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*Corresponding author: Susan Broom Gibson, School of Natural and Behav-
ioral Sciences, Department of Psychology, William Carey University, 710 Wil-
liam Carey Parkway, Hattiesburg, MS 39401, USA, Tel: +1 2283040522; E-mail:
sgibson@wmcarey.edu
Citation: Rutherford L, Gadol E, Broom SL, Olds T, Mestayer RF, et al. (2020)
Intravenous Administration of Nicotinamide Adenine Dinucleotide Alleviates
Tremors Associated with Parkinson’s Disease: A Case Report. J Gerontol
Geriatr Med 6: 047.
Received: January 31, 2020; Accepted: February 24, 2020; Published: March 02,
2020
Copyright: © 2020 Rutherford L, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits un-
restricted use, distribution, and reproduction in any medium, provided the original
author and source are credited.
Introduction
Parkinson’s Disease (PD) is a progressively disabling neurodegen-
erative disease marked by the formation of Lewy body aggregates
and the death of dopaminergic neurons within the brain’s substan-
tia nigra. The symptoms of PD-related neurodegeneration often in-
volve noticeable disturbances in motor functionality, including trem-
ors and bradykinesia, as well as cognitive impairments in executive
functioning, including compromised working memory, attention and
problem-solving [1,2]. Current pharmacological treatment options
involve the use of dopamine agonists and dopamine replacement
agents, yet such treatments have produced signicant adverse effects
for patients, including visual hallucinations, dyskinesia and psychosis
[3]. In consideration of alternate treatments for PD, prior research has
shown that supplementation with the co-factor Nicotinamide Adenine
Dinucleotide (NAD+), a critical molecule involved in maintaining
healthy cellular redox metabolism and mitochondrial functionality,
can replenish the neuronal loss implicated in PD and other neurode-
generative diseases [4]. With respect to prion and prion-like neurode-
generative diseases including Alzheimer’s, Parkinson’s, and Hunting-
ton’s diseases, researchers found that NAD+ starvation in a murine
model induced neurodegeneration, whereas NAD+ supplementation
displayed neuroprotective qualities in delaying neurodegeneration in
prion-infected mice [5]. Additionally, a recent study found a direct
link between the administration of an NAD+ precursor in the pre-
vention of dopaminergic neuronal loss amongst patient-derived in-
duced pluripotent stem cells of those with Parkinson’s disease [6].
Rutherford L, et al., J Gerontol Geriatr Med 2020, 6: 047
DOI: 10.24966/GGM-8662/100047
HSOA Journal of
Gerontology & Geriatric Medicine
Case Report
Intravenous Administration
of Nicotinamide Adenine Di-
nucleotide Alleviates Tremors
Associated with Parkinson’s
Disease: A Case Report
Rutherford L1, Gadol E2, Broom SL3*, Olds T1, Mestayer RF1,2 and
Mestayer P1,2
1Springeld Wellness Center, Springeld, Louisiana, USA
2NAD Research, Inc., Springeld, Louisiana, USA
3School of Natural and Behavioral Sciences, Department of Psychology,
William Carey University, Hattiesburg, Mississippi, USA
Abstract
Introduction: Parkinson’s Disease (PD) is a neurodegenerative
disorder characterized by Lewy body formation and dopaminergic
neuronal death in the substantia nigra. Current pharmacological do-
pamine agonists and dopamine replacement therapy for PD treat-
ment has shown adverse effects including hallucinations, cardiovas-
cular complications, psychosis and further dyskinesia. The co-factor
Nicotinamide Adenine Dinucleotide (NAD+) serves a vital role in
cell functionality and dopaminergic neuronal replenishment, where
NAD+ depletion has been associated with the onset of neurodegen-
erative disease such as PD. Additionally, in a previous case study
in a PD patient, an Intravenous (IV) NAD+ administration protocol
showed a rapid and sustained alleviation of PD-related symptoms,
providing rationale for further investigating the positive effects of IV
NAD+ through quantiable measurements on tremors and cognitive
function associated with PD.
