Parkinsonism & related disorders
-
Parkinsonism Relat. Disord. · Jan 2013
Comparative StudyIn vivo microglia activation in very early dementia with Lewy bodies, comparison with Parkinson's disease.
Reactive microgliosis, hallmark of neuroinflammation, may contribute to neuronal degeneration, as shown in several neurodegenerative diseases. We in vivo evaluated microglia activation in early dementia with Lewy bodies, still not reported, and compared with early Parkinson's disease, to assess possible differential pathological patterns. ⋯ [(11)C]-PK11195 Positron Emission Tomography imaging revealed neuroinflammation in dementia with Lewy bodies and Parkinson's disease, mirroring, even at a single subject level, the common and the different topographical distribution of neuropathological changes, yet in the earliest stages of the disease process. Focusing on those events that characterize parkinsonisms and Parkinson's disease may be the key to further advancing the understanding of pathogenesis and to taking these mechanisms forward as a means of defining targets for neuroprotection.
-
Parkinsonism Relat. Disord. · Jan 2013
Medication and subthalamic nucleus deep brain stimulation similarly improve balance and complex gait in Parkinson disease.
Dopaminergic medications and subthalamic nucleus deep brain stimulation (STN-DBS) alleviate motor symptoms in Parkinson disease, but balance and gait are more variably affected. Balance reports are particularly inconsistent. Further, despite their prevalence in daily life, complex gait situations including backward and dual task gait are rarely studied. We aimed to assess how medications, STN-DBS, and both therapies combined affect balance and complex gait. ⋯ Overall, dopaminergic medications and STN-DBS provided similar improvements in balance and gait tasks, although the effects of STN-DBS were stronger, potentially due to reductions in medication doses after surgery. Lack of synergistic effect of treatments may suggest both therapies improve balance and gait by influencing similar neural pathways.
-
Parkinsonism Relat. Disord. · Jan 2013
Parkinson's disease in patients and obligate carriers of Gaucher disease.
Gaucher disease is an autosomal recessive disorder caused by glucocerebrosidase gene mutations. Accumulating evidence from several Parkinson's disease cohorts of varying ethnicities suggests that glucocerebrosidase mutations even in the heterozygous state (carriers) may be a susceptibility factor for Parkinson's. Very few studies have analyzed the frequency of Parkinson's in carriers and individuals with Gaucher disease. ⋯ Our study suggests that the risk for developing Parkinson's may be higher in affected versus carriers of glucocerebrosidase mutations and suggests that L444P may pose a higher risk of developing Parkinson's than other mutations. It also confirms previous findings that the age of onset of Parkinson's associated with glucocerebrosidase mutations is earlier than in the general population.
-
Parkinsonism Relat. Disord. · Dec 2012
Multicenter StudyWhat are the issues facing Parkinson's disease patients at ten years of disease and beyond? Data from the NPF-QII study.
Parkinson's disease (PD) is the second most common neurodegenerative syndrome, classically characterized by levodopa-responsive motor features accompanied by non-motor mood, cognitive, sensory and autonomic issues. Over time, disease burden slowly accumulates resulting in diminished health status. Many clinicians consider the 10 year disease duration mark as significant, however the clinical status and health-related quality of life of patients reaching this milestone have not been well documented. ⋯ Our data on PD patients with at least 10 years disease duration confirmed the younger age of onset of PD, but not the higher proportion of females or rest tremor, or the lower proportion of Caucasians seen in other aged PD cohorts. PD-10 patients had increased disease burden, increased caregiver burden, and impaired health-related quality of life. Although subjects mostly remained independently mobile, balance could be impaired with frequent falls identified. The prevalence of PD-10 patients living at home (93%) was very high in our sample which was drawn from specialty clinics, compared to prior studies reporting up to 27% PD patients institutionalized at 10 years duration. Thus policies to improve in-home support and caregiver support will be crucial in efforts aimed at maintaining patients in a home setting.
-
Parkinsonism Relat. Disord. · Dec 2012
ReviewThe conceptual framework of palliative care applied to advanced Parkinson's disease.
With the incidence of Parkinson's disease rising, while imposing a large cost on health care systems around the world, optimizing care has become crucial. The complexity of our patients increases dramatically in the advanced stages. Recently our understanding of advanced Parkinson's disease has led to the question of whether Palliative care approaches would be complementary to the care of these patients. ⋯ Pain has become recognized as a common symptom that can be difficult to treat. Given the success of early Palliative care involvement in cancer populations, it should not be surprising that our specialized Palliative Parkinson's Clinic at the Toronto Western Hospital has become indispensable for our patients. This article will describe the rational for combining the expertise of the Neurology department with that of Palliative care in the care of patients suffering from Parkinson's disease.