Lewy Body Dementia: Diagnosis, Management and Future Directions

Size: px
Start display at page:

Download "Lewy Body Dementia: Diagnosis, Management and Future Directions"

Transcription

1 Lewy Body Dementia: Diagnosis, Management and Future Directions Bradley F. Boeve, M.D. Divisions of Behavioral Neurology and Movement Disorders Center for Sleep Medicine Department of Neurology Mayo Clinic Rochester, Minnesota

2 Disclosures Financial/Other Investigator for clinical trials sponsored by Cephalon, Inc., Allon Pharmaceuticals, and GE Healthcare Royalties from the publication of a book entitled Behavioral Neurology Of Dementia (Cambridge Medicine, 2009) Honoraria from the American Academy of Neurology Research support from the NIA, NINDS, Alzheimer's Association, and Mangurian Foundation Off-label and/or Investigational Use Will discuss use of many medications which are not FDA-approved for the indications to be reviewed

3 Dementia with Lewy Bodies/Lewy Body Dementia Outline Nomenclature Diagnostic Features Management Options Future Directions

4 The Syndrome Dementia With Lewy Bodies Nomenclature Dementia with Lewy bodies (DLB)/Lewy body dementia (LBD) Clinically probable DLB Clinically possible DLB The Disease Lewy body disease (LBD) brainstem limbic neocortical

5 Clinical Features and Diagnostic Criteria Core features Dementia syndrome plus: Spontaneous parkinsonism (unrelated to drugs) Recurrent fully formed visual hallucinations Fluctuating arousal/cognition 2 or 3 of above = clinically probable DLB 1 of above = clinically possible DLB McKeith et al, Neurology 1996 McKeith et al, Neurology 1999 McKeith et al, Neurology 2005

6 Clinical Features and Diagnostic Criteria Suggestive features (one or more present in addition to one or more core features is sufficient for a diagnosis of probable DLB, and in the absence of any core features is sufficient for possible DLB) REM sleep behavior disorder (which may precede onset of dementia by several years) Severe neuroleptic sensitivity Abnormal (low uptake) in basal ganglia on SPECT dopamine transporter scan Boeve et al, Neurology 1998 McKeith et al, Neurology 2005

7 Clinical Features and Diagnostic Criteria Ferman et al, Neurology 2012 Core features Dementia syndrome plus: Spontaneous parkinsonism (unrelated to drugs) Recurrent fully formed visual hallucinations Fluctuating arousal/cognition RBD Any 2 of the following c/w DLB RBD plus 1 of the other features - >90% accurate

8 Video Example - RBD

9 Hypersomnia The data confirms subjective (ESS) and objective evidence of EDS (MSLT) is present in DLB and not in AD. Ferman et al, AAN 2010

10 Neuropsychiatric Features The most frequent neuropsychiatric features in DLB: Visual hallucinations Illusions Delusions (including Capgras syndrome) Depression Apathy

11 Neuropsychological Features Ferman et al, Neurology 1999 Ferman et al, Clin Neuropsych 2006 Cognitive Domains Learning & Memory Language Executive Functions Visuospatial Functions Impairment 0 to ++ 0 to + + to to +++

12 Neuropsychological Features Evaluation 2 14 AD Impaired on: Memory measures BNT and/or Cat Flu 2 0 DRS WMS- LM WMS- VR AVLT-PR BNT COWAT CAT FLU TMT-A TMT-B WAIS- DS WAIS- BD WAIS- PC REY-O Global Memory Language Attention/Executive Visuospatial Evaluation 1 DLB Impaired on: TMT, Dig Symbol WAIS-BD, -PC Rey-O CFT 0 DRS WMS-LM WMS-VR AVLT-PR BNT COWAT CAT FLU TMT-A TMT-B WAIS- DS WAIS- BD WAIS- PC Global Memory Language Attention/Executive Visuospatial REY-O Ferman et al, Neurology 1999 Ferman et al, Clin Neuropsych 2006

13 Please draw this figure: Dementia With Lewy Bodies Neuropsychological Features Please draw this figure: Draw a clock showing the time of 11:10:

14 Neuroimaging Features MRI Normal AD DLB normal hippocampi hippocampal atrophy normal hippocampi

15 Neuroimaging Features MRI VBM Whitwell et al, Brain 2007

16 Neuroimaging Features FDG-PET Normal

17 Neuroimaging Features FDG-PET Kantarci et al, Neurobiol Aging 2011 AD Posterior cingulate Temporoparietal Frontal DLB Occipital

18 Neuroimaging Features - DaTscan caudate Ioflupane putamen DaTscan - meaures nigrostriatal uptake of dopamine transporter in the caudate and putamen Normal

19 Neuroimaging Features - DaTscan AD DLB

20 Neuropathologic Features A B C A Ach DA 5-HT HCT-1 Ach? (RBD) B C

21 Neuropathologic Features H&E -synuclein Photomicrographs courtesy Dennis Dickson, M.D.

22 Clinical Tools - ESS

23 Clinical Tools - MSQ 1. Have you ever seen the patient appear to act out your dreams while sleeping? (punched or flailed arms in the air; shouted or screamed) SN: 100% SP: 97% Olmsted County

24 Clinical Tools - MFS Nl AD DLB Ferman et al, Neurology 2004

25 Clinical Tools - Friedman Friedman Palate Position Friedman Tonsil Grading Friedman et al, Laryngoscope 2004;114:

26 Management Consider symptoms as they relate to: cognitive impairment neuropsychiatric features motor features sleep disorders autonomic dysfunction Ask patient/family to prioritize the most troublesome issues they seek to change Boeve BF. AAN Continuum 2004

27 Management Cognitive impairment Varying degrees of memory impairment Verbal blocking Executive dysfunction Bradyphrenia Spatial/geographic disorientation Visual misidentification Fluctuations Management Education and counseling Therapies: Aricept, Razadyne, Exelon Sinemet, Mirapex Provigil, Nuvigil, methylphenidate, Adderall

28 Cognition issues Dementia With Lewy Bodies Brain-Behavior Relationships Mainly due to reduced Ach Reductions in other brain chemicals contributes to cognitive impairment Some degree of neuron cell loss too A A B C HCT B Ach DA 5-HT C

29 Management Neuropsychiatric features Visual hallucinations Illusions Delusions Capgras syndrome Depression Anxiety Agitation/aggressive behavior Management Education and counseling Therapies: Aricept, Razadyne, Exelon SSRIs, melatonin Seroquel, Zyprexa Provigil, Nuvigil, methylphenidate, Adderall NO HALDOL

