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Query: UMLS:C0030567 (Parkinson's disease)
 63,064 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

New concepts about the pathogenesis and pathophysiology of Parkinson's disease have emerged. For these concepts to be useful, they must be understood, and for them to be applied, the psychology of the patient and the patient's family must be understood. The initial consultation is crucial in establishing a successful relationship between a patient, family, and physician. This consultation is analyzed and ways of avoiding errors and misconceptions delineated. Emphasis is placed on imaginitive questioning using the format of the ADL portion of the UPDRS in establishing the diagnosis and following treatment. The rational for starting treatment with selegiline at this time is discussed in the context of the role that increased MAO-B activity plays in the progression of Parkinson's disease. After making the diagnosis and starting treatment with selegiline, deciding when to start levodopa is the next crucial decision. Often as important as deciding when to start levodopa is overcoming the resistance of the patient to accept this treatment. The next crucial decision occurs after the patient develops response fluctuations on levodopa. A format for assessing the fluctuations is presented, and the merits of different treatments, including selegiline, dopamine agonists (bromocriptine and pergolide), and sustained-release or controlled-release levodopa preparations (Sinemet CR), discussed. The management of patients with depression, sleep problems, and advanced disease including postural instability and mental changes are reviewed.
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PMID:An integrated approach to patient management in Parkinson's disease. 135 53

We have studied 97 patients with dementia who have been discharged from our hospital and 106 inpatients with dementia who have been admitted during last two years in our hospital. The diagnosis of dementia was done according to the criteria of DSM-III. Based on their clinical course, neurological signs, Hachinski's ischemic score and neuroradiological findings, we divided patients into 4 groups, [senile dementia of the Alzheimer type (SDAT), vascular dementia (VD), unclassified dementia and other dementias which includes dementia with Parkinson's disease or motor neuron disease, etc.]. Concerning 70 demented patients who died during hospitalization, the average age of onset and the duration of illness of SDAT were 80.5 years old and 4.6 years respectively and those of VD were 77.6 years old and 2.7 years respectively. The common causes of death were pneumonia (50%) and cardiac failure (24%). Recurrence of cerebral vascular accident (CVA) was also another frequent cause of death in VD. The most common behavioral problems causing admission in patients of SDAT were aimless wandering, nocturnal delirium, illusion and hallucination. In VD, nocturnal delirium, aimless wandering, violence and abnormal monologue were most common causes of admission. The important causes degrading ADL of inpatients were fracture, especially fracture of the hip joint, pneumonia, intestinal bleeding and CVA. Concerning the increase of the population of over 75 years old, it will be suggested that the care and treatment of demented patients in this age group will become a major social problem.
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PMID:[Clinical and epidemiological studies on inpatients with dementia]. 238 92

In a randomized, single-blind, crossover study, we evaluated physical disability in moderately advanced Parkinson's disease (PD) patients after 4 weeks of normal physical activity and 4 weeks of an intensive physical rehabilitation program. We used a timed motor task and a standard assessment of PD severity (the Unified Parkinson's Disease Rating Scale [UPDRS] with subscales for mentation, activities of daily living [ADL], and motor function) completed by an investigator blinded to the physical rehabilitation status of the patient. Following physical rehabilitation, there was significant improvement in the UPDRS ADL and motor scores, but no change in mentation score. During the 6 months following physical rehabilitation, patients did not regularly exercise, and the UPDRS scores returned to baseline. We conclude that physical disability in moderately advanced PD objectively improves with a regular physical rehabilitation program, but this improvement is not sustained when normal activity is resumed.
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PMID:Physical therapy and Parkinson's disease: a controlled clinical trial. 782 27

