A Double-Blind,Randomized, Placebo-Controlled Trial of Ursodeoxycholic Acid (UDCA) in Parkinson's Disease

Background

Rescue of mitochondrial function is a promising neuroprotective strategy for Parkinson's disease (PD). Ursodeoxycholic acid (UDCA) has shown considerable promise as a mitochondrial rescue agent across a range of preclinical in vitro and in vivo models of PD.

Objectives

To investigate the safety and tolerability of high-dose UDCA in PD and determine midbrain target engagement.

Methods

The UP (UDCA in PD) study was a phase II, randomized, double-blind, placebo-controlled trial of UDCA (30 mg/kg daily, 2:1 randomization UDCA vs. placebo) in 30 participants with PD for 48 weeks. The primary outcome was safety and tolerability. Secondary outcomes included 31-phosphorus magnetic resonance spectroscopy (³¹P-MRS) to explore target engagement of UDCA in PD midbrain and assessment of motor progression, applying both the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III) and objective, motion sensor-based quantification of gait impairment.

Results

UDCA was safe and well tolerated, and only mild transient gastrointestinal adverse events were more frequent in the UDCA treatment group. Midbrain ³¹P-MRS demonstrated an increase in both Gibbs free energy and inorganic phosphate levels in the UDCA treatment group compared to placebo, reflecting improved ATP hydrolysis. Sensor-based gait analysis indicated a possible improvement of cadence (steps per minute) and other gait parameters in the UDCA group compared to placebo. In contrast, subjective assessment applying the MDS-UPDRS-III failed to detect a difference between treatment groups.

Conclusions

High-dose UDCA is safe and well tolerated in early PD. Larger trials are needed to further evaluate the disease-modifying effect of UDCA in PD. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.     

Structural competency in mental health nursing: Understanding and applying key concepts

Achieving mental health equity requires that nursing address structures that impede the ability of individuals and populations to achieve optimal mental health. Consistent with calls for structural change, this paper intends to promote structural competency in mental health nursing by applying this concept to the field. The first half of the paper discusses structural competency and key concepts vital for its development, namely, structure, social influencers of mental health, equity, structural justice, and historical understanding. In the second half we apply structural competency to mental health nursing at the educational, practice and system levels and conclude with recommendations for change.     

Introduction: aging education in a global context

Introduction to a collection of articles on aging education in a global context based on the proceedings of the annual conference of the Association for Gerontology in Higher Education (AGHE). The volume includes a dual focus on (1) issues related to gerontology and geriatric education around the world and (2) issues related to teaching about global and cross-cultural aging. Several of the chapters provide useful information and resources for educators seeking ways to incorporate cross-cultural aging into their courses. The remaining three chapters deal with issues related to aging education in Kenya, Japan and China.