30 Brain-Behavior Relationships Neuropsychiatric issues Hallucinations and delusions related to DA imbalance Depression related to low 5-HT Apathy many causes A B C A B Ach DA 5-HT C

31 Management Motor dysfunction Tremor Bradykinesia Rigidity Myoclonus Shuffling gait Stooped posture Difficulty with fine motor skills Masked facies Sialorrhea Management Education and counseling Therapies: Sinemet Mirapex, Requip, Neupro patch (when available) Clonazepam, Neurontin

32 Motor issues Dementia With Lewy Bodies Brain-Behavior Relationships The Parkinson s disease-like features (parkinsonism) primarily relate to the reduction in DA A A B C B DA C

33 Management Sleep disorders REM sleep behavior disorder Excessive daytime somnolence Insomnia Obstructive sleep apnea Central sleep apnea Restless legs syndrome Periodic limb movement in sleep Management Education and counseling Therapies: Clonazepam, Melatonin Provigil, Nuvigil, methylphenidate, Adderall Trazodone, Ambien, chloral hydrate nasal CPAP oxygen, temazepam Mirapex, Sinemet

34 Sleep issues Dementia With Lewy Bodies Brain-Behavior Relationships Daytime sleepiness, insomnia, and fragmented sleep relate in part to the loss in HCT Acting out dreams (RBD) relates to changes in the dorsal pons Reduced DA and 5-HT also affects sleep A A B C HCT B DA 5-HT? C

35 Management Autonomic dysfunction Orthostatic hypotension Impotence Urinary incontinence Constipation Management Education and counseling Therapies: Midodrine, Florinef, salt Viagra, etc. Enablex, Gelnique, Sanctura Senokot, MiraLAX

36 Autonomic issues Many autonomic changes related to changes in the spinal cord and peripheral nerves in and around the: heart stomach intestines bladder sex organs Dementia With Lewy Bodies Brain-Behavior Relationships

37 Management Initial evaluation Follow-up evaluation donepezil levodopa CPAP MMSE: 21 ESS: 14 MMSE: 28 ESS: 4 Boeve BF. AAN Continuum 2004

38 Initial evaluation Dementia With Lewy Bodies Management Follow-up evaluation donepezil levodopa modafinil MMSE: 7/30 STMS: 21/38 DRS: 52/144 ESS: 15 MMSE: 25/30 STMS: 31/38 DRS: 129/144 ESS: 6

39 Future Directions

40 Future Directions Braak et al, Cell Tiss Res 2004 Boeve BF. Ann NY Acad Sci 2010

41 Functioning Dementia With Lewy Bodies Future Directions Assessment Tools RBD onset MCI MPS DLB PD Age

42 Future Directions Boot et al, Ann Neurol 2012

43 Future Directions 15/44 subjects developed MCI/PD (14 MCI, 1 PD) HR 2.2 Boot et al, Ann Neurol 2012

44 Future Directions Iranzo et al, Lancet Neurol 2011

45 Future Directions Normal RBD RBD RBD Boeve et al, unpublished data

46 Functioning Dementia With Lewy Bodies Future Directions Assessment Tools RBD onset Delay the onset and slow the course of symptoms MCI MPS DLB PD Rx Age

47 Resources Lewy Body Dementia Association Please access this website and check it at least monthly, review the newsletter

48 Resources

49 Resources

50 Collaborators/Support Ronald Petersen, PhD, MD David Knopman, MD Daniel Drubach, MD Keith Josephs, MD Laura Allen, RN, CNP Sue Kennebeck, RN Angela Lunde, MA Tanis Ferman, PhD Glenn Smith, PhD Robert Ivnik, PhD Julie Fields, PhD John Lucas, PhD Cliff Jack, Jr., MD Kejal Kantarci, MD Val Lowe, MD Jennifer Whitwell, PhD David Jones, MD Mike Silber, MBBS Erik St. Louis, MD Maja Tippmann-Peikert Mithri Junna, MD Joseph Parisi, MD Dennis Dickson, MD Departments of Neurology, Psychiatry and Psychology, Diagnostic Radiology, Pathology and Laboratory Medicine, Community Internal Medicine, and Health Sciences Research, Mayo Clinic Rochester, Mayo Clinic Jacksonvile, and Mayo Clinic Scottsdale; Neuropathology Laboratory, Mayo Clinic Jacksonville; Mayo Alzheimer s Disease Research Center, Mayo Foundation; and M.H. Udall PD Center of Excellence Grant, Mayo Foundation Supported by grants AG006786, AG016574, and AG from the NIA; Mangurian Foundation

Comprehensive Approach to DLB Management

Comprehensive Approach to DLB Management Comprehensive Approach to DLB Management Bradley F. Boeve, MD Division of Behavioral Neurology Department of Neurology Mayo Clinic Rochester, Minnesota Comprehensive Approach to DLB Management Disclosures

More information

Revised criteria for the clinical diagnosis of dementia with Lewy. Dementia with Lewy bodies. (Dementia with Lewy Bodies)

Revised criteria for the clinical diagnosis of dementia with Lewy. Dementia with Lewy bodies. (Dementia with Lewy Bodies) Dementia with Lewy bodies First described: Okazaki H, 1961, Diffuse intracytoplasmic ganglionic inclusions (Lewy type) associated with progressive dementia and quadriparesis in flexion. J Neuropathol Exp

More information

Evaluation of Parkinson s Patients and Primary Care Providers

Evaluation of Parkinson s Patients and Primary Care Providers Evaluation of Parkinson s Patients and Primary Care Providers 2018 Movement Disorders Half Day Symposium Elise Anderson MD Medical Co-Director, PBSI Movement Disorders 6/28/2018 1 Disclosures GE Speaker,

More information

DIFFERENTIAL DIAGNOSIS SARAH MARRINAN

DIFFERENTIAL DIAGNOSIS SARAH MARRINAN Parkinson s Academy Registrar Masterclass Sheffield DIFFERENTIAL DIAGNOSIS SARAH MARRINAN 17 th September 2014 Objectives Importance of age in diagnosis Diagnostic challenges Brain Bank criteria Differential

More information

Parkinson Disease. Lorraine Kalia, MD, PhD, FRCPC. Presented by: Ontario s Geriatric Steering Committee

