Scientific Writings on Chemistry and Geology

Parkinson published The Chemical Pocket Book (1800) as a short book for beginners to complement the well-known chemistry texts of Lavoisier, Fourcroy, Chaptal, and Nicholson.124 His book provided useful information for novices and inspired questions for more advanced readers. The Chemical Pocket Book presents information on elements and compounds that was up to date with early nineteenth century scientific literature. Chemical properties of earths, calorics, light, gases, alkalis, acids,...

Effect Of Urological Surgery

Obstructive uropathies coexistent with PD may also cause obstructive symptoms, and at the same time they may trigger detrusor hyperreflexia in their own right. The obstructive symptoms may be further enhanced by an overdistention injury to the bladder (myogenic arreflexia), which may gradually resolve after relief of the obstruction. (It should be noted that myogenic arreflexia may also be secondary to a temporary obstruction of the bladder outlet).35 The surgical relief of a well documented...

Colonic Dysmotility

When patients report the presence of bowel dysfunction, they typically use the term constipation as an all-inclusive descriptor that encompasses both decreased bowel movement frequency, often with hard stools, and difficulty with the act of defecation itself in the form of increased straining and sometimes incomplete evacuation.138 From both a physiological and clinical standpoint, however, these two problems are quite different and a separate classification and discussion of each is warranted....

Info

A. et al., Familial parkinsonism, dementia, and Lewy body disease study of family G, Ann. Neurol., 42, 638, 1997. Wszolek, Z. K. et al., Western Nebraska family (family D) with autosomal dominant parkinsonism, Neurology, 45, 502, 1995. Wszolek, Z. K. et al., Hereditary Parkinson disease report of 3 families with dominant autosomal inheritance German , Nervenarzt, 64, 331, 1993. Denson, M. A. and Wszolek, Z. K., Familial parkin-sonism our experience and review, Parkinsonism Relat....

Disease onset and clinical expression

PD is estimated to affect 2 to 3 percent of the population over the age of 65.4748 Age is the strongest and most consistent risk factor for the development of PD. In a recent study of PD using data from a large health maintenance organization, the estimated incidence increased rapidly over 60 yr of age, with a mean age at diagnosis of 70.5 yr.49 PD is uncommon in people younger than 40, and when it occurs, Wilson's disease (WD), Huntington's disease (HD), or dopa-responsive dystonia (DRD) are...

Contents

Pathophysiological Considerations Clinical Features Alterations in the Organization of Sleep Nocturnal Motor Activity Sleep Benefit REM Sleep Behavior Disorder (RBD) Nocturnal Respiratory Disorders Excessive Daytime Sleepiness (EDS) Diagnostic Evaluations Importance of Medical History and Clinical Examination Technical Recordings of Sleep and Excessive Daytime Sleepiness (EDS) Treatment Options Periodic Limb Movements during Sleep (PLMS) and Restless Legs Syndrome (RLS) Insomnia Nocturnal...

Park8

A genomewide linkage analysis of a Japanese family from Sagamihara (Sagamihara family) with autosomal dominant parkinsonism strongly supported the mapping of the parkinsonism locus to 12p11.2-q13.1.62 This new locus has been named PARK8. The clinical features of these patients were compatible with those of patients with typical sporadic Parkinson's disease a mean age at onset of 51 6 yr, the presence of asymmetry of parkinsonism at onset, and a good response to levodopa.63,64 The haplotype was...

Detrusor Arreflexia

Detrusor arreflexia, is a cystometrograhic finding where there is a decreased sensation during filling and an increased bladder capacity25,27 on the order of 600 ml or higher, and a desire to void usually first experienced at a high filling volume.3 The post-void residual volume is higher than 100 ml.3 This results in hesitancy and weak urinary stream.27 Detrusor Arreflexia Is Uncommon in PD Prevalence figures in series of urologically symptomatic patients3,13,22,24 have ranged from 0 (0 9)13...

