal cords, those can be removed surgically.

“We go over healthy voice habits, such as increasing water intake,” Brim says, describing how she might work with someone after surgery. “Have a humidifier in the house to help increase moisture in the air. Use more of a quiet voice. Try not to yell or project too loudly because that can strain the vocal cords. Try to make your voice sound different but not in a way that causes harm.”

Something else Brim will preach to patients that you might not connect with voice issues: reduce your caffeine intake. Caffeine can increase muscle tension in your vocal cords, she says.

• Vocal cord paralysis: Brim says this is commonly caused by trauma to the throat, such as a car accident or having a breathing tube.
  
  “It’s similar to a bruise or fracture or torn ligament. When there’s trauma to the vocal cord area, there’s damage. And that causes paralysis sometimes,” Brim says. “You can have, most commonly, unilateral vocal cord paralysis, where one doesn’t move. Or you can have bilateral [paralysis] where both aren’t moving.”
  
  Brim says this is often treated with Botox or surgery to get the vocal cords vibrating again. The person would follow up with speech therapy.

There is hope

Brim is up front with her patients: You might not get your voice back to where it was, but you can make improvements. So don’t give up.

“I’d love to wave a magic wand and make your voice great,” Brim suggests with a smile. “But there are other steps we can take so you don’t feel locked in. You don’t feel like no one can understand you and no one can communicate with you.”

Learn more

Read about all the ways medical professionals help restore voices on the OSF HealthCare website.

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There have been numerous studies suggesting gut health is linked to brain health and can influence the development of diseases such as Alzheimer’s. Now, there’s research results that specifically advance the idea that a person’s gut microbiome and damage to the upper gastrointestinal tract significantly increase a person’s risk of developing Parkinson’s disease.

The study points out Parkinson’s disease is a progressive neurodegenerative disorder that affects 8.5 million people worldwide based on 2019 estimates. The number of cases has more than doubled over the past three decades. It is considered the fastest growing neurodegenerative disorder globally, even surpassing Alzheimer’s, according to the World Health Organization.

Omar Khokhar, MD, a gastroenterologist with OSF HealthCare suggests there’s a strong connection between damage to the lining of your gastrointestinal tract and the impact of damage on the rest of the body.

“There's this whole theory about absorbing things we shouldn't be absorbing, leading to systemic inflammation. And in this case with Parkinson's, is it neuroinflammation? Is it absorption of things you shouldn't be eating quickly or eventually, over time, could potentially accumulate in the brain to cause Parkinson's?”

The research involved more than 9,300 people who had a scope of their upper gastrointestinal tract, including their esophagus, stomach or upper part of the small intestine that required a biopsy. The study showed those whose mucosal lining was damaged had a 76% greater risk of developing Parkinson’s disease during the follow-up period – an average of 14.9 years for the group.

It has been a long-held belief that Parkinson’s disease has its origins in the brain, but now researchers see growing evidence it might begin in the gut. The latest study shows a strong correlation but doesn’t definitely link problems with the gut lining as a cause of Parkinson’s. However, Dr. Khokhar says it appears that gut health makes a big difference.

“If your gut lining is intact and strong, it will absorb what you should absorb for adequate nutrition, digestion and healthy living and not absorb what you shouldn’t be absorbing.”

According to the study, a protein called alpha-synuclein found in the gut can travel to the brain and form clumps called Lewy bodies, which are a hallmark of Parkinson's.

As he glances at a screen with research results, Dr. Khokhar says he looks forward to a day when a person’s microbiome health could be evaluated through a blood or breath test, and then specific prebiotics or probiotics could be ordered to address deficiencies, much like what’s done today with vitamins.

“Once we can get to this point where we can look at ‘this is what you’re eating and what you’re eating is resulting in these different changes and levels of your specific microbiota,’ that’s where it gets really, really groundbreaking.”

But, that type of precision medicine could be five to 10 years away. So until then, what’s the best approach? Dr. Khokar says it’s important for anyone with gastrointestinal issues to improve their diet and be diligent about following up with regular check-ups. In fact, with increasing evidence that what we eat can impact gut and brain health, Dr. Khokhar says it’s time for everyone to start paying more attention to what they eat.

“I challenge everyone who eats a granola bar or who eats a bag of Doritos or whatever the case may be. If I can’t tell you and the scientists can’t tell you what ingredients six through 22 are, should you really be putting that in our mouth? Or is there a trade off or is there a cost to that?”

What about prebiotics and probiotics? Should people be taking them to keep a healthy gut? Dr. Khokhar advises a better approach is to get those nutrients through food by regularly eating things such as Greek yogurt, kefir (milk or non-dairy based milk such as soy, coconut and water), sauerkraut, kimchi, pickles, miso, tamari (soy), kombucha, sour cream, cottage cheese and aged cheese.

If those are too challenging to include in your diet, Dr. Khokhar says to talk with your medical provider. If you feel better after taking prebiotics or probiotics, then go for it.

Video with Dr. Omar Khokhar