Method: A 59 year old male was diagnosed with PD four years prior
to entering an outpatient clinic for treatment, reporting to have used
PD medications with no alleviation of symptoms. Patient received a
specic protocol of NAD+ (called BR+NAD) for a total of six days,
with two days of 1,500mg IV NAD+, followed by four days of 500-
750mg IV NAD+. Tremors were recorded in the client’s dominant
right and left hands using an accelerometer and gyroscope. Re-
searchers recorded periodic measurements (Hz) beginning on Day
2 through the end of Day 5 with 13 total measurements, on three
axes; vertical, horizontal and anterior-posterior. Following Day 6,
client received sublingual NAD+ tablets (300mg, twice per day X 14
days) after nishing IV treatment.
Results: 1) Vertical axis tremors decreased by 75.9%, horizontal
axis tremors decreased by 83.0% and anterior-posterior axis trem-
ors decreased by 9.1%. 2) Mean tremor on Day 2 was 44.5Hz, while
on Day 6 was 20.6Hz, resulting in a decline of 54.7% over the 4
day span. 3) Patient self-report of tremors continued to decline two
weeks post BR+NAD (average 12Hz) with maintenance sublingual
supplementation and application of a relaxation technique.
Conclusion: These data show the effectiveness and endurance of
the initial IV BR+NAD followed by sublingual tablets (300mg, twice
per day) in maintaining decline and alleviation of PD symptoms.
Additionally, these results substantiate previous research and case
study ndings, while establishing a protocol for empirically measur-
ing PD symptom changes of IV NAD+.
Keywords: Accelerometer and gyroscope; Nicotinamide adenine
dinucleotide; Parkinson’s disease; Parkinson’s symptoms; Tremors
Citation: Rutherford L, Gadol E, Broom SL, Olds T, Mestayer RF, et al. (2020) Intravenous Administration of Nicotinamide Adenine Dinucleotide Alleviates
Tremors Associated with Parkinson’s Disease: A Case Report. J Gerontol Geriatr Med 6: 047.
• Page 2 of 5 •
J Gerontol Geriatr Med ISSN: 2381-8662, Open Access Journal
DOI: 10.24966/GGM-8662/100047
Volume 6 • Issue 1 • 100047
This increasing evidence supports the rationale for further investi-
gating the therapeutic potential of NAD+ as an alternative form of
treatment in PD.
In a prior case study conducted by Gadol and colleagues [7], one
Parkinson’s patient showed signicant improvement in PD symp-
tomology, in addition to the discontinuation of PD-related medica-
tion, following an 8-day treatment course of intravenously delivered
NAD+ with monthly IV maintenance. Based on these ndings, the
present case study sought to quantitatively measure and further elab-
orate on similar symptom alleviation effects found in another PD pa-
tient [8] through directly measuring PD symptoms and corresponding
symptom changes over a 6-day treatment course of intravenously de-
livered NAD+ [9].
Method
We present a case of a 58-year-old male who had been diagnosed
with PD ve years prior to entering an outpatient clinic specializing
in IV (Intravenous) NAD+ therapy. Before beginning treatment, the
patient reported the following PD symptoms: gait rigidity (an impair-
ment in ability to walk uidly), bilateral hand tremors with a more
pronounced tremor in the left hand, impaired movement of ngers
and hands, difculty typing, and difculty opening and closing a
st. Additionally, the patient indicated that in the past four years, his
increased levels of anxiety and stress, as well as lack of consistent,
healthy sleep, had greatly affected his quality of life and led to an
increase of PD symptomology. According to the patient, his Parkin-
sonian symptoms began manifesting with severity over these last four
years. The patient reported taking PD medications in the class of do-
pamine agonists during these four previous years, yet decided to dis-
continue his PD-related medication before entering NAD+ treatment,
reporting that he had minimal alleviation of symptoms.
The treatment (known as BR+NAD, or Brain Restoration Plus
NAD) was comprised of IV infusions of NAD+, as well as added oral
supplementation of Vitamin C, B6, Folate, Selenium, N-acetyl-L-cys-
teine, N-acetyl-L-tyrosine and electrolytes. The patient received
BR+NAD for a total of six treatment days. He received 1,500mg of
BR+NAD for Days 1 and 2, followed by 500-750mg of BR+NAD
for Days 3-6 (Table 1). Tremor measurements were recorded in his
left, more compromised hand beginning on Day 2 using a comput-
erized program that included a gyroscope and accelerometer, called
Toozon Tremor. Empirical measurements of tremor severity (Hz)
were analyzed on the vertical, horizontal and anterior-posterior axes.
