Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030567 (Parkinson's disease)
 63,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although most parkinsonian patients greatly benefit from medical and/or surgical treatment, their clinical management should not be limited to these two interventions. Axial symptoms, freezing, postural instability, speech and swallowing problems may be drug-resistant, and disability may persist in spite of improvement of motor symptoms. A coordinate interdisciplinary approach facilitates the clinical management of the disease. Physiotherapy, occupational therapy and speech therapy may contribute to reduce impairment and improve quality of life; a psychological and social support of patients and caregivers helps them carrying the burden of the disease; counseling through a specialized nurse may give practical solutions to problems like bladder incontinence, symptomatic hypotension or hypersalivation. As sensory cueing may help patients bypassing the disease-specific motor control deficits, it should be included in training programs. Rehabilitatory interventions are part of the standards of care of Parkinson's disease and their efficacy is supported by several neurophysiological and clinical investigations. However, the poor methodological quality of most clinical studies as compared with the standard of pharmacological investigations fails to provide clear-cut evidence in favour of rehabilitation.
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PMID:[Rehabilitation of parkinsonian patients]. 1722 22

Neurogenic bladder leading to urinary incontinence has been described in patients of stroke, dementia, Parkinson's disease, and some schizophrenia cases with cognitive impairment possibly due to impaired cortical inhibition of the urinary bladder. The underlying brain abnormalities for urinary incontinence are similar in such cases. We report here such a case of neurogenic bladder responding to treatment with clozapine. The possible mechanism of action and clinical implications are described.
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PMID:Clozapine for the treatment of neurogenic bladder. 1724 73

The aim of this study was to investigate the association between depression and clinical illness among a group of elderly in the city of Salvador, Bahia, Brazil. The study population included 1,120 individuals over 60 years of age treated at a geriatric outpatient clinic. Crude and stratified prevalence ratios were calculated. Data were stratified by gender, age, and nutritional status. Ninety-five percent of the sample presented at least one chronic disease, the most frequent being hypertension (62.2%), osteoarthritis (40%), and urinary incontinence (35%). Depression was diagnosed in 23.4%, more commonly among women (PR = 1.28; 95%CI: 0.99-1.65) and those under 75 years (PR = 1.24; 95%CI: 1.00-1.53). There was an association between number of chronic diseases (> 3) and depression (PR = 1.31; 95%CI: 1.04-1.66). Parkinson's disease was associated with depression, more evident among females (PR = 1.59; 95%CI: 1.05-2.41) and in the 70-79-year age group (PR = 2.02; 95%CI: 1.28-3.20). The study demonstrates an association between depression and chronic comorbidity. Since many elderly present multiple chronic diseases, health professionals should be alert to the possibility of depressive symptoms in these patients.
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PMID:[Depression and clinical illness: comorbidity in a geriatric outpatient clinic]. 1733 82

Idiopathic normal pressure hydrocephalus (INPH) is characterized by a classic triad of symptoms including dementia, urinary incontinence, and gait disturbance. INPH is clinically diagnosed in most patients during the sixth or seventh decade of life. Many older adults are incorrectly diagnosed with disorders such as Parkinson's disease and dementia when their symptoms are actually caused by INPH. As life expectancy increases, the necessity of accurately diagnosing and effectively treating these affected individuals will become more challenging. The diagnosis of INPH is challenging and requires a combination of clinical signs and symptoms, radiographic findings, and diagnostic testing. The purpose of evaluation and testing of individuals with suspected INPH is to determine if surgical implantation of a ventriculoperitoneal (VP) shunt will be beneficial. VP shunting is now a common neurosurgical procedure, but it is one associated with risks and complications, which makes evaluation of "shunt-responsiveness" essential.
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PMID:Diagnosis and treatment of idiopathic normal pressure hydrocephalus. 1747 25

We have made a questionnaire survey on an enuresis rate among old males living in Vilnus. Using questionnaires on enuresis, MMSE-30 test and GDS-15, we have examined a random sample of 294 males aged 75 to 95 years and older from January 2003 to December 2004. Enuresis was diagnosed in 26.5% of them. In age groups 75-79, 80-84, 85-89, 90-94, 95 years and older enuresis symptoms occurred in 32.8, 24.0, 12.2, 36.4, 9.1% males, respectively. Only 58.4% males with enuresis sought medical advice. Most of the patients suffered from enuresis for 1 to 5 years. The type of incontinence was stated according to international criteria of ICS (2002). The incontinence was urgent in 66.2% and stress in 3.9%. Only 13.0% males used hygienic protectors. The following risk factors were revealed: intake of alpha-adrenoblockers (OR = 3.89, 95% CI = 1.98-7.67), depression (OR = 2.51, 95% CI = 1.13-5.55). The risk to develop continuous incontinence grows in the presence of Parkinson's disease (OR = 3.50; 95% CI = 1.01-12.23), prostatic adenoma (OR = 5.29; 95% CL = 2.91-9.65). The responders believe that their incontinence is due to combination of factors: 2-3 factors were pointed by 36.4%, 4-5 factors--20.8%, 6 and more--by 22.0%.
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PMID:[Prevalence of enuresis in old males according to questionnaire data]. 1757 96

