inspite of parkinson’s · 2017. 12. 14. · parkinson’s is known to alter these brain regions....
TRANSCRIPT
Inspite of Parkinson’sA/Prof Sanjay Raghav
What Parkinson’s Taught me
The power of acceptance
• The truth is that not all problems are solvable.
• As much as we’d like to believe otherwise, we don’t have full control over the conditions of our lives.
• But the one thing we do have control over is how we relate to ourselves and the the world around us.
• We accept what is or struggle against it
• Its not giving up or caving in
• But the moment is as it is.
• When we accept what is, we are free. Free to act in accordance with reality. Free to be at peace with the circumstances of our lives, no matter how undesirable or difficult they are.
PREPARES THE
MIND-BODY COMPLEX FOR
PHYSICAL ACTION
TO
AUTONOMIC NERVOUS SYSTEM
EMOTIONAL CORTEX
CONSTRICTS
BLOOD
VESSELS
INCREASED
FORCE OF
CONTRACTION
OF THE HEART
Anger Fear Tension
BP
ADRENALIN
NOR-ADRENALIN
CORTISOL
PROLACTIN
GROWTH HORMONE
THYROXIN
DHEA
Is a
Mandatory
Reflex
for
Survival
IF YOU DON’T ALLOW THE SYSTEM TO REGAIN ITS NORMALCY
A HEALING OVERVIEW
Protection- the Red Zone Growth- the Green ZonePerceived threat/challenge/task Perceived safety/freedom
Stress Response Relaxation Response
Sympathetic N.S. dominant Parasympathetic N.S.Fight/Flight/Withdrawal/Please/Freeze Rest/Digest responseInitiated by HPA axis & SNS Blood flows to digestive system & organs More blood to limbs and hindbrain Physical: Physical:muscular tension muscular tensioncortisol and noradrenaline serotonin and melatoninheart rate, B.P. heart rate, B.P.costal breathing diaphragmatic breathing digestive enzymes digestive enzymesimmune system deregulation immune systemtissue/cell repair and healing tissue/cell repair and healingdigestion/absorption/waste elimination digestion/absorption/eliminationacidity & toxicity oxygenation alkalinity and oxygenationfree radicals and inflammation experience of painsense of pain but general desensitisation sensitisation & sensualitycholesterol and fats in bloodstream/sticky blood tumour angiogenesistelomere shortening genetic instability
Stress & PD
• It has been hypothesized that stress contributes to the development of PD and that depression may exacerbate the symptoms of PD.
• Stress may play a role in the development of PD. The principle risk factor for PD is aging, which may also be associated with elevated levels of cortisol (Gould and Tanapat, 1999).
• Cortisol is elevated in PD patients compared to healthy age-matched controls (Charlettet al., 1998).
• Acute treatment with levodopa can reduce plasma cortisol levels in PD patients (Müller et al., 2007), suggesting a connection between dopamine hypofunction and HPA axis hyperactivity.
• Stressful life events may also precipitate the development of PD. For example, prisoners of war had a much higher incident rate of PD development (Gibberd and Simmonds, 1980).
• Emotional stress can transiently increase motor symptoms (Macht et al., 2007), consistent with acute effects on nigrostriatal function.
Hemmerle et al Exp Neurol. 2012 January ; 233(1): 79–86
Yogic Definition of Stress -
isStress
ÁDHI - THE SEED OF DISEASES
DISTURBED PRÁNA BALANCE
WRONG DIRECTION
WRONG QUANTITIES
CONSTRICTIONS
BLOCKS
HAPHAZARD BREATHING
SETTLES DOWN IN
ANNAMAYA KOSA AS
ORGAN DAMAGE
ÁDHI VYÁDHI
PRANIC IMBALANCE
ÁDHIJA VYÁDHI
ANNAMAYA KOSA
1. Psychic phase MANOMAYA
Psychological warnings
2. Psycho-somatic phase PRANAMAYA
3. Somatic Phase
PRANIC DISTURBANCES
Target organs affected
4. Organic Phase ANNAMAYA
Settles in target organs
Yogah cittavrtti nirdhahSAGE PATANJALI
Yoga is to gain mastery
over the modifications of
the mind
FIVE LAYERED EXISTENCE
OF HUMAN BEINGS
Taittirèya Upanishad has presented this systematically. Man has 5 major sheaths of existence.
