ORIGINAL CONTRIBUTION. Parkinson Disease With Old-Age Onset. A Comparative Study With Subjects With Middle-Age Onset

Size: px
Start display at page:

Download "ORIGINAL CONTRIBUTION. Parkinson Disease With Old-Age Onset. A Comparative Study With Subjects With Middle-Age Onset"

Transcription

1 ORIGINAL CONTRIBUTION Parkinson Disease With Old-Age Onset A Comparative Study With Subjects With Middle-Age Onset Nico J. Diederich, MD; Charity G. Moore, MSPH, PhD; Sue E. Leurgans, PhD; Teresa A. Chmura, BS; Christopher G. Goetz, MD Background: To our knowledge, no prior study has focused on subjects with Parkinson disease (PD) with elderly disease onset, and there is little evidence-based knowledge of treatment outcomes in these patients. Objective: To compare the clinical presentation, comorbidities, treatment, and evolution of PD in patients with old-age onset with those of patients with middleage onset in one US university center. Design: In the Rush Movement Disorder Database, we retrieved 43 patients with PD with onset at 78 years or older. By using a case-control design, we assigned each patient with old-age PD onset 1 (n=5) or 2 (n=38) patients with middle-age PD onset, matched for disease duration but with disease onset between the ages of 43 and 66 years. We compared the groups on several clinical measures using conditional logistic regression. Results: At a comparable length of PD duration (mean, 5.1 years for patients with old-age PD onset and 5.5 years for patients with middle-age PD onset), the total Unified Parkinson s Disease Rating Scale motor score was significantly higher in those with old-age PD onset than in those with middle-age PD onset (33.3 vs 21.2; P.001). The patients with old-age onset had higher scores for rigidity (5.2 vs 4.3; P=.03), bradykinesia (13.0 vs 9.6; P=.001), and axial impairment (12.8 vs 5.2; P.001), but not for tremor (2.2 vs 2.0; P=.68). They were more likely to have at least one comorbid condition compared with patients with middle-age onset (24 [56%] of 43 patients vs 20 [25%] of 81 patients; P=.002), but even when adjusting for comorbidities, they still maintained higher motor scores than controls. When treating patients with oldage PD onset, clinicians used levodopa monotherapy more frequently than in patients with middle-age PD onset (34 patients [79%] vs 16 patients [20%]; P.001), and agonists were prescribed less frequently (5 patients [12%] vs 29 patients [36%]; P=.005). Conclusions: At the same disease duration, patients with old-age PD onset have greater motor impairment than patients with middle-age PD onset. This difference may be due to more rapid disease progression, less aggressive or less potent medical treatment, the elderly age of the subjects with old-age PD onset at study end independent of disease onset, or yet-to-be elucidated influences of comorbid conditions. Focused research on oldage PD onset is important to delineate the confounding influences of aging and comorbidities and to establish the safety and efficacy of new treatments for this group of patients. Arch Neurol. 2003;60: From the Department of Neuroscience, Centre Hospitalier de Luxembourg, Luxembourg (Dr Diederich); the Departments of Neurology (Drs Diederich, Moore, Leurgans, and Goetz and Ms Chmura) and Preventive Medicine (Drs Moore and Leurgans), Rush-Presbyterian-St Luke s Medical Center, Chicago, Ill; and the Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Columbia (Dr Moore). PARKINSON DISEASE (PD) is a neurodegenerative disease occurring in the aging brain, but in very old subjects without PD (aged 80 years), the numbers of midbrain catecholaminergic neurons do not significantly decline, strongly arguing that PD is not caused by an acceleration of a naturally occurring aging process. 1 Epidemiological studies have actually pointed to a decline in the incidence of PD after the age of 70 to 75 years, 2-4 and have shown that PD is not a frequent primary cause of mortality for those older than 85 years. 5 Whereas aging is no longer considered a primary cause of PD, the debate is ongoing over whether old age contributes to the phenotypic expression or impairment profile of PD Numerous age-related factors have been advanced as influences on parkinsonism: overlap between signs of senescence and parkinsonian signs, confounding comorbidities, loss of therapeutic efficacy because of age-related altered pharmacokinetics and pharmacodynamics, and increasing prevalence of nondopaminergic lesions, causing drug-resistant motor impairment. The clinical repercussions of PD in combination with advanced age could include a faster progression of PD in late life 12 and differences in clinical presentation, with predominance of axial and gait disturbances However, only 529

2 3 studies 10,13,17 have specifically analyzed clinical impairment in patients with PD onset after the age of 70 years. The results of these studies disagree concerning the outcome over time. To our knowledge, no prior study has focused on subjects with old-age PD onset. There is also little evidence-based knowledge of treatment outcomes in these very old patients, because they are generally excluded from clinical trials. 18 Even observational retrospective therapeutic studies 19 are unusual in this age group. Because elderly patients represent a growing population of subjects with PD and little is known about the prognosis and adequate therapeutic management for these elderly patients, we conducted this study on patients with old-age PD onset. We used a case-control method and analyzed clinical signs, comorbidities potentially aggravating the parkinsonian symptoms, treatment regimens, and dosages in subjects with PD onset at 78 years or older compared with subjects with PD onset between the ages of 43 and 66 years. We hypothesized that patients with old-age PD onset would have a milder disease course, comparable to cancer progression at this age, but that comorbidities would be more frequent. Finally, we expected less aggressive PD treatment in these patients. METHODS PATIENTS We consulted the Rush Movement Disorder Database, covering January 1, 1995, to June 30, 2000, containing visit information for 2389 patients with idiopathic PD. In July 2000, we retrieved 43 patients with disease onset at 78 years or older, at least one follow-up examination, and a complete Unified Parkinson s Disease Rating Scale (UPDRS) 20 examination at their last visit. The diagnosis of PD was based on the assessment of 1 of 6 experienced movement disorder specialists. Cases considered by the treating physician as atypical parkinsonism, vascular parkinsonism, or any PD plus syndrome were excluded. By using a casecontrol design, each patient with old-age PD onset was matched with 2 (n=38) or 1 (n=5) control patient with PD onset between the ages of 43 and 66 years, and of same sex and same disease duration (±2 years). The cutoff ages for the patients 78 years or older, called patients with old-age PD onset, and for the control patients between the ages of 43 and 66 years, called patients with middle-age PD onset, were empirically defined, based on the available study subjects in the data bank and with the goal to have (1) groups of sufficient size for proper statistical analysis and (2) the largest possible age gap between groups. For patients with old-age PD onset, their last medical visit before July 2000 was defined as their target date, and disease duration, calculated to this point, served to determine a comparable examination target date for the patients with middle-age PD onset. The medical record review and standardized database consultation gathered the following data, available at the target visit: UPDRS motor score; comorbidities, as noted in the medical record by the clinician during the last visits; PD medication; and other medications. When calculating the total medication dosages, we used the following equivalencies: (1) 1 mg of slow-released levodopa equals 0.7 mg of regular levodopa; and (2) dopamine agonists are expressed in pergolide equivalents, with 1 mg of pergolide equal to 10 mg of bromocriptine, equal to 1 mg of pramipexole, equal to 3 mg of ropinirole. The study was approved by the Institutional Review Board of Rush-Presbyterian-St Luke s Medical Center. STATISTICAL ANALYSIS The statistical analysis used descriptive statistics and conditional logistic regression. Means and SDs are presented for continuous variables (age, duration of PD, and subscales of the UPDRS motor score), and proportions are calculated when investigating categorical variables (comorbidities and drugs). All significance testing comparing patients with old-age PD onset with patients with middle-age PD onset was performed using conditional logistic regression (a logistic model that takes the matching into account), unless small numbers (counts of 0 or 1 after cross tabulations) prevented doing so. 21,22 Additional exploratory models were performed, adjusting for comorbidities. The results are presented using relative risks and 95% confidence intervals. A relative risk of greater than 1 corresponds to a higher score for cases compared with controls. A 95% confidence interval that does not contain 1 signals a statistically significant difference between scores in cases and controls after adjusting for comorbidities. In such instances, an exact inference was made, using the binomial distribution and taking into account the matched design. 23 All performed tests were 2-sided, with =.05. RESULTS PATIENT CHARACTERISTICS The average onset age was 82.2 years (SD, 3.4 years; range, years) for the patients with old-age PD onset and 54.7 years (SD, 4.1 years; range, years) for the patients with middle-age PD onset. The average duration of PD at the last visit was 5.1 (SD, 2.6) years for patients with old-age onset and 5.5 (SD, 2.6) years for patients with middle-age onset (P=.46). Nineteen (44%) of the patients with old-age onset and 37 (46%) of the patients with middle-age onset were men. At the target date, the UPDRS motor score was significantly higher in patients with old-age onset than in patients with middle-age PD onset. Patients with oldage PD onset had significantly higher rigidity, bradykinesia, and axial impairment scores than patients with middle-age PD onset. However, patients with middle- and old-age onset did not differ in tremor ratings (Table 1). COMORBIDITIES Patients with old-age PD onset were more likely to have comorbid conditions than patients with middle-age PD onset. Specific comorbidities more common in patients with old-age onset than in patients with middle-age onset were cerebrovascular disease, auditory deficits (especially presbycusis), and visual impairment (cataract, glaucoma, and macular degeneration) (Table 2). Neither osteoporosis nor arthritis was documented significantly more often in patients with old-age onset than in patients with middle-age onset. Dementia was documented in 6 patients with old-age PD onset (14%) and in 1 patient with middle-age PD onset (1%). These low crude numbers precluded statistical comparison. When adjusting for any comorbidities as potentially interfering variables, patients with old-age onset still had higher motor scores than patients with middle-age onset (Table 3). 530

