Meet Dennis: Husband, educator, Parkinson’s patient

In 2013, Dennis and his family traveled from Missoula to Portland so he could undergo Deep Brain Stimulation surgery for his Parkinson’s disease.

In honor of Parkinson’s Awareness Month, Dennis has agreed to share his Parkinson’s story.

Originally published on Summit For Parkinson’s, a group of Montanans giving back to the Parkinson’s community.

Screen Shot 2016-03-25 at 9.42.04 AMMy intimate experience with Parkinson’s disease began 20 years ago when my father, at age 74, was diagnosed and began his journey dealing with the progress of the disease.

I watched him decline from a six-foot four healthy senior citizen and former police officer to a man who was unable to walk without aids, was unable to care for his spouse without endangering himself.

Dad finally passed away due to the consequences of two broken hips from Parkinson’s related instability leading to treacherous falling incidents.

The complications associated with pain management and other medical issues along with having Parkinson’s overwhelmed him. He passed away 10 years ago at age 84. I was diagnosed with Parkinson’s within a month of his death at age 54. I would have been very happy to wait another 20 years to age 74, but such choices are not available.

My Parkinson’s developed almost exactly in the same progression as my Dad’s giving some credence to the genetic causality argument. At this point my wife and my family including the ever developing little support unit now totaling four grandchildren have supported me and cared for me in ways that make one certain that a diet of love and a lot of laughter and commitment to each other is essential when facing any progressive disease or for that matter any health problem.

It may have been due to my observation of my father’s physical decline but I became committed to fighting Parkinson’s by following a program of vigorous exercise. Exercise is given considerable attention through the literature, websites and to some extent by the various neurologists I consulted at the beginning of this journey. However it is not given enough emphasis compared to the medicinal approaches. The key to exercise in a realistic world depends on one’s own individual commitment and to the support and accommodation by others.

In my case, I continued to play handball, golf, bicycle, ski, swim, and dry fly fish when my condition allows. All of the debilitating aspects of Parkinson’s such as loss of agility and hand eye coordination, balance and body management and control in three dimensional environments can be managed somewhat and even pushed back by engaging in this variety of athletic activities.

Fishing in Alaska with my son, 2010

Fishing in Alaska with my son, 2010

I owe the deepest gratitude to those men in the Missoula handball community for their unwavering encouragement and demanding standards “that the game must be played right” for 10 years of hard exercise in the company of good hearted men that kept me going when lesser incentives might let one quit trying to go it alone.

In addition, those I have played golf with, swum with, bicycled with, skied with and fished with kept me on track as well. In such an active environment I lost 50 pounds and maintained a number of skills after 10 years.

I cannot explain how or why the exercise works as I can’t explain how I can wobble my way to the tee box and hit a solid drive or seven iron between tremors, or cast to a rising cutthroat between shakes, but it works. I’m sure it works because I have continuously maintained my exercise program. Those skills make everyday life manageable within the parameters set by the progression of the disease.

The medicinal choices available to those people afflicted with Parkinson’s are limited with no major breakthrough cure emerging at this time. Further research is essential and needs the support of massive financial and intellectual resources. Until the time a cure is found those with Parkinson’s must live well today and must be ready for tomorrow and that requires more than medications alone.

When I was diagnosed with Parkinson’s I was a Professor of Economics and Asian Studies at the University of Montana. Teaching was my passion and my career was on full overdrive with fascinating work in emergent China with the US State Department and the Foreign Ministry of China just getting underway. I also served as an expert witness Economist in civil and criminal litigation for 30 years at the national level, including working for the US Department of Justice.

At the end of my first four years with Parkinson’s I had to stop teaching on a regularly scheduled basis primarily due to the inability to manage the side effects of medication. I couldn’t teach without unduly distracting my students. To a person, the undergraduate and graduate students at the University of Montana gave me the most inspiring level of support and genuine accommodation anyone could ever hope for. I have nothing but respect for them and hope for the future based on their good hearts and souls.

Because of the progress of the disease, it became extremely difficult to travel internationally. The research and program development work in Asian Studies and Economics came to an end in the seventh year.  I received tremendous support and encouragement from a broad range of faculty colleagues who were colleagues in the broadest and noblest sense of the term.