ANNAMAYA KOÙA
PRÁÏAMAYA KOÙA
MANOMAYA KOÙA
VIJÒÁNAMAYA KOÙA
Ánandamaya Koùa
The Concept of the Body Structure in Yoga
All of us have five levels of existence
…from gross to subtle..
*Annamayakosa
*Pranamayakosa
*Manomayakosa
*Vignanamayakosa
*Anandamayakosa
The physical structure
The level of life energy
The mental process
The level of discrimination
& choice
The most subtle of all…
pure bliss our REAL state!
NCDs begins in
STRESS -
BEGINS IN MANOMAYA
Sheath
STRESS PRODUCING FACTORS
* Lack of knowledge
* “ ‘I’ness”
* Strong likes
* Strong dislikes
* Fear (of death, situation)
REDUCE THE SPEED
AT ALL LEVELS
MIND SHEATH
ENERGY SHEATH
FOOD SHEATH
Annamaya Kosa
Pranamaya Kosa
Manomaya Kosa
Diet
Kriyas
Asanas
Pranayama
SELF INQUIRY
MEDITATION
Emotion Culture
BLISS SHEATH
WISDOM SHEATH
IAYT
Vijnanamaya Kosa
Anandamaya Kosa
Notional Correction
Happiness Analysis
Karma Yoga
(Action in Bliss)
Yoga
• Yoga brings in:
• Self imposed Lifestyle modification featured by:– Physical activity
– Slow, deep breathing
– Healthy diet habits
– Relaxation
– Positive mental attitude
– Philosophy of life
Cognitive Benefit
• Yoga is as effective as memory enhancement training in improving functional connectivity in relation to verbal memory performance in subject with mild cognitive impairment
[J Alzheimers Dis. 2016;52(2):673-84.]
MODERN MEDICINE, SURGERY
MUSCULAR LEVEL
NERVOUS SYSTEM
CELLULAR LEVEL
NEURO TRANSMITTERS - BRAIN
HENCE ONLY SYMPTOMATIC RELIEF at FOOD
SHEATH
NO “CURE”
Meditation/Mindfulness
Regular Meditation
Deep physical relaxation with undistracted awareness
An effective way to overcome excessive thinking and calm the busy mind
Ancient tool
Why Meditate? Reduces inflammation Reduces cortisol Increases melatonin Reduces metabolic syndrome Improves genetic repair
Reduces number of genetic mutations Improves pain & symptom management Decreases depression, anxiety, distress Improves our ability to cope Improves immune system
Evidence base > 6000 research articles related to benefits of meditation
Me Circuit ! DMN• When the brain is not engaged in goal-directed activities and at rest, there are still measureable patterns of activity. One resting-state network, the default mode network (DMN) is responsible for a self-referential introspective state.
• Active during daydreaming and mind-wandering. But it is also active when the individual is thinking about others, thinking about themselves, remembering the past, and planning for the future.
• Negatively correlated with other networks in the brain such as attention networks.
• There is reduced activation and reduced functional connectivity of the DMN in long-term practitioners.
(Neurosci Biobehav Rev. 2014 Jun;43:48-73) between 2007 and 2014 there were 1384 papers published.
Me Circuit ! DMN
The Mind-Made Me:
roles
images
hopes/wishes/dreams
shoulds/have to’s/ ought to’s/can’ts/musts
stories
histories
dramas
expectations
demands
fears
projections
beliefs
Meditation & Telomeres• Meditation might even slow the ageing process. Telomeres, the protective caps on the ends of chromosomes, get shorter every time a cell divides and so play a role in ageing.
• Clifford Saron of the Center for Mind and Brain at the University of California, recently showed that levels of an enzyme that builds up telomeres were higher in people who attended a three-month meditation retreat than in a control group.
• In Saron’s three-month meditation study, the increase in levels of the enzyme that repairs telomeres correlated with an increased sense of control and an increased sense of purpose in life.
(Psychoneuroendocrinology, vol 36, p 664).
Short-term meditation induces white matter changes in the anterior cingulate, improves self regulation
• The anterior cingulate cortex (ACC) is part of a network implicated in the development of self-regulation and whose connectivity changes dramatically in development.
• In previous studies they showed that 3 h of mental training, (integrative body–mind training, IBMT), increases ACC activity and improves self-regulation.
• Tang group reported that 11 h of IBMT increases fractional anisotropy (FA), an index indicating the integrity and efficiency of white matter in the corona radiata, an important white-matter tract connecting the ACC to other structures. Thus IBMT could provide a means for improving self-regulation and perhaps reducing or preventing various mental disorders.