3 Table 1. Comparison of UPDRS Subscale Scores Between Cases and Controls* UPDRS Subscale at the Target Date Cases (n = 43) Controls (n = 81) P Value Motor (0-92) 33.3 ± ± Tremor (0-16) [resting tremor in the RUE, LUE, RLE, and LLE; item 20] 2.2 ± ± Rigidity (0-16) [rigidity in the RUE, LUE, RLE, and LLE; item 22] 5.2 ± ± Bradykinesia (0-32) [finger taps in the RUE and LUE, rapid alternating hand movements in the RUE 13.0 ± ± and LUE, pronation or supination in the RUE and LUE, and leg agility in the RLE and LLE; items 23-26] Axial impairment (0-28) [speech, facial expression, arising from a chair, posture, gait, posture stability, and body bradykinesia; items 18, 19, and 27-31] 12.8 ± ± Abbreviations: LLE, left lower extremity; LUE, left upper extremity; RLE, right lower extremity; RUE, right upper extremity; UPDRS, Unified Parkinson s Disease Rating Scale. *Data are given as mean ± SD. Cases are patients with old-age onset (mean, 82 years) Parkinson disease; controls are patients with middle-age onset (mean, 55 years) Parkinson disease. Data in parentheses are the range of scores for that subscale. DRUG TREATMENT All 43 patients with old-age PD onset were taking at least one PD medication (levodopa, a dopamine agonist, amantadine hydrochloride, selegiline or rasagiline, an anticholinergic agent, or entacapone) compared with 72 (89%) of the 81 patients with middle-age PD onset (P=.02). Patients with old-age onset were more likely than patients with middle-age onset to be receiving levodopa monotherapy (34 patients [79%] vs 16 patients [20%]; P.001). They were less likely to be using a dopamine agonist (5 patients [12%] vs 29 patients [36%]; P=.005) and combination therapy of 2 or more drugs (8 patients [19%] vs 45 patients [56%]; P.001). For those taking levodopa, the average dosage was 489 mg for the patients with old-age onset (n=41) and 509 mg for the patients with middle-age onset (n=51); and for those taking a dopamine agonist, the average dosage was 2.0 mg for the patients with old-age onset (n=5) and 2.2 mg for the patients with middle-age onset (n=29). To evaluate whether patients with old- and middleage PD onset differed in exposure to medications that could aggravate PD, we compared use of the following drug classes: calcium antagonists, dopamine receptor blockers, and antihypertensive agents. Exposure to one, all, or any combination of these classes was not more frequent among the patients with old-age onset than the patients with middle-age PD onset. COMMENT At the same disease duration of approximately 5 years, patients with old-age PD onset had greater motor impairment, as rated by the UPDRS, than subjects with middle-age PD onset. This observation strictly refutes our original hypothesis of a milder disease course when there is very late disease onset. The difference was evident for axial impairment signs, including gait and posture, and it also affected bradykinesia and rigidity. Only tremor severity was not different in the 2 groups. Similar findings have been observed in comparisons 8,15,16 of patients with young PD onset (defined as onset at 40 years) vs old onset (defined as onset at 60 or 70 years). Together, Table 2. Frequencies of Comorbidities in Cases and Controls* Comorbidity Cases (n = 43) Controls (n = 81) P Value Any comorbidities 24 (56) 20 (25).002 Cerebrovascular disease 8 (19) 1 (1).03 Osteoporosis 3 (7) 0.16 Arthritis 11 (26) 14 (17).33 Auditory deficit 10 (23) 3 (4).006 Visual deficit 8 (19) 4 (5).02 *Data are given as number (percentage) in each group. The cases and controls are defined in the second footnote to Table 1. Table 3. The RRs and 95% CIs From Conditional Logistic Regression With and Without Adjusting for Any Comorbidities UPDRS Subscale Conditional RR (95% CI) Motor No comorbidity 1.15 ( ) Any comorbidity 5.56 ( ) Tremor No comorbidity 1.06 ( ) Any comorbidity 3.72 ( ) Rigidity No comorbidity 1.21 ( ) Any comorbidity 3.42 ( ) Bradykinesia No comorbidity 1.16 ( ) Any comorbidity 4.23 ( ) Axial impairment No comorbidity 1.89 ( ) Any comorbidity ( ) Abbreviations: CI, confidence interval; RR, relative risk; UPDRS, Unified Parkinson s Disease Rating Scale. these data establish that, with increasing age of PD onset, axial and hypokinetic parkinsonian symptoms become more severe and may even predominate the clinical presentation. Our study extends these observations to patients with disease onset in their late 70s and 80s, and uses a robust case-control method with a large mean 531

