Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It must be recognised that patients with idiopathic Parkinson's disease will eventually get worse and, where appropriate, realistic prognostications of the future should be conveyed to patients and their responsible relatives. Some 15 per cent of patients will not respond to levodopa. When a patient does not show a significant improvement on therapy a number of important questions should be considered. Is the diagnosis correct? Consider an alternative diagnosis such as progressive supranuclear palsy, drug effect, multi infarct dementia, Alzheimer's disease, striatonigral degeneration, senile or essential tremor and the Shy-Drager syndrome which all may be mistaken for Parkinson's disease. Is the patient complying with therapy? Is the dose adequate and the frequency of administration appropriate? Are the symptoms caused by drug therapy? Would the addition of other therapy assist, for example amantadine, anticholinergics or bromocriptine? Is the patient on other drugs which may be contributing to the impaired function? Is the patient depressed? Is there some other underlying condition aggravating the Parkinson's disease?
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PMID:Difficulties in long term management of Parkinson's disease. 649 65

Of 123 patients with parkinsonism attending a department of medicine for the elderly who were assessed, 73% were thought to have idiopathic Parkinson's disease, and 91% of these cases and 52% of the remaining cases had a history of rest tremor; 34% of all cases were demented. The prevalence of dementia did not correlate with the duration of disease. Demented patients with presumed idiopathic Parkinson's disease were not distinguishable from non-demented by duration of disease, presence of a history of rest tremor or use of L-dopa. Eighty-eight per cent of non-demented patients but only 44% of demented patients were thought to have responded to L-dopa. Lower doses of L-dopa were used than are conventional with younger patients.
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PMID:Diagnosis and management of parkinsonism in the elderly. 666 Jan 39

CAT activity was decreased in the frontal cortex and the substantia innominata of parkinsonian subjects, post-mortem. The decrease was greater in the frontal cortex of parkinsonians with dementia. The density of muscarinic cholinergic receptors increased in the cortex. This increase was inversely correlated with tremor. The effects on these parameters of both neuronal degeneration and anticholinergic therapy are discussed.
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PMID:A subcortico-cortical cholinergic system is affected in Parkinson's disease. 666 17

Sixty-five cases of clinically diagnosed multiple lacunar state have been analysed. The clinical course of multiple lacunar state is usually progressive in nature, simulating degenerative diseases, in contrast with the mode of acute onset seen in the other vascular diseases. Average age at the initial visit was 63.8 year-old, and sex ratio showed marked male preponderance, being 12 for males and 1 for females. Gait disturbance and speech disturbance are the most frequent initial symptoms, followed by slow motion, emotional lability and swallowing difficulty. Neurological manifestations are dysarthria, short-stepped and apraxic gait, hyperreflexia, positive Babinski and Chaddock reflexes, minimal spasticity, dementia, positive palmo-mental reflex, emotional lability, fixed face, rigidity, bradykinesia, foot grasping, dysphagia, positive Myerson's sign and tremor, in the order described. The important point is that the rigidity is paratonic and the tremor is action or postural, not the cogwheel rigidity or resting tremor like Parkinson's disease. The appearance of pathological reflexes (Babinski and Chaddock reflexes) are quite important, especially Chaddock reflex, which can frequently become positive despite negative or equivocal Babinski reflex. Hypertension, especially longstanding in nature, is the major contributing factor in this disorder. CT scan showed the presence of one or more lacunes in 52 out of 65 cases (80.0%). The detection of lacune can be influenced by the quality of CT scan, and the high resolution CT scanner is greatly useful for that purpose. It is stressed that the detailed neurological and computed tomographic evaluations will make it possible to reach the clinical diagnosis and appropriate treatment of multiple lacunar state.
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PMID:[Clinical studies on multiple lacunar state]. 674 15

