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Revision as of 03:04, 21 February 2006

Role of ND5 in pathophysiology of Parkinson disease

"microheteroplasmic mutations in one of the mitochondrial complex I genes, ND5, were found to be sufficient to diagnose sporadic PD correctly in 27 out of 28 cases. While additional studies are needed, mitochondrial microheteroplasmic mutations may be the cause of the majority of PD cases."

I believe this passage from the Toxins section strongly overstates the relative importance of ND5 mutations in particular, and microheteroplasmic mutations in general with respect to the pathophysiology of Parkinson disease. The only PubMed article I could find on ND5 mutations being used to classify PD cases versus controls is this one , and it mentioned correct classification of 15 of 16 samples, not the 27 out of 28 cited above. This means there were only 8 cases and 8 controls, which is a pretty small sample size, certainly not enough to make the sweeping statement, "mitochondrial microheteroplasmic mutations may be the cause of the majority of PD cases." AFGriffithMD 01:05, 16 February 2006 (UTC)

Awakenings

Awakenings deals with Parkinson's? I thought it was encephalitis. - Montréalais

The patients in Awakenings were suffering from post-encephalitic Parkinsonism. The encephalitis had occurred 50 years earlier and the infection was over. However it had left damage, causing their Parkinsonism. RTC 06:06 Nov 2, 2002 (UTC)

Amphetamines

I think it is more than worthwhile to mention amphetamines as a possible cause. (Minor comment reg. your last statement: the epidemic was in 1919-20 and the movie appears to play in the early fifties...which fits to the CV of Oliver Saks :-)

I'm sorry I edited the page. I was trying to prove to someone it doesn't actually edit it in real-time. Boy was I wrong. I did fix it though. Sorry again.

it's worth noting that ritalin is quite useful for the ADD like deficits in attention in PD.Bldavids 05:46, 10 January 2006 (UTC)

Ozzy?

Does Ozzy Ozbourne really have Parkinsons Disease? I know he has Parkinsonian symptoms, but I thought it was due to drug-induced damage to the dopaminergic system rather than actual PD. - Sayeth 22:24, Nov 18, 2004 (UTC

"Parkinson Disease" or "Parkinson's Disease"

The first name seems to be the more popular and proper one, being referenced more often in recent literature and on Google. taion 11:10, 23 Nov 2004 (UTC)

"inclinations towards Catholicism"

Is this a bogus edit?

It's a jibe at John Paul II. JFW | T@lk 00:49, 18 August 2005 (UTC)

You don't have to be Catholic to have PD!

removed Katharine Hepburn

Katharine Hepburn did not have Parkinson's Disease. She had a condition called Essential tremor.

Micrographia

One of the symptoms mentioned is "micrographia (small handwriting)" — is this accurate? Is small handwriting symptomatic of disease? Either way, the link currently goes to an article about a popular science book, which I don't think was the author's intention. -- 213.122.16.164 20:04, 17 August 2005 (UTC)

Well, micrographia alone is not particularly indicative of PD. In the context of other symptoms, though, it is an informative symptom. JFW | T@lk 00:48, 18 August 2005 (UTC)

The statement is accurate; it's a classic symptom. So, its presence is definitely informative but not diagnostic. sensitive but not specific. Bldavids 05:48, 10 January 2006 (UTC)

Exercise neuroprotective

I am dubious about the alleged "neuroprotective effect" of exercise. I'd like to see a reference please. --Dubbin 23:23, 23 September 2005 (UTC)

See: “Parkinson's Disease” an on-line summary @http://www.bcm.edu/neurol/jankovic/educ_pd.htm, by Joseph Jankovic, M.D., an internationally recognized expert on Parkinson disease, and the medical director of the Udall Parkinson Disease Research and Treatment Center in Houston (Note: “Udall Center” is a federal designation denoting excellence in PD treatment and research):

“Recent animal research has provided strong evidence that exercise can increase brain levels of neurotrophic factors, increase resistance to brain insult or injury, and improve learning and mental as well as motor performance.” Dr. Jankovic is a highly credible sourcer.Bldavids 05:50, 10 January 2006 (UTC)

Here's a good place to start: PMID 15214505. (Then click on "Related Articles" and you'll see many studies on the topic.) --Arcadian 18:08, 3 January 2006 (UTC)

see also:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15790541&query_hl=25&itool=pubmed_docsum

Terminology depends on which side of the Atlantic you are on

Parkinson disease is used in American scientific literature. There has bee a move away from the apostrophe (e.g. Alzheimer disease vs. Alzheimer's disease). The British and the rest of the world use "Parkinson's disease" (preferred term).

