As the daughter of a Mom living with Parkinson's disease, I'm always eager to learn more about PD treatments, up and coming research, and how to best support a loved one with Parkinson's. So, I was thrilled to have the opportunity to interview Dr. Kara Smith, a Movement Disorder Specialist at UMASS Memorial Medical Center Parkinson's Disease and Movement Disorders Clinic in Worcester, MA. She speaks about why she decided to specialize in Parkinson's, some exciting new treatments, and why she's hopeful that Parkinson's disease will be conquered within her career.
How did you decide to become a Movement Disorder Specialist specializing in Parkinson's disease?
PD is a fascinating and complex condition that continually inspires my intellectual curiosity. It involves such a broad range of symptoms and is extremely variable between individual patients. To me, this makes research and treatment of PD both challenging and rewarding. Second, there are many effective treatments that I am able to offer to my patients. We can typically manage symptoms well and keep patients functioning almost normally for years, which is not the case in many neurologic conditions. Our scientific understanding of PD has grown tremendously since I began my training and I have high hopes for new breakthroughs in the near future. Finally, as a Movement Disorders Specialist, I have the opportunity to build relationships with patients and their families over many years. I find it highly rewarding to help patients through their journey with PD.
What is your day-to-day like? Do you mostly see patients in your office?
I split my time between patient care and clinical research. I view my office as a laboratory and am always listening to my patients for new research ideas. I believe that education and engagement in research empower patients and leads to better outcomes.
What is your main research focus?
My main research interest is cognition in PD. PD can cause a spectrum of cognitive symptoms, from subtle changes early in the disease course to the development of dementia in some patients. Currently we do not have good ways to predict or prevent future cognitive decline. My goal is to find new tools to diagnose, monitor and treat cognitive changes in PD. I am currently conducting a study of cognitive training, or “brain games” through a website, to improve mild cognitive symptoms such as word finding difficulty in PD. I am also studying the use of speech and voice to monitor cognitive function in daily life.
Are there any new treatments available or coming soon?
There are many new and exciting treatments on the horizon. In the pipeline, there are new formulations of levodopa, drugs for motor fluctuations, dyskinesias and cognition. There are also new deep brain stimulation devices being used in research settings aimed at optimizing benefit and reducing side effects. In the past year or so, newly available medications include a long acting formulation of carbidopa/levodopa called Rytary, and a medication for psychosis and hallucinations called Nuplazid.
Outside of medicine and surgical options, do you recommend any other treatments to your patients? (For example, exercise or nutrition therapy?)
Absolutely! Exercise is the only treatment currently known to slow down the progression of PD. Studies have shown that moderate intensity aerobic exercise improves motor function, mood, and cognition in PD. We also know that exercise prevents the loss of dopamine neurons in animals and we think this is true in humans as well. Many types of exercise can achieve this goal, from brisk walking, swimming and stationary bike, to classes for PD like dance and boxing.
Physical, occupational and speech therapy are also a mainstay of PD treatment. Physical therapy can be extremely helpful at any point in the disease course from “pre-habilitation” to train your body to fight future PD symptoms, to fall prevention in later stages. The BIG/LOUD program is an intensive program for PD that increases amplitude of movements and voice. This program has been validated in studies and many patients find it greatly beneficial.
Are there any new medical treatments on the horizon that you are excited for?
One of the most exciting new avenues in my opinion is immunotherapy and vaccination directed against alpha-synuclein. We know that alpha-synuclein misfolding leads to the dopamine neuron dysfunction that causes PD, and that this process spreads gradually through the nervous system. Vaccination has the potential to halt this spread early on, and stop the disease in its tracks. Although this research is still in early phases, it gives me great hope that we will conquer this disease during my career.
Are there any stories or patients that you've treated that stand out to you?
I have had the honor of treating many inspirational and exceptional patients. Diagnosing PD can come with mixed emotions for both the patient and myself. On the one hand, I feel positive about my ability to put a name to the symptoms the patient has been experiencing, and to reassure them that current treatments can help drastically. I have been able to help patients go from uncertainty and denial to embracing the diagnosis in an optimistic light. Several of my patients have given back enormously to the PD community, through providing free counseling services to other patients, leading support groups, fundraising, and utilizing their professional skills to contribute to research.
How can family members and friends best support their loved one's with Parkinson's?
Being respectful and listening with an open mind is a good way to start. People vary a lot in how much they want to talk about their symptoms and their diagnosis. Understandably, PD patients are concerned about what the future holds, and have great difficulty talking about this to family and friends. I encourage my patients to voice these thoughts, ask for help when they need it, and realize that there will be good days and bad days. There is also a difficult balance between wanting to be independent and knowing when to ask for help. Caregivers often also suffer from stress and burnout, and there are resources available through local and national associations that can help provide relief. Caregivers need to take care of their physical and mental health in order to best care for their loved ones with PD.
Are there any programs or organizations you point your patients to, who want to get involved with Parkinson's research or advocacy?
Patients who are interested in participating in clinical trials may search www.clinicaltrials.gov for all Parkinson’s studies registered in the US. The Michael J Fox Foundation (MJFF) has a great tool to find a trial that applies to you. Patients should also ask their neurologists about any research studies in their area.
There are many excellent programs for patients and families to get involved in advocacy in its many forms.
The Parkinson’s Action Network, which recently merged with The Michael J Fox Foundation (MJFF), is a voice for PD patients in public policy at the state and federal level. You can visit the new Public Policy section on the MJFF website to learn more and contact your representatives.
The Parkinson Disease Foundation’s Patient Advocates in Research program trains patients to become active in working with researchers, enhancing clinical trial development and recruitment, and making sure the needs of the PD community are being met by current research.
Can you tell us more about the UMass Parkinson's center?
The UMass Movement Disorders and Parkinson’s Disease Center is located at UMass Memorial Medical Center in Worcester, MA. We are a comprehensive center providing a patient-centered approach to care. We offer medical management with the latest therapies, deep brain stimulator evaluations and programming, and botulinum toxin (“Botox”) injections for a range of Movement Disorders.
Thank you so much to Dr. Kara Smith for taking the time to talk about her life as a Parkinson's doctor, and her thoughts on upcoming treatments and research.
Hearing that Dr. Smith is hopeful that the vaccination directed against alpha-synuclein could lead to a cure for Parkinson's in our lifetime motivates me even further to put my full passion and effort into Photo Shoot for a Cure. Every shoot we book brings us closer to finding better treatments, and we hope, closer to finding a cure. Please like us on Facebook and join our mailing list to stay up to date with upcoming shoots.
If you'd like to donate to our team, please visit Team Fox Photo Shoot for a Cure.