Additionally, researchers used a standardized battery of computerized
tests using Luminosity to assess cognitive performance in the areas
of memory, attention and problem solving on Day 1 (baseline score)
and Day 5. Lastly, in addition to the BR+NAD infusions, the client
learned and practiced a combination of relaxation techniques, includ-
ing deep diaphragmatic breathing, progressive muscle relaxation,
and a form of guided self-hypnosis (e.g., “With each breath I become
more relaxed,” etc.,). The results of the patient’s cognitive perfor-
mance on Day 5 of his IV BR+NAD treatment were compared to
his baseline scores on Day 1 for observable, quantiable evidence of
improvements in cognitive abilities following his IV BR+NAD infu-
sion. Following Day 6, for additional maintenance of his Parkinson’s
symptoms, the patient received sublingual NAD+ tablets (300mg,
twice per day) for 14 days. The patient recorded mean tremors for 14
days and provided additional self-report of changes through email fol-
low-up. Data were prepared in table and gure formats and analyzed
by descriptive analysis using Microsoft Excel.
Results
Baseline symptomology, treatment dose/timeline and qualitative
changes in PD symptoms are summarized in table 1.
As stated previously, the patient initially presented symptoms
including bilateral hand tremors (more pronounced in left hand),
shufing gate/gait rigidity and impairments in movements of the
hands and ngers. The patient indicated that he did not experience
cognitive or mood impairments typical of many PD patients. The
rst set of tremor measurements (in the left hand) occurred on Day
2 of the BR+NAD treatment. The patient took the rst measurement
at 12:00pm, approximately four hours after beginning his second
BR+NAD infusion, or approximately 35 hours into the treatment
process. The scores for Day 2 were 54.307Hz for vertical, 47.985Hz
for horizontal and 31.216Hz for anterior-posterior. The patient took
the second measurement at 1:00pm. These scores were 31.988Hz for
vertical, 20.255Hz for horizontal and 30.133Hz for anterior-posterior.
To note, within this one-hour timeframe, there was a 58% decrease in
tremors on the vertical axis, a 42% decrease in tremors on the hori-
zontal axis, and nally a 1% decrease on the anterior-posterior axis
(Figure 1). On Day 3 of the patient’s BR+NAD treatment, the second
set of measurements was gathered. The patient took the rst measure-
ment at 1:00pm, with measured tremor scores of 23.168Hz for verti-
cal, 14.538Hz for horizontal and 30.143Hz for anterior-posterior. At
2:00pm, the second measurement was taken with scores of 22.343Hz
for vertical, 13.084Hz for horizontal and 29.674Hz for anterior-pos-
terior.
Treatment Day BR+NAD Dose (mg) PD Symptoms and Symptom Changes
Baseline 0 Tremors in both hands; more pronounced in left hand; shufing gate/gait rigidity; difculty writing/making a st; mood and cognitive ability
rated appropriate
Day 1 1, 500 Baseline luminosity tests conducted; bilateral tremors present; patient reporting stress in am; By noon, patient reports decreasing tremors
“Something is happening!”
Day 2 1,500 Average tremors (left hand) declining from 47-24 HZ; Patient actively participating in treatment plan discussion
Day 3 750 Mood and Sleep quality good; Average tremors left hand continue to decline, lowest point at 16.9Hz
Day 4 750 Average tremors (left hand) stabilizing at 22.17 by mid-day; Patient noted that stressors caused an increase in tremors late in the day
Day 5 500 Average tremors (left hand) nal recording at 20.63HZ
Day 6 750 Steady gait; Tremors reduced in combination with breathing exercises/relaxation "I feel good." Second round of luminosity tests conducted.
Day 20 300mg 2X day Steady gait; Patient reported tremors present initially at wake up time, then drop off with relaxation exercises
Table 1: Summary of treatment days and corresponding PD symptoms.
Citation: Rutherford L, Gadol E, Broom SL, Olds T, Mestayer RF, et al. (2020) Intravenous Administration of Nicotinamide Adenine Dinucleotide Alleviates
Tremors Associated with Parkinson’s Disease: A Case Report. J Gerontol Geriatr Med 6: 047.