I was able to keep my expert witness work viable by narrowing its scope progressively until the end of the 10th year. Expert testimony requires an extraordinary amount energy that must be sustained to maintain analytic rigor in changing markets and to prepare for depositions and court room testimony. Eventually Parkinson’s makes testifying in front of judges and juries for long periods of time physically impossible.

I emphasize the continuation of work during the development of Parkinson’s to ensure those who eventually face the same problem that they can effectively continue working as long as they are very careful to be highly realistic regarding their changing capacity. In my case, the extraordinary professionalism of lawyers, judges and particularly the amazing capacity of jurors to look past disability and find the value of solid analysis can never be underestimated. It is a tribute to the way our system of justice really works.

The story of my Parkinson’s journey has many more chapters to be written. However, the story so far is mostly about the importance of your mate, your family, your friends and colleagues plus the goodwill of fine decent people that appear out of thin air, most of whom you know for only moments, who graciously support your will to fight on. Because of their support a person must find the will to fight on.

Get back in the game with ImPACT concussion testing

Having worked in the high school setting as an athletic trainer for eight years before coming to the OHSU Sports Medicine department, I have found that concussion management is one of the most complex tasks for a high school athletic trainer to facilitate.

Between the on-the-field examination to determine if the athlete has a concussion, educating the coaching staff and parents on concussion management, following up with the school administration and staff regarding accommodations for the concussed athlete, and managing the athlete through the return-to-play process in collaboration with the team physician, an athletic trainer can find themselves very busy.Players on the field

One useful tool that assists with the return-to-play decision making process is the ImPACT concussion evaluation system.

This computer-based neurocognitive-testing program allows an athletic trainer and team physician to make a more objective return-to-play decision based on data specific to the concussed athlete.

To effectively utilize the ImPACT test, it is important that at the beginning of the playing season, each student athlete takes the baseline ImPACT test. The baseline test represents the athlete’s attention span, working memory, sustained and selective attention time, response variability, non-verbal problem solving, and reaction time.

If the athlete sustains a concussion during the playing season, the athletic trainer will conduct a physical exam of the athlete, a post-injury ImPACT test, and follow a graded return-to-play program before allowing the athlete to return to full competition. The post-injury ImPACT test reevaluates the same categories as the baseline, thus providing an objective measurement of the changes the athlete may be experiencing after the concussion.

The return-to-play process also includes being evaluated and cleared by the team physician or the athlete’s primary care provider.

The ImPACT test is a very useful tool to have in the toolbox to assess return to play readiness, but it is important to remember that it is just a tool that is most effective when combined with the physical exam and graded return-to-play process.

If you, or someone you know is interested in completing a baseline ImPACT test please contact the OHSU Sports Medicine clinic at 503-494-9992 with any questions or to set up an appointment. We offer baseline ImPACT testing and post concussive management by our Sports Medicine specialists as well as many other services and we look forward to serving you!


Ryan Rockwood, A.T.C. specializes in high school outreach, presents to local schools and businesses on concussion management, and is a member of the concussion management team at OHSU Sports Medicine.  


Research links infrequent daily computer use and common early signs of Alzheimer’s disease

A new study sheds light on a powerful tool that may detect signs of Alzheimer’s disease before patients show any symptoms of cognitive decline: the home computer.  

OHSU researchers have found a significant correlation between infrequent daily computer use and brain imaging signs commonly seen in early-stage Alzheimer’s patients. The researchers have been following a group of volunteers in Portland for nine years through a suite of embedded technology in their homes.Senior at computer

These tools allow the researchers to assess their mobility, sleep, socialization, computer use and medication intake. 

The purpose of this monitoring is to identify meaningful changes in everyday life that don’t involve the participants taking tests or going to doctor appointments.

Using an MRI scan, the researchers measured the volume of the hippocampus — a brain region integral to memory function — in adults aged 65 years and older who were cognitively intact and dementia-free.  

Diminished hippocampal volume is a well-known sign, or biomarker, of Alzheimer’s disease and the eventual development of dementia. 

The study, led by Lisa Silbert, M.D., with the OHSU Layton Center for Aging & Alzheimer’s Disease, found that an additional hour of computer use a day was associated with a .025 percent larger hippocampal volume. A smaller hippocampal volume is an indicator of increased risk for developing Alzheimer’s disease.