Clinical studies were carried out on 97 patients with Parkinson disease. Radiological and manometric studies were performed on 9 patients. The patients histories revealed about 30% had a feeling of dysphagia. Recognition of dysphagia especially in the second phase increases with an increase in duration of the disease and with deterioration of ADL. More than 40% of patients who suffered more than ten years or whose conditions were more severe than third degree of Yahr's scale complained of dysphagia. Some patients felt the disturbance in the first or the third phase of swallowing from the early stage. X-ray studies disclosed abnormal findings in 6 patients including delayed initiation of swallowing (3 patients), vallecular stasis (3 patients), aspiration (2 patients) and slight dilatation of lower esophagus (2 patients). Abnormal findings in oral phase were more severe than those in pharyngeal phase. Manometric study showed high intraluminal resting pressure of the lower esophagus and loss of negative wave in the lower esophageal sphincter after swallowing, suggesting the disturbance of smooth muscle of esophagus. Cricopharygeal dysfunction and disturbance of peristaltic wave of esophagus were not obvious. Pharynx and striated muscle of esophagus were not so severely involved. Dysfunction of tongue and lower esophagus are thought to be probably due to the disturbance of the extrapyramidal system and the autonomic nervous system, respectively.
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PMID:[Dysphagia in Parkinson disease]. 831 85

We compared the vesicourethral function between progressive supranuclear palsy (7 cases) and Parkinson's disease (vesicourethral function study in 8 patients with dysuria and questionnaire study in 44 patients). The frequency of urinary incontinence in the 44 patients with Parkinson's disease was 38.7%. Vesicourethral function study showed hypersensitivity, low bladder capacity, detrusor hyperreflexia and normal sphincter EMG. The frequency of urinary incontinence in supranuclear palsy was 85.7%. Vesicourethral function study showed hyposensitivity and detrusor hyperreflexia in 6 cases, and 4 of these 6 cases had residual urine due to impaired detrusor contraction in micturition phase and/or abnormal sphincter EMG. Compliance was normal, but bladder capacity was decreased in progressive cases. Impaired contraction and hyposensitivity made it more difficult to control the urinary incontinence in supranuclear palsy than in Parkinson's disease. Dementia and lower ADL were frequently accompanied with supranuclear palsy (rare in Parkinson's disease). These were other factors that worsen the control of incontinence.
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PMID:[Comparison of the vesicourethral function between progressive supranuclear palsy and Parkinson's disease]. 833 78

A significant concern among health care personnel is the assessment of the quality of life (QOL) among patients with chronic neurological diseases such as amyotrophic lateral sclerosis, spinocerebellar degeneration and Parkinson disease, which are designated as intractable diseases by the Ministry of Health and Welfare of Japan. A purposes for the assessment of QOL of patients with intractable diseases is to allow evaluation of whether the increased QOL resulted from remission of clinical symptoms, social support, or improvement in ADL and environment. QOL for these patients was defined an attainment of a desirable life, which is reflected in acceptance of their own disease, satisfaction in their life, and morale. An item-pool consisting of 87 questions was derived from our observation of the patients, reviews of previous literature and suggestions from specialists in the field. Based on a preliminary test administered to 88 patients living in communities, 27 items were selected for the final QOL scale through factor analysis. Correlation coefficients between QOL score and each item were in the range of 0.192 to 0.655 and Cronbach's alpha-coefficient was 0.871, showing a moderate and high internal consistency, respectively. In an extended survey administered to 259 patients including those for the preliminary test, high test-retest reliability was demonstrated (r = 0.854). The factor structure of the questionnaire assessed by a factor analysis with Varimax rotation was consistent with our original concept of QOL, suggesting a high validity of the QOL scale.
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PMID:[Development of a quality of life rating scale for patients with chronic neurological diseases]. 883 18

Coimplants of adrenal medulla (AM) and peripheral nerve (PN) in animal models of Parkinson's disease (PD) have shown that AM cells survive longer, tend to show neuronal phenotype, and enhance sprouting of host fibers. Since 1987, our implants of perfused AM and fetal ventral mesencephalon (FVM) in PD patients have achieved varying degrees of clinical improvement. If the donor tissue determines the improvement, different types of implants should result in qualitatively and quantitatively different degrees of improvement. The purpose of this study is to determine whether or not the clinical course, improvement slope, and reduction of medication observed in PD patients who undergo tissue transplantation (Tx) depend on the donor tissue type. In a pilot study, four grade IV-V PD patients received implants of precoincubated autologous AM and intercostal nerve in the caudate nucleus (open surgery). Clinical assessment was based on international scales (UPD) as reported for Tx of FVM and perfused AM. There were no systemic or neurologic complications. Four years post-Tx, longer On phases and improved PD symptoms (ADL and motor-UPD) in On and Off persist in four cases, with reduced dyskinesias. Progress appears to be stepwise, starting within weeks of Tx (similar to AM and sooner than our FVM implants), followed by a period of stability and, after a second wave of improvement 12-18 months post-Tx (similar to FVM implants), continues to date. L-dopa medication has been reduced by more than 60% and dopamine agonist use has not resumed. We conclude that our recipients continue to be clinically better than prior to Tx. The course of recovery after co-Tx of AM and PN differs from that of FVM or AM implants. This fact may be related to the etiological factors that produce the improvement.
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PMID:Clinical experience with cotransplantation of peripheral nerve and adrenal medulla in patients with Parkinson's disease. 895 92