Dysphagia

As noted earlier in this chapter, the act of swallowing requires multiple muscles in the mouth, throat, and esophagus to produce a precisely controlled and coordinated cascade of movement. This, perhaps not surprisingly, turns out to be difficult for the individual with PD. Survey studies reveal a rather broad range of positive responses when PD patients are asked whether they perceive difficulty swallowing. While the two large survey studies67 each catalogued a subjective sense of dysphagia in...

Impact And Nature Of Fatigue In Pd

Fatigue in PD was first mentioned in 1967 by Hoehn and Yahr,55 which is notable because fatigue, rather than motor dysfunction, was the presenting complaint in a handful of patients. The study of fatigue was begun in earnest in 1993, with studies by Van Hilten et al.51 and Friedman and Friedman.6 Van Hilten et al.51 published the first report focused on fatigue in PD. They compared nondemented patients with PD to age-matched controls to test the hypothesis that fatigue in PD worsened over the...

Sf

> 200 g 12 hr Early PD-119 ng ml Late PD-222 ng ml 441 pg ml 418 pg ml 179 pg ml 159 pg ml 10 ng g Presence negatively correlated with disease duration N-methyl-(R)salsolinol 6.15 nM, HVA 250 nM. Levels decreased after 2 yr of treatment with levodopa 1.2 ng ml 1300 pg ml 851 pg ml 427 pg ml 245 pg ml 1 ng g Sadler et al. 197387 Antkiewicz-Michaluk et al. 199788 M ller et al. 199964 M ller et al. 199964 M ller et al. 199964 M ller et al. 199964 Niwa et al. 198711 Not detected in a Moser et al....

References

Parkinson, J., An essay on the shaking palsy, Sherwood, Nealy and Jones, London, 1817. 2. Hoehn, M. M. and Yahr, M. D., Parkinsonism onset, progression and mortality, Neurology, 17, 427, 1967. 3. Mosewich, R. K. et al., Pulmonary embolism an under-recognized yet frequent cause of death in parkinsonism, Mov. Disord., 9, 350, 1994. 4. Nakashima, K. et al., Prognosis of Parkinson's Disease in Japan, Tottori University Parkinson's Disease Epidemiology (TUPDE) Study Group, Eur. Neurol., 38, 60,...

Exercise And Respiration

Patients with PD do not coordinate breathing with locomotion as seen in normal individuals.63 Combining this with fatigability of the respiratory pump during repetitive actions,46 it is not surprising that patient with PD have prominent fatigue and poor exercise tolerance. However, patients are able to improve pulmonary function through a pulmonary rehabilitation program.64 Furthermore, those who engage in regular aerobic exercise may maintain good pulmonary function.65,66 These types of...

Detrusor Hyperreflexia

Detrusor hyperreflexia is a cystometric finding characterized by the presence of involuntary detrusor contractions in response to bladder filling that the patient is unable to inhibit, with pressure values exceeding 15 cm of water.5,24,20 This hyperactive bladder is able to generate a subjective perception of fullness and a desire to void at an early stage in the course of filling the bladder.25 A correlation has been described of irritative symptom scores with low maximum cystometric capacity...

Restrictive Abnormalities

In an early review of nine parkinsonian patients, with and without complaints of dyspnea, Nugent et al. found that vital capacity and airway pressures were reduced as compared to controls.41 These authors compared the spiromet-ric data to similar data collected from neuromuscular disease patients and postulated the restrictive pattern in parkinsonism to be secondary to muscle weakness. Further studies emphasized the restrictive element of pulmonary changes in PD and, for many years, this was...

Anorectal Dysfunction

Anorectal dysfunction, characterized by excessive straining and often accompanied by pain and a sense of incomplete evacuation, is actually the more prevalent form of bowel dysfunction in PD. In their survey study, Edwards and colleagues7 differentiated between decreased bowel movement frequency and defecatory dysfunction and noted the latter in 67 of PD patients, compared with only 29 who reported decreased bowel movement frequency (see above). As with slow transit constipation, anorectal...