219.95.213.43 00:40, 20 October 2005 (UTC)M K Lee

neuropsychiatric aspects of parkinson's disease

Depression, anxiety, and executive dysfunction have been estimated to account for up to 70 percent of the disability associated with Parkinson disease. Dementia and psychosis may ultimately effect more than a third of all Parkinson patients. There is a movement among researchers and patients to weaken the emphasis on "movement disorder" and strengthen the emphasis on "neuropsychiatric disease".Bldavids 06:35, 16 January 2006 (UTC)

If you have documentary support for this shift in paradigm it would make a very important point in the article. JFW | T@lk 12:17, 16 January 2006 (UTC)

Gladly:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15043801&query_hl=3&itool=pubmed_docsum

see also:

Curr Psychiatry Rep. 2003 May;5(1):68-76. Related Articles, Links

Neuropsychiatric aspects of Parkinson's disease: recent advances.

Marsh L, Berk A. Division of Psychiatric Neuroimaging, Geriatric and Neuropsychiatry Programs, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 300-C, Baltimore, MD 21287, USA. lmarsh@jhmi.edu

Psychiatric disturbances are a common feature of Parkinson's disease (PD), which is a degenerative disorder defined by its characteristic movement abnormalities. Its management is optimal when PD is viewed as a neuropsychiatric disorder, because this encourages consideration of the motor deficits along with its psychiatric and cognitive aspects. This review addresses the diagnosis and treatment of the most common psychiatric disorders in PD, and provides an update of related clinical research, including studies on neurosurgical treatments.

Is this sufficient? It's not a flippant question: I don't know the standard. Bldavids 04:42, 18 January 2006 (UTC)

Symptoms that cross over the physical into the cognitive and affective realms

The lists as constituted are poor vehicles for certain symptom sets: for example, speech-language problems. In PD, there are defects in articulation and breath support and voicing, but there are also problems with comprehension of complex syntax, with word finding, and with both expression and reception of prosody. Likewise vision and visual processing: the defects in vision are quite complex, seemingly a function of the combined effect of impaired attending, impaired gating of response, and slowed reaction time. The physical and cognitive and affective components of the disease are all snarled together, because the job of the pre-frontal cortex is precisely the integration of these kinds of inputs and outputs. The dysfunction observed in the prefrontal cortex when deprived of dopamine is subtle but radical: disconnects between physical stimulae and perception, between intention and action, between feelings and responses. At some point, these lists will not serve. Bldavids 23:18, 17 January 2006 (UTC)

I agree, the symptom section needs to be reorganized. I did a bit of minor cleanup in one section, but it should be something like:

Symptoms:

• Cardinal Symptoms
• Other Motor Symptoms
• Non-Motor Symptoms
  • Sensory
  • Visual
  • Neuropsychiatric
  • Cognitive

AFGriffithMD 23:31, 14 February 2006 (UTC)

dear afgriffith; you really did a super job. it's much clearer, more logical, and internally consistent. it also reads better. i appreciate that you left the language about patient rights and relationships, as that section above all others that i've contributed matters to me. i would like to ask you a question re: pd data, since i looked up your professional affiliation, and am very pleased to have someone with a connection to booth gardner contributing as you are: what is your best sense of both incidence and prevalence of dementia, by subpopulations, and also across the broadest historical study that you're aware of? i have found radically divergent estimations--30%, 40%, 40-80%. it strikes me that there mu[st be some real bias in the data, because people who are doing badly are more frequently lost to follow-up than are indvidiausl who are doing well. barb

Thanks, Barb. I'm working on this article section by section, mostly trying to reorganize without completely overwriting what has gone before, unless it's inaccurate or outdated. With respect to your question about dementia, I think Heiko Braak's work on Parkinson disease pathology is most illuminating. He published an article in Neurology linking incidence of dementia to severity of pathology. I'm going to be working on the pathology/pathophysiology section next, and will have more to say on that subject. AFGriffithMD 19:26, 20 February 2006 (UTC)

Dear A: I'd like to use your first name some variant of it, but don't wish to be presumtuous. may i use your your/ first initial? i'd also ask if you'd take a look at both this article and the wikipedia dementia article, in light of a citation i just came across: (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12567332&query_hl=21&itool=pubmed_docsum) "making it the most common cause of degenerative dementia after AD" and also: (http://jnnp.bmjjournals.com/cgi/content/extract/76/7/903) Patients with Parkinson’s disease (PD) have a significant risk of developing dementia in the course of their illness. Cross sectional studies suggest a dementia prevalence rate of 30% to 40%.1 Longitudinal studies indicate that the cumulative frequency of dementia in patients with PD is 60% to 80%.1 The risk of dementia for individuals with PD is approximately six fold greater than that of age matched controls.

80 percent is a looooong ways from 30 percent.

thanks for your thoughts.

I assume you know bill bell?

barb