Parkinson Disease. Lorraine Kalia, MD, PhD, FRCPC. Presented by: Ontario s Geriatric Steering Committee Parkinson Disease Lorraine Kalia, MD, PhD, FRCPC Key Learnings Parkinson Disease (L. Kalia) Key Learnings Parkinson disease is the most common but not the only cause of parkinsonism Parkinson disease is

More information

Dementia Update. Daniel Drubach, M.D. Division of Behavioral Neurology Department of Neurology Mayo Clinic Rochester, Minnesota

Dementia Update. Daniel Drubach, M.D. Division of Behavioral Neurology Department of Neurology Mayo Clinic Rochester, Minnesota Dementia Update Daniel Drubach, M.D. Division of Behavioral Neurology Department of Neurology Mayo Clinic Rochester, Minnesota Nothing to disclose Dementia Progressive deterioration in mental function

More information

Parkinson s Disease Initial Clinical and Diagnostic Evaluation. J. Timothy Greenamyre, MD, PhD

Parkinson s Disease Initial Clinical and Diagnostic Evaluation. J. Timothy Greenamyre, MD, PhD Parkinson s Disease Initial Clinical and Diagnostic Evaluation J. Timothy Greenamyre, MD, PhD Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported

More information

The Spectrum of Lewy Body Disease: Dementia with Lewy Bodies and Parkinson's Disease Dementia

The Spectrum of Lewy Body Disease: Dementia with Lewy Bodies and Parkinson's Disease Dementia Disclosures Research support, Parkinson Society Canada, Canadian Institutes of Health Research, Ministry of Economic Development and Innovation, Teva Novartis clinical trial, Principal Investigator CME

More information

Assessment Toolkits for Lewy Body Dementia

Assessment Toolkits for Lewy Body Dementia Study : Assessment Toolkits for Lewy Body Dementia There are two toolkits, depending on whether the patient is presenting with a primary cognitive problem or with cognitive decline in the context of established

More information

Optimizing Clinical Communication in Parkinson s Disease:

Optimizing Clinical Communication in Parkinson s Disease: Optimizing Clinical Communication in Parkinson s Disease:,Strategies for improving communication between you and your neurologist PFNCA Symposium March 25, 2017 Pritha Ghosh, MD Assistant Professor of

More information

Parkinson s Disease: initial diagnosis, initial treatment & non-motor features. J. Timothy Greenamyre, MD, PhD

Parkinson s Disease: initial diagnosis, initial treatment & non-motor features. J. Timothy Greenamyre, MD, PhD Parkinson s Disease: initial diagnosis, initial treatment & non-motor features J. Timothy Greenamyre, MD, PhD Involuntary tremulous motion, with lessened muscular power, in parts not in action and even

More information

The PD You Don t See: Cognitive and Non-motor Symptoms

The PD You Don t See: Cognitive and Non-motor Symptoms The PD You Don t See: Cognitive and Non-motor Symptoms Benzi M. Kluger, M.D., M.S. Associate Professor of Neurology and Psychiatry Director Movement Disorders Center University of Colorado Denver Goals

More information

III./3.1. Movement disorders with akinetic rigid symptoms

III./3.1. Movement disorders with akinetic rigid symptoms III./3.1. Movement disorders with akinetic rigid symptoms III./3.1.1. Parkinson s disease Parkinson s disease (PD) is the second most common neurodegenerative disorder worldwide after Alzheimer s disease.

More information

The PD You Don t See: Cognitive and Non-motor Symptoms

The PD You Don t See: Cognitive and Non-motor Symptoms The PD You Don t See: Cognitive and Non-motor Symptoms Benzi M. Kluger, M.D., M.S. Assistant Professor of Neurology and Psychiatry University of Colorado Denver Goals 1) What are the most common non-motor

More information

MOVEMENT DISORDERS AND DEMENTIA

MOVEMENT DISORDERS AND DEMENTIA MOVEMENT DISORDERS AND DEMENTIA FOCUS ON DEMENTIA WITH LEWY BODIES MADHAVI THOMAS MD NORTH TEXAS MOVEMENT DISORDERS INSTITUTE, INC DEMENTIA de men tia dəˈmen(t)sh(ē)ə/ nounmedicine noun: dementia a chronic

More information

Overview. Overview. Parkinson s disease. Secondary Parkinsonism. Parkinsonism: Motor symptoms associated with impairment in basal ganglia circuits

Overview. Overview. Parkinson s disease. Secondary Parkinsonism. Parkinsonism: Motor symptoms associated with impairment in basal ganglia circuits Overview Overview Parkinsonism: Motor symptoms associated with impairment in basal ganglia circuits The differential diagnosis of Parkinson s disease Primary vs. Secondary Parkinsonism Proteinopathies:

More information

3/7/2017. Alzheimer s and Dementia Research: An Advanced Discussion. Alzheimer s and Dementia Research: An Advanced Discussion

3/7/2017. Alzheimer s and Dementia Research: An Advanced Discussion. Alzheimer s and Dementia Research: An Advanced Discussion Alzheimer s and Dementia Research: An Advanced Discussion Brad Boeve, MD Department of Neurology Mayo Clinic Alzheimer s and Dementia Research: An Advanced Discussion Theoretical Constructs in Aging/Dementia

More information

NON-AD DEMENTIAS: ALPHA-SYNUCLEINOPATHIES

NON-AD DEMENTIAS: ALPHA-SYNUCLEINOPATHIES NON-AD DEMENTIAS: ALPHA-SYNUCLEINOPATHIES Bradley F. Boeve, MD Professor of Neurology Mayo Clinic Rochester, Minnesota Overview With the advent of α-synuclein immunocytochemistry, some of the Parkinson-plus

More information

Non-Motor Symptoms of Parkinson s Disease

Non-Motor Symptoms of Parkinson s Disease Non-Motor Symptoms of Parkinson s Disease Samantha Holden, MD University of Colorado Movement Disorders MOTOR SYMPTOMS Rigidity Bradykinesia Tremor Gait Imbalance NON-MOTOR SYMPTOMS Dementia Urinary frequency

More information

Parkinson s Disease WHERE HAVE WE BEEN, WHERE ARE WE HEADING? CHARLECE HUGHES D.O.