4 interval of age of onset (28 years) between those with middle-age and those with old-age onset. The distinctive phenotype of PD with old-age onset may relate to different reasons: first, a different natural course of parkinsonism may occur among older persons because of an implicitly different extent or rate of nigrostriatal degeneration in very elderly persons; second, reduced compensatory mechanisms may exist in the very old brain, leading to a quantitatively more pronounced impairment with more rapid disease progression 24 ; and third, there may be higher motor impairment because of the more frequent comorbidities. Comorbidities in those with PD have not been investigated so far in living patients, but have been analyzed in one study 25 using data from death certificates. The 2 studies support one another in documenting many cerebrovascular diseases in patients with old-age PD onset. A detection bias cannot be excluded, however, for both studies because neurologists may be more apt to diagnose and document comorbidities in elderly patients. Our method did not permit a clear delineation of the causative role of vascular disease relative to the primary neurodegeneration in these subjects, all of whom were diagnosed by clinical movement disorder specialists as having typical PD and not vascular parkinsonism. In contrast to vascular comorbidities, arthritis and osteoporosis were surprisingly low among patients with old-age PD onset. Although we cannot exclude underreporting of these common signs associated with senescence, the data suggest that nonspecific comorbidities affecting dexterity and mobility do not adequately explain the higher motor impairment scores on the UPDRS among patients with old-age PD onset. We specifically corrected our analysis to adjust for comorbidities and still found continued significant differences in UPDRS scores. As hypothesized, less aggressive treatment strategies were used in patients with old-age PD onset. The clinicians preferred monotherapy with levodopa vs a combination with dopamine agonists or the use of agonists alone. The mean dosages of all drugs were similar in both age groups. We recognize that these treatment strategies reflect only one center s approach, but we suggest that they reflect a more generalized reluctance to use complex treatment combinations in the patients with oldage onset. One recent report 19 argued for the safety of dopamine agonists in the elderly population. However, the actual efficacy and safety of various monotherapies and combination therapies are unknown, because very elderly patients are generally excluded from random prospective studies or, if included, are not presented as a separate subgroup. 18 Patient sensitivity to treatment may change with age, and a less robust clinical effect of the immediate levodopa test has been shown in elderly patients with PD. 14,26 Another potential influence on prescribing patterns could also relate to cognitive deficits among elderly patients. Valid data on cognitive impairment and psychiatric symptoms are missing from our report because they were not systematically recorded for all subjects. Consequently, we cannot exclude that such problems, real or expected, influenced the clinicians choice for less aggressive treatment in the patients with old-age onset. On the other hand, it is also possible that patients with old-age onset, without psychiatric symptoms or dementia, who attended a tertiary care center staffed by PD specialists may request assertive, albeit careful, treatment precisely because these physicians are experienced in the field. Others 11 have found that predominant axial impairment can be associated with incident dementia. In this study, we did not systematically monitor the presence and severity of adverse effects of antiparkinsonian drug treatment. The most important adverse effects in the literature are dyskinesias and psychotic signs. Dyskinesias, especially of the dystonic and ballistic types, have frequently been reported in patients with youngonset PD. 14,17 One researcher 17 report that psychotic adverse effects predominate in the elderly patients with PD. Our study design was not longitudinal, and we documented only cross-sectional data on PD signs and treatment. A prospective study with systematic data collection at several times would permit an analysis of the evolution of disability and impairment. 27 However, when designing the present study, we realized that patients with old-age PD onset were not seen as regularly and frequently as patients with middle-age PD onset. We cannot exclude a preselection toward benign cases of parkinsonism among the very old, because the study assessments took place at a tertiary referral center to which patients had to travel. Those patients who travel to a tertiary care center may tend to have fewer comorbidities than those patients with PD remaining in the community for health care. The medical records do not always document educational level or economic standing. Finally, the lack of brain imaging precludes the exclusion of anatomically visible confounding variables, such as diffuse or focal brain atrophy or lacunar infarcts in strategic regions for motricity. Some specific hyperintensities on magnetic resonance imaging scans have been useful for the differentiation of nonparkinsonian gait disturbances in elderly patients: frontal periventricular hyperintensities are sensitive, and parieto-occipital periventricular hyperintensities are specific. 28 A final explanation for the observed differences could relate to the old age of the old-age onset cohort, independent of onset age. It is possible that, regardless of onset age, when PD is superimposed on the very old brain, the outcome is clinically more severe than the impairment seen in middle-aged subjects. To test this hypothesis, we would need control groups composed of old subjects matched for age at the time of data collection but with middle-age onsets. We are in the process of identifying this cohort. While some of these limitations are likely to persist in future studies of this select population, we consider the very elderly population with PD an important focus for research and clinical trials. We encourage further studies analyzing the impact of the frequent comorbidities on the clinical expression of PD and randomized clinical trials to delineate the therapeutic responses of these patients in terms of safety and efficacy and to investigate different dosing schedules. Accepted for publication December 2, Author contributions: Study concept and design (Drs Diederich and Goetz); acquisition of data (Dr Diederich and Ms Chmura); analysis and interpretation of data (Drs 532