Effect Of Dopaminergic Medication

One has to distinguish between effects during bladder emptying and effects during bladder filling. The effects on bladder emptying are frequently referred to as effects on voiding efficiency and include parameters such as bladder contractility, urethral pressure, and urethral flow. The effects on bladder filling are particularly focused on the effects on detrusor hyperreflexia, although effects on other parameters are also of interest such as urethral closure pressure. Effect on Bladder...

Table of Contents

Goldman and Christopher G. Goetz Chapter 2 Paralysis Agitans Refining the Diagnosis and Treatment Chapter 3 The Role of Dopamine in Parkinson's Disease A Historical Review Chapter 4 Parkinson's Disease Where Are We Ajit Kumar, Zhigao Huang, and Donald B. Calne Chapter 5 Epidemiology of Parkinson's Disease An Overview Monica Korell and Caroline M. Tanner Chapter 6 Environmental Toxins and Parkinson's Disease Marcia H. Ratner and Robert G. Feldman Chapter 7 Rural Environment and...

Effects Of Basal Ganglia Surgery

There is very limited information on the effects of basal ganglia surgery on urological dysfunction. The few reports present contradictory results. Murnaghan reported results of basal ganglia surgery on urological symptoms and urological findings in 29 PD patients. Eight complained of bladder disturbances, and 11 had abnormal cystometrograms. Eleven patients had cystometrograms performed pre- and postoperatively. and only five were unchanged postoperatively. Normal bladder function was...

Headache IN PD

Headache is an important symptom that may occur in PD, but its relationship to the disease is uncertain. It does not fit into the pain categories described above but instead represents a painful symptom that often requires its own specific evaluation and treatment. In a survey of 71 patients with PD, headache was described in 25 individuals (35 ).58 Headaches were generally located in the nuchal region but did not correlate with a clinical assessment of nuchal rigidity. The character of the...

Charcot on the Progressive Nature of Parkinsons Disease

What follows next in Charcot's discourse is a more elaborate and detailed discussion on the manner of its invasion, when referring to the shaking palsy. In the immense majority of cases, the invasion is insidious, the disease first showing itself as slight and benignant. The tremor is circumscribed to the foot, the hand, or the thumb. At this stage of the disease the tremor may be merely passing and transitory. It breaks out when least expected, the patient enjoying complete repose of mind and...

Visual Contrast Sensitivity

Visual contrast sensitivity (VCS) is a function that is not commonly tested by neurologists, yet it is an important sensory function that pervades many activities of daily living. It is probably a more meaningful reflection of functional vision than standard visual acuity tests as measured in most clinical settings. VCS has consistently been found to be abnormal in Parkinson's disease. VCS is measured by determining the minimal contrast required to distinguish objects from one another presented...

Charcot on the Terminal Events of Parkinsons Disease

Charcot details the events leading to death in patients with Parkinson's disease. The affection pursuing its course, the difficulty of movement increases, and the patients are obliged to remain, the whole day long, seated on a chair, or are altogether confined to the bed. Then, nutrition suffers, especially the nutrition of the muscular system. There may supervene, as I have twice observed, a genuine fatty wasting of the muscles. At a given moment, the mind becomes clouded and the memory is...

Imaging Of Dementia In Pd

In the evaluation and management of PD, neuroimaging tends to occupy an ancillary position. Widely available imaging modalities, as currently utilized, primarily examine anatomy and effectively evaluate for the presence of space-occupying lesions (i.e., malignancy, ischemia, and so on). Magnetic resonance (MR) imaging has largely supplanted computed tomography as the method of choice for this application. Functional imaging with positron emission tomography (PET) and single-photon emission...

Table

Tetrahydrosisoquinolines in Brain (continued) a 1-benzyl-TIQ was detected in a single monkey brain 5 days after a 66-day period of daily subcutaneous injections. DMDHIQ+, ion. ND, none detected. a 1-benzyl-TIQ was detected in a single monkey brain 5 days after a 66-day period of daily subcutaneous injections. DMDHIQ+, ion. ND, none detected. Pictet-Spengler condensation of acetaldehyde with dopamine yields equal amounts of each enantiomer. In contrast, putative stereoselective enzymatic...

