Neuro-degeneration is a terrible condition, whether caused by Parkinson’s disease, Alzheimer’s or another origin. Quality of life irreversibly − if erratically − deteriorates, and there are no cures. Yet there are ways to alleviate symptoms and stave off further deterioration, and Boston-born Jeffrey M. Hausdorff, professor of neuroscience, has been awarded the Nefesh B’Nefesh Bonei Zion award for his contributions toward improving life for the movement-impaired.
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“Our major focus is Parkinson’s but we are also very interested in aging more generally. We also do some work with strokes,” says Hausdorff, 51,who teaches at Tel Aviv University and runs a research lab at Ichilov Hospital in the city, having made aliya with his wife and three young children in 2000. (Now they have four − “One’s a sabra!”)
A key finding is that beyond the physical problem, state of mind is crucial to improving the quality of life and that cognitive training with physical therapy can be enormously helpful.
“People assume that walking is pretty automatic,” says the professor, but it isn’t so. Gait turns out to be profoundly dependent on mind.
A long-term goal for his team is to understand how cognitive impairment affects walking, and thereby, to prevent falls − which can be hugely physically and psychologically damaging among the elderly.
It is the brain that allows people to allocate attention among different tasks and to prioritize different tasks. Take walking and chatting at the same time: You’re not walking “automatically.” Your brain is deciding how much resources to allocate to the various tasks you’re doing, says Hausdorff.
“Even in perfectly healthy young adults, if you walk and talk on the phone at the same time, gait pattern changes quite remarkably,” he says. “That’s okay in healthy young adults. But what happens in older adults is that when they try to walk and talk on the phone at the same time, they not only slow down − their gait pattern changes, and they become more unstable.”
In pathological conditions such as Parkinson’s, even at early stages, says the professor, the cognitive domain is impaired to begin with, and resource allocation suffers.
Fear of falling
And as their motor functions really do begin to fail, many patients develop fear, which can be paralyzing.
“Fear of falling in older adults and in Parkinson’s patients can often make their gait even worse,” in a process of self-fulfilling prophecy, says Hausdorff. “They may have nothing much wrong with them, merely mild deficits, but they hug the wall or refuse to walk at all, or walk super-slowly just out of fear.”
Thus encouragement to help contend with fear can be crucial to the patient’s quality of life.
But the most important thing, says Hausdorff, is exercise − appropriate physical exercises for the condition, not just any movement, he qualifies. And cognitive training.
In one set of tests, they had subjects play computer games for weeks to see if it improved their skills. In the long run, there is good evidence that they did, says the professor.
In a second set, they’re putting subjects on treadmills, while seeing themselves in virtual reality with virtual obstacles. “As they walk, which is a real everyday task, they get to train their cognitive aspects that are critical to safe ambulation, such as dealing with obstacles, attending to the task at hand − all those key aspects that are critical to everyday walking, not in the lab where it’s quiet,” says Hausdorff.
“We have built up a fair amount of preliminary data that this seems to work and improves gait, balance and cognitive aspects. Now we’re actually implementing this in a clinical setting and doing a randomized control trial with centers in Europe to try to nail down its effect on the brain itself, through neural imaging before and after the intervention.”
But although drug therapy matters, even hugely sometimes, “The best medicine is definitely exercise, as a preventative medicine and later on,” says Hausdorff. Not just any exercise, but physical effort tailored to the specific needs of the patient. Ichilov recently opened a ground-breaking outpatient clinic specifically to provide training for cognitive-motor aspects, to try to improve the cognitive control of walking. And this is why he made aliya: “We felt this is the place to be, and wanted to contribute to the country in a small way.” Mission accomplished.