5 Diederich, Moore, Leurgans, and Goetz); drafting of the manuscript (Drs Diederich and Goetz and Ms Chmura); critical revision of the manuscript for important intellectual content (Drs Diederich, Moore, Leurgans, and Goetz); statistical expertise (Drs Moore, Leurgans, and Goetz); obtained funding (Dr Diederich); administrative, technical, and material support (Ms Chmura and Dr Goetz); study supervision (Dr Goetz). This study was supported by Fondation Think, Luxembourg, Luxembourg; and the Parkinson Disease Foundation, New York, NY. This study was presented in part at the 126th Annual Meeting of the American Neurological Association, Chicago, Ill, October 1, We thank the following attending physicians from Rush- Presbyterian-St Luke s Medical Center for allowing us to examine their patients: Cynthia L. Comella, MD; Harold L. Klawans, MD (deceased); Katie Kompoliti, MD; Eric Pappert, MD; and Kathleen M. Shannon, MD. Corresponding author and reprints: Nico J. Diederich, MD, Department of Neuroscience, Centre Hospitalier de Luxembourg, 5 Rue Barblé, L-1210 Luxembourg, Luxembourg ( diederich.nico@chl.lu). REFERENCES 1. Kubis N, Faucheux BA, Ransmayr G, et al. Preservation of midbrain catecholaminergic neurons in very old human subjects. Brain. 2000;123: Koller W, O Hara R, Weiner W, et al. Relationship of aging to Parkinson s disease. Adv Neurol. 1986;45: Teravainen H, Forgach L, Hietanen M, Schulzer M, Schoenberg B, Calne DB. The age of onset of Parkinson s disease: etiological implications. Can J Neurol Sci. 1986;13: Tanner CM. Parkinson s disease. In: Gorelick PB, Alter M, eds. Handbook of Neuroepidemiology. New York, NY: Marcel Dekker Inc; 1994: Aevarsson O, Svanborg A, Skoog I. Seven-year survival rate after age 85 years: relation to Alzheimer s disease and vascular dementia. Arch Neurol. 1998;55: Critchley M. The neurology of old age. Lancet. 1931;1: Agid Y, Blin J, Bonnet AM, et al. Does aging contribute to aggravation of Parkinson s disease? In: Calne DB, Comi G, Crippa D, Horowski E, Trabucchi M, eds. Parkinsonism and Aging. New York, NY: Raven Press; 1989: Blin J, Dubois B, Bonnet AM, Vidailhet M, Brandabur M, Agid Y. Does ageing aggravate parkinsonian disability? J Neurol Neurosurg Psychiatry. 1991;54: Wolters EC, Calne DB. Is Parkinson s disease related to aging? In: Calne DB, Comi G, Crippa D, Horowski E, Trabucchi M, eds. Parkinsonism and Aging. New York, NY: Raven Press; 1989: Gibb WRG, Lees A. A comparison of clinical and pathological features of youngand old-onset Parkinson s disease. Neurology. 1988;38: Levy G, Tang MX, Cote LJ, et al. Motor impairment in Parkinson s disease: relationship to incident dementia and age. Neurology. 2000;55: Hughes AJ, Daniel SE, Balnkson S, Lees AJ. A clinicopathological study of 100 cases of Parkinson s disease. Arch Neurol. 1993;50: Petit H, Vermersch P, Pasquier F. Some clinical aspects of late-onset parkinsonism. Clin Neurol Neurosurg. 1992;94(suppl l):s137-s Arevalo GG, Jorge R, Garcia S, Scipioni O, Gershanik O. Clinical and pharmacological differences in early- versus late-onset Parkinson s disease. Mov Disord. 1997;12: Pantelatos A, Fornardi F. Clinical features and medical treatment of Parkinson s disease in patient groups selected in accordance with age at onset. Adv Neurol. 1993;60: Diamond SG, Markham CH, Hoehn MM, McDowell FH, Muenter MD. Effect of age at onset on progression and mortality in Parkinson s disease. Neurology. 1989;39: Friedman A. Old-onset Parkinson s disease compared with young-onset disease: clinical differences and similarities. Acta Neurol Scand. 1994;89: Mitchell SL, Sullivan EA, Lipsitz LA. Exclusion of elderly subjects from clinical trials for Parkinson disease. Arch Neurol. 1997;54: Shulman LM, Minagar A, Rabinstein A, Weiner WJ. The use of dopamine agonists in the very elderly patients with Parkinson s disease. Mov Disord. 2000; 15: Fahn S, Elton R, and members of the UPDRS Development Committee. The Unified Parkinson s Disease Rating Scale. In: Fahn S, Marsden D, Calne B, Goldstein M, eds. Recent Developments in Parkinson Disease. Vol 2. Florham Park, NJ: MacMillan Healthcare Information; 1987: Stokes ME, Davis CS, Koch GG. Categorial Data Analysis Using the SAS System. Cary, NC: SAS Institute Inc; 1995: Brown H, Prescott R. Applied Mixed Models in Medicine. West Sussex, England: John Wiley & Sons Ltd; Breslow NE, Day NE. Statistical Methods in Cancer Research, Vol 1: The Analysis of Case-Control Studies. Lyon, France: International Agency for Research on Cancer; Wong DF, Wagner HN, Dannals RF, et al. Effects of age on dopamine and serotonin receptors measured by positron tomography in the living human brain. Science. 1984;226: Gorell JM, Johnson CC, Rybiccki BA. Parkinson s disease and its comorbid disorders: an analysis of Michigan mortality data, 1970 to Neurology. 1994; 44: Albanese A, Bonuccelli U, Brefel C, et al. Consensus statement on the role of acute dopaminergic challenge in Parkinson s disease. Mov Disord. 2001;16: Louis ED, Tang MX, Cote L, Alfaro B, Mejia H, Marder K. Progression of parkinsonian signs in Parkinson disease. Arch Neurol. 1999;56: Benson RR, Guttmann CRG, Wei X, et al. Older people with impaired mobility have specific loci of periventricular abnormality on MRI. Neurology. 2002;58:

Clinimetrics, clinical profile and prognosis in early Parkinson s disease Post, B.

Clinimetrics, clinical profile and prognosis in early Parkinson s disease Post, B. UvA-DARE (Digital Academic Repository) Clinimetrics, clinical profile and prognosis in early Parkinson s disease Post, B. Link to publication Citation for published version (APA): Post, B. (2009). Clinimetrics,

More information

ORIGINAL CONTRIBUTION. Functional Correlates and Prevalence of Mild Parkinsonian Signs in a Community Population of Older People

ORIGINAL CONTRIBUTION. Functional Correlates and Prevalence of Mild Parkinsonian Signs in a Community Population of Older People ORIGINAL CONTRIBUTION Functional Correlates and Prevalence of Mild Parkinsonian Signs in a Community Population of Older People Elan D. Louis, MS, MD; Ming X. Tang, PhD; Nicole Schupf, PhD; Richard Mayeux,

More information

ORIGINAL CONTRIBUTION

ORIGINAL CONTRIBUTION ORIGINAL CONTRIBUTION Common Misdiagnosis of a Common Neurological Disorder How Are We Misdiagnosing Essential Tremor? Samay Jain, MD; Steven E. Lo, MD; Elan D. Louis, MD, MS Background: As a common neurological

More information

Form B3L: UPDRS Part III Motor Examination 1

Form B3L: UPDRS Part III Motor Examination 1 Initial Visit Packet NACC Uniform Data Set (UDS) LBD MODULE Form B3L: UPDRS Part III Motor Examination 1 ADC name: Subject ID: Form date: / / Visit #: Examiner s initials: INSTRUCTIONS: This form is to

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

Re-Submission. Scottish Medicines Consortium. rasagiline 1mg tablet (Azilect ) (No. 255/06) Lundbeck Ltd / Teva Pharmaceuticals Ltd.

Re-Submission. Scottish Medicines Consortium. rasagiline 1mg tablet (Azilect ) (No. 255/06) Lundbeck Ltd / Teva Pharmaceuticals Ltd. Scottish Medicines Consortium Re-Submission rasagiline 1mg tablet (Azilect ) (No. 255/06) Lundbeck Ltd / Teva Pharmaceuticals Ltd 10 November 2006 The Scottish Medicines Consortium (SMC) has completed

More information

Freezing of gait in patients with advanced Parkinson s disease

Freezing of gait in patients with advanced Parkinson s disease J Neural Transm (2001) 108: 53 61 Freezing of gait in patients with advanced Parkinson s disease N. Giladi, T. A. Treves, E. S. Simon, H. Shabtai, Y. Orlov, B. Kandinov, D. Paleacu, and A. D. Korczyn Movement

More information

Parkinson s Disease. Sirilak yimcharoen

Parkinson s Disease. Sirilak yimcharoen Parkinson s Disease Sirilak yimcharoen EPIDEMIOLOGY ~1% of people over 55 years Age range 35 85 years peak age of onset is in the early 60s ~5% of cases characterized by an earlier age of onset (typically

More information

Clinical Features and Treatment of Parkinson s Disease

Clinical Features and Treatment of Parkinson s Disease Clinical Features and Treatment of Parkinson s Disease Richard Camicioli, MD, FRCPC Cognitive and Movement Disorders Department of Medicine University of Alberta 1 Objectives To review the diagnosis and

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

NIH Public Access Author Manuscript Mov Disord. Author manuscript; available in PMC 2009 May 18.

