no evidence of neuroprotection? perhaps not…perhaps so

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Accepted Manuscript No evidence of neuroprotection? Perhaps Not…Perhaps So Matthew R. Lewin , MD, PhD Diana P. Blum , MD PII: S1353-8020(14)00188-6 DOI: 10.1016/j.parkreldis.2014.05.002 Reference: PRD 2341 To appear in: Parkinsonism and Related Disorders Received Date: 19 March 2014 Accepted Date: 2 May 2014 Please cite this article as: Lewin MR, Blum DP, No evidence of neuroprotection? Perhaps Not…Perhaps So, Parkinsonism and Related Disorders (2014), doi: 10.1016/j.parkreldis.2014.05.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Page 1: No evidence of neuroprotection? Perhaps not…perhaps so

Accepted Manuscript

No evidence of neuroprotection? Perhaps Not…Perhaps So

Matthew R. Lewin , MD, PhD Diana P. Blum , MD

PII: S1353-8020(14)00188-6

DOI: 10.1016/j.parkreldis.2014.05.002

Reference: PRD 2341

To appear in: Parkinsonism and Related Disorders

Received Date: 19 March 2014

Accepted Date: 2 May 2014

Please cite this article as: Lewin MR, Blum DP, No evidence of neuroprotection? Perhaps Not…PerhapsSo, Parkinsonism and Related Disorders (2014), doi: 10.1016/j.parkreldis.2014.05.002.

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service toour customers we are providing this early version of the manuscript. The manuscript will undergocopyediting, typesetting, and review of the resulting proof before it is published in its final form. Pleasenote that during the production process errors may be discovered which could affect the content, and alllegal disclaimers that apply to the journal pertain.

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Title:

No evidence of neuroprotection? Perhaps Not…Perhaps So

Authors:

Matthew R. Lewin, MD, PhD*

California Academy of Sciences, San Francisco, California

Diana P. Blum, MD

Peninsula Private Neurology, Palo Alto, California

*Correspondence

Matthew R. Lewin, MD, PhD

Director

Center for Exploration and Travel Health

California Academy of Sciences

55 Music Concourse Drive

San Francisco, CA 94118

Phone: 415-425-7892

Fax: 415-891-8530

e-mail: [email protected]

Declaration: The authors have no conflicts to declare

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No evidence of neuroprotection? Perhaps Not…Perhaps So

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We read the report by Park and Colleagues with keen interest, but think an important

and readily assessed surrogate for neuroprotection (or lack thereof) in exercise was

overlooked in reporting the effects of their delayed start design as well as in the

limitations of the study [1].

Though they used the change in total change in UPDRS and three simultaneous

endpoints as their primary outcome measure, they did not report on changes in

medication use or requirements any form within either the primary or secondary

endpoints. Increased or decreased need for medication could have influenced the

authors’ conclusions and is a significant limitation of the study. UPDRS scores might not

have changed to suggest neuroprotection or the opposite, but an effect could have

been masked by changed in the use of Parkinson’s-related medication.

Returning to the original data and abstracting this information could be useful for

hypothesis generation going forward. If these data are available, we hope the authors

have the opportunity to comment on this, here.

[1] Park A, Zid D, Russell J, Malone A, Rendon A, Wehr A, Li X. Effects of a

formal exercise program on Parkinson's disease: a pilot study using a delayed

start design. Parkinsonism Relat Disord. 2014 Jan;20(1):106-11. doi:

10.1016/j.parkreldis.2013.10.003. Epub 2013 Oct 15.