Parkinson's disease causes loss of 60-80% of dopamine-producing neurons, which impairs automatic movements and creates a sensory deficit where patients cannot perceive their own speech quality; care partners can help by using specific cues like 'Say that again with intent' to encourage patients to use their intentional motor system, which compensates for dopamine deficiency, and by understanding that apathy is a symptom of the disease rather than laziness.
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Deep Dive
Parkinson's Family Education Group - What Every Parkinson's Care Partner Must UnderstandAdded:
Hello everybody.
We are going to get started. You have arrived at Parkinson Voice Project's Family Education Group and we are so glad you're here. My name is Hilary Bayit. I'm a certified Speak Out provider and the chief operating officer here at Parkinson Voice Project. I am joined by Jamie Allen who's my fabulous executive assistant. And it looks like we have over a hundred of y'all with us today. So we are thrilled. Parkinson Voice Project is a non-profit with the sole purpose of helping people with Parkinson's regain and retain their speech and swallowing. This group has been established to help care partners, friends and family of folks with Parkinson's navigate the journey of Parkinson's with intent.
Jamie, if you'll advance to our next slide, we'll give you an overview of what we're talking about today.
This is April. So y'all know it is Parkinson's Awareness Month. And the theme I chose for today and this month is awareness is great. I want the world aware of Parkinson's and I want you aware of all the challenges you and your loved one are facing.
And then I want to quickly pivot and turn that awareness into another A word and that's action. So how do we take the information that you have and turn that into proactive positive steps to help you navigate this journey? That's what we're going to talk about. So we're going back over some things you may have heard me talk about. Some of them are so important. I'm not sure I can talk about them enough. So thank you for allowing us to do so. We're going to start though by having a quiz and before we get to that quiz, let me highlight what we're going to talk about. We're going to talk about the scope and the history of Parkinson's. Then we're going to talk about what is happening with Parkinson's. Why does it make things so hard?
We're going to talk about two specific challenges with Parkinson's that sensory deficit and apathy and then finally we're going to talk about more proactive things you can actually do to make a difference in the life of your loved one in maintaining that speech and swallowing. And finally, we're going to end with some more education about Parkinson's in general and I'm going to give a shout out to Dr. Ray Dorsey in the book that he co-authored this past year. Um I wanted to start with that scope we talked about. So yes, unfortunately over one million people in these United States are suffering with Parkinson's and worldwide the estimate is over 10 million.
And it is the fastest growing neurodegenerative disease.
That is why it is so important that we reach everyone with Parkinson's and let them know how they can regain and retain their speech and swallowing.
We have a lot of work to do to make sure we are doing that. So understanding that scope is that urgency that we associate with that. So let's look back at the history. I want to make sure that y'all understand what we do know about Parkinson's.
So in 1817, James Parkinson, a doctor in London, was the first one to notice and then document what we know now is a person with Parkinson's. He had three patients of his own and spotted a few others in London.
Um they had that stooped posture, they had tremors and they were having difficulty walking about.
1817 London. Chat if you know what was happening during that time. Like bring us to the point of history, 1817 London.
Because if y'all have been hearing about the research on the causes of Parkinson's, you're going to have an idea.
Jamie, is there anyone chatting and telling us what was happening at that time? Not yet. Use the chat feature. Oh, it's not chat? No, it is. If you just hit that chat button on the bottom and you can just type what you think the answer is there.
Yes.
Well, are you ready? Spoiler alert, it was the Industrial Revolution. When you think about that time and you picture London, do you see all the smog that I'm seeing in my brain right now?
So smog and pollution and so several neurologists and researchers have gone out to say that was likely the origin for those people.
Fast forward a couple of decades and Dr. Charcot out of France was the next one who had a significant contribution to understanding Parkinson's.
He renamed the disease that Dr. James Parkinson had named the shaking palsy to Parkinson's in honor of the work of him.
He also made two important discoveries as well.
He recognized that all people with Parkinson's do not have a tremor. In fact, we know today that about 70% of people with Parkinson's will have a tremor, but not everybody. And secondly, he contributed the very important knowledge that Parkinson's doesn't make muscles weak.
Some other neurodegenerative diseases do that. Parkinson's does not.
Muscles get weak from not being used.
It's that old adage, use it or lose it and I often reference my daughter who two years ago um we were on a fabulous trip to Colorado and she slipped when we were in the Garden of the Gods and broke her ankle.