Progression of Parkinson's disease (PD) can be detected through changes in clinical ratings or disability assessments. A clinical trial, Deprenyl and Alpha-Tocopherol Antioxidative Therapy of Parkinsonism (DATATOP), used a novel study end point: increase in parkinsonian disability to the extent that investigators determined the need for treatment with levodopa. We analyzed DATATOP results to learn if this operationally defined end point could be reproduced from elements of the Unified PD Rating Scale (UPDRS) and other conventional clinical scales. Our analysis involved UPDRS, Schwab and England Activities of Daily Living (S-E ADL), and Hoehn and Yahr (H-Y) scores when DATATOP subjects reached the study end point. Various UPDRS components were examined, including subscores measuring severity of impaired ADL, bradykinesia, postural instability and gait difficulty, tremor, and rigidity. Data from subjects reaching the end point were compared with assessments of those DATATOP subjects who did not, matched for the same duration of enrollment. All measures showed subjects who reached the end point had significantly greater mean impairment than did controls, although the two groups had substantial overlap. Multivariate analysis by using conditional logistic regression suggested that the end point was determined more by functional (S-E ADL and the UPDRS ADL scores) than by clinical examination criteria. The method of classification and regression trees suggested a simple decision tree splitting, respectively, on S-E ADL, UPDRS ADL, H-Y score, and UPDRS ADL again, with an estimated overall misclassification probability of 18%. We conclude that the DATATOP end point cannot be fully reproduced from the traditional clinical measures, although it can give results that are consistent with these scales in a well-designed clinical trial.
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PMID:The need for levodopa as an end point of Parkinson's disease progression in a clinical trial of selegiline and alpha-tocopherol. Parkinson Study Group. 908 76

The clinical, pathophysiological and therapeutic approaches to the representative involuntary movements encountered in the aged are described. The prevalence rates of Parkinson disease and essential tremor are very high, and their diagnoses and treatments are quite important. Recent advances in treating Parkinson disease with anti-parkinsonian medications and essential tremor with beta-adrenergic blockers were presented. Blepharospasms, though uncommon, but occasionally seen in the aged persons, are disabled conditions. The botulinus toxin injections to the orbicularis oculi muscles proved to show dramatic therapeutic effects, greatly contributing to these patients' ADL. The importance of neuroscience in the coming 21st century is also stressed.
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PMID:[Motor dysfunction in the aged--approach to involuntary movements]. 926 46

Music therapy (MT) is an unconventional, multisensorial therapy poorly assessed in medical care but widely used to different ends in a variety of settings. MT has two branches: active and passive. In active MT the utilisation of instruments is structured to correspond to all sensory organs so as to obtain suitable motor and emotional responses. We conducted a prospective study to evaluate the effects of MT in the neurorehabilitation of patients with Parkinson's Disease (PD), a common degenerative disorder involving movement and emotional impairment. Sixteen PD patients took part in 13 weekly sessions of MT each lasting 2 hours. At the beginning and at the end of the session, every 2 weeks, the patients were evaluated by a neurologist, who assessed PD severity with UPDRS, emotional functions with Happiness Measures (HM) and quality of life using the Parkinson's Disease Quality of Life Questionnaire (PDQL). After every session a significant improvement in motor function, particularly in relation to hypokinesia, was observed both in the overall and in the pre-post session evaluations. HM, UPDRS-ADL and PDQL changes confirmed an improving effect of MT on emotional functions, activities of daily living and quality of life. In conclusion, active MT, operating at a multisensorial level, stimulates motor, affective and behavioural functions. Finally, we propose active MT as new method to include in PD rehabilitation programmes. This article describes the methods adopted during MT sessions with PD patients.
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PMID:Active music therapy and Parkinson's disease: methods. 958 75


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