Silbert and colleagues hypothesize that the reason that patients with smaller hippocampal volumes may spend less time using their home computer is it requires the use of multiple cognitive domains, including executive function, attention and memory. 

The researchers will continue to follow these participants to see if their smaller hippocampal volume and decreased computer use predict future cognitive decline.

Learn more:
Journal of Alzheimer’s DiseaseLess daily computer use is related to smaller hippocampal volumes in cognitively intact elderly
The OregonianCould computer use keep Alzheimer’s at bay?
Portland Business Journal: Home computer use could help predict Alzheimer’s risk
Neuroscience News: Infrequent computer use may be an indicator of early cognitive decline

Men suffering from depression who have social support less likely to seek mental health treatment

Researchers, led by Alan Teo, M.D., assistant professor of psychiatry at OHSU, and researcher at the VA Portland Health Care System, sought to determine whether support from a loved one encourages people experiencing depression to seek treatment from a health provider or whether that support, by serving as informal treatment, inadvertently discourages people from seeking mental health services.Closeup of a thoughtful young man seen through a window

Their findings show that men experiencing moderate or severe depression who had social support from family or friends were likely to see a primary care or other non-mental health care providers, but only rarely saw a mental health specialist.

The less social support that men reported, the more likely they were to seek help from a mental health provider.

Women, on the other hand, were relatively consistent in their use of mental health services. The researchers studied a nationally representative sample of more than 1,000 middle-aged and older adults in the United States.

Social support can take the form of emotional (someone serving as a confidant), informational (a friend providing facts on depression) or instrumental (a family member driving someone to an appointment) help.

Dr. Alan Teo

Dr. Alan Teo

Depression is the leading cause of disability and a significant risk factor for suicide.

Fewer than half of severely depressed people receive drug or behavioral treatment.

Just one in 10 with persistent depression receive both appropriate medication and counseling, and older adults with depression are especially unlikely to use mental health services.

The study authors hope to raise awareness among general practitioners that they’re likely to encounter men with clinical depression who are unlikely to seek mental health treatment themselves. The researchers encourage proactive treatment with an antidepressant, psychotherapy, or collaboration with mental health providers.

The paper was published in the journal General Hospital Psychiatry.

Diabetes drug may prevent recurring strokes and heart attacks

Wayne Clark, M.D.

The OHSU Stroke Center was an integral part of an NIH-funded global study that has shown that a diabetes drug may prevent a second stroke or heart attack in patients with insulin resistance.

The study was conducted at 167 institutions in seven countries, with the Oregon Stroke Center enrolling the second highest number of participants across the globe.

Wayne Clark, M.D. was a co-author of the paper.

The following press release was originally published by the NIH on February 17, 2016:

NIH-funded global study suggests novel approach for preventing repeated cardiovascular events

Pioglitazone, a drug used for type 2 diabetes, may prevent recurrent stroke and heart attacks in people with insulin resistance but without diabetes.

The results of the Insulin Resistance Intervention after Stroke (IRIS) trial, presented at the International Stroke Conference 2016 in Los Angeles and published in the New England Journal of Medicine, suggest a potential new method to prevent stroke 20160217-ischemic-strokeand heart attack in high-risk patients who have already had one stroke or transient ischemic attack.

This large, international study was supported by the National Institutes of Health’s National Institute of Neurological Disorders and Stroke (NINDS).

The IRIS trial is the first study to provide evidence that a drug targeting cell metabolism may prevent secondary strokes and heart attacks even before diabetes develops.

Insulin regulates metabolism and keeps blood sugar levels from getting too high, along with many other processes, in the body. Insulin resistance is a condition in which the body produces insulin but does not use it effectively.

“This study represents a novel approach to prevent recurrent vascular events by reversing a specific metabolic abnormality thought to increase the risk for future heart attack or stroke,” said Walter J. Koroshetz, M.D., director of the NINDS.

Read more…

Discover how alcohol, gaming, and marijuana impact your brain

Indulging in pleasurable activities is sometimes characterized as a dichotomy of good or bad. But is it all or nothing when it comes to the brain? When are healthy pleasures susceptible to harmful effects?

Our 2016 Brain Awareness Season will delve into the brain science behind three very popular pastimes: alcohol, gaming, and marijuana.