It was horrible, but we uh she she recovered. Let's leave it at that. But what was so striking to her and to me and y'all have experienced this, I'm sure, is that when that cast came off, not only was her anchor ankle smaller noticeably, but her entire calf was, right? Because she was on crutches and didn't use it. That's what I want you to keep thinking about as these muscles get weak because they're not being used fully. That is what is happening.
So I want you to keep in mind something about your loved one. So it's not those muscles are getting weak.
What's changing is the autopilot feature that they have managed on. That is what is changing. Things they used to do without thinking about them, those are the things that become more challenging.
So let's move on and talk about from automatic to intentional.
So when someone has Parkinson's, now we fully understand is that the what's happening in their brain is that the neurons that produce, we had mentioned earlier, that neurotransmitter dopamine, they die or become misfolded.
And when someone is diagnosed with Parkinson's and often it's not just a straight line, it's a journey to get the proper diagnosis because it is a clinical diagnosis.
But when someone is finally diagnosed with Parkinson's, they have likely lost between 60 and 80% of their dopamine.
And that dopamine is not coming back.
We know that there's great medication now that replicates dopamine and and that's how people with Parkinson's move and live better. But what's happening is the automatic movements. Those are what it are affected because dopamine's job, dopamine that neurotransmitter, its main function is to help plan and execute automatic movements.
Things we do without thinking.
Walking, talking, drop in the chat some others if you have some other ideas. I like to think about putting on a seat belt. That happens automatically. Getting dressed, putting on a sweater, brushing your teeth, tying your shoes. There are so many things.
Yes, blinking. I love that. Blinking.
And there are so many things that we do without thinking about them.
So to help understand what your person with Parkinson's is going through, it is very helpful I think sometimes to think about how many things our brain is doing for us without even thinking. And our brain craves habit it habit. It wants you to do things auto- automatically so that it can get on to doing really important things like solving all the world's problems. So it wants you to do as much as you can automatically.
We laugh sometimes and we talk about driving. Driving sometimes, you know, is something that happens automatically.
Now, I'm not saying that's a good thing, but I can get in the car and be driving somewhere and be deep in thought and arrive someplace and think, "How did I get here?" Now, I know that never happens to any of y'all.
Um but or I can leave the clinic here one day um and it's a beautiful day like it is right now. It's spring and we do spring in Texas really, really well, but there is a lot of pop-up storms. So, I could leave here and be driving home carefree and then a storm hits. And so, suddenly I turn off that radio, put my hands at 10:00 and 2:00, and I drive with purpose and intent. So, that's a behavior I can do automatically or I can do it with intent.
That is my segue into intent, but I see someone else popped up with some other things that they do automatically. What were the other ideas? Oh, using a device. Yes, I love that. That's a great thing, right? You don't even think about where your fingers go sometimes.
I like that for an example. So many things we do automatically. So, when Parkinson's affects someone and in doing those things automatically becomes a challenge, there is good news and this is where intent comes in. We as humans are wonderfully made. We have two operating systems in our brain. We like to think of the one I've been describing as the automatic motor system.
That system is highly dependent upon dopamine. That is why things that happen automatically are so affected by that lack of dopamine, but here's the good news. We as humans have that second operating system. It's our backup system, I'm going to say. We call it the intentional motor system. It is less dependent on dopamine.
This is how people with Parkinson's compensate for that lack of dopamine.
They learn how to use the intentional motor system. And speak out therapy, many of you and your person with Parkinson's have gone through it. If you haven't, I I want y'all to so very much.
We teach people with Parkinson's how to transition speech from an automatic function to an intentional act. Let me say that again.
We teach people with Parkinson's how to transition speech from an automatic function to an intentional act.
That is how we teach them to speak and swallow with intent. Intent is the way to compensate for that lack of dopamine. And so, thinking about using intent when you are learning a new skill, think about learning a new language or learning to play the piano.
In the beginning, you are really practicing the notes and where to put your fingers.
When you master the art of playing piano, many of that happens m- much of that, let me say that. Much of that playing happens automatically.
Same like if you're learning ballet, you're being so intentional to learn all the moves and then eventually all of that happens automatically.
I hope that helps y'all understand the difference between automatic and intent.