• Page 3 of 5 •
J Gerontol Geriatr Med ISSN: 2381-8662, Open Access Journal
DOI: 10.24966/GGM-8662/100047
Volume 6 • Issue 1 • 100047
At 3:00pm, the third measurement was taken with scores were
20.628Hz for vertical, 11.275Hz for horizontal and 18.718Hz for
anterior-posterior. At 4:00pm, the fourth measurement was taken,
with scores of 12.212Hz for vertical, 16.278Hz for horizontal and
20.802Hz for anterior-posterior (Figure 1). On Day 4 of receiving
his BR+NAD infusion, the third set of measurements was recorded
starting at 1:00pm. His scores were 24.2Hz for vertical, 13.1Hz for
horizontal and 29.7Hz for anterior-posterior. At 3:00pm, the second
measurement was taken with scores of 23.1Hz for vertical, 12.1Hz
for horizontal and 33.3Hz for anterior-posterior. At 6.30pm, the third
measurement was taken with scores of 37.0Hz for vertical, 16.1Hz for
horizontal and 27.5Hz for anterior-posterior.
The patient reported that he felt the results for the vertical dimen-
sion were inuenced by psychological stressors at the time, and there-
fore not quite as accurate a measurement as the prior measurements.
At 6:45pm, the fourth measurement was taken, with scores of 15.2Hz
for vertical, 4.6Hz for horizontal and 24.0Hz for anterior-posterior.
On Day 5 of the six-day treatment, his fourth set of measurements
was recorded starting at 8:15am. His scores were 28.6Hz for vertical,
18.5Hz for horizontal and 26.0Hz for anterior-posterior. At 12:30pm,
the second measurement was taken with scores of 30.3Hz for vertical,
17.03Hz for horizontal and 22.3Hz for anterior-posterior. At 1:30pm,
the third measurement was taken with scores of 19.5Hz for vertical,
13.0Hz for horizontal and 29.4Hz for anterior-posterior. As shown in
gure 1, overall, the vertical axis tremors decreased by 75.9%, the lat-
eral axis decreased by 83.0% and the anterior-posterior axis decreased
by 9.1%. Collectively, the average decline from baseline to Day 6 was
54.7%. Patient self-report of tremors continued to decline two weeks
post IV BR+NAD (average 12Hz) by utilizing maintenance NAD+
sublingual tablets, along with the application of relaxation techniques
(data not shown).
On Day 1 and Day 5 of the patient’s IV BR+NAD, cognitive per-
formance was measured in the areas of problem solving, attention
and memory (Figure 2). Figure 2 shows raw scores on these three
cognitive performance measures. Values range on a scale of 0-20,000
(zero being the lowest possible score; 20,000 being the highest possi-
ble score). On Day 1 of treatment, the patient’s score on the memory
test was 3560, where on Day 5, the patient’s score increased by 29.8%
to 4620. On Day 1 of treatment, the patient’s score on the attention
test was 1500, where on Day 5, the patient’s score increased by 320%
to 6300. On Day 1 of treatment, the patient’s score on the problem
solving test was 17260, where on Day 5, the patient’s score increased
by 7.5% to 18550.
Discussion
As the number of individuals diagnosed with Parkinson’s disease
continues rising, with numbers of diagnosed cases nearly doubling
globally between the years of 1990 and 2015, the importance of nd-
ing effective therapeutic approaches in disease treatment and preven-
tion is paramount [10]. Prior research demonstrates the neuro-re-
generative and neuroprotective capacity of NAD+ supplementation
in both in vitro and in vivo studies, providing rationale for further
investigation of the effects of NAD+ on neurodegenerative diseases
such as PD [5,6]. Additionally, as intracellular NAD+ levels of this
neuroprotective co-factor are known to progressively lower with age,
where markedly low levels are indeed present in adult-onset neurode-
generative diseases of Alzheimer’s and Parkinson’s diseases, utilizing
this co-factor for PD lends additional evidence for potentially promis-
ing treatment results [11,12].
