“Aging is not inevitable; it is an opportunity. Not everyone has the chance to grow old,” said Robert Friedland, professor of neurology at the University of Louisville and an expert on aging. “How well we age depends on what we do.”

Inspired by his grandfather’s struggle with dementia, Friedland has spent nearly five decades as a neurologist and researcher, studying the causes of neurological diseases and seeking new ways to treat and prevent them. In addition to seeing patients with a focus on cognitive, behavioral and geriatric neurology, his ongoing research investigates the connection between microbes in the gut and mouth and the development of Alzheimer’s and Parkinson’s disease and other neurodegenerative conditions.

Based on this work, Friedland says it is possible for people to preserve health into later years by stockpiling reserves in cognitive, physical, psychological and social health.

Although Friedland admits that certain physical declines are inevitable with age and that genetics can predispose a person to certain diseases, he believes in many cases these reserves can prevent diseases or lessen their effects, delay age-related declines and allow an older person to recover from accidents and illness.

“Genetics do have a role in our health but they are not the whole story. Choices we make throughout life affect whether diseases develop and how much they reduce our health when they do,” Friedland said. “We can do things that delay or mitigate heart disease, diabetes and cognitive and neurological diseases and allow us to recover from life events that otherwise may cause permanent declines in health.”

Each of Friedland’s four factors, described below, is dependent on the others. Friedland provides tips on increasing reserves of each area. By developing habits that add to these reserves, you can maximize your opportunity to remain active and healthy as you get older.

Cognitive reserve – The ability of the brain to work effectively, solve problems and make decisions.

Since the brain controls every system in the body, it makes sense that a healthy brain will support other reserve factors (physical, psychological, social).

Keep the brain healthy by seeking opportunities to learn new things and challenge your ways of thinking throughout life. Learn a new language or a new skill, such as playing a musical instrument or crochet. Play chess or other games. Any activity that involves learning and strategy will strengthen your brain.

“Watching television is not a good activity since it is completely passive and does not require participation. Reading is a better choice as it demands involvement,” Friedland said. “Telling stories is good for your memory and attention skills.”

Physical reserve��– The health of the body’s cardiovascular, neurological, musculoskeletal and other systems.

These reserves depend on eating the right food, engaging in physical activity every day and receiving regular health care.

A diverse diet of healthy foods supports both your body and your microbiota, the microorganisms that live in and on the body and are essential to your overall health. Friedland recommends a diet that is mostly plants, high in fiber and low in sugar, salt and saturated fat. When you improve your diet, you also can improve the health of your microbes which aids your own health.

“I call it gene therapy in the kitchen,” Friedland said. “By making the best choices in your food, you can alter the genetic makeup of your microbiota and improve your overall health in as little as two weeks.”

Exercising for 30 minutes each day, regardless of weather or circumstance, is enough to improve physical health, Friedland says. More is better, of course, and when you combine physical activity with social interactions and cognitive activity by playing a sport such as golf or tennis, the benefits multiply.

Taking steps to protect yourself from injury or illness also is important. Wear a helmet when you are riding a bike, wash your hands and avoid exposure to toxins.

It also is important to get enough quality sleep each night, practice good dental hygiene, avoid excess alcohol and have regular medical checkups.

Polypharmacy is another problem to avoid. Friedland said that as people age, they may accumulate prescriptions for multiple health concerns that can interact or alter the effectiveness of each other. If you are taking several prescriptions, regularly evaluate all of them with your health care provider.

Psychological reserve��– A healthy mental state that is free of agitation, anxiety and depression.

Poor mental health can affect your ability to interact with others or maintain your physical health. Practice a positive mental attitude, engage in activities that are meaningful to you and manage stress with meditation or other measures.

“Depression is common in older people, and that can lead to memory problems,” Friedland said. “Physical factors can contribute to depression, such as poor sleep or vitamin deficiency. A lack of social interactions and physical activity also can cause or aggravate depression.”

Social reserve��– Personal relationships and the ability to function in society.

The company of others can motivate people to take care of themselves and encourage them to maintain healthful behaviors. Positive relationships can be with a spouse, a group of friends or professional colleagues.

“Studies indicate that dementia is more common among people whose social activity declines later in life,” Friedland said. “Humans need relationships with others in order to maintain good health.”����

Social engagement can go hand in hand with the other types of activity by including friends in physical exercise, games, a craft or work. Involvement in community or religious activities also can increase a sense of belonging and a desire to stay active.