Proaggregation Factors

Many chemical species promote the aggregation of a-syn. Chief among these is genetically wild-type a-syn itself. Excessive concentrations of the protein cause it to aggregate. This phenomenon has been demonstrated in multiple animal models55 56 and in yeast.57 It also may be the mechanism of toxicity of one form of PARK1 human PD in which a-syn of normal amino acid sequence is over-expressed by virtue of a genetic triplication.1213 The process of aggregate formation by excessive concentrations...

Charcot on Gait Disturbances in Parkinsons Disease

Charcot also described freezing of gait, festination, propulsion, and retropulsion. Yet a word upon the gait peculiar to patients affected by paralysis agitans. You have seen some of our patients get up slowly and laboriously from their seats, hesitate for some seconds to step out, then, once started, go off in spite of themselves at a rapid rate. Several times they threatened to fall heavily forward. Does this irresistible tendency to adopt a running pace depend exclusively on the center of...

Differentiation Of Pd From Multiple System Atrophy

A proportion of patients with parkinsonism do not have PD but other forms of degenerative disease such as Lewy body disease, progressive supranuclear palsy, and multiple system atrophy (MSA). In MSA, there is a progressive cell loss in the motor nuclei of the striated sphincters located in the S2-S4 segments of the spinal cord (Onuf's nucleus), a finding that has not been reported in PD.1438 MSA frequently courses with prominent urological symptoms. Since this disease carries a worse prognosis,...

Introduction

The discovery that (MPTP Figure 9.1A) can cause parkinsonism12 led to a search for MPTP analogs as possible endogenous or exogenous neurotoxins critical to the neurodegeneration seen in Parkinson's disease (PD). In the context of identifying other neurotoxins that show some degree of dopaminergic selectively, it is important to remember that (1) MPTP is converted to 1-methyl-4-phenyl-pyridinium ion (MPP+) by monoamine oxidase (MAO)-B, (2) MPP+ is actively transported into presynaptic...

Mptp

The most widely studied chemical that can induce parkin-sonism in humans is (MPTP). MPTP is formed as a by-product of the synthesis of (MPPP), a potent meperidine-analog. The occurrence of parkinsonism following exposure to MPTP was first reported in users of illicit synthetic heroin or MPPP that was contaminated with MPTP.35 The clinical picture and neuropathology of MPTP poisoning is very similar to PD. Exposure to the MPTP, has been associated with damage to cells in the pars compacta of the...

Clinical Phenomenology

A generalized slowness of movement is arguably the defining feature of PD and other parkinsonian disorders, and this phenomenon has been termed bradykinesia. Bradykinesia is often used interchangeably with two other terms, akinesia (absence of movement) and hypokinesia (poverty of movement), and is a major cause of disability in PD. It is eventually seen in all patients and is a requirement for diagnosis of PD in many published diagnostic criteria.5-7 Patients often have a difficult time...

Industries And Occupations Associated With Pd

Epidemiologic studies have provided contradictory evidence regarding etiologic risks for PD. No area more clearly demonstrates these contradictions than in the area of occupational and environmental risk factors and PD. Numerous studies demonstrate a higher risk of PD for individuals living in a rural environment 12 however, these findings are inconsistent, possibly due to lack of power in the negative studies.3-6 On the other hand, there is some evidence that the prevalence of PD may be higher...

Blood Pressure Control

Hypotension or hypertension may result from disruption of autonomic control. As organ function is dependent upon an adequate perfusion pressure, the symptoms arising from hypotension (such as syncope with head-up postural change) often are more prominent than those resulting from hypertension. In humans, standing upright results in considerable strains to the cardiovascular system as a result of gravitational forces. Maintaining blood pressure with head-up posture is essential to adequately...

Tiq

N-methyl-TIQ N-methyl-IQ+ 1-benzyl-TIQ 1-benzyl-TIQ 1-benzyl-TIQ 1-methyl-TIQ monkey Rhesus and crab-eating monkeys C57BL 6J mice Subcutaneously (10-140 mg kg) with cumulative dose of 420 mg kg in a single surviving marmoset Subcutaneously (50 mg kg) X 11 days Subcutaneously (60-150 mg kg) 5 x wk X 4 wk Subcutaneously (50 mg kg) daily or 70 days Intrastriatal infusion via microdialysis cannula with measurement of dopamine Subcutaneus (20 mg kg) daily for up to 104 days forebrain bundle...