NIH Public Access Author Manuscript Mov Disord. Author manuscript; available in PMC 2009 May 18. NIH Public Access Author Manuscript Published in final edited form as: Mov Disord. 2008 August 15; 23(11): 1602 1605. doi:10.1002/mds.22161. Emergence of Parkinsons Disease in Essential Tremor: A Study

More information

The Use of Amantadine HCL in Clinical Practice: A Study of Old and New Indications

The Use of Amantadine HCL in Clinical Practice: A Study of Old and New Indications The Use of Amantadine HCL in Clinical Practice: A Study of Old and New Indications Carlos Singer, MD* Spiridon Papapetropoulos, MD, PhD* Gadith Uzcategui, BA Lydia Vela, MD * Department of Neurology, University

More information

Combined Effect of Age and Severity on the Risk of Dementia in Parkinson s Disease

Combined Effect of Age and Severity on the Risk of Dementia in Parkinson s Disease Combined Effect of Age and Severity on the Risk of Dementia in Parkinson s Disease Gilberto Levy, MD, 1 Nicole Schupf, PhD, 1 3 Ming-Xin Tang, PhD, 1,2,4 Lucien J. Cote, MD, 5 Elan D. Louis, MD, MS, 1,5

More information

What is the best medical therapy for early Parkinson's disease? Medications Commonly Used for Parkinson's Disease

What is the best medical therapy for early Parkinson's disease? Medications Commonly Used for Parkinson's Disease FPIN's Clinical Inquiries Treatment of Early Parkinson's Disease Clinical Question What is the best medical therapy for early Parkinson's disease? Evidence-Based Answer Treatment of early Parkinson's disease

More information

ORIGINAL CONTRIBUTION. History of Vascular Disease and Mild Parkinsonian Signs in Community-Dwelling Elderly Individuals

ORIGINAL CONTRIBUTION. History of Vascular Disease and Mild Parkinsonian Signs in Community-Dwelling Elderly Individuals ORIGINAL CONTRIBUTION History of Vascular Disease and Mild Parkinsonian Signs in Community-Dwelling Elderly Individuals Elan D. Louis, MD, MS; Jose A. Luchsinger, MD, MPH Background: Mild parkinsonian

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

Switching from pergolide to pramipexole in patients with Parkinson s disease

Switching from pergolide to pramipexole in patients with Parkinson s disease J Neural Transm (2001) Switching 108: 63 70 from pergolide to pramipexole in PD 63 Switching from pergolide to pramipexole in patients with Parkinson s disease P. A. Hanna 1,2, L. Ratkos 2, W. G. Ondo

More information

P athological examination of the brains of patients with a

P athological examination of the brains of patients with a PAPER How valid is the clinical diagnosis of Parkinson s in the community? A Schrag, Y Ben-Shlomo, N Quinn... See end of article for authors affiliations... Correspondence to: Professor N P Quinn, Sobell

More information

The Effect of Pramipexole on Depressive Symptoms in Parkinson's Disease.

The Effect of Pramipexole on Depressive Symptoms in Parkinson's Disease. Kobe J. Med. Sci., Vol. 56, No. 5, pp. E214-E219, 2010 The Effect of Pramipexole on Depressive Symptoms in Parkinson's Disease. NAOKO YASUI 1, KENJI SEKIGUCHI 1, HIROTOSHI HAMAGUCHI 1, and FUMIO KANDA

More information

Does Resistance Training Improve Mobility in Patients with Parkinson s Disease?

Does Resistance Training Improve Mobility in Patients with Parkinson s Disease? Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2016 Does Resistance Training Improve Mobility

More information

Continuous dopaminergic stimulation

Continuous dopaminergic stimulation Continuous dopaminergic stimulation Angelo Antonini Milan, Italy GPSRC CNS 172 173 0709 RTG 1 As PD progresses patient mobility becomes increasingly dependent on bioavailability of peripheral levodopa

More information

The Shaking Palsy of 1817

The Shaking Palsy of 1817 The Shaking Palsy of 1817 A Treatment Update on Parkinson s Disease Dr Eitzaz Sadiq Neurologist CH Baragwanath Acadamic Hospital Parkinson s Disease O Premature death of dopaminergic neurons O Symptoms

More information

PUBLIC HEALTH RESEARCH

PUBLIC HEALTH RESEARCH PUBLIC HEALTH RESEARCH Prevalence and Correlates of Parkinson s Disease among Elderly Patients Attending Neurology Clinic at Serdang Hospital in 2016 Minhat Halimatus Sakdiah 1 *, Liyana Najwa Inche Mat

More information

PARKINSON S DISEASE. Nigrostriatal Dopaminergic Neurons 5/11/16 CARDINAL FEATURES OF PARKINSON S DISEASE. Parkinson s disease

PARKINSON S DISEASE. Nigrostriatal Dopaminergic Neurons 5/11/16 CARDINAL FEATURES OF PARKINSON S DISEASE. Parkinson s disease 5/11/16 PARKINSON S DISEASE Parkinson s disease Prevalence increases with age (starts 40s60s) Seen in all ethnic groups, M:F about 1.5:1 Second most common neurodegenerative disease Genetics role greater

More information

Rasagiline and Rapid Symptomatic Motor Effect in Parkinson s Disease: Review of Literature

Rasagiline and Rapid Symptomatic Motor Effect in Parkinson s Disease: Review of Literature Neurol Ther (2014) 3:41 66 DOI 10.1007/s40120-013-0014-1 REVIEW Rasagiline and Rapid Symptomatic Motor Effect in Parkinson s Disease: Review of Literature Michele Pistacchi Francesco Martinello Manuela

More information

A major aim in the management of advanced Parkinson s

A major aim in the management of advanced Parkinson s 396 PAPER Use and interpretation of on/off diaries in Parkinson s disease J Reimer, M Grabowski, O Lindvall, P Hagell... See end of article for authors affiliations... Correspondence to: Peter Hagell,

More information

Keywords: deep brain stimulation; subthalamic nucleus, subjective visual vertical, adverse reaction

Keywords: deep brain stimulation; subthalamic nucleus, subjective visual vertical, adverse reaction Re: Cost effectiveness of rasagiline and pramipexole as treatment strategies in early Parkinson's disease in the UK setting: an economic Markov model evaluation Norbert Kovacs 1*, Jozsef Janszky 1, Ferenc

More information

TRANSPARENCY COMMITTEE OPINION. 18 March 2009

TRANSPARENCY COMMITTEE OPINION. 18 March 2009 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 18 March 2009 REQUIP LP 2 mg extended-release tablet Box of 21 tablets (CIP: 379 214-8) Box of 28 tablets (CIP: 379

More information

Safinamide: un farmaco innovativo con un duplice meccanismo d azione

Safinamide: un farmaco innovativo con un duplice meccanismo d azione Safinamide: un farmaco innovativo con un duplice meccanismo d azione AINAT Sardegna Cagliari, 26 novembre 2016 Carlo Cattaneo Corporate Medical Advisor CNS & Rare Diseases Reichmann H. et al., European

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

Prior Authorization with Quantity Limit Program Summary

Prior Authorization with Quantity Limit Program Summary Gocovri (amantadine) Prior Authorization with Quantity Limit Program Summary This prior authorization applies to Commercial, NetResults A series, SourceRx and Health Insurance Marketplace formularies.

