Postuma, Ronald B
Research Institute of the McGill University Health Centre
Caffeine as a Therapeutic Agent in Parkinson's disease
Parkinson’s disease is a common neurodegenerative disorder in which patients experience progressive motor disability and many disabling non-motor symptoms. Recent studies have consistently found that people who do not use caffeine are at higher risk of developing Parkinson’s disease. This suggests that caffeine may have potential as a treatment for PD. To investigate this, we recently completed a trial where we gave PD patients caffeine. Although it was mainly focused on daytime sleepiness, we found a very interesting benefit on the motor manifestations of disease. There have been other lines of evidence that have suggested caffeine could be useful in PD. The question now is how useful can caffeine can be, and also whether it could even have long term benefits in PD. To test this, we are proposing a three-stage trial to assess caffeine. We will randomly give patients either caffeine 200 mg twice per day (about three cups of coffee per day) or a matching placebo. In the first six-month stage, we will hold medications constant, to see whether caffeine does have motor benefits. Then we will perform a four-year extension stage to define if the effects of caffeine persist (or even magnify), and to see if caffeine helps reduce dose of other PD meds and/or prevents their side effects. Finally, we will finish with a six-month stage in which we will place all patients on caffeine – this will allow us to assess caffeine’s use in later disease, but more importantly, will assess whether early use of caffeine produces long term changes beyond its immediate effects. If caffeine can be found useful for PD, it may have extremely important advantages, including low cost, established safety, and perhaps even long term neuroprotective benefits. Such an opportunity should not be missed.