But for people with Parkinson's, they learn how to speak with intent and that learning to speak with intent does not come automatic. They will always need to think about speaking with intent. So, we're asking a great deal. That is why the care partner's involvement in speak out therapy is essential for a successful outcome in the long haul.
So, let's keep talking about that more because I really want to um make sure everyone does understand what is causing Parkinson's and how to compensate for it. Automatic versus intent.
Okay. Now, we can teach someone how to speak with intent pretty quickly, but there are some challenges to maintaining that function.
So, there are two challenges with Parkinson's that result from that loss of dopamine. The first one I want to explain to you again is on the sensory deficit. What that means for speech is that people with Parkinson's uh don't feel how they sound.
They have an impaired feedback loop in their brain and they don't get that understanding of how they sound.
So, when I tell you it is so common for a patient to have a speak out evaluation and say, "I don't have a problem with my speech. It's my spouse's hearing."
If this has happened to anybody, please chat me and tell me that. It is so common and it's tricky because it means that um people with Parkinson's sometimes don't believe they really have a problem. And this breaks my heart as a speech language pathologist just because I hear the stories about people with Parkinson's trying to make a phone call and they're hung up on. They hung up on them because they didn't hear them or their speech was too hard to understand.
And the person with Parkinson's is like, "Why is this happening to me?" Or they're trying to enter a conversation with a group of friends and when they start talking, people just talk right over them like they're invisible. And they're not recognizing that they're not heard. They might think everyone's just ignoring them and being rude.
It's a travesty. This is horrible. Or they're at the doctor's office and trying to speak for themselves and they're not being heard and so the spouse takes over and there's not a good understanding of what just happened.
So, that self-perception of speech is a huge part of what makes treating Parkinson's tricky. That is why if you follow us on social media and I do hope you are following us, our posts, the most popular ones are educational. So, I love that. I want to get the word out on Parkinson's and especially how speak out therapy can help. But we talk about that self-perception being off because I really want the messaging out. So, when someone is like, "Yeah, my friend um I told him I can't hear him and he doesn't think anything is wrong. He thinks it's me." So, I want everyone to be aware of that. Jamie, I'm seeing some of these chats, too. I'm going to pull them up.
Um >> [clears throat] >> he is loud and he is not. My partner's dealing with this exact same issue. It's interesting. It's good one day and then next day soft voice. When I tell you that is so typical for Parkinson's.
That is what it is. That is Parkinson's, I say, having its way with your partner's voice.
So, that is a significant challenge. Um there we go. So, the part though for care partners, and this is the really important part I want you to understand, is that you have a very important role. Speak out therapy is amazing. We teach patients how to speak with intent. We also teach them the exercises that they must do every day with intent. We're asking for about 15 to 20 minutes a day for the rest of their life. Yes, I know that sounds daunting, but our motto is that we're in it with you for the long haul. It's not good enough to retain your speech and swallowing for a month after therapy, even 5 years. I'm not impressed. It has to be for your entire life. That is what our focus is. I want people with Parkinson's to be able to speak and swallow for as long as they live. Right?
There's a myth out there that people with Parkinson's will absolutely lose their voice and have a feeding tube.
That is not the reality that we see with our patients. Speak out therapy works.
But and I should say it I didn't say but, we'll cross that out. And it requires effort. Effort on that person with Parkinson's to practice every day and I can just a shout-out to all of our patients who do that. I'm so impressed.
It it takes such a level of commitment and they are doing it so that everyone hears them and I I just respect that effort.
This is where the care partner comes in so well, too. So, they're going to have speak out therapy half an hour twice a week for 4 weeks, but they're home with their family and friends the rest of that time. So, with that sensory perception being off, they need ongoing cue to make sure they are speaking with intent.
Right? Because they're not the It's not as though over time they get better perceiving it. What does get better is them understanding the amount of effort it takes.
Because when you're speaking with intent, it's going to be effortful, and you're going to be aware of that. So, we will keep asking during therapy, "How much effort did you use when you just spoke with intent?" I like to say like 1 to 10, what do you think? When someone says eight or nine, I'm like, "Okay.
Okay. I I feel like you're giving it great effort. Keep doing that. That's the effort."
And so, it's really important for them to get that feedback even, especially, outside of the therapeutic relationship, right? When you're home with your person. When you're out and about with your person.
So, that's why we figure out what is each patient's best cue to speak with intent. If you know what you have been trained, or you know what your person's best cue is, drop that in the chat for me. I would love to see some of those. What that means is that every person may have a different cue that when heard reminds them to speak with intent.