Parkinson s Disease WHERE HAVE WE BEEN, WHERE ARE WE HEADING? CHARLECE HUGHES D.O. Parkinson s Disease WHERE HAVE WE BEEN, WHERE ARE WE HEADING? CHARLECE HUGHES D.O. Parkinson s Epidemiology AFFECTS 1% OF POPULATION OVER 65 MEAN AGE OF ONSET 65 MEN:WOMEN 1.5:1 IDIOPATHIC:HEREDITARY 90:10

More information

PARKINS ON CENTER. Parkinson s Disease: Diagnosis and Management. Learning Objectives: Recognition of PD OHSU. Disclosure Information

PARKINS ON CENTER. Parkinson s Disease: Diagnosis and Management. Learning Objectives: Recognition of PD OHSU. Disclosure Information OHSU PARKINS ON CENTER Parkinson s Disease: Diagnosis and Management for Every MD Disclosure Information Grants/Research Support: National Parkinson Foundation, NIH, Michael J. Fox Foundation Consultant:

More information

How to Diagnose Early (Prodromal) Lewy Body Dementia. Ian McKeith MD, FRCPsych, F Med Sci.

How to Diagnose Early (Prodromal) Lewy Body Dementia. Ian McKeith MD, FRCPsych, F Med Sci. How to Diagnose Early (Prodromal) Lewy Body Dementia Ian McKeith MD, FRCPsych, F Med Sci. Parkinson s Disease Lewy Body Disease Time PD Dementia Lewy Body Dementias Dementia with Lewy Bodies (DLB) Diagnostic

More information

Improving diagnosis of Alzheimer s disease and lewy body dementia. Brain TLC October 2018

Improving diagnosis of Alzheimer s disease and lewy body dementia. Brain TLC October 2018 Improving diagnosis of Alzheimer s disease and lewy body dementia Brain TLC October 2018 Plan for this discussion: Introduction to AD and LBD Why do we need to improve diagnosis? What progress has been

More information

Perspectives on Frontotemporal Dementia and Primary Progressive Aphasia

Perspectives on Frontotemporal Dementia and Primary Progressive Aphasia Perspectives on Frontotemporal Dementia and Primary Progressive Aphasia Bradley F. Boeve, M.D. Division of Behavioral Neurology Department of Neurology Mayo Clinic Rochester, Minnesota Alzheimer s Disease

More information

Mild Cognitive Impairment (MCI)

Mild Cognitive Impairment (MCI) October 19, 2018 Mild Cognitive Impairment (MCI) Yonas E. Geda, MD, MSc Professor of Neurology and Psychiatry Consultant, Departments of Psychiatry & Psychology, and Neurology Mayo Clinic College of Medicine

More information

Behavioral Aspects of Parkinson s Disease

Behavioral Aspects of Parkinson s Disease Behavioral Aspects of Parkinson s Disease Joseph H. Friedman, MD Director, Movement Disorders Program Butler Hospital Dept of Neurology Alpert Medical School of Brown University 1 Disclosures Drugs will

More information

Parkinson s Disease Current Treatment Options

Parkinson s Disease Current Treatment Options Parkinson s Disease Current Treatment Options Daniel Kassicieh, D.O., FAAN Sarasota Neurology, P.A. PD: A Chronic Neurodegenerative Ds. 1 Million in USA Epidemiology 50,000 New Cases per Year Majority

More information

Joint Session with ACOFP and Mayo Clinic. Parkinson's Disease: 5 Pearls. Jay Van Gerpen, MD

Joint Session with ACOFP and Mayo Clinic. Parkinson's Disease: 5 Pearls. Jay Van Gerpen, MD Joint Session with ACOFP and Mayo Clinic Parkinson's Disease: 5 Pearls Jay Van Gerpen, MD Parkinson s Disease: 5 Pearls J.A. van Gerpen, MD Sections of Movement Disorders and Clinical Neurophysiology

More information

Dementia Update. October 1, 2013 Dylan Wint, M.D. Cleveland Clinic Lou Ruvo Center for Brain Health Las Vegas, Nevada

Dementia Update. October 1, 2013 Dylan Wint, M.D. Cleveland Clinic Lou Ruvo Center for Brain Health Las Vegas, Nevada Dementia Update October 1, 2013 Dylan Wint, M.D. Cleveland Clinic Lou Ruvo Center for Brain Health Las Vegas, Nevada Outline New concepts in Alzheimer disease Biomarkers and in vivo diagnosis Future trends

More information

ASYMMETRICAL CORTICAL DEGENERATIVE SYNDROMES

ASYMMETRICAL CORTICAL DEGENERATIVE SYNDROMES ASYMMETRICAL CORTICAL DEGENERATIVE SYNDROMES Richard Caselli, MD Professor & Chair, Department of Neurology Mayo Clinic Arizona & Clinical Core Director, Arizona Alzheimer s Disease Center Objectives:

More information

Faculty. Joseph Friedman, MD

Faculty. Joseph Friedman, MD Faculty Claire Henchcliffe, MD, DPhil Associate Professor of Neurology Weill Cornell Medical College Associate Attending Neurologist New York-Presbyterian Hospital Director of the Parkinson s Institute

More information

Dementia: It s Not Always Alzheimer s

Dementia: It s Not Always Alzheimer s Dementia: It s Not Always Alzheimer s A Caregiver s Perspective Diane E. Vance, Ph.D. Mid-America Institute on Aging and Wellness 2017 My Background Caregiver for my husband who had Lewy Body Dementia

More information

Introduction, use of imaging and current guidelines. John O Brien Professor of Old Age Psychiatry University of Cambridge

Introduction, use of imaging and current guidelines. John O Brien Professor of Old Age Psychiatry University of Cambridge Introduction, use of imaging and current guidelines John O Brien Professor of Old Age Psychiatry University of Cambridge Why do we undertake brain imaging in AD and other dementias? Exclude other causes

More information

Parkinson s Disease Update. Presented by Joanna O Leary, MD Movement disorder neurologist Providence St. Vincent s

Parkinson s Disease Update. Presented by Joanna O Leary, MD Movement disorder neurologist Providence St. Vincent s Parkinson s Disease Update Presented by Joanna O Leary, MD Movement disorder neurologist Providence St. Vincent s What is a movement disorder? Neurological disorders that affect ability to move by causing

More information

FOUNDATION OF UNDERSTANDING PARKINSON S DISEASE

FOUNDATION OF UNDERSTANDING PARKINSON S DISEASE FOUNDATION OF UNDERSTANDING PARKINSON S DISEASE DEE SILVER M.D MOVEMENT DISORDER SPECIALIST MEDICAL DIRECTOR -- PARKINSON ASSOCIATION OF SAN DIEGO 1980 TO PRESENT SCRIPPS MEMORIAL HOSPITAL, LA JOLLA CA.