Held at the Newmark Theater in downtown Portland (sometimes called “Brains on Broadway”), this series features nationally known neuroscience experts and authors.


Alcohol and the brain
Monday, February 22
7–8:30 p.m.

grant-head-banner600x600The positive health benefits of red wine have been popular news headlines for many years. In moderation, alcohol has been seen to improve cardiovascular health, immune system response, and even prevent gallstones.

On the other hand, the negative health and social impacts of alcoholism are apparent in just as much news coverage. Dr. Kathleen Grant will explore how behavioral neuroscience informs how, why, and when the risks of alcohol may outweigh the benefits.

Buy your tickets now

Gaming and the brain
Monday, February 29
7–8:30 p.m.

gazzaley-head-banner600x600The generation just coming of age has been exposed to more electronic technology than any one prior to it. Video games in particular have drawn scrutiny as influencing the obesity epidemic, attention deficits, and pronounced violence of our youth.

They also show promise as educational tools, memory enhancers, and improving high-level thinking. Dr. Adam Gazzaley will present the science behind your brain on games.

Buy your tickets now

Marijuana and the brain
Monday, March 7
7–8:30 p.m.

stella-head-banner600x600Oregon recently joined only three other states to legalize recreational marijuana. As consumption of the plant’s products becomes more a mainstream activity, its health benefits and risks will be at the forefront of policy discussions.

Dr. Nephi Stella will explain the role marijuana plays in cutting edge neuroscience research.

Buy your tickets now


The Season also includes the always popular Brain Fair and Teacher Workshop. Don’t miss these free opportunities to learn about the brain.

OHSU Brain Institute Brain Fair
Saturday, March 12, 2016
10 a.m.–5 p.m.brain-fair-03-1200x628

The OHSU Brain Fair is an annual event at the Oregon Museum of Science & Industry (OMSI). The Brain Fair is held each spring.

This year’s Brain Fair includes interactive exhibits, real human and animal brains, prizes and dozens of OHSU Brain Institute neuroscientists explaining and demonstrating their groundbreaking research in a way that will be fascinating for all ages.

No museum admission is required to attend.

Brain Awareness Teacher Workshop
Saturday, April 16, 2016

Let a teacher in your life know about this  special day for classroom teachers featuring presentations on the adolescent brain and early-life nutrition and a highly interactive resource fair.

Speakers include Bonnie Nagel, Ph.D. and Susan Bagby. M.D. who will touch on how addiction manifests itself  in the brains of youth, among other telling research.

Register now

Special delivery: Discovery of viral receptor bodes better gene therapy

There is much hope for gene therapy’s future potential to treat a number of human diseases. The use of adeno-associated virus (AAV) vectors to transport genetic material into cells has been critical to the initial success of experimental gene therapy treatments of hereditary diseases, including hemophilia B.  But in order to develop gene therapy cures for additional diseases and conditions, like diabetes and heart disease, it will be necessary to deliver the treatment to specific tissues. Achieving this required an understanding of how AAV enters cells. 


Michael Chapman, Ph.D.

Now, for the first time, researchers at OHSU and Stanford have identified the protein (KIAA0319L) to which AAV adheres on the outside of human cells and uses to gain entry, a discovery published in the journal Nature

The paper, “An essential receptor for adeno-associated virus infection,” is jointly authored by Michael Chapman, Ph.D., R.T. Jones Professor of Structural Biology, OHSU School of Medicine, and Jan Carette, Ph.D., Assistant Professor, Microbiology & Immunology, Stanford University School of MedicineMajor contributors to the study include Sirika Pillay, Ph.D., Stanford University School of Medicine, and Nancy Meyer, M.S., Research Associate, OHSU.  

The following post about the study originally appeared on Stanford Medicine’s blog, Scope.

Special delivery: Discovery of viral receptor bodes better gene therapy
Written by Bruce Goldman
Photo by Loco Steve

Photo by Loco Steve

Gene therapy, whereby a patient’s disorder is treated by inserting a new gene, replacing a defective one, or disabling a harmful one, suffered a setback in 1999, when Jesse Gelsinger, an 18-year-old with a genetic liver disease, died from immense inflammatory complications four days after receiving gene therapy for his condition during a clinical trial. It was quite a while before clinical trials in gene therapy resumed.