Ideally, you will begin developing habits that contribute to these reserves early in life, but Friedland says it is possible to add to reserves and improve your health at any age – even once you reach an age when you experience the effects of deficits.

“Aging is not inevitable,” Friedland said. “The chance to be alive should be recognized as an opportunity – an opportunity to manage our lifestyle factors to maximize survival, health, fitness and meaning as we age.”

More detailed advice from Friedland that may help people live longer, healthier lives and a deeper discussion of the reasons he makes these recommendations are available in his book, “.” Published in October by Cambridge University Press, the book was cited by the Wall Street Journal as one of the five best books on aging and retirement published in 2022.

The half-day event is Saturday, March 2, from 8:30 a.m. to 12:15 p.m. in the conference center of the Rudd Heart and Lung Building, 201 Abraham Flexner Way, next to Jewish Hospital. There is no charge to attend.

Ahlskog, professor of neurology at Mayo Clinic Alix School of Medicine, is the author of a popular guide for people with Parkinson’s disease and their families. He will give the keynote talk for the symposium, “Debunking Ten Myths that May Sabotage Treatment of Parkinson’s Disease.”

In addition, Karen Robinson, PhD, FAAN, of the , will discuss the importance of support for caregivers, and Robert Friedland, MD, professor and researcher in the Department of Neurology at UofL, will explain the impact of the microbiome in Parkinson’s disease and dementia. Finally, a panel discussion will include providers from the .

“We have organized this opportunity to allow patients and their families to meet one another and to learn about the best ways to manage the journey of Parkinson’s disease,” said Kathrin LaFaver, MD, director of the��UofL Physicians – Parkinson’s Disease and Movement Disorders clinic��and the at the��. “This year, they will have a unique chance to hear from Dr. Ahlskog, a renowned expert in Parkinson’s care. We also will introduce a caregivers’ support group, which will begin in March.”

Parkinson’s disease caregiver support group

Caring for a partner��or family member with Parkinson’s disease has many rewards, but also has been associated with physical, mental, social and financial stressors. Beginning in March, the UofL Physicians – Parkinson’s Disease and Movement Disorders clinic will offer a monthly��caregiver support group led by Kelly Bickett, a registered nurse in the movement clinic with special expertise in the care of Parkinson’s disease. To facilitate attendance at support group meetings, respite care will be made available on an as-needed basis through a professional health-care agency for up to four hours.��

The group will begin Friday, March 29, and meet the fourth Friday of each month from 2:30 to 4 p.m. Register for the support group by calling 502-582-7654.

Bill Collins Symposium for Parkinson’s Disease agenda

• Keynote: “Debunking Ten Myths that May Sabotage Treatment,” by J. Eric Ahlskog, MD, PhD
• Active Break: Dance for Health – David X. Thurmond, professional dancer, choreographer and teacher
• Microbiome in Parkinson’s disease and dementia – Robert P. Friedland, MD, UofL Department of Neurology and the Mason C. and Mary D. Rudd Endowed Chair in Neurology
• Supporting caregivers of those with Parkinson’s disease – Karen Robinson, PhD, FAAN, UofL School of Nursing
• Panel discussion with Ahlskog and Kathrin LaFaver, MD, along with Victoria Holiday, MD, UofL Department of Neurology and Laura Dixon, D.N.P. A.P.R.N., UofL Physicians – Parkinson’s Disease and Movement Disorders.

There is no charge to attend the symposium, but please register by Feb. 25 by calling 502-582-7654 or��via email. Include your name, the number of guests attending and a telephone number.

At UofL, van Wouwe will work on research to understand the function of the basal ganglia in patients with Parkinson’s disease, Huntington’s disease, Tourette syndrome and other conditions. The basal ganglia are located at the base of the forebrain and are associated with control of voluntary movements, cognition, emotion and other functions. She will work with Joseph Neimat, MD, chair of the Department of Neurological Surgery, on experiments conducted in the operating room during deep brain stimulation surgeries. Her NIH-funded research will investigate how the basal ganglia affect cognitive functions crucial to navigating daily life situations, such as the ability to stop or change action.

“For example, patients with Parkinson’s disease may find it difficult to stop and control voluntary actions. The ability to stop an action can also depend on whether a positive or negative outcome is expected,” van Wouwe said. “Generally, dopaminergic medication and deep brain stimulation restore the ability to control actions, but some patients develop impulse control disorders. A better understanding of failures in adaptive behavior in neurologic or neuropsychiatric disorders with altered frontal basal-ganglia circuitry could ultimately help tailor treatment to individual needs.”