(Tang et al.vol. 107 no. 35, 15649-15652, 2010 PNAS)
Short-term meditation induces white matter changes in the anterior cingulate
• Demonstration of brain regions with significant FA increases after 11 h of IBMT.
• The demonstration map shows the significant FA increases in the left anterior corona radiata(green area), the left superior corona radiata (purple area), the genu of corpus callosum (blue area), and the body of corpus callosum (red area) after 11 h of IBMT, all P < 0.05.
Brain areas active during meditation
• Evoked Potential studies –Diencephalon
• Imaging studies –– Anterior Cingulate
– Dorso-lateral Prefrontal Cortex
– Regions of limbic systems – Int J Psychophysiol. 2011
May;80(2):103-11
– J Altern Complement Med. 2010 Dec;16(12):1253-8
Mindfulness based intervention in Parkinson’s disease
• Positive link between meditation and Parkinson’s was reported by Pickut and associates in “Mindfulness based intervention in Parkinson’s disease leads to structural brain changes on MRI”.
• In the Parkinson’s group using mindfulness, MRI’s revealed increased grey matter density in several areas of the brain [hippocampus (left and right), amygdala (right), caudate nucleus (right and left), occipital lobe (left), and thalamus (left)]. Parkinson’s is known to alter these brain regions.
• Interestingly, in the Parkinson’s group not using mindfulness, MRI’s revealed increased grey matter density in the cerebellum. These results agree with other data that implies this area of the brain compensates for the other regions that are affected by Parkinson’s.
Meditation EFFECT
• Meditation has been shown to release dopamine in the striatum.
• The hypothesis that meditation might cure or benefit PD patients can be partially explained by it.
A potential case of remission of Parkinson’s disease
• 78-year-old male who, 16 years ago, was diagnosed with Parkinson’s disease (PD) by a neurologist.
• He initially presented with left-hand tremor, stooped posture, shuffling gait, and frequent falls, which eventually progressed to bilateral motor symptoms after 3 years.
• Since 2012, his symptoms and signs have almost completely remitted, and he has been off all pharmacotherapy for that time.
• The accuracy of the initial PD diagnosis is supported by an appropriate clinical presentation, history of positive response to Sinemet, and an abnormal SPECT DaT scan;
• This case suggests the possibility of remission of symptoms in some patients.
• They propose that the patient’s long history of meditation practice may have been one contributing factor of this improvement as meditation has been shown to release dopamine in the striatum.
Smart, K., Durso, R., Morgan, J., et al. (2016). A potential case of remission of Parkinson’s disease . Journal of Complementary and Integrative Medicine, 13(3), pp. 311-315.
Telomeres and aging
Life style modification and telomere activity
Telomerase activity is associated with complex changes in lifestyle
Cell Biology International (2011) 35, 1079–1083
Telomerase and meditation• 30 meditators (mindfulness)
• 6 hours daily for 3 months
• ↑ Telomerase activity in retreat participants compared to controls
• ↑ Perceived Control, ↓Neuroticism, and ↑ in both Mindfulness and Purpose in Life were greater in the retreat group (p < 0.01)
Psychoneuroendocrinology, 2011
Types of MeditationMindfulness-
attention.
Imagery-
intention.
Contemplation-
inquiry.
Mindfulness Meditation
Paying attention in a particular way:
on purpose, in the present moment and
non-judgementally.
(Jon Kabat-Zinn)
Mindfulness is the energy of being aware and awake to the present moment. It is the continuous practise of touching life deeply in every moment.
-Thich Nhat Hanh
Protective Mode to opennessHyperactive threat detector (amygdala).Narrow focus of attention.Excessive thinking.Projection in time & space.Constant doing.The “more” syndrome.Problem saturation.Emotional reactivity or repression.
Choosing to be present byconsciously bringing your attention to here and now experience with:
InterestOpennessReceptivityAcceptancePatienceKindnessPerseverance
God help us to change.
To change ourselves and to change our world.
To know the need for it. To deal with the pain of it.
To feel the joy of it.
To undertake the journey without understanding the destination.
The art of gentle revolution.
Amen.
(Leunig)
The MindTwo Aspects of the Mind:
Active Mind:thinkingacquired/conditioned“monkey” mind
Passive Mind:awarenessobservingsilentoriginal
The thinking mind is a goal-oriented
problem solving mechanism.