Discovery Of Dopamine As A Neurotransmitter

The concept of neurohumoral transmission arose around the turn of the twentieth century with the work of Lewan- dowsky, Langley, and Elliott (see Ref. 10), and epinephrine was the first candidate neurotransmitter. A little over a decade later, norepinephrine began to emerge as the leading candidate for the neurohumoral substance released by the sympathetic nervous system. In subsequent years, the role of norepinephrine was clearly delineated,11 and research in this area led to the awarding of...

Causes Of Hypersexual Behavior

Different mechanisms have been suggested to explain hypersexuality in response to antiparkinsonian therapy. The dopaminergic system, which is widely distributed in the central nervous system (CNS) and pelvic organs, is necessary for male sexual arousal and ejaculation, as documented in animal experiments and human studies.65 The serotonergic system, which is also widely distributed in the CNS, has an inhibitory role in the sexual response cycle. Dopaminergic agents such as levodopa,...

The Interplay Of Mood And Cognition In Pd

Depression may mimic dementia, and vice versa. Determining if a patient is suffering from one or the other, or both, may be challenging, since both diagnoses are relatively common in PD. Furthermore, when the two entities coexist, depression may make existing cognitive deficits appear worse than they really are and lead to excess disability, that is, functional impairment greater than would be expected from PD or depression alone. Also, as cognitive impairment progresses, it can be increasingly...

Clinical Features

The most common sleep-related complaints in parkinsonism are difficulties with sleep initiation and sleep maintenance, nocturnal akinesia, and RBD with nocturnal vocalizations and complex movements. Sleep disturbances tend to increase with progression of the disease. Daytime drowsiness and EDS become increasingly common, and EDS is experienced in about 15 of PD patients as compared to 1 of healthy elderly.18 Sudden sleep onset, so-called sleep attacks, have been described recently and include...

Phenotypes Of Parkinsonism

Parkinsonism may have no identifiable cause (idiopathic), or it may be observed in conjunction with another neurodegenerative disorder or as a result of an identifiable cause. 1. Without an identifiable cause, the condition is known as Parkinson's disease or idiopathic par-kinsonism. 2. As a part of other neurodegenerative disorders, it is known as a Parkinson-plus syndrome, such as progressive supranuclear palsy, corticobasal degeneration, multiple system atrophy, spino- cerebellar ataxias...

Park10

Autosomal Dominant Parkinson's Disease Known Genes In 1996, the genotype of a large Italian-American kindred (from the town of Contursi in Salerno, Italy) with a Parkinson's disease phenotype was mapped to the chromosomal region 4q21-23.1819 The following year, the analysis of candidate genes in this region led to the identification of a missense mutation in exon 4 of the a-synuclein gene in the Contursi kindred as well as in three unrelated Greek kindreds.20 The mutation is a G-to-A...

Social Issues of Child Abuse and Education

Although no longer known as Old Hubert, Parkinson still expressed his social viewpoints, particularly when related to medical care and reform. Comments on child abuse and parenting appear in The Villager's Friend and Physician (1800) under the section on Dropsy of the brain, or watery head, since vigorous correction of children was another cause of dropsy Parents too often forget the weight of their hands and the delicate structure of a child. You must excuse the digression it was but yesterday...

Parkinson Disease Gastrointestinal Dysfunction Lecture

Parkinson, J., An Essay on the Shaking Palsy, Whitting-ham and Rowland, London, 1817. 2. Romberg, M. H., Nervous Diseases of Man, Sydenham Society, London, 1853. 3. Charcot, J. M., Lectures on the Diseases of the Nervous System, Vol. 1, New Sydenham Society, London, 1877. 4. Hammond, W. A., A Treatise on Diseases of the Nervous System, Appleton and Company, New York, 1871. 5. Gowers, W. R., Diseases of the Nervous System, P. Blak-iston and Company, Philadelphia, 1888. 6. Eadie, M. J. and Tyrer,...