More information

Drug Therapy of Parkinsonism. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia

Drug Therapy of Parkinsonism. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Drug Therapy of Parkinsonism Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Parkinsonism is a progressive neurological disorder of muscle movement, usually

More information

The Direct Cost of Parkinson Disease at Juntendo Medical University Hospital, Japan

The Direct Cost of Parkinson Disease at Juntendo Medical University Hospital, Japan ORIGINAL ARTICLE The Direct Cost of Parkinson Disease at Juntendo Medical University Hospital, Japan Asako Yoritaka 1,2, Jiro Fukae 3, Taku Hatano 2,EiseiOda 4 and Nobutaka Hattori 2 Abstract Objective

More information

What contributes to quality of life in patients with Parkinson s disease?

What contributes to quality of life in patients with Parkinson s disease? 308 Department of Neurology, Institute of Neurology, Queen Square, London WC1N 3BG, UK A Schrag M Jahanshahi N Quinn Correspondence to: Professor NP Quinn n.quinn@ion.ucl.ac.uk Received 2 Sepyember 1999

More information

Parkinsons Disease & Movement Disorder Aug 11-13, Frankfurt l Dr. Geeta Shroff

Parkinsons Disease & Movement Disorder Aug 11-13, Frankfurt l Dr. Geeta Shroff USE OF HUMAN EMBRYONIC STEM CELLS IN THE TREATMENT OF PARKINSON S DISEASE Dr. Geeta Shroff Founder and Medical Director, Nutech Mediworld CONDITIONS TREATED Spinal Cord Injury Cell Culture Technology Diabetes

More information

Scottish Medicines Consortium

Scottish Medicines Consortium Scottish Medicines Consortium rotigotine 2mg/24 hours, 4mg/24 hours, 6mg/24 hours, 8mg/24 hours transdermal patch (Neupro ) (No: 289/06) Schwarz Pharma Ltd. 7 July 2006 The Scottish Medicines Consortium

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

Original Articles. Calne, resting tremor. Mortimer, Pirozzolo, Hansch, & Webster, postural disturbance III

Original Articles. Calne, resting tremor. Mortimer, Pirozzolo, Hansch, & Webster, postural disturbance III 2004 97-106 Original Articles 1 2 3 1 1 2 3 47 22 III I II muscular rigidity postural disturbance resting tremor bradykinesia Calne, 2001 Mortimer, Pirozzolo, Hansch, & Webster, 1982 Tel: 02-23627076 E-mail:

More information

idiopathic Parkinson s disease was:

idiopathic Parkinson s disease was: 590 Department of Neurology, City Hospital NHS Trust, Dudley Road, Birmingham B18 7QH, UK, and Division of Neuroscience, University of Birmingham, Edgbaston, Birmingham B15 2TH, UK C E Clarke School of

More information

A survey of impulse control disorders in Parkinson s disease patients in Shanghai area and literature review

A survey of impulse control disorders in Parkinson s disease patients in Shanghai area and literature review Wang et al. Translational Neurodegeneration (2016) 5:4 DOI 10.1186/s40035-016-0051-7 RESEARCH Open Access A survey of impulse control disorders in Parkinson s disease patients in Shanghai area and literature

More information

Dr Barry Snow. Neurologist Auckland District Health Board

Dr Barry Snow. Neurologist Auckland District Health Board Dr Barry Snow Neurologist Auckland District Health Board Dystonia and Parkinson s disease Barry Snow Gowers 1888: Tetanoid chorea Dystonia a movement disorder characterized by sustained or intermittent

More information

Measuring symptom change in patients with Parkinson s disease

Measuring symptom change in patients with Parkinson s disease Age and Ageing 2000; 29: 41 45 2000, British Geriatrics Society Measuring symptom change in patients with Parkinson s disease JOHN E. HARRISON, SARAH PRESTON 1,STAVIA B. BLUNT 1 CeNeS Ltd, Compass House,

More information

Best Medical Treatments for Parkinson s disease

Best Medical Treatments for Parkinson s disease Best Medical Treatments for Parkinson s disease Bernadette Schöneburg, M.D. June 20 th, 2015 What is Parkinson s Disease (PD)? Progressive neurologic disorder that results from the loss of specific cells

More information

Understanding Parkinson s Disease Important information for you and your loved ones

Understanding Parkinson s Disease Important information for you and your loved ones Patient Education Understanding Parkinson s Disease Important information for you and your loved ones This handout explains the signs, symptoms, and possible treatments of Parkinson s disease. Parkinson

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Dopamine Transporter Imaging with Single Photon Emission File Name: Origination: Last CAP Review: Next CAP Review: Last Review: dopamine_transporter_imaging_with_single_photon_emission_computed_tomography

More information

10/13/2017. Disclosures. Deep Brain Stimulation in the Treatment of Movement Disorders. Deep Brain Stimulation: Objectives.

10/13/2017. Disclosures. Deep Brain Stimulation in the Treatment of Movement Disorders. Deep Brain Stimulation: Objectives. Deep Brain Stimulation in the Treatment of Movement Disorders Disclosures None Eleanor K Orehek, M.D. Movement Disorders Specialist Noran Neurological Clinic 1 2 Objectives To provide an overview of deep

More information

Unified Parkinson Disease Rating Scale (UPDRS)

Unified Parkinson Disease Rating Scale (UPDRS) Unified Parkinson Disease Rating Scale (UPDRS) The UPDRS is a rating tool to follow the longitudinal course of Parkinson's Disease. It is made up of the 1)Mentation, Behavior, and Mood, 2)ADL and 3)Motor

More information

Anticholinergics. COMT* Inhibitors. Dopaminergic Agents. Dopamine Agonists. Combination Product

Anticholinergics. COMT* Inhibitors. Dopaminergic Agents. Dopamine Agonists. Combination Product Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-945-5220 Fax 503-947-1119 Class Update: Parkinson s Drugs Month/Year of Review:

More information

Neuropsychiatric Symptoms of Patients With Progressive Supranuclear Palsy and Parkinson s Disease

Neuropsychiatric Symptoms of Patients With Progressive Supranuclear Palsy and Parkinson s Disease Neuropsychiatric Symptoms of Patients With Progressive Supranuclear Palsy and Parkinson s Disease Dag Aarsland, M.D., Ph.D. Irene Litvan, M.D. Jan P. Larsen, M.D., Ph.D. Neuropsychiatric symptoms are common

More information

Parkinson's Disease KP Update

Parkinson's Disease KP Update Parkinson's Disease KP Update Andrew Imbus, PA-C Neurology, Movement Disorders Kaiser Permanente, Los Angeles Medical Center No disclosures "I often say now I don't have any choice whether or not I have

More information

BORDEAUX MDS WINTER SCHOOL FOR YOUNG

BORDEAUX MDS WINTER SCHOOL FOR YOUNG BORDEAUX MDS WINTER SCHOOL FOR YOUNG NEUROLOGISTS INFUSION THERAPIES IN PARKINSON S DISEASE Apomorphine, T. Henriksen Tove Henriksen, MD MDS Clinic University Hospital of Bispebjerg, Copenhagen MOTOR FLUCTUATIONS

More information

Parkinson s Disease. Gillian Sare

Parkinson s Disease. Gillian Sare Parkinson s Disease Gillian Sare Outline Reminder about PD Parkinson s disease in the inpatient Surgical patients with PD Patients who cannot swallow End of life care Parkinson s disease PD is the second

More information

Motor Fluctuations in Parkinson s Disease

Motor Fluctuations in Parkinson s Disease Motor Fluctuations in Parkinson s Disease Saeed Bohlega, MD, FRCPC Senior Distinguished Consultant Department of Neurosciences King Faisal Specialist Hospital & Research Centre Outline Type of fluctuations