More information

Parkinson s Disease. Prevalence. Mark S. Baron, M.D. Cardinal Features. Clinical Characteristics. Not Just a Movement Disorder

Parkinson s Disease. Prevalence. Mark S. Baron, M.D. Cardinal Features. Clinical Characteristics. Not Just a Movement Disorder Prevalence Parkinson s Disease Mark S. Baron, M.D. Associate Professor of Neurology Movement Disorders Section VCU School of Medicine Common disorder Approaching 1% by 65 yrs of age, 2% by 80 yrs of age

More information

Update on functional brain imaging in Movement Disorders

Update on functional brain imaging in Movement Disorders Update on functional brain imaging in Movement Disorders Mario Masellis, MSc, MD, FRCPC, PhD Assistant Professor & Clinician-Scientist Sunnybrook Health Sciences Centre University of Toronto 53 rd CNSF

More information

Sleep disorders such as rapid eye movement (REM) sleep SCIENTIFIC INVESTIGATIONS

Sleep disorders such as rapid eye movement (REM) sleep SCIENTIFIC INVESTIGATIONS http://dx.doi.org/10.5664/jcsm.2670 Validation of the Mayo Sleep Questionnaire to Screen for REM Sleep Behavior Disorder in a Community-Based Sample Bradley F. Boeve, M.D., F.A.A.S.M. 1,3 ; Jennifer R.

More information

Parkinson s Disease Associated Sleep Disturbance Ehsan M. Hadi, MD, MPH. Dignity Health Neurological Institute

Parkinson s Disease Associated Sleep Disturbance Ehsan M. Hadi, MD, MPH. Dignity Health Neurological Institute Parkinson s Disease Associated Sleep Disturbance Ehsan M. Hadi, MD, MPH. Dignity Health Neurological Institute Parkinson s Disease 2 nd most common neurodegenerative disorder Peak age at onset is 60 years

More information

United Council for Neurologic Subspecialties Geriatric Neurology Written Examination Content Outline

United Council for Neurologic Subspecialties Geriatric Neurology Written Examination Content Outline United Council for Neurologic Subspecialties Geriatric Neurology Written Examination Content Outline REV 3/24/09 The UCNS Geriatric Neurology examination was established to determine the level of competence

More information

Parkinson s Disease in the Elderly A Physicians perspective. Dr John Coyle

Parkinson s Disease in the Elderly A Physicians perspective. Dr John Coyle Parkinson s Disease in the Elderly A Physicians perspective Dr John Coyle Overview Introduction Epidemiology and aetiology Pathogenesis Diagnosis and clinical features Treatment Psychological issues/ non

More information

CAREGIVER SUMMIT. The PD You Can't See: Dealing with Non-Motor Symptoms. Kaitlyn Roland, PhD. Sponsored by:

CAREGIVER SUMMIT. The PD You Can't See: Dealing with Non-Motor Symptoms. Kaitlyn Roland, PhD. Sponsored by: CAREGIVER SUMMIT The PD You Can't See: Dealing with Non-Motor Symptoms Kaitlyn Roland, PhD Sponsored by: Cognition VS Dementia Memory Executive Function Attention Bradyphrenia Visuospatial Language Hallucinations

More information

10th Medicine Review Course st July Prakash Kumar

10th Medicine Review Course st July Prakash Kumar 10th Medicine Review Course 2018 21 st July 2018 Drug Therapy for Parkinson's disease Prakash Kumar National Neuroscience Institute Singapore General Hospital Sengkang General Hospital Singhealth Duke-NUS

More information

Diagnosing and Managing Lewy Body Dementia

Diagnosing and Managing Lewy Body Dementia Diagnosing and Managing Lewy Body Dementia A Comprehensive Guide for Healthcare Professionals Provided by: Diagnosing and Managing Lewy Body Dementia 1 Table of contents 1. About Lewy Body Dementia...

More information

Program Highlights. Michael Pourfar, MD Co-Director, Center for Neuromodulation New York University Langone Medical Center New York, New York

Program Highlights. Michael Pourfar, MD Co-Director, Center for Neuromodulation New York University Langone Medical Center New York, New York Program Highlights David Swope, MD Associate Professor of Neurology Mount Sinai Health System New York, New York Michael Pourfar, MD Co-Director, Center for Neuromodulation New York University Langone

More information

Welcome and Introductions

Welcome and Introductions Parkinson s Disease Spotlight on Treatment Advances Tuesday, January 26, 2016 Welcome and Introductions Stephanie Paul Vice President Development and Marketing American Parkinson Disease Association 1

More information

Extrapyramidal Motor System. Basal Ganglia or Striatum. Basal Ganglia or Striatum 3/3/2010

Extrapyramidal Motor System. Basal Ganglia or Striatum. Basal Ganglia or Striatum 3/3/2010 Extrapyramidal Motor System Basal Ganglia or Striatum Descending extrapyramidal paths receive input from other parts of motor system: From the cerebellum From the basal ganglia or corpus striatum Caudate

More information

PACIFIC MOVEMENT DISORDERS CENTER AT PACIFIC NEUROSCIENCE INSTITUTE SM

PACIFIC MOVEMENT DISORDERS CENTER AT PACIFIC NEUROSCIENCE INSTITUTE SM AT PACIFIC NEUROSCIENCE INSTITUTE SM PARKINSON S DISEASE: NON-MOTOR SYMPTOM MANAGEMENT Non-motor symptoms can have a large impact on quality of life and level of functioning in patients with PD. In some

More information

Clinical and Cognitive Features of DLB. James E. Galvin, MD, MPH Washington University School of Medicine

Clinical and Cognitive Features of DLB. James E. Galvin, MD, MPH Washington University School of Medicine Clinical and Cognitive Features of DLB James E. Galvin, MD, MPH Washington University School of Medicine James E. Galvin, MD, MPH Disclosure of Interest Research Support 1. National Institutes of Health

More information

Evaluation and Management of Parkinson s Disease in the Older Patient

Evaluation and Management of Parkinson s Disease in the Older Patient Evaluation and Management of Parkinson s Disease in the Older Patient David A. Hinkle, MD, PhD Comprehensive Movement Disorders Clinic Pittsburgh Institute for Neurodegenerative Diseases University of

More information

Diagnosis and management of non-alzheimer dementias. Melissa Yu, M.D. Department of Neurology