Figure 105

Xenobiotic Neuroprotectants and Smoking FIGURE 10.6 Rotenone (also known as Derrin Nicouline Rotenonum Tubatoxin Derril, Extrax, Mexide). Chemical name 2R-(2a, 6a alpha, 12a alpha) -1, 2,12, benzopyranol 3,4-b furo 12,3-h I benzopyran-6(6aH)-one. FIGURE 10.6 Rotenone (also known as Derrin Nicouline Rotenonum Tubatoxin Derril, Extrax, Mexide). Chemical name 2R-(2a, 6a alpha, 12a alpha) -1, 2,12, benzopyranol 3,4-b furo 12,3-h I benzopyran-6(6aH)-one. A fourth potentially neurotoxic action of...

Types Of Fatigue In Pd

Central and peripheral fatigue have been identified in PD patients.16,18 Although some believe these are distinct types of fatigue, there is evidence that central mechanisms may underlie the accelerated muscle fatigue thought to be corroboration of peripheral fatigue.17,18 Central fatigue is characterized by difficulty in initiating and sustaining mental and physical tasks in the absence of cognitive or motor impairment.18 Mental fatigue has two subdivisions mental lassitude induced either by...

Sensory Symptoms

Numbness is the most common term used by patients with PD to describe unwanted somatic sensations. Other patients describe tingling, others burning, yet others itching or crawling. Some experience focal coldness as though the limb were going to sleep. The extent to which all these different descriptions reflect differing pathophysiology or semantics is uncertain. When asked what they think is the origin or depth of these types of sensations, most patients chose skin rather than muscle or bone....

Hypophonia

Hypophonia is inventoried in the Unified Parkinson's Disease Rating Scale. It is graded by the patient as the difficulty in being understood by others. It is assessed by the clinician as the amount of monotonicty and intelligibility of speech during the examination. It can be considered a cardinal sign of PD, since it is a direct effect of bradyki-nesia and rigidity of the vocal cords and pharyngeal mus-cles.78 It is a very common sign with more than 70 of patients experiencing problems with...

Specific Industrial Occupations

Epidemiologic studies have also been performed to attempt to find occupations at high risk for developing PD. Fall et al. performed an occupation case control study and found an increased risk of PD in carpenters odds ratio (OR) 3.9 , cabinet makers (OR 11), and cleaners (OR 6.7) compared to a population-based control group.12 Tanner et al. performed a case control study (nonpopula-tion-based) of occupational exposures and PD in China and found that occupations involving industrial chemical...

Primary Visual Impairments In Pd

The Role of Dopamine in Retinal Processing In the last decades pharmacological studies related to the electroretinogram (ERG) in normal human volunteers and in PD patients have suggested a specific role of dopamine (DA) in retinal processing of visual input.21 3793 99 Going beyond the limitations of human studies, extensive neu-ropharmacological and neurotoxicological studies affecting the dopaminergic system in the monkey and lower vertebrates have led to a more detailed understanding of...

Treatment

The irritative symptoms in PD themselves a manifestation of detrusor hyperreflexia frequently respond to anticholinergics,520 although there are no reports specifically evaluating the effectiveness and safety in PD.34 Examples of commonly prescribed anticholinergics include oxybu-tinin (Ditropan ), propantheline bromide (Pro-banthine), hyoscyamine sulfate (Cystopaz and other), flavoxate hydrochloride (Urispas ), and tolteridone tartrate (Detrol ).1 Oxybutinin is possibly the most frequently...

Factors Associated with Increased Risk for Parkinsons Disease

Demographic Factors Increasing age Male gender White race Family history of Parkinson's disease Personality traits (shyness, risk averse) Environmental Exposures Occupation (health care, teaching, construction work) Infections Encephalitis Nocardia asteroides In case-control studies, persons with Parkinson's disease consistently report more affected family members than do controls.55,56 However, biased recall has been found to contribute to this in at least one study in which reported history...