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

05-Nov-15. Impact of Parkinson s Disease in Australia. The Nature of Parkinson s disease 21st Century

05-Nov-15. Impact of Parkinson s Disease in Australia. The Nature of Parkinson s disease 21st Century Peter Silburn Professor Clinical Neuroscience University of Queensland Queensland Brain Institute Neurosciences Queensland Impact of in Australia Second most common neurodegenerative disorder Up to 64,000

More information

The Need for Levodopa as an End Point of Parkinson's Disease Progression in a Clinical Trial of Selegiline and a-tocopherol

The Need for Levodopa as an End Point of Parkinson's Disease Progression in a Clinical Trial of Selegiline and a-tocopherol Mowmetir 1hsor.der.s Vol. 12, No. 2, 1997, pp. 183-189 0 1997 Movement Disorder Society The Need for Levodopa as an End Point of Parkinson's Disease Progression in a Clinical Trial of Selegiline and a-tocopherol

More information

ORIGINAL CONTRIBUTION

ORIGINAL CONTRIBUTION Dystonia-Predominant Adult-Onset Huntington Disease Association Between Motor Phenotype and Age of Onset in Adults ORIGINAL CONTRIBUTION Elan D. Louis, MD, MS; Karen E. Anderson, MD; Carol Moskowitz, RN;

More information

Rotigotine patches (Neupro) in early Parkinson s disease Edited by AdRes Health Economics & Outcomes Research

Rotigotine patches (Neupro) in early Parkinson s disease Edited by AdRes Health Economics & Outcomes Research Rotigotine patches (Neupro) in early Parkinson s disease Edited by AdRes Health Economics & Outcomes Research Synthetic DRUG PROFILE Introduction Parkinson s disease (PD) is a neurodegenerative disorder

More information

Parkinson s disease Therapeutic strategies. Surat Tanprawate, MD Division of Neurology University of Chiang Mai

Parkinson s disease Therapeutic strategies. Surat Tanprawate, MD Division of Neurology University of Chiang Mai Parkinson s disease Therapeutic strategies Surat Tanprawate, MD Division of Neurology University of Chiang Mai 1 Scope Modality of treatment Pathophysiology of PD and dopamine metabolism Drugs Are there

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

Influence of moderate intensity exercise on Levodopa bioavailability in Parkinsonian patients

Influence of moderate intensity exercise on Levodopa bioavailability in Parkinsonian patients Ahmed Talaat Al-Ghoneimy et al. Influence of moderate intensity exercise on Levodopa bioavailability in Parkinsonian patients Ahmed Talaat Al-Ghoneimy 1, Nabil Bahrawy 2, Hatem Samir 1, Mohammed El-Sayed

More information

Nature, prevalence and clinical significance. Barcelona, Spain

Nature, prevalence and clinical significance. Barcelona, Spain Nature, prevalence and clinical significance Jaime Kulisevsky Barcelona, Spain 1 Non motor (neuropsychiatric) symptoms are an integral part of Parkinson s s disease (PD) Affective disorders And are associated

More information

Pharmacologic Treatment of Parkinson s Disease. Nicholas J. Silvestri, M.D. Assistant Professor of Neurology

Pharmacologic Treatment of Parkinson s Disease. Nicholas J. Silvestri, M.D. Assistant Professor of Neurology + Pharmacologic Treatment of Parkinson s Disease Nicholas J. Silvestri, M.D. Assistant Professor of Neurology + Overview n Brief review of Parkinson s disease (PD) n Clinical manifestations n Pathophysiology

More information

Movement Disorders: A Brief Overview

Movement Disorders: A Brief Overview Movement Disorders: A Brief Overview Albert Hung, MD, PhD Massachusetts General Hospital Harvard Medical School August 17, 2006 Cardinal Features of Parkinsonism Tremor Rigidity Bradykinesia Postural imbalance

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

parts of the gastrointenstinal tract. At the end of April 2008, it was temporarily withdrawn from the US Market because of problems related to

parts of the gastrointenstinal tract. At the end of April 2008, it was temporarily withdrawn from the US Market because of problems related to parts of the gastrointenstinal tract. At the end of April 2008, it was temporarily withdrawn from the US Market because of problems related to crystallization of the drug, which caused unreliable drug

More information

New Medicines Committee Briefing July 2011

New Medicines Committee Briefing July 2011 New Medicines Committee Briefing July 2011 Pramipexole immediate-release (Mirapexin ) and Pramipexole modifiedrelease (Mirapexin prolonged release) for the treatment of Parkinson s Disease Pramipexole

More information

Chapter 8. Parkinsonism. M.G.Rajanandh, Dept. of Pharmacy Practice, SRM College of Pharmacy, SRM University.

Chapter 8. Parkinsonism. M.G.Rajanandh, Dept. of Pharmacy Practice, SRM College of Pharmacy, SRM University. Chapter 8 Parkinsonism M.G.Rajanandh, Dept. of Pharmacy Practice, SRM College of Pharmacy, SRM University. Definition of Parkinson s Disease Parkinson's disease is a progressive, neurodegenerative disease

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

MAXIMIZING FUNCTION IN PARKINSON S DISEASE

MAXIMIZING FUNCTION IN PARKINSON S DISEASE 1 MAXIMIZING FUNCTION IN PARKINSON S DISEASE September 13, 2016 End Falls This Falls Conference Jan Goldstein Elman One Step Ahead Mobility Toronto, Ontario Outline An overview of Parkinson s disease (PD):

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

BORDEAUX MDS WINTER SCHOOL FOR YOUNG

BORDEAUX MDS WINTER SCHOOL FOR YOUNG BORDEAUX MDS WINTER SCHOOL FOR YOUNG NEUROLOGISTS HOW TO EVALUATE MOTOR COMPLICATIONS IN PARKINSON'S DISEASE T. Henriksen Tove Henriksen, MD MDS Clinic University Hospital of Bispebjerg, Copenhagen MOTOR

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

History Parkinson`s disease. Parkinson's disease was first formally described in 1817 by a London physician named James Parkinson

History Parkinson`s disease. Parkinson's disease was first formally described in 1817 by a London physician named James Parkinson Parkinsonismm History Parkinson`s disease Parkinson's disease was first formally described in 1817 by a London physician named James Parkinson Definition : Parkinsonism: Parkinsonism is a progressive neurological

More information

Drugs Affecting the Central Nervous System

Drugs Affecting the Central Nervous System Asst Prof Inam S Arif isamalhaj@yahoo.com Drugs Affecting the Central Nervous System Ass Efferent neurons in ANS Neurodegenerative Diseases Parkinson s Disease Multiple Sclerosis Alzheimer s Disease

More information

Patient selection for surgery: Parkinson s disease

Patient selection for surgery: Parkinson s disease Patient selection for surgery: Parkinson s disease Dr. María C. Rodríguez-Oroz Neurology and Neuroscience. University Hospital Donostia, Research Institute BioDonostia, Ikerbasque Senior Researcher San

More information

Report on New Patented Drugs Azilect

Report on New Patented Drugs Azilect Report on New Patented Drugs Azilect Under its transparency initiative, the PMPRB publishes the results of the reviews of new patented drugs by Board Staff, for purposes of applying the Board s Excessive

More information

Can Tango Help Improve Quality of Life for Patients with Parkinson s Disease?