Diagnosis and management of non-alzheimer dementias. Melissa Yu, M.D. Department of Neurology Diagnosis and management of non-alzheimer dementias Melissa Yu, M.D. Department of Neurology AGENDA Introduction When to think of alternate diagnoses Other forms of dementia Other reasons for confusion

More information

Update on the DLB Module. ADC Directors Meeting Baltimore, MD October 14-15, 2016

Update on the DLB Module. ADC Directors Meeting Baltimore, MD October 14-15, 2016 Update on the DLB Module ADC Directors Meeting Baltimore, MD October 14-15, 2016 Committee Members James Galvin, Florida Atlantic University (Chair) James Leverenz Cleveland Clinic Brad Boeve Mayo Clinic,

More information

Welcome and Introductions

Welcome and Introductions Parkinson s Disease Spotlight on Addressing Motor and Non-Motor Symptoms The Changing Landscape Wednesday, March 8, 2017 Welcome and Introductions Stephanie Paul Vice President Development and Marketing

More information

Dementia ALI ABBAS ASGHAR-ALI, MD STAFF PSYCHIATRIST MICHAEL E. DEBAKEY VA MEDICAL CENTER ASSOCIATE PROFESSOR BAYLOR COLLEGE OF MEDICINE

Dementia ALI ABBAS ASGHAR-ALI, MD STAFF PSYCHIATRIST MICHAEL E. DEBAKEY VA MEDICAL CENTER ASSOCIATE PROFESSOR BAYLOR COLLEGE OF MEDICINE Dementia ALI ABBAS ASGHAR-ALI, MD STAFF PSYCHIATRIST MICHAEL E. DEBAKEY VA MEDICAL CENTER ASSOCIATE PROFESSOR BAYLOR COLLEGE OF MEDICINE Objectives At the conclusion of the session, participants will be

More information

Update on the DLB Module. ADC Directors Meeting Baltimore, MD October 14-15, 2016

Update on the DLB Module. ADC Directors Meeting Baltimore, MD October 14-15, 2016 Update on the DLB Module ADC Directors Meeting Baltimore, MD October 14-15, 2016 Committee Members James Galvin, Florida Atlantic University Chair James Leverenz Cleveland Clinic Brad Boeve Mayo Clinic

More information

2016 Programs & Information

2016 Programs & Information Mayo Alzheimer s Disease Research Clinic Education Center 2016 Programs & Information BROCHURE TITLE FLUSH RIGHT for Persons & Families impacted by Mild Cognitive Impairment Alzheimer s Disease Dementia

More information

Non Alzheimer Dementias

Non Alzheimer Dementias Non Alzheimer Dementias Randolph B Schiffer Department of Neuropsychiatry and Behavioral Science Texas Tech University Health Sciences Center 9/11/2007 Statement of Financial Disclosure Randolph B Schiffer,,

More information

Depression & Anxiety. What can I do? What are other possible treatments? What is this? Why does this happen? KEY POINTS

Depression & Anxiety. What can I do? What are other possible treatments? What is this? Why does this happen? KEY POINTS Depression & Anxiety One set of important protectors from depression is friends and family as much as you can, keep yourself active and engaged with others. Exercise, particularly while outside, may help.

More information

Moving Treatment Earlier Disease Modification in Early PD

Moving Treatment Earlier Disease Modification in Early PD Moving Treatment Earlier Disease Modification in Early PD Ron Postuma Montreal General Hospital McGill University Disclosures: - Grants: Fonds de la Recherche en Sante Quebec, Canadian Institute of Health

More information

A BRIEF LOOK AT DEMENTIA

A BRIEF LOOK AT DEMENTIA Dementia A BRIEF LOOK AT DEMENTIA David Kaufman, MD Neurology Consultants of Bellin Health November 2, 2017 Defined as a progressive decline in cognitive function that impairs daily activities. Always

More information

Role of TDP-43 in Non-Alzheimer s and Alzheimer s Neurodegenerative Diseases

Role of TDP-43 in Non-Alzheimer s and Alzheimer s Neurodegenerative Diseases Role of TDP-43 in Non-Alzheimer s and Alzheimer s Neurodegenerative Diseases Keith A. Josephs, MD, MST, MSc Professor of Neurology 13th Annual Mild Cognitive Impairment (MCI) Symposium: Alzheimer and Non-Alzheimer

More information

Multiple choice questions: ANSWERS

Multiple choice questions: ANSWERS Multiple choice questions: ANSWERS Chapter 1. Redefining Parkinson s disease 1. Common non-motor features that precede the motor findings in Parkinson s disease (PD) include all of the following except?

More information

Treatment of Parkinson s Disease: Present and Future

Treatment of Parkinson s Disease: Present and Future Treatment of Parkinson s Disease: Present and Future Karen Blindauer, MD Professor of Neurology Director of Movement Disorders Program Medical College of Wisconsin Neuropathology: Loss of Dopamine- Producing

More information

What APS Workers Need to Know about Frontotemporal, Lewy Body and Vascular Dementias

What APS Workers Need to Know about Frontotemporal, Lewy Body and Vascular Dementias What APS Workers Need to Know about Frontotemporal, Lewy Body and Vascular Dementias Presenter: Kim Bailey, MS Gerontology, Program & Education Specialist, Alzheimer s Orange County 1 1 Facts About Our

More information

What is Parkinson s Disease?

What is Parkinson s Disease? 2018 Update in Parkinson s Disease: Treatments and Future Plans Arita McCoy, MSN, CRNP Johns Hopkins Parkinson s Disease and Movement Disorder Center A National Parkinson Foundation Center of Excellence

More information

The ABCs of Dementia Diagnosis

The ABCs of Dementia Diagnosis The ABCs of Dementia Diagnosis Dr. Robin Heinrichs, Ph.D., ABPP Board Certified Clinical Neuropsychologist Associate Professor, Psychiatry & Behavioral Sciences Director of Neuropsychology Training What

More information

Imaging biomarkers for Parkinson s disease

Imaging biomarkers for Parkinson s disease 3 rd Congress of the European Academy of Neurology Amsterdam, The Netherlands, June 24 27, 2017 Teaching Course 6 MDS-ES/EAN: Neuroimaging in movement disorders - Level 2 Imaging biomarkers for Parkinson