But what Stanford virologist Jan Carette, PhD, describes as “intense interest” in the field is once again in full bloom. Gene therapies for several inherited genetic disorders have been approved in Europe, and a gene-therapy approach for countering congenital blindness is close to approval in the United States.

That a virologist would be paying such close attention to this topic isn’t odd, as the most well-worked-out method for introducing genetic material to human cells involves the use of a domesticated virus.

If there’s one thing viruses are really good at, it’s infecting cells. Another viral trick is transferring their genes into cellular DNA — it’s part of their modus operandi: hijacking cells’ replicative machinery and diverting it to production of numerous copies of themselves. Scientists have become increasingly adept at taming viruses, tweaking them so they retain their ability to infect cells and insert genes, but no longer contain factors that wreck tissues or taunt the infected victim’s immune system into a rage destructive to virus and victim alike.

Adenovirus-associated virus — ubiquitous in people and not associated with any disease – makes a great workhorse. Properly bioengineered, it can infect all kinds of cells without replicating itself inside of them or triggering much of an immune response, instead obediently depositing medically relevant genes into the infected cells to repair a patient’s defective metabolic, enzymatic, or synthetic pathways.

Figuring out how to tailor this viral servant so it will invade cells more efficiently, or invade some kinds of cells and tissues but not others, would broaden gene therapy’s utility and appeal. In a series of experiments described in a study in Nature, Carette’s group, with collaborators from Oregon Health & Science University and the Netherlands, used a sophisticated method pioneered by Carette to bring that capability a step closer.

A virus can attach itself to a target cell by latching onto a molecule embedded in that cell’s surface. In the case of adenovirus-associated virus, that viral-receptor molecule is already known. (The molecule obviously is there for some constructive purpose, which doesn’t stop the invading virus from taking advantage of the mutual attraction.) Simply glomming on to the cell’s surface isn’t enough, though. To get to the all-important nucleus, where the genetic jewelry is ensconced, the virus has to penetrate the cell as well. Until now, the molecule on which adenovirus-associated virus hops a ride downtown was anybody’s guess.

In the new study, Carette and his colleagues identified, in human cells, precisely that transport molecule. This discovery could lead to ways of raising or lowering the molecule’s expression in different tissues so that therapeutic genes get delivered to their intended addresses, and nowhere else.


Read more:
Portland Business Journal: OHSU researchers reach major gene therapy breakthrough
MedCity News: Researchers in Oregon are changing the face of gene therapy with new breakthrough

Neurosurgery resident waltzes through joys of ballroom dance

There may be a joke out there somewhere about how ballroom dancing is hardly brain surgery, but Kunal Gupta isn’t likely going to be the person to make it. Instead, Gupta, a native of the United Kingdom, is actually someone with an affinity for and a connection to both brain surgery and ballroom dancing.

Now in his fourth of seven years as a neurosurgery resident at Oregon Health & Science University, Gupta, MBChB, PhD, grew up in Birmingham, England, where he took a fair amount of acting classes. To complement those, his parents also enrolled him in a few dance classes at a local recreation center.

Though he never fully dove into the pastime as a youngster, the exposure to dance did leave an impression.ballroom-02

“It was just one of those experiences that kind of stuck with me,” said Gupta, now 32. In fact, it stuck with him so much that when he arrived at the University of Cambridge for medical school, Gupta decided to try out for the Cambridge University Dancesport Team.

The team represents the university at national competitions across the country, competing in five ballroom dances — waltz, quickstep, foxtrot, Viennese waltz and tango — and five Latin American dances, including jive, samba, rumba, paso doble and cha cha.

Gupta didn’t make the first team on his first try, but a year later he did, which set the stage for his enjoyment of competitive ballroom dancing to take off.

“It’s not so much fun when you’re a 12-year-old kid,” Gupta said, “but it gets much more interesting when you’re an adult.” As part of the team at Cambridge, Gupta built up his dancing deftness and moved his way up in the ranks.

While studying for a time in Edinburgh, Gupta wanted to keep his dancing sharp and needed to find a partner. He found one in a young researcher and dancer who also happened to be studying in Edinburgh just two labs away from Gupta.

The two began dancing together and, eventually, they married. “It’s funny, but it’s how I met my wife,” Gupta said.