Can Tango Help Improve Quality of Life for Patients with Parkinson s Disease? Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2018 Can Tango Help Improve Quality of Life

More information

Objectives. Emerging Treatments in Parkinson s s Disease. Pathology. As Parkinson s progresses it eventually affects large portions of the brain.

Objectives. Emerging Treatments in Parkinson s s Disease. Pathology. As Parkinson s progresses it eventually affects large portions of the brain. Objectives Emerging Treatments in Parkinson s s Disease 1) Describe recent developments in the therapies for Parkinson s Disease Jeff Kraakevik MD Assistant Professor OHSU/Portland VAMC Parkinson s Center

More information

Deep Brain Stimulation: Patient selection

Deep Brain Stimulation: Patient selection Deep Brain Stimulation: Patient selection Halim Fadil, MD Movement Disorders Neurologist Kane Hall Barry Neurology Bedford/Keller, TX 1991: Thalamic (Vim) DBS for tremor Benabid AL, et al. Lancet. 1991;337(8738):403-406.

More information

SIGNS of parkinsonism 1-3 are frequently found on neurologic

SIGNS of parkinsonism 1-3 are frequently found on neurologic Vol. 334 No. 2 PARKINSONIAN SIGNS AND ASSOCIATED MORTALITY IN OLDER PEOPLE 71 PREVALENCE OF PARKINSONIAN SIGNS AND ASSOCIATED MORTALITY IN A COMMUNITY POPULATION OF OLDER PEOPLE DAVID A. BENNETT, M.D.,

More information

Drugs used in Parkinsonism

Drugs used in Parkinsonism Drugs used in Parkinsonism قادة فريق علم األدوية : لي التميمي & عبدالرحمن ذكري الشكر موصول ألعضاء الفريق املتميزين : جومانة القحطاني ندى الصومالي روان سعد القحطاني pharma436@outlook.com @pharma436 Your

More information

European Commission approves ONGENTYS (opicapone) a novel treatment for Parkinson s disease patients with motor fluctuations

European Commission approves ONGENTYS (opicapone) a novel treatment for Parkinson s disease patients with motor fluctuations July 6, 2016 European Commission approves ONGENTYS (opicapone) a novel treatment for Parkinson s disease patients with motor fluctuations Porto, 5 July 2016 BIAL announced that the medicinal product ONGENTYS

More information

Basal ganglia motor circuit

Basal ganglia motor circuit Parkinson s Disease Basal ganglia motor circuit 1 Direct pathway (gas pedal) 2 Indirect pathway (brake) To release or augment the tonic inhibition of GPi on thalamus Direct pathway There is a tonic inhibition

More information

Pathogenesis of Degenerative Diseases and Dementias. D r. Ali Eltayb ( U. of Omdurman. I ). M. Path (U. of Alexandria)

Pathogenesis of Degenerative Diseases and Dementias. D r. Ali Eltayb ( U. of Omdurman. I ). M. Path (U. of Alexandria) Pathogenesis of Degenerative Diseases and Dementias D r. Ali Eltayb ( U. of Omdurman. I ). M. Path (U. of Alexandria) Dementias Defined: as the development of memory impairment and other cognitive deficits

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

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

years; baseline off-state Unified Parkinson s Disease Rating Scale (UPDRS) motor ratings 24.6 ± 6.8).

years; baseline off-state Unified Parkinson s Disease Rating Scale (UPDRS) motor ratings 24.6 ± 6.8). Jourdain et al. 1 Supplemental Data Supplemental Methods Subjects We studied 28 PD subjects (20 men and 8 women; age 61.0 ± 9.6 (mean ± SD) years; duration 8.7 ± 9.6 years; baseline off-state Unified Parkinson

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

Pharmacologic Treatment of Parkinson s Disease. Nicholas J. Silvestri, M.D. Associate Professor of Neurology

Pharmacologic Treatment of Parkinson s Disease. Nicholas J. Silvestri, M.D. Associate Professor of Neurology + Pharmacologic Treatment of Parkinson s Disease Nicholas J. Silvestri, M.D. Associate Professor of Neurology + Disclosures n NO SIGNIFICANT FINANCIAL, GENERAL, OR OBLIGATION INTERESTS TO REPORT + Learning

More information

Clinical Trial Results Posting

Clinical Trial Results Posting RD..3.2 V1. Page/Seite 1 of/von 5 CT Registry ID#: NCT2428 (ClinicalTrials.gov Identifier number) These results are supplied for informational purposes only. Prescribing decisions should be made based

More information

Precise evaluation of motor and non-motor dysfunction in Parkinson s disease using the KINARM

Precise evaluation of motor and non-motor dysfunction in Parkinson s disease using the KINARM Precise evaluation of motor and non-motor dysfunction in Parkinson s disease using the KINARM Project lead: Dr. Ron Levy Pauline Gaprielian, Dr. Stephen H. Scott, Dr. Giovanna Pari Queen s University,

More information

Clinimetrics, clinical profile and prognosis in early Parkinson s disease Post, B.

Clinimetrics, clinical profile and prognosis in early Parkinson s disease Post, B. UvA-DARE (Digital Academic Repository) Clinimetrics, clinical profile and prognosis in early Parkinson s disease Post, B. Link to publication Citation for published version (APA): Post, B. (2009). Clinimetrics,

More information

Views and Reviews. [ 123 I]FP-CIT (DaTscan) SPECT Brain Imaging in Patients with Suspected Parkinsonian Syndromes ABSTRACT

Views and Reviews. [ 123 I]FP-CIT (DaTscan) SPECT Brain Imaging in Patients with Suspected Parkinsonian Syndromes ABSTRACT Views and Reviews [ 123 I]FP-CIT (DaTscan) SPECT Brain Imaging in Patients with Suspected Parkinsonian Syndromes Robert A. Hauser, MD, Donald G. Grosset, MD From the Departments of Neurology, Molecular

More information

Deep Brain Stimulation: Indications and Ethical Applications

Deep Brain Stimulation: Indications and Ethical Applications Deep Brain Stimulation Overview Kara D. Beasley, DO, MBe, FACOS Boulder Neurosurgical and Spine Associates (303) 562-1372 Deep Brain Stimulation: Indications and Ethical Applications Instrument of Change

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

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

Karen Tu MD, MSc, CCFP, FCFP Scientist ICES Associate Professor DFCM, University of Toronto Active Staff Toronto Western Hospital FHT

Karen Tu MD, MSc, CCFP, FCFP Scientist ICES Associate Professor DFCM, University of Toronto Active Staff Toronto Western Hospital FHT Validation of administrative data algorithms to determine population prevalence and incidence of Alzheimer's disease, dementia, MS, epilepsy and Parkinson's disease Karen Tu MD, MSc, CCFP, FCFP Scientist

More information

Weight loss in the early stage of progressive supranuclear palsy

Weight loss in the early stage of progressive supranuclear palsy Received: 28 May 2016 Revised: 31 October 2016 Accepted: 2 November 2016 DOI: 10.1002/brb3.616 ORIGINAL RESEARCH Weight loss in the early stage of progressive supranuclear palsy Ayako Tsuge 1 Satoshi Kaneko

More information