Since 2012, van Wouwe has been researching cognition and movement disorders at Vanderbilt Medical Center in Nashville. She was educated at Leiden University in the Netherlands and conducted research at the Netherlands Organization for Applied Scientific Research in Soesterberg before moving to the United States.

Van Wouwe’s research uses cognitive behavioral tasks, neurophysiological measurements, neuropsychological instruments and interventions such as medication withdrawal and deep brain stimulation to identify changes in action control and action-outcome learning resulting from neurodegenerative diseases. She is investigating the role of the subthalamic nucleus in action control and action-valence learning by means of cognitive testing, deep brain stimulation and intraoperative recording studies.

The PD Buddy Program, now in its third year, is a collaboration between the UofL School of Medicine, UofL Physicians – Parkinson’s Disease and Movement Disorders, UofL College of ����ֱ�� and Human Development and the Parkinson’s Support Center of Kentuckiana.

The program matches first-year medical students with patients affected by Parkinson’s disease. The “buddy” pairs meet monthly to share challenges and accomplishments of living with the disease.

The program offers students an opportunity to learn about PD outside a classroom setting, and patients can share their stories and benefit from social interactions. Students also receive education about PD and several group activities, such as a holiday party or a bowling afternoon, are scheduled throughout the year.
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The program runs from September 2017 through April 2018 and the average time commitment is 3 to 4 hours per month. For more information about the PD Buddy Program, .

To sign up, contact the UofL Physicians clinic at 502-582-7654. The deadline for registration is Aug. 31.

Ali will be the featured speaker at Knock Out Parkinson’s Disease, a special event at the Muhammad Ali Center, Friday, June 9, organized to raise awareness of the disease and the most advanced treatments available.

The event begins at 5 p.m. Following Ali’s talk and a buffet dinner, medical experts in Parkinson’s disease from University of Louisville Physicians will discuss the treatment and management of Parkinson’s disease.

“We want to make sure everyone with Parkinson’s disease has access to the best treatments available,” said Kathrin LaFaver, MD, director of the UofL Physicians Parkinson’s Disease and Movement Disorders Center and Raymond Lee Lebby Chair for Parkinson’s Disease Research in the UofL School of Medicine. “We are dedicated to helping each Parkinson’s patient achieve the best quality of life regardless of race or socioeconomic status.”

Knock Out Parkinson’s Disease is a kickoff event for Louisville’s first , to take place on Saturday, June 10 at Waterfront Park. Moving Day is sponsored by the National Parkinson Foundation to engage the community in the fight against Parkinson’s disease. It will feature a family friendly walk course, a kids’ area, a caregivers’ relaxation tent and a Movement Pavilion featuring yoga, dance, Tai Chi, Pilates, and other activities, all proven to help manage the symptoms of PD.

Knock Out Parkinson’s Disease 2017 also is part of the , a six-week series of events commemorating Muhammad Ali’s six core principles. I Am Ali runs June 3 through��July 15.

There is no cost to attend Knock Out Parkinson’s Disease, but reservations are required. Register and .��

Speakers will provide insight into a variety of topics affecting patients with Parkinson’s, including new advancements and treatments, and new developments and services within the UofL Physicians Parkinson’s Disease and Movement Disorders program.

The keynote speaker��is Dr. Michael Okun, the national medical director for the , a best-selling author and a leading national spokesman on Parkinson’s disease. Okun is also chairman of Neurology and co-director of the Center for Movement Disorders and Neurorestoration at the .

Some of the topics that will be discussed include:

• Breakthrough Therapies for Parkinson’s Disease
• Advances in Deep Brain Stimulation Surgery
• Hallucinations and Psychosis in Parkinson’s Disease
• Exercise in Parkinson’s Disease – What are the Benefits?
• Caregiving – Finding Your Village
• The Parkinson’s Disease Buddy Program: What Have We Learned from Each Other?

“The symposium is a great resource for patients and their families, as it’s an opportunity to hear more about what we know about Parkinson’s disease, what we are learning and how we can help,” said Dr. Kathrin LaFaver, director of the and the Raymond Lee Lebby Chair in Parkinson’s Disease Research at the . “Patients get the opportunity to hear from and talk with several experts in one place.”