More information

Ian McKeith MD, F Med Sci, Professor of Old Age Psychiatry, Newcastle University

Ian McKeith MD, F Med Sci, Professor of Old Age Psychiatry, Newcastle University Ian McKeith MD, F Med Sci, Professor of Old Age Psychiatry, Newcastle University Design of trials in DLB and PDD What has been learnt from previous trials in these indications and other dementias? Overview

More information

PARKINSON S PRIMER. Dr. Kathryn Giles MD, MSc, FRCPC Cambridge, Ontario, Canada

PARKINSON S PRIMER. Dr. Kathryn Giles MD, MSc, FRCPC Cambridge, Ontario, Canada PARKINSON S PRIMER Dr. Kathryn Giles MD, MSc, FRCPC Cambridge, Ontario, Canada COPYRIGHT 2017 BY SEA COURSES INC. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted

More information

Diagnosis and Treatment of Alzhiemer s Disease

Diagnosis and Treatment of Alzhiemer s Disease Diagnosis and Treatment of Alzhiemer s Disease Roy Yaari, MD, MAS Director, Memory Disorders Clinic, Banner Alzheimer s Institute 602-839-6900 Outline Introduction Alzheimer s disease (AD)Guidelines -revised

More information

Parkinson s Disease Update

Parkinson s Disease Update Parkinson s Disease Update Elise Anderson MD Providence Center for Parkinson s Disease October 26, 2017 11/6/2017 1 Disclosures GE Speaker, DaTSCAN 11/6/2017 2 Outline PD diagnosis Motor and nonmotor symptoms

More information

2/20/18. History of Parkinson s. What is happening in the brain? DOPAMINE! Epidemiology. Parkinson s Disease. It s much more than tremor

2/20/18. History of Parkinson s. What is happening in the brain? DOPAMINE! Epidemiology. Parkinson s Disease. It s much more than tremor Parkinson s Disease History of Parkinson s It s much more than tremor Laura Dixon, DNP, MPA, APRN, FNP-BC University of Louisville Department of Neurology Movement Disorders Division Parkinson s Disease

More information

Patterns of Cognitive Impairment in Dementia

Patterns of Cognitive Impairment in Dementia Patterns of Cognitive Impairment in Dementia Lindsay R. Clark, PhD Assistant professor (CHS) Department of Medicine - Division of Geriatrics & Gerontology UW-Madison School of Medicine & Public Health

More information

Any interventions, where RCTs in PD are not available, are not included in the tables.

Any interventions, where RCTs in PD are not available, are not included in the tables. Tables Interventions where new studies have been published are indicated in bold italics. Changes in conclusions are indicated in italics and are highlighted in yellow. Any interventions, where RCTs in

More information

Patterns of Cognitive Impairment in Dementia

Patterns of Cognitive Impairment in Dementia Patterns of Cognitive Impairment in Dementia Lindsay R. Clark, PhD Assistant professor (CHS) Department of Medicine - Division of Geriatrics & Gerontology UW-Madison School of Medicine & Public Health

More information

Clinical Differences Among Four Common Dementia Syndromes. a program of Morningside Ministries

Clinical Differences Among Four Common Dementia Syndromes. a program of Morningside Ministries Clinical Differences Among Four Common Dementia Syndromes a program of Morningside Ministries Introduction Four clinical dementia syndromes account for 90% of all cases after excluding reversible causes

More information

Differential Diagnosis of Hypokinetic Movement Disorders

Differential Diagnosis of Hypokinetic Movement Disorders Differential Diagnosis of Hypokinetic Movement Disorders Dr Donald Grosset Consultant Neurologist - Honorary Professor Institute of Neurological Sciences - Glasgow University Hypokinetic Parkinson's Disease

More information

Form D1: Clinician Diagnosis

Form D1: Clinician Diagnosis Initial Visit Packet Form D: Clinician Diagnosis NACC Uniform Data Set (UDS) ADC name: Subject ID: Form date: / / Visit #: Examiner s initials: INSTRUCTIONS: This form is to be completed by the clinician.

More information

Scott J Sherman MD, PhD The University of Arizona PARKINSON DISEASE

Scott J Sherman MD, PhD The University of Arizona PARKINSON DISEASE Scott J Sherman MD, PhD The University of Arizona PARKINSON DISEASE LEARNING OBJECTIVES The Course Participant will: 1. Be familiar with the pathogenesis of Parkinson s Disease (PD) 2. Understand clinical

More information

Parkinsonian Disorders with Dementia

Parkinsonian Disorders with Dementia Parkinsonian Disorders with Dementia George Tadros Consultant in Old Age Liaison Psychiatry, RAID, Heartlands Hospital Professor of Dementia and Liaison Psychiatry, Aston Medical School Aston University

More information

What s new for diagnosing and treating Parkinson s Disease?

What s new for diagnosing and treating Parkinson s Disease? What s new for diagnosing and treating Parkinson s Disease? Erika Driver-Dunckley, MD Associate Professor of Neurology Program Director Movement Disorders Fellowship Assistant Program Director Neurology

More information

Key Concepts and Issues in Parkinson s Disease in 2016

Key Concepts and Issues in Parkinson s Disease in 2016 Key Concepts and Issues in Parkinson s Disease in 2016 Michael Rezak, M.D., Ph.D. Section Chief, Neurosciences Institute Director, Movement Disorders and Neurodegenerative Diseases Center Northwestern

More information

FDG-PET e parkinsonismi

FDG-PET e parkinsonismi Parkinsonismi FDG-PET e parkinsonismi Valentina Berti Dipartimento di Scienze Biomediche, Sperimentali e Cliniche Sez. Medicina Nucleare Università degli Studi di Firenze History 140 PubMed: FDG AND parkinsonism

More information

Enhanced Primary Care Pathway: Parkinson s Disease

Enhanced Primary Care Pathway: Parkinson s Disease Enhanced Primary Care Pathway: Parkinson s Disease 1. Focused summary of PD relevant to primary care Parkinson s Disease (PD) and Essential tremor (ET) are two of the most common movement disorders encountered

More information

DEMENTIA IN PARKINSON`S DISEASE. DR C PADMAKUMAR MD FRACP FRCP(Edin) Director-Parkinson`s Disease Service for the Older Person HNELHD

DEMENTIA IN PARKINSON`S DISEASE. DR C PADMAKUMAR MD FRACP FRCP(Edin) Director-Parkinson`s Disease Service for the Older Person HNELHD DEMENTIA IN PARKINSON`S DISEASE DR C PADMAKUMAR MD FRACP FRCP(Edin) Director-Parkinson`s Disease Service for the Older Person HNELHD DEMENTIA IN PD The concept of Non Motor Symptoms in PD Dementia in Parkinson`s