I'm seeing if we have any of those responses.
Uh Uh Here we go. Well, so what happens a lot of the time for people is to say, "Say that again with intent."
"Speak out more."
"Say every word like you mean it."
So, for each person, the certified Speak Out provider will figure out what the best cue is. That is why that care partner being there through Speak Out therapy is essential. We want you there at the evaluation to understand all of the information, and we want you during to be a part of it so that you're learning also what that best cue is, and you have practice using it. Because sometimes it's challenging to interrupt your person with Parkinson's, and you may have developed a habit of just accepting that you're not understanding everything. These are the things that break my heart as a healthcare provider and clinician, but I know it's the reality. But what we do know is that if I'm cueing a patient when I'm treating them, they're they're not offended. They expect me in that role. So, our our best approach then is to have you, the care partner, perform in that same role.
Jamie, if you Uh yes, uh I saw one of our patients say his wife just says, "Intent." And when he hears that, he remembers, "I'm going to speak with intent." Because you might get so wrapped up in a story you're telling that you forget to speak with intent.
So, that one cue can bring you back. So, I love that. Thank you for sharing that.
Jamie, if you will share the um funny, I think funny, um meme before I start talking more about best cues.
I I saw this on a kitchen towel in a store one day, so I know it's real.
Okay, well, she's going to get that up.
When that comes up, you will hopefully have a giggle with me. But oh, Jamie, is it showing and I can't see it?
There we go. You're on mute. There we go. Okay, perfect. Thank y'all for your patience. Uh Okay, is anyone laughing yet?
Okay. So, this is the reality, I think, all over the world.
So, okay, Jamie, thank you. You can take that down. So, when we start talking about using our best cue, it is so common for folks to have conversations in their home from other sides of the house.
I know I experienced that with my husband. So, I'm going to tell you that is not the best way to communicate.
That's probably not shocking to you.
Thank you, Colleen, for that agreement.
But that's not the best way to carry on a conversation, especially if someone has Parkinson's and we're trying to give them every advantage.
So, when you are using the best cue with your person, whatever that is, if it's say intent, I want you to think of yourself as a coach and not a critic.
I recently talked with a patient whose wife was not comfortable interrupting him to tell him to speak with intent because she thought that was What do you think she said?
If you're thinking rude, you're right.
Like, how rude to interrupt him.
But we talked about how he needs that.
He needs that cueing, and that is how he will get better. Thank you, Jennifer.
You're exactly right. Rude, rude, rude.
But that is what they need. So, here's the other phrase that I want you to let go of is, "Honey, I'm so sorry. What did you say? Say that again." So, instead of that, you're replacing it with the best cue, and you and your partner are going to understand that's what you're doing.
It takes practice on your part because you have been saying, "Honey, what did you say?" for sometimes a long time. So, I like you working on getting that cueing better. It's a good discipline for you. It helps even more have even more empathy for your person with Parkinson's who is using that effort to speak with intent. Because And let me tell you why it's so important.
When we say, "Honey, I didn't hear what you say. Please say that again." there's emotion attached to that, right? You You don't feel great saying it. You didn't hear the message. Your person with Parkinson's might be like, It takes effort to say it again.
And the worst thing I ever hear was, "Wasn't that important. I'm not going to even say it." So, on behalf of speech pathologists everywhere, just know that breaks our heart. Because we want everyone to have their voice and to say whatever they want to say, how seemingly unimportant it is. All of it matters.
So, that is why when you stop saying, "Honey, what did you say? Please say that again. Honey, sit up straight. Take a breath. Slow down." All the things you probably have been saying, when you stop saying that and you simply say, "Say that again with intent." or "Say every word like you mean it." That turns your cueing into therapeutic cueing, and it gets in the brain better, deeper, and we cut out the middleman of emotion.
There's no emotion to go It just goes right to the heart of it, and it turns into therapeutic cueing.
So, I want you to think about that, being a coach, not a critic.
And as I alluded with that funny statement, is that be intentional about communication in your home. Don't start conversations from other rooms. Wait until you're in the same room, facing each other, and turning off whatever it is. Putting the phone down, turning off the show, and speaking with intent. It will make such a difference. And yes, I'm here to say I know it takes more time. You really have to plan it, but that's okay because it's worth it. It will result in more meaningful, impactful speech communication in your family.