1 Benzyl Norsalsolinol

In Vitro Toxicity of Tetrahydroisoquinolines Nijima et al. 1991,22 Nishi et al. 199423 N-methyl-TIQ, N-methyl-IQ+, (R S)salsolinol, N-methyl-(R S) salsolinol, norsalsolinol, N-methyl-norsalsolinol (R)salsolinol, (S salsolinol, DMDHIQ+, N-methyl-(R)salsolinol N-methyl-norsalsolinol Dopaminergic neuroblastoma SH-SY5Y cells Rat nucleus accumbens homogenate Dopaminergic neuroblastoma SH-Sy5Y cells Dopaminergic neuroblastoma SH-SY5Y cells Nigral dopaminergic cell line, SN4741 Organotypic slice...

Color Vision

Abnormal color discrimination has frequently been reported in patients with Parkinson's disease.27 28 In many studies, this impairment has been found to be most prominent in the tritan (blue-yellow) axis.29,30 Abnormalities of color perception have been demonstrated using both bedside clinical testing techniques such as the Farnsworth-Munscll (FM) 100-hue test30 or more elaborate psycho-physical means such as a computer-generated assessment of color contrast sensitivity.29 Haug et al.29 offered...

Risk Factors And Associated Conditions

A discussion of disease-related risk factors generally includes an analysis of patient traits and environmental exposures, the presence of which affect the likelihood of developing a certain condition. In the case of PD, little is known about the existence of specific environmental exposures that might contribute to the risk of developing dementia. One study compared 43 demented and 51 non-demented PD patients and found that pesticide exposure was associated with a threefold greater risk of the...

Gi Anatomy And Physiology

The GI system, like the nervous system, performs its vital tasks largely hidden from view and without conscious planning or effort (eating and evacuating being the obvious exceptions). It encompasses a rather astounding length and surface area between its oral and anal portals. Just as the study of the nervous system has been slowed by its complexity and inaccessibility, so has study of the GI system in many respects. While the function of the GI system seems quite straightforward to process...

Oral Dysfunction

It is generally perceived that individuals with PD are prone to develop dental dysfunction.44-47 Difficulty with the repetitive motions necessary for teeth brushing, pooling of saliva in the mouth, or (alternatively) dry mouth, jaw muscle rigidity, difficulty retaining dentures, and involuntary jaw movements are problems that may be encountered by the person with PD.48-50 The propensity of patients with PD to have a penchant for sweets has also led to concerns that this might promote dental...

About the Editors

Earned a B.S. degree in chemistry from Park University (Parkville, Missouri, 1960), an M.S. degree in pharmacology from the University of Missouri College of Pharmacy (Kansas City, 1962), and a Ph.D. degree in pharmacology from the University of Missouri College of Medicine (Columbia, 1967). He completed his postdoctoral training in the Laboratory of Preclinical Pharmacology at the National Institute of Mental Health (Washington, D.C., 1970), under the able direction of Erminio Costa, M.D., an...

Neuropsychological Prediction Of Incident Dementia

Is there a pattern of neuropsychological impairment that might predict the onset of dementia in PD Demographic risks (e.g., older age) have been identified, and risks related to the disease itself (e.g., motor symptom severity) have been acknowledged.18,33 Research has also begun to highlight the presence of a pattern of neuropsychological risk, and several authors71,94,95 have suggested that subtle executive dysfunction may precede the onset of dementia in PD. For example Jacobs et al.71 noted...

Antiparkinsonian Therapy And Hypersexuality

With the advent of antiparkinsonian therapy, reports of increased libido and sexual performance, hypersexual behavior (with or without concomitant hypomania), and rarely paraphilias have appeared in the literature.11-25 Comparisons cannot be made among studies, as different criteria were used to collect data. Due to the small size of the studies, the incidence of increased sexual drive in patients receiving treatment with antiparkinsonian therapy cannot be determined. The data does not provide...