In addition to his wife, Gupta danced with many different partners while he competed at Cambridge and in a few amateur competitions. He described the competitions as “these amazing round robins” where 20 different couples all dance and are judged at the same time.

“You spend half the time trying to dance and half the time trying not to trip over or run into everyone else around you,” he said. “It’s really fun.” Gupta also said he enjoys the music that accompanies ballroom dancing — plenty of big band music from the 1920s and 1930s — and the social interaction that dancers share.

In addition, he said that at Cambridge, many of the dancers were in fields more closely related to science than, say, the humanities, so there has been that connection for him as well.

“There are a lot of technical steps involved to do it right, so I think that is very appealing,” Gupta said. When he was competing, Gupta and his partners did fairly well, winning some competitions or at least making a solid showing.

At the more advanced level, however, Gupta said it’s hard to compete against people who have been dancing seriously since they were children. “You can’t compete with that,” he said, “but it’s an honor to be dancing beside people who are that good.”

ballroom-01Though Gupta and his wife, E. Jolanda Muenzel, MD, PhD, a post-doctoral fellow in neuroscience at OHSU, still dance occasionally, they have found that their time is monopolized these days by work and study.

Gupta, who has a bachelor of medicine and a bachelor of surgery and also a PhD from Cambridge, is at a point in his residency where he is taking care of critical patients and assisting surgeons.

He is also gaining more autonomy in the operating room as he works toward ever more complex surgical procedures.

While his earlier research focused, according to an OHSU bio, on “the novel discoveries he made around glial-neuronal interaction under molecular paradigms of traumatic brain injury, using a human stem cell platform,” Gupta’s main interest these days is in epilepsy, as it is an affliction where a strong case for surgical treatment, rather than pharmaceutical treatment, can be made.

He said he plans to use his sixth year of residency for epilepsy research, followed by his seventh and final year of surgery.

After that, Gupta, who also enjoys tennis, skiing and snowboarding, is hopeful that eventually his schedule may free up time for a little more dancing. “I’d love to because it really is a lot of fun,” he said. “Maybe when I have more control over my schedule.”


This article was originally published in The Scribe, a publication from the Medical Society of Metropolitan Portland.

Your health questions answered: Is pain a part of Parkinson’s disease?

You ask. OHSU experts answer.

Q: I was once told that pain is not a part of Parkinson’s disease. Is that true?

A: Pain is a common symptom in people with Parkinson’s Disease (PD) and people with PD are more likely to have pain than those without PD.

86810406It is unclear what causes this increase of painful symptoms, however.

There are several theories including loss of dopamine or other neurotransmitters (natural chemicals) in the brain, alterations of nerves in the skin, or the general muscle stiffness and reduced movement caused by PD.

Pain in PD is commonly divided into five categories:

• musculoskeletal (inflammation of muscles, tendons, ligaments and bones as in arthritis)

• dystonic (an abnormal pulling or twisting of muscles)

• central (related to changes in the brain)

• akathitic (a restless or uncomfortable feeling)

• radicular/neuropathic (caused by damage to nerves in the back or limbs)

Due to the lack of understanding of the mechanisms of pain in PD there are no guidelines for the optimal way to treat it; however, there are many treatments that can be considered including physical therapy, optimizing PD medications, and using analgesics (medications that treat pain).

Treatment is individualized based on the type and location of the pain. If you suffer from pain, please talk to your neurologist about how they can help.




Keiran Tuck, M.B.B.S.
Fellow, OHSU Parkinson Center

Study hopes to clarify the link between sleep problems and Alzheimer’s disease

An upcoming study led by Jeffrey Iliff, Ph.D. and Bill Rooney, Ph.D. hopes to clearly determine the relationship between a lack of sleep and Alzheimer’s disease. The team received funding from the Paul G. Allen Foundation to test their approach. They hope to begin scanning the brains of participants within a year, using a 7-Tesla MRI (pictured below).

Iliff and Rooney recently spoke to Jon Hamilton at NPR’s Morning Edition about the upcoming study and the importance of adequate sleep.

Listen to the full NPR interview here.

MRI Photos_7

MRI Photos_24

Jeffrey Illiff and Bill Rooney with the 7-Tesla MRI.

Jeffrey Illiff and Bill Rooney with the 7-Tesla MRI.

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