----------------------------
“The intuitive mind is our sacred gift
and the rational, thinking mind is a
faithful servant. We have created a
society that honours the servant and
has forgotten the gift.”
(Einstein)
ThinkingThe Nature of Thinking:
Memory and ImaginationCommentary in words and picturesNaming/labellingEvaluatingJudging ComparingAnalysing/interpretingSpeculatingPlanningRecalling
Excessive Thinking-Reactivity:
Fight: Flight:
Blame/resentment Worrying
Guilt /shame Awfulising
Pride/stubbornness Despairing
High expectations Self-pity
Perfectionism Avoiding
Argument Hopelessness
Defending/controlling Helplessness
Intolerance Procrastinating
Righteousness Depression
Holding on
Simplify.
There are only two feelings.
Love and fear.
There are only two languages.
Love and fear.
There are only two activities.
Love and fear.
There are only two motives,
two procedures, two frameworks,
two results.
Love and fear.
Love and fear
(Leunig)
The more consciousness you bring into the body,
the stronger the immune system becomes.
The body loves your attention.
Most illnesses creep in when you are not present in the body.
If the Master is not present in the house, all kinds of shady
characters will take up residence there.
(Eckhart Tolle)
Thinking Awareness
active passive
commentary silent
words/pictures formless
judges non-judgemental
outcomes process
busy/moving still/unchanging
future/past now
acquired original
“the critic” clear/perfect
Emotion
CognitiveInterpretation
AnalysisJudgment
Justifications Distractions
Taking a positionHolding on
Wanting to win/be right
Indulging/DenyingMoods/Attitudes
“The Story”
AffectiveFeelingSensationsBodyEnergyVulnerabilitySensitivity“The Experience”
Meditation Releases:
Fear of:
the unknown
losing control
letting go
being alone
missing out
being nobody
not being wanted
death
NOTHINGNESS
Meditation
• Mindfulness – Being aware
• Dwelling upon positive thoughts
• Remembering enjoyable moments of life
• Being connected with family and friends
• Actively engaging in mental tasks
You don’t stop laughing when
you grow old, you grow old
when you stop laughing
……………. George Bernard Shaw
Spiritual wellbeing
• Spirituality is a very personal matter and something we each feel differently about.
• Often ‘spirituality’ is confused with the structures of formal, organisedreligion.
• Emerging role in health care as potential health benefits spiritual wellbeing can bring.
• Good spiritual health can bring with it a sense of inner peace and comfort.
• Belonging to a faith community, symbolic or ritual practices, meditation, prayer, retreat, pilgrimage, reading scripture, playing or listening to sacred music, Tai Chi, yoga, group activities and engaging with and enjoying the arts and nature.
Spirituality & Parkinson’s
• Being diagnosed with an illness such as Parkinson’s can understandably challenge values and beliefs and affect our spiritual wellbeing.
• Such a life changing event can deepen or alter spiritual beliefs.
• Spiritual strength can help provide a sense of hope for the future and a means of adapting to the way ahead.
Spiritual wellbeing- Benefits
• an awareness and fostering of values such as patience, honesty, kindness, hope, wisdom, joy and creativity
• enhanced confidence and self-esteem
• improved relationships
• a new sense of optimism about life, together with a sense of inner peace and acceptance of problems we face in life
• It can also help to feel at ease with yourself
• give you a new understanding of who you are
• as well as the meaning and purpose of life and the world in which we live.
Spiritual ReliefIn recent years I have detected an interesting phenomenon within myself. I sometimes experience what I call ‘spiritual relief’ from my symptoms. When this happens, my ‘off’ episodes disappear. In other words, my Parkinson’s symptoms withdraw and it is as if they had never existed. The circumstances that result in this relief are generally as follows:
• When I am among friends who love me and I feel their respect
• Whenever I overcome my doubts and lack of confidence and manage to write something valuable, so that even my tough critical self is satisfied with it
• Whenever I participate in a new and challenging task
• When I perform a good deed, such as helping a friend who is suffering a lot
• In other words, the disappearance of symptoms seems to be linked to emotions such as love or fulfilment, or to acts of altruism.
Israeli psychiatrist Ariel Arieli has had Parkinson’s for more than 20 years.
• http://parkinsonslife.eu/dont-worry-be-happy-finding-spiritual-relief-from-parkinsons/#.Wh9niLGtl4k.gmail