To attend the symposium, register by April 3 by calling 502-582-7654 or via email.��Provide the following information: Name, number of guests and telephone number.

Supported by the Bill Collins family and the Jewish Hospital & St. Mary’s Foundation, part of KentuckyOne Health, and presented by University of Louisville Physicians and Frazier Rehab Institute, also part of KentuckyOne Health, the symposium will take place from 9:30 a.m. to 2:30 p.m. in the conference center of the Rudd Heart and Lung Building, 201 Abraham Flexner Way next to Jewish Hospital.

Speakers will provide insight into a variety of topics affecting patients with Parkinson’s, including new advancements and treatments, and new developments and services within the UofL Physicians Parkinson’s Disease and Movement Disorders program.

The keynote speaker is Michael Okun, MD, the national medical director for the Parkinson’s Foundation, a best-selling author and a leading national spokesman on Parkinson’s disease. Okun is chairman of Neurology and co-director of the Center for Movement Disorders and Neurorestoration at the University of Florida College of Medicine.

Discussion topics include:

• Breakthrough Therapies for Parkinson’s Disease
• Advances in Deep Brain Stimulation Surgery
• Hallucinations and Psychosis in Parkinson’s Disease
• Exercise in Parkinson’s Disease – What are the Benefits?
• Caregiving – Finding Your Village
• The Parkinson’s Disease Buddy Program: What Have We Learned from Each Other?

“The symposium is a great resource for patients and their families, as it’s an opportunity to hear more about what we know about Parkinson’s disease, what we are learning and how we can help,” said Kathrin LaFaver, MD, director of the UofL Physicians Movement Disorders Clinic and the Raymond Lee Lebby Chair in Parkinson’s Disease Research at the University of Louisville School of Medicine. “Patients get the opportunity to hear from and talk with several experts in one place.”

To attend the symposium, register by April 3 via email��or by��calling 502-582-7654 with name,��number of guests, and telephone number.

Robert P. Friedland, MD, the Mason C. and Mary D. Rudd Endowed Chair and professor of Neurology at the University of Louisville School of Medicine, and a team of researchers have discovered that these processes may be triggered by proteins made by our gut bacteria (the microbiota). Their research has revealed that exposure to bacterial proteins called amyloid, that have structural similarity to brain proteins, leads to an increase in clumping of the protein alpha-synuclein in the brain. Aggregates, or clumps, of misfolded alpha-synuclein and related amyloid proteins are seen in the brains of patients with the neurodegenerative diseases AD, PD and ALS.

Alpha-synuclein (AS) is a protein normally produced by neurons in the brain. In both PD and AD, alpha-synuclein is aggregated in a clumped form called amyloid, causing damage to neurons. Friedland has hypothesized that similarly clumped proteins produced by bacteria in the gut cause brain proteins to misfold via a mechanism called cross-seeding, leading to the deposition of aggregated brain proteins. He also proposed that amyloid proteins produced by the microbiota cause priming of immune cells in the gut, resulting in enhanced inflammation in the brain.

The research, which was supported by , involved the administration of bacterial strains of E. coli that produce the bacterial amyloid protein curli to rats. Control animals were given identical bacteria that lacked the ability to make the bacterial amyloid protein. The rats fed the curli-producing organisms showed increased levels of AS in the intestines and the brain and increased cerebral AS aggregation, compared with rats who were exposed to E. coli that did not produce the bacterial amyloid protein. The curli-exposed rats also showed enhanced cerebral inflammation.

Similar findings were noted in a related experiment in which nematodes (Caenorhabditis elegans) that were fed curli-producing E. coli also showed increased levels of AS aggregates, compared with nematodes not exposed to the bacterial amyloid. A research group led by neuroscientist Shu G. Chen, PhD, of Case Western Reserve University, performed this collaborative study.

This new understanding of the potential role of gut bacteria in neurodegeneration could bring researchers closer to uncovering the factors responsible for initiating these diseases and ultimately developing preventive and therapeutic measures.

“These new studies in two different animals show that proteins made by bacteria harbored in the gut may be an initiating factor in the disease process of Alzheimer’s disease, Parkinson’s disease and ALS,” Friedland said. “This is important because most cases of these diseases are not caused by genes, and the gut is our most important environmental exposure. In addition, we have many potential therapeutic options to influence the bacterial populations in the nose, mouth and gut.”