More information

475 GERIATRIC PSYCHOPHARMACOLOGY (p.1)

475 GERIATRIC PSYCHOPHARMACOLOGY (p.1) 475 GERIATRIC PSYCHOPHARMACOLOGY (p.1) I. General Information? Use lower doses? Start low and go slow? Expect prolonged elimination ½ lives? Expect sedative-hypnotics to be dementing, to impair cognitive

More information

Brain imaging for the diagnosis of people with suspected dementia

Brain imaging for the diagnosis of people with suspected dementia Why do we undertake brain imaging in dementia? Brain imaging for the diagnosis of people with suspected dementia Not just because guidelines tell us to! Exclude other causes for dementia Help confirm diagnosis

More information

An old man with hallucination

An old man with hallucination An old man with hallucination Inter-hospital Geriatric Meeting 30 March 2012 Speaker: Dr Siu Chun Yue Chairman: Dr Leung Chi Shing Caritas Medical Center History Admission 4/2011 75/M Premorbid: ADLI,

More information

18F-FDG PET in Posterior Cortical Atrophy and Dementia with Lewy Bodies

18F-FDG PET in Posterior Cortical Atrophy and Dementia with Lewy Bodies Journal of Nuclear Medicine, published on September 29, 2016 as doi:10.2967/jnumed.116.179903 1 18F-FDG PET in Posterior Cortical Atrophy and Dementia with Lewy Bodies 1 Jennifer L. Whitwell, PhD; 2 Jonathan

More information

DEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017.

DEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017. DEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017. Introduction. Parkinson's disease (PD) has been considered largely as a motor disorder. It has been increasingly recognized that

More information

Multiple System Atrophy

Multiple System Atrophy Multiple System Atrophy This document has been prepared to help you become more informed about Multiple System Atrophy. It is designed to answer questions about the condition and includes suggestions on

More information

ASHI691: Why We Fall Apart: The Neuroscience and Neurophysiology of Aging. Dr. Olav E. Krigolson Lecture 5: PARKINSONS DISEASE

ASHI691: Why We Fall Apart: The Neuroscience and Neurophysiology of Aging. Dr. Olav E. Krigolson Lecture 5: PARKINSONS DISEASE ASHI691: Why We Fall Apart: The Neuroscience and Neurophysiology of Aging Dr. Olav E. Krigolson krigolson@uvic.ca Lecture 5: PARKINSONS DISEASE The Basal Ganglia Primary motor cortex Execution of movement

More information

Date of Referral: Enhanced Primary Care Pathway: Parkinson s Disease

Date of Referral: Enhanced Primary Care Pathway: Parkinson s Disease Specialist LINK Linking Physicians CALGARY AND AREA Patient Name: Date of Birth: Calgary RHRN: PHN / ULI: Date of Referral: Referring MD: Fax: Today s Date: CONFIRMATION: TRIAGE CATEGORY: REFERRAL STATUS:

More information

What if it s not Alzheimer s? Update on Lewy body dementia and frontotemporal dementia

What if it s not Alzheimer s? Update on Lewy body dementia and frontotemporal dementia What if it s not Alzheimer s? Update on Lewy body dementia and frontotemporal dementia Dementia: broad term for any acquired brain condition impairing mental function such that ADLs are impaired. Includes:

More information

DIFFUSE LEWY BODY DISEASE (DLBD)

DIFFUSE LEWY BODY DISEASE (DLBD) CASE #2 Mr. S is a 62 years old male who was hospitalized in the dept. of psychogeriatrics after a suicide attempt (tried to jump from his balcony on the second floor). After a few days it was clear that

More information

UPDATE ON RESEARCH IN PARKINSON S DISEASE

UPDATE ON RESEARCH IN PARKINSON S DISEASE UPDATE ON RESEARCH IN PARKINSON S DISEASE Charles H. Adler, M.D., Ph.D. Professor of Neurology Mayo Clinic College of Medicine Co-Principal Investigator Arizona Parkinson s Disease Consortium Arizona Study

More information

LEWY BODY DEMENTIA. Information for Patients, Families, and Professionals. LEARN ABOUT: Dementia with Lewy bodies Parkinson s disease dementia

LEWY BODY DEMENTIA. Information for Patients, Families, and Professionals. LEARN ABOUT: Dementia with Lewy bodies Parkinson s disease dementia LEWY BODY DEMENTIA Information for Patients, Families, and Professionals LEARN ABOUT: Dementia with Lewy bodies Parkinson s disease dementia National Institute on Aging National Institute of Neurological

More information

WHAT DEFINES YOPD? HANDLING UNIQUE CONCERNS REBECCA GILBERT, MD, PHD VICE PRESIDENT, CHIEF SCIENTIFIC OFFICER, APDA MARCH 14, 2019

WHAT DEFINES YOPD? HANDLING UNIQUE CONCERNS REBECCA GILBERT, MD, PHD VICE PRESIDENT, CHIEF SCIENTIFIC OFFICER, APDA MARCH 14, 2019 WHAT DEFINES YOPD? HANDLING UNIQUE CONCERNS REBECCA GILBERT, MD, PHD VICE PRESIDENT, CHIEF SCIENTIFIC OFFICER, APDA MARCH 14, 2019 YOUNG ONSET PARKINSON S DISEASE Definition: Parkinson s disease diagnosed

More information

Quantifying the risk of neurodegenerative disease in idiopathic REM sleep behavior disorder

Quantifying the risk of neurodegenerative disease in idiopathic REM sleep behavior disorder Published Ahead of Print on January 7, 2009 as 10.1212/01.wnl.0000340980.19702.6e Quantifying the risk of neurodegenerative disease in idiopathic REM sleep behavior disorder R.B. Postuma, MD J.F. Gagnon,

More information

Objectives. Distinguishing Parkinson s disease from other parkinsonian and tremor syndromes. Characteristics. Basal Ganglia Structures

Objectives. Distinguishing Parkinson s disease from other parkinsonian and tremor syndromes. Characteristics. Basal Ganglia Structures 12:45 1:30 pm PD or not PD? Distinguishing Parkinson s Disease From Other Parkinsonian and Tremor Syndromes SPEAKER Jennifer G. Goldman, MD, MS Presenter Disclosure Information The following relationships

More information