In this case report, further evidence of the therapeutic potential
of IV NAD+ [8] was indeed documented, supporting the decreased
PD-related symptom ndings of a previous case study of tremor reduc-
tion associated through NAD+ use [7]. Yet, this case study builds on
these prior ndings by providing quantiable evidence of both trem-
or reduction and cognitive improvements. Over the course of the six
NAD+ treatment days, the patient’s PD symptoms overall improved,
as shown by a signicant decline in hand tremors, development of a
steady gate, increased sociability, increased cognitive functioning and
improved sleep (Table 1). Signicant tremor improvements on the
vertical, horizontal, and anterior-posterior axes hold strong support
in NAD+ supplementation in this individual. Additionally, the cog-
nitive improvements in memory, attention, and problem solving from
Days 1 to 5 may lend further support for the neuroprotective quality
of NAD+ use. Although the increased cognitive scores are consistent
with the Practice Effect (i.e., an individual may score better on a test
when taken the second time in comparison to the rst), the dramatic
increase in his attention score by 320% may not be easily explained
through this phenomenon. Moreover, in a murine study of Alzhei-
mer’s affected mice, utilizing an NAD+ precursor for the building of
intracellular NAD+ showed signicant improvements in a number of
cognitive performance tests [13]. Therefore, it is possible to attribute
the improvement in this patient’s cognitive performance to be due in
part to his NAD+ treatment program.
Figure 1: Tremors measured in hertz on vertical (X) horizontal (Y) and anterior-pos-
terior (Z) axes as a function of IV BR+NAD treatment day.
Figure 2: Cognitive performance scores on Day 1 and Day 5 of IV BR+NAD treat-
ment day.
Citation: Rutherford L, Gadol E, Broom SL, Olds T, Mestayer RF, et al. (2020) Intravenous Administration of Nicotinamide Adenine Dinucleotide Alleviates
Tremors Associated with Parkinson’s Disease: A Case Report. J Gerontol Geriatr Med 6: 047.
• Page 4 of 5 •
J Gerontol Geriatr Med ISSN: 2381-8662, Open Access Journal
DOI: 10.24966/GGM-8662/100047
Volume 6 • Issue 1 • 100047
Additionally, the overall effectiveness and lasting effects of NAD+
in this particular patient can be understood by the continued decline
in PD-related tremors both during treatment and through NAD+ sub-
lingual tablets post-treatment (dosage was approximately 300mg of
NAD+ per tablet, twice per day). If this trend in PD-symptom alle-
viation continues throughout the course of the patient’s follow ups,
not only is strong evidence for the effectiveness of the IV infusion
supported in this particular case, it also poses possible effectiveness
for oral NAD+ supplementation in maintaining PD symptom stabili-
zation. Likewise, as stress was a predominant trigger for the patient’s
tremor severity, the positive patient self-reports of utilizing a com-
bination of deep diaphragmatic breathing, progressive muscle relax-
ation, and guided imagery/self-hypnosis techniques on lowering his
hand tremors supports relaxation techniques as additional treatment
for PD sufferers.
As the delivery of NAD+ intravenously may not be practical in a
growing population of individuals with Parkinson’s disease, this case
study shows that the use of alternate means of NAD+ delivery, such
as through the use of sublingual tablets, can be another promising
method of reducing Parkinson’s disease symptomology. Additionally,
the use of NAD+ precursors can be another promising and sustainable
option in PD treatment. Previous research indicates that the NAD+
precursor, Nicotinamide Riboside (NR), signicantly improves mito-
chondrial functionality in the cells of those with Parkinson’s disease
exhibiting notable dysfunction, as well as prevents further loss of do-
paminergic neurons and motor impairment in a y model of PD [6].
Additionally, a clinical trial is currently underway investigating the
role of nicotinamide supplementation in a neurodegenerative disease
known to signicantly impair motor function [14]. In summary, using
such alternative approaches in boosting NAD+ for PD treatment may
be promising to employ as well.
Overall, data discussed in this case study show repeatable and
quantiable results, and they also provide a protocol for treating
the symptoms of PD in an efcient manner with little to no report-
ed side effects during treatment and follow-up. Results show that IV
BR+NAD effectively reduces tremors and improves cognitive perfor-
mance in a subset of PD patients, further supporting previous ndings
on tremor alleviation using NAD+. Likewise, the results establish a
protocol for empirically measuring the effects of IV NAD+ on PD
symptoms, specically tremors, and show the effectiveness of symp-
tom alleviation in this treatment as compared to traditional PD phar-
macotherapies.
Acknowledgment
Thank you to Springeld Wellness Center for providing the set-
ting and clinical staff in support for this project. Thank you to NAD
Research, Inc. for funding this project. Thank you to William Carey
University for providing a Professional Development Grant in sup-
port of this project.
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