Friedland is the corresponding author of the article, , published online Oct. 6 in Scientific Reports, a journal of the Nature Publishing Group. UofL researchers involved in the publication in addition to Friedland include Vilius Stribinskis, PhD, Madhavi J. Rane, PhD, Donald Demuth, PhD, Evelyne Gozal, PhD, Andrew M. Roberts, PhD, Rekha Jagadapillai, Ruolan Liu, MD, PhD, and Richard Kerber, PhD.��

This work supports recent studies indicating that the microbiota may have a role in disease processes in age-related brain degenerations.��It is part of Friedland’s ongoing research on the relationship between the microbiota and age-related brain disorders, which involves collaborations with researchers in Ireland and Japan.

“We are pursuing studies in humans and animals to further evaluate the mechanisms of the effects we have observed and are exploring the potential for the development of preventive and therapeutic strategies,” Friedland said.

Kathrin LaFaver, MD, the Raymond Lee Lebby Chair for Parkinson’s Disease Research in the Department of Neurology at UofL, designed the program and is presenting��results from its first year in three poster sessions this week at the (WPC 2016) in Portland, Oregon. More than 4,000 health professionals, researchers and advocates from around the world are expected at WPC 2016. The four-day event is organized every three years by the to share information on the latest science, clinical research and health care related to Parkinson’s disease. Denise Cumberland, PhD, assistant professor of organizational leadership and learning at UofL, and Erika Branch, executive director of the , also will be presenting the posters, which feature both the patients’ and students’ perspectives.

The PD Buddy Program, the only one of its kind for patients with Parkinson’s disease, was launched in September 2015, a partnership between the UofL School of Medicine and the Parkinson Support Center. Twenty-five first-year students from the UofL School of Medicine were matched with patients served by the center. The students and patients met one-on-one monthly for nine months for activities and to allow the patients to share their experience in living with Parkinson’s with the students. The students kept a journal of their interactions with the patients and attended monthly lectures and mentoring sessions about Parkinson’s disease.

Participating patients were surveyed following the program and indicated they enjoyed interacting with the students and appreciated the opportunity to help them learn about Parkinson’s disease. The students’ knowledge scores about Parkinson’s disease rose 20 percent following the program, compared with their scores before the program.

“I got to learn about Parkinson’s and I got to take a break and spend some time with them. We mutually got something big out of it. It is a great program and a great setup,” said Megan Good, a second-year medical student who participated in the program.

The PD Buddy Program kicked off its second year on August 30.

At WPC 2016, LaFaver also will present a poster on unmet needs experienced by Parkinson’s disease patients based on research conducted at UofL. Surveys revealed that Parkinson’s patients and their caregivers find the most troublesome symptoms of PD are tremor, walking/balance problems and fatigue. These symptoms represent the greatest need for new therapy development.

The PD Buddy program, the only one of its kind for Parkinson’s patients, was launched last summer as a partnership between UofL and the . Twenty-five buddy pairs participated in the year-long program designed to give the patients social interaction and allow them to share their stories with the students, who in turn gained first-hand knowledge about living with a nervous system disorder. The program also serves to better educate students about Parkinson’s, introduce students to research and career opportunities in neurology and movement disorders, and provide people with Parkinson’s Disease the opportunity to interact more closely with the medical community.

Kathrin LaFaver, MD, the Raymond Lee Lebby Chair for Parkinson’s Disease Research in the Department of Neurology at UofL and director of the Parkinson’s and Movement Disorders Clinic at UofL Physicians, said the exchanges give the students a deeper understanding of how patients cope with the disease. LaFaver also meets monthly with the students to provide additional medical information and inform the students about research and career opportunities in neurology and movement disorders.

Since this program is unique for Parkinson’s patients, LaFaver, along with Erika Branch, executive director of the Parkinson Support Center, and Denise Cumberland, PhD, assistant professor in the UofL College of ����ֱ�� and Human Development, will present findings from the first year of the PD Buddy Program at the in Portland, Oregon, in September.

The PD Buddy Program, also sponsored by KentuckyOne Health, is open to anyone diagnosed with Parkinson’s Disease who has the time and interest to participate. In addition to one-on-one meetings with the students, several group activities will be planned over the course of the year. Patients must understand that this is an education program and that the medical students will not be able to give medical advice.

Interested individuals may call the UofL Physicians Movement Disorders Clinic at 502-582-7654, the Parkinson Support Center of Kentucky at 502-254-3388, or email a completed application form to outreach@parkinsoncenter.org prior to August 15. Application forms may be .��