So, consider that.
I want to also offer some sample scripts. Because here's the thing, um when someone is speaking with intent and then they're not speaking with intent, it might go in and out. This is normal, and and they will get better at it. We have seen people, when they graduate from Speak Out therapy, keep making progress and keep making that transition to conversation in 6 months to 2 years.
So, when, after 3 weeks of doing Speak Out therapy, a a patient's spouse tells me, "Oh yeah, he speaks with intent with you, but not with me at home." Exactly.
That is normal, and we keep encouraging that cueing to hasten the carryover. But that's why the care partner is a very important part of making it happen um better, smoother, faster.
So, but when someone says a whole sentence, and you miss the last part, like maybe you asked him what he wanted for dinner, and he told you, but then he trailed off at the end. You did hear him say he did want that leftover chicken, but you weren't sure if he wanted a salad or that broccoli. And so, that's how you can help. Honey, I heard you say that you wanted steak, but I wasn't sure. Do you want broccoli or salad?
Tell me with intent. So, you're not having the laborious effect of making him or her repeat the whole thing. Focus in on that.
Another helpful tip, I hope, is that when you're in a noisy place, restaurant is what comes to mind. Maybe it's a tile floor.
Maybe you're having some great Mexican food. If you're in Texas, you are.
And but those restaurants are notorious notoriously loud.
And so, before your person with Parkinson's places that order, maybe you're reminding them, "Honey, remember to order with intent."
Say that order like you mean it.
So, that's a helpful strategy before starting.
And then, um another helpful tip could be when your person with Parkinson's is doing their daily practice and you're involved in it and they're reading some sentences with intent and you are quite sure that they're fatiguing a bit and they could use more effort and you have participated in the session. So, you know they can read with more intent. You might say, "You're doing great, but I want you to read those other sentences with more intent."
So, being very specific and focusing on parts that they can redo or keep doing with intent is a helpful way to encourage, meet them where they are and really be such a valuable part of this journey.
Okay, I mentioned two um parts of Parkinson's that make it difficult. That first one is that sensory deficit. In particular, that speech perception that is off. The other one y'all heard me talk about is apathy.
And I will state this from the top of the mountains that people with Parkinson's are not lazy. Lazy to me is a four-letter word that we don't talk about except when I'm teaching. But, people with Parkinson's are not lazy. That lack of dopamine is having its way.
And it's so important to understand this because I mentioned that daily speak out practice, right? It's going to be hard to establish a habit for some folks.
But, the care partner understanding that, supporting them on that journey is going to be a really helpful part of getting that habit established and maintained.
Okay.
I want to close with this last part and here is my question.
Do you know that Parkinson's is preventable?
You can chat and tell me.
I'll keep talking, but I'll be interested in in hearing your responses.
Neurologists, researchers are announcing, have said, and it's all out there now that less than 15% 15 1 5% of cases of Parkinson's are genetically linked.
That means 85% of cases of Parkinson's now, they are saying are from environmental factors.
Think pesticides and pollutants.
Have y'all seen this book?
I hope you have.
So, these authors are amazing men, neurologists, who have been in this space for quite some times. This book is a very important read, I think. If you have Parkinson's, if you love anyone with Parkinson's, I encourage you to get this book, have a look at it. You can also, Jamie, um can you show them We had the pleasure in October of 25 of hosting Ray Dorsey here in our very clinic. He spoke and he did a webinar. We recorded that. Jamie's going to show you where you can access that.
And if you go to our website, which I encourage you to do, all of these resources are available to you without charge, thanks to our generous donors, for whom we are grateful for them. Yeah, she's going to go on to learn about Parkinson's and then dropping down to the Parkinson's lectures. Thank you, Jamie. Then, when you click on that, you're going to be in a fabulous space of all kinds of education. But, the top left one is the one I mentioned with the Parkinson's plan, Ray Dorsey. I encourage you to check that out. It is inspiring. It is informative. It's convicting.
Okay, I wanted to quickly go to the back of the book. I am a little bit obsessed and people know who talk to me, they're going to hear about this. This is the Parkinson's 25.
Um Dr. Okun and Dr. Dorsey wrote a first book called Ending Parkinson's. Thank you, Jamie, for that link there. And so many people ask them, "Okay, you're telling me that Parkinson's is caused by some environmental factors. How can I make sure I don't get Parkinson's? How can I lower my risk? And if I already have Parkinson's, is there anything I can do to slow the progression?"