Family Medical Tradition

James Parkinson was born on April 11, 1755, at No. 1 Hoxton Square in the parish of St. Leonard's, Shoreditch, England, to John and Mary Parkinson. Hoxton, now a London neighborhood but then a separate village, grew from a medieval town to a place of gardens and large residential homes in the seventeenth and eighteenth centuries. Subsequently, Hoxton ceded to industrial development, overcrowding, and poverty in the eighteenth and nineteenth centuries.1-4 The parish church of St. Leonard's...

Defective Proprioception And Kinesthesia In Pd

A Model Explaining PD Signs as Consequences of Disordered Sensorimotor Integration The precise function of the basal ganglia remains mysterious more than 20 years after Marsden's proposal that they automatically execute learned motor plans.36 Accu rate execution requires sensory feedback from the muscles, joints, soft tissues, and skin. Three stages of a circuit might be considered a sensory input, a black box sensorimotor integrator, and a motor output. Basal ganglia have often been considered...

Toxicity Of Isoquinolines

Neurotoxins may disrupt a variety of cellular activities such as DNA repair, protein trafficking, and neurotrans- mitter release. Cell death precipitated by neurotoxin inhibition of oxidative phosphorylation may, however, be the mechanism most relevant to PD. With this perspective, McKnaught and colleagues6 examined the effects of three classes of isoquinoline derivatives (e.g., isoquinolines, dihydroisoquinolines, TIQs) or MPP+ on respiratory chain complexes I, II-III, and IV from rat brain...

History

A-syn was discovered in 1988 as a component of cholinergic synapses of the electric organ of a fish, Torpedo californica.1 A role in synaptic plasticity and learning was found in other species, and a hint of a relationship to human disease appeared when a portion of the protein was found to be identical to the non-0-amyloid component of amyloid plaques in Alzheimer's disease2 and to bind beta-amyloid3 But any further role of the protein in Alzheimer's disease was elusive and a test for an...

Mapping And Cloning Of Prkn

Cases of parkinsonism with early disease-onset and recessive inheritance families with affected siblings, but usually no transmission from one generation to the next were first recognized and described as a clinical entity in Japan.3 Clinically, these patients suffered from L-dopa-responsive parkinsonism with onset in the second to fourth decade. Some of the patients showed diurnal fluctuations with symptoms becoming worse later in the day, similar to patients with dopa-responsive dystonia DRD...

Essay on the Shaking Palsy

Parkinson's Essay on the Shaking Palsy 1817 is often thought to represent his greatest contribution to medi-cine.26 27 The study is based on six cases, some never actually examined by Parkinson but observed on the streets. The five chapters of this 66-page octavo volume include I. Definition History Illustrative Cases, II. Pathognomic symptoms examined Tremor Coactus Scelotyrbe Festinians, III. Shaking Palsy distinguished from other disease with which it may be confounded, IV. Proximate cause...

Charcot on Bradykinesia and Rigidity

Charcot clearly describes masked facies as an essential component of Parkinson's disease. While James Parkinson mentioned face and voice abnormalities in his clinical cases and definitively described bradykinesia in his patients, he did not elaborate on this symptom nor did he include masked facies in his definition of shaking palsy. Charcot elaborates extensively on this topic. Far from trembling, the muscles of the face are motionless, there is even a remarkable fixity of look, and the...

Rigidity

Tone in the context of the neurologic examination can be defined as the general resistance of a muscle to passive manipulation. Rigidity is a hypertonic state that is commonly seen in disorders of the basal ganglia and is defined as unvarying increased resistance within the range of passive movement about a joint.17 Rigidity is therefore independent of the velocity used to manipulate the limb. This feature distinguishes it from spasticity, which is seen in disorders of the corticospinal tract,...

Clinical Staging Of Gait Disorders In Pd

Gait Disorder

In accordance with progression of nigro-striato-pallidal dysfunction, gait disorders in PD can be staged as follows Stage 1. Nonsignificant Gait Disturbances In this first stage, functionally nonsignificant gait disturbances, such as decreased gait speed, shortened steps, decreased arm swing, and increased stride-to-stride variability as detected by gait dynamics analysis, may be observed.10 Stage 2. Mild to Moderate Functional Gait Disturbances In the second stage, shuffling with marked...