Lower urinary tract dysfunction is frequent in Parkinson's disease and other Parkinsonian syndromes and can cause urinary incontinence complicating a urgency-frequency syndrome or on the contrary, dysuria. These disorders are a frequent urological presenting complaint due to their impact on the patient's quality of life. Urologists must be aware of the different natural histories of diseases such as Parkinson's disease and Parkinsonian syndromes such as multisystem atrophy, which often have a severe course and are marked by resistance to neuropharmacological treatments. These various diseases can also directly induce urinary symptoms, independently of urological complications. Inversely, the development of urinary disorders, especially obstructive symptoms, in a patient with Parkinsonian syndrome may require review of the neurological diagnosis. Finally, therapeutic management is complex due to the difficulty of using pharmacological treatments, and the risk of deterioration after surgical treatment of obstructive uropathy.
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PMID:[Lower urinary tract dysfunction and parkinsonian syndromes]. 1762 65

This report describes the case of an elderly physician who endured a slowly progressive, ambulatory illness, which was erroneously diagnosed as Parkinson's disease. After ten years of progressive illness the correct diagnosis of normal pressure hydrocephalus (NPH) was finally made, revealing itself, by accident, through incontinence and mild dementia. The patient-physician enjoyed an instantaneous remission induced by a large lumbar puncture (LP) sustained by a ventriculosystemic shunt. The patient-physician dedicated his renewed life to informing the medical profession about this dramatic syndrome, which he believes is more common and more reversible than generally thought. Although the patient had been virtually restored to normal, a series of complications typical of ventriculosystemic shunting (VSS) occurred, including significant hearing loss and subdural haematoma (SDH). The patient feels, however, that his clinical improvement far outweighs the complications and that every patient with NPH should have the opportunity to decide whether or not to have a VSS.
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PMID:Normal pressure hydrocephalus: a case report by a physician who is the patient. 1788 83

According to the diagnostic consensus criteria [1] akinesia, rigidity and tremor as well as primitive reflexes and incontinence support the diagnosis of fronto-temporal dementia (FTD). However, the prevalence of extrapyramidal signs (EPMS), primitive reflexes and incontinence in FTD has not yet been systematically studied. In the present study, thirty-one patients with mild or moderate FTD without previous or present antipsychotic medication underwent a detailed neurological exam including the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). The average total score on the motor subscale of the UPDRS was 14.0 points. Akinesia and Parkinsonian gait or posture were found frequently but were mild in most instances. Rigidity was found in 36% of the patients. Resting tremor was a rare symptom. The only primitive reflex that occurred was a positive palmomental that was found in 7% of the patients. Urinary incontinence was present in 26%. The results have to be confirmed with larger or pooled patient samples from different ascertainment scenarios. If the results of the present study can be replicated, a revision of the consensus criteria from 1998 might be considered.
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PMID:Extrapyramidal signs, primitive reflexes and incontinence in fronto-temporal dementia. 1766 5

We analysed non-motor symptoms (NMS) related to autonomic dysfunction in 3414 patients with Parkinson's disease (PD) enrolled in the multicentre registry of the German Competence Network on PD. Orthostatic hypotension (> 20 mmHg systolic or > 10 mmHg diastolic) was reported for 10% of women and 11% of men, urinary incontinence for 22% of women and 21% of men, sexual dysfunction for 8% of women and 30% of men (50% of whom reported erectile dysfunction) and sleep disturbances for 43% of women and 35% of men. Autonomic symptoms occurred in a frequency similar to severe disabling dyskinesia which was reported for 16% of women and 11% of men. A logistic regression analyses with age, sex and disease duration as covariates revealed a significant correlation of orthostatic hypotension and urinary incontinence with age and disease duration whilst sexual dysfunction was related to age only. These observations suggests that the effects of the PD process and ageing contribute to non-levodopa responsive NMS. Sleep disturbances were more common in women and a correlation was found with disease duration only supporting the notion that sleep is specifically affected in PD.
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PMID:Autonomic dysfunction in 3414 Parkinson's disease patients enrolled in the German Network on Parkinson's disease (KNP e.V.): the effect of ageing. 1794 52

After 20 years follow-up of newly diagnosed patients with Parkinson's disease (PD), 100 of 136 (74%) have died. The mortality rate fell in the first 3 years of treatment, then rose compared to the general population, the standardized mortality ratio from 15 to 20 years reaching 3.1. Drug induced dyskinesia and end of dose failure were experienced by most patients, but the main current problems relate to the non-levodopa responsive features of the disease. Dementia is present in 83% of 20-year survivors. Dementia correlates with increasing age and probably reflects an interplay of multiple pathologies. Seventeen people with dementia had postmortems. Eight had diffuse Lewy bodies as the only cause of dementia, while others had mixed neuropathology. Only one person lives independently and 48% are in nursing homes. Excessive daytime sleepiness is noted in 70%, falls have occurred in 87%, freezing in 81%, fractures in 35%, symptomatic postural hypotension in 48%, urinary incontinence in 71%, moderate dysarthria in 81%, choking in 48%, and hallucinations in 74%. The challenge is to understand the cellular mechanisms underlying the diverse features of advanced PD that go far beyond a lack of dopamine.
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PMID:The Sydney multicenter study of Parkinson's disease: the inevitability of dementia at 20 years. 1830 61


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