And so, with a researched answer, they say yes and that is what the Parkinson's 25 is. That is a really important part of this book.
So, I wanted to highlight parts of that.
So, the number one thing that they start off with, I wonder if many of you are already doing it.
Okay, here's your hint.
This is my apple.
When I buy apples, and I buy them often, what do you think I do with them when I get home?
Oh, this is a little heavy. This is a big one, but this is what I use at home.
Can y'all see that? Yes. Wash, wash, wash, wash, wash. There are many ways that you can wash your your fruits and vegetables.
Okay, so the way I do is um I fill up a metal bowl in the sink with water and I glug glug glug vinegar in there. The exact ratio, I believe, and again, you can look at different sources, is about a third cup of vinegar to a cup of water.
Um and then you put your apples and everything in there um and you rub them and then wash them in there. They say leaving them in there at 5 minutes is plenty, but I'm here to tell you I have left berries for 4 hours and thought I would have pickled berries. I did not. I rinsed them and they were just fine.
But, don't do that.
So, washing even organic fruits and vegetables is highly recommended. Even if you already have Parkinson's, I heard people say, "Oh, Hillary, I have Parkinson's.
This won't help me." They are showing that it could because you have some dopamine left. I want everyone to keep every bit of dopamine they have remaining. And so, if there's ways that we can do that, I want you to do it. So, that's the number one way. The other one I want to talk about is what I'm doing right now.
I am drinking a cup of I bet you can guess. Thank you. Yes, coffee. So, isn't that kind of fun? For those of you who enjoy coffee, when you're drinking your coffee, you are doing a good thing.
Sorry, um I do, Vicky, about a third of cup of vinegar to a cup of sorry, yes, a third of cup of vinegar to one cup of water. And again, I kind of glug glug, so I'm not exacting. But, there's also washes you can get out there and they say water by itself is better than nothing. Water with a little salt can be helpful, too.
There we go. Okay, yeah, I eyeball, too, Sandy. But, so coffee. It is the caffeine in it that they say it is very helpful and it may protect our dopamine-producing cells.
Now, it doesn't say have 42 cups of coffee.
But, one cup for sure is helpful. And of course, it doesn't say load it up with sugar and cream.
Moderation for all those other things. I I personally, this is just Hillary talking, recommend that.
It is Yes, it is all the caffeine. So, black tea and coffee are similar in their result. Um and and there's more Don't take everything from me. I am reporting, but I want y'all to keep looking it up.
Okay, the other thing they talk about is using a water filter. Many of you probably already have that built in um to your refrigerator. So, a water filter is really helpful. They have found that um dangerous chemicals can be released in water. There is um pesticides that can get in the water.
And so, there are many reasons why having a water filter is a good practice.
The last one I want to mention is avoiding the dry cleaners. Have you heard that one before?
So, the The research on it is that the chemicals can get in the water. They can also transfer in the air. And so, if you visit the dry cleaners, they recommend taking off the plastic very quickly and letting the chemicals air out.
But, I have stopped going to the dry cleaners, and I like to look proper. I'm telling y'all. So, do you know what this is?
Can you tell? Do you know what this is?
This is a steamer. I am not a great ironer, full confession.
I will, but a steamer is a great way to heat up and knock out some of those wrinkles.
So, this is what I recommend. I think it's very helpful. But, dry cleaning, avoiding dry cleaning is what is recommending, or you can seek out a dry cleaner that doesn't use the trichloroethylene or the perc.
One of my colleagues here shared that a dry cleaner that she has found advertises that they are green and they are not using those chemicals. Well, that gave me great hope that other dry cleaners are doing that, too.
So, all of this and more is in the Parkinson's 25.
In the Parkinson's plan. Check it out. I think you'll really enjoy it. Thank y'all so much for being here. I hope this was helpful. I I want you aware this Parkinson's awareness month. I want the world aware about people with Parkinson's, and I want all of the help and treatment and cure that we can have.
And I want you as a care partner to turn that awareness into action, so that y'all are navigating your journey with Parkinson's with intent. Thank you all for being here. I really appreciate the effort. I appreciate you taking the time to join us, and I'll look forward to seeing you next month. Thank you so much.
Bye.
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