Parkinson’s disease (PD) is a progressive neurodegenerative disorder with increasing disability as the disease progresses. Motor disability in advanced disease can be related to either complications ...of antiparkinsonian therapy or to the progression of the disease. Motor complications related to levodopa therapy include motor fluctuations and dyskinesia. Disease progression often results in the development of postural instability and freezing.1
The choice of initial therapy for treating early Parkinson’s disease is best individualized after consultation with the patient, family members, and other caregivers. Patients can report how they ...feel and how motor and nonmotor symptoms affect their experiences of daily life. Their families and caregivers can relate observations of symptoms of which the patient may not be aware, such as rest tremor or confusion.
Parkinsonism is a syndrome that presents with motor symptoms including tremor, bradykinesia (slowness of movement), rigidity, and postural instability. In general, to make a clinical diagnosis of ...parkinsonism the presence of at least two of four major signs is required: tremor at rest, rigidity, bradykinesia, and postural instability.
Anxiety Fernandez, Hubert H.; Simuni, Tanya
Parkinson’s Disease and Nonmotor Dysfunction
Book Chapter
Anxiety disorders in Parkinson’s disease (PD) have been found to exceed prevalence rates in the geriatric population. Anxiety occurs more frequently in PD than in most other medical illnesses of ...comparable disability. Thus, anxiety may be etiologically related to the neurobiological changes that accompany PD and not simply a behavioral reaction to chronic disability. The anxiety disorder in PD tends to be panic, phobic, or generalized anxiety disorder. It can be a manifestation of an “off” state, can be worsened by motor fluctuations, or can occur independently from—and even precede—motor manifestations. Anxiety in PD may be directly related to dopaminergic deficit or may be the result of imbalance in other neurochemical pathways. The neurotransmitters primarily implicated in the pathogenesis of anxiety are norepinephrine, serotonin, and γ-aminobutyric acid, as well as some neuropeptides.
The key to successful management of anxiety in PD is its early recognition. A “team approach” to treatment that includes pharmacological and nonpharmacological measures, such as education, counseling, and stress-reduction strategies, is most beneficial, particularly in a complex illness where motor and behavioral dysfunction are often intertwined and tend to affect each other.
Well-designed studies that address the pharmacological management of anxiety in PD are needed. Nonetheless, based on clinical experience, the effective agents for primary anxiety disorders seem comparably efficacious in PD-related anxiety.
Differential diagnosis Park, Ariane; Zadikoff, Cindy
Parkinson's Disease,
01/2009
Book Chapter
Parkinsonism is characterized by tremor, akinesia (or bradykinesia), rigidity, and postural instability. While idiopathic Parkinson’s disease (PD) is the most common cause of parkinsonism, there are ...a wide range of other diseases that can also cause parkinsonism. In fact, approximately 25% of patients initially diagnosed with PD are found to have parkinsonism as part of another disorder.12 As therapeutic advances are made, it becomes increasingly important to not only recognize PD in its early stages but also distinguish PD from other causes of parkinsonism. Therefore, it is important to recognize some of the unique features that can help distinguish between the different causes of parkinsonism.
Increasing interest in functional neurosurgery for Parkinson’s disease (PD) has been fostered over the past decade by the limitations of levodopa therapy, our improved understanding of basal ganglia ...pathophysiology, and technological advances, most importantly the development of deep brain stimulation (DBS). When used for the treatment of movement disorders, DBS typically targets three areas of the brain: the ventral intermediate nucleus of the thalamus (Vim), the globus pallidus pars interna (GPi), and the subthalamic nucleus (STN). As Vim DBS almost exclusively improves contralateral tremor, it has been progressively replaced by DBS at the two other targets for PD treatment, even when tremor predominates.
Although Parkinson’s disease (PD) is traditionally thought of as a disorder of motor function, nonmotor symptoms are increasingly recognized as a significant source of disability and suffering. ...Nonmotor symptoms can be classifled as intrinsic or iatrogenic. The most common intrinsic nonmotor symptoms recognized in PD patients are depression, cognitive impairment, sleep disorders, and autonomic dysfunction. Frequent iatrogenic complications include psychosis, compulsions, and impulse control disorders. These symptoms often do not respond to standard dopaminergic PD therapies. In fact, dopaminergic medications frequently contribute to the onset and exacerbation of these symptoms. The spectrum of nonmotor manifestations of PD is reviewed in Chapter 1. This chapter highlights some of the unique challenges associated with their treatment.
There have been no specific guidelines regarding which genes should be tested in the clinical setting for Parkinson's disease (PD) or parkinsonism. We evaluated the types of clinical genetic testing ...offered for PD as the first step of our gene curation.
The National Institutes of Health (NIH) Genetic Testing Registry (GTR) was queried on 12/7/2020 to identify current commercial PD genetic test offerings by clinical laboratories, internationally.
We identified 502 unique clinical genetic tests for PD, from 28 Clinical Laboratory Improvement Amendments (CLIA)-approved clinical laboratories. These included 11 diagnostic PD panels. The panels were notable for their differences in size, ranging from 5 to 62 genes. Five genes for variant query were included in all panels (SNCA, PRKN, PINK-1, PARK7 (DJ1), and LRRK2). Notably, the addition of the VPS35 and GBA genes was variable. Panel size differences stemmed from inclusion of genes linked to atypical parkinsonism and dystonia disorders, and genes in which the link to PD causation is controversial.
There is an urgent need for expert opinion regarding which genes should be included in a commercial laboratory multi-gene panel for PD.
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