Patients with renal failure may manifest a variety of neurologic disorders. Patients with chronic renal failure who have not yet received dialytic therapy may develop a symptom complex progressing from mild sensorial clouding to delirium and coma, with tremor, asterixis, multifocal myoclonus, and seizures. After the institution of adequate maintenance dialysis therapy, patients may continue to be afflicted with more subtle nervous dysfunction, including impaired mentation, generalized weakness, and peripheral neuropathy. These central nervous system disorders are referred to as uremic encephalopathy. The dialytic treatment of end-stage renal disease has itself been associated with the emergence of two distinct, new disorders of the central nervous system; dialysis dysequilibrium and dialysis dementia. The dialysis disequilibrium syndrome consists of headache, nausea, muscle cramps, obtundation, and seizures, and is a consequence of the initiation of dialysis therapy in some patients. Dialysis dementia is a progressive, generally fatal encephalopathy which affects patients on chronic hemodialysis. There are at least three different forms of dialysis encephalopathy: sporadic, epidemic; and that associated with renal disease in children. In addition to the foregoing neurologic diseases which are specifically related to uremia and/or dialysis, a number of other neurologic disorders occur with increased frequency in patients with end-stage renal disease on chronic hemodialysis. These include subdural hematoma, electrolyte disorders, vitamin deficiencies, drug intoxication, hypertensive encephalopathy, and acute trace element intoxication. Renal transplantation is associated with a variety of central nervous system infections, reticulum cell sarcoma, and central pontine myelinosis. The present manuscript will review the clinical, structural, and biochemical components of those neurologic disorders which are peculiar to the uremic state and its treatment with dialysis.
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PMID:Uremic encephalopathies: clinical, biochemical, and experimental features. 675 30

It is useful to divide Parkinsonian patients into those whose signs are confined to tremor, rigidity and akinesia, and those with evidence of a more diffuse disturbance. The treatment of choice in the former is levodopa combined with a peripheral decarboxylase inhibitor. At the onset of the disease, when disability is minimal, amantadine or anticholinergic drugs may suffice. Bromocriptine is useful in some patients who derive only short-lived benefit from each dose of levodopa. The role of stereotactic surgery is now confined to patients with an incapacitating unilateral tremor which has not improved with drug therapy. In elderly patients with evidence of diffuse cerebral dysfunction such as dementia, grasp reflex, hyper-reflexia or severe postural hypotension, the beneficial effect of these drugs is often outweighed by the side effects. Small doses of levodopa alone may be tried. Anticholinergic drugs and amantadine should be avoided in such patients.
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PMID:The management of Parkinson's disease. 704 20

Clinical and autopsy studies of 14 patients treated with amphotericin B methyl ester (AME) for focal, disseminated, and nervous system mycotic infections revealed a high incidence of progressive neurologic dysfunction (dementia, akinesia, mutism, hyperreflexia, and tremor) and diffuse white matter degeneration. All of seven patients who received greater than 9.8 g of AME intravenously developed severe neurologic and neuropathologic changes. Two of three patients given 5-7.2 g of AME developed less severe neurologic symptoms; all three had mild diffuse white matter gliosis. Four patients given less than 1.5 g of AME had no bran abnormalities except those related to coccidioidal meningitis. Thirty-one control patients who died on untreated or amphotericin B-treated coccidioidal meningitis showed no diffuse white matter abnormalities. These findings indicate that prolonged administration of AME and/or other contaminating polyenes injures human white matter. Long-term animal studies, with particular attention to nervous system histology, must precede human use of other polyene derivatives.
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PMID:Leukoencephalopathy in patients treated with amphotericin B methyl ester. 710 68

Clinical and neuropsychological findings, EEG, and several blood and CSF parameters were investigated in 36 patients with Alzheimer's disease (AD) and 35 patients with senile dementia of Alzheimer type (SDAT). There were more women among senile patients and more familial cases among presenile patients. The average duration of the symptoms was longer in presenile patients (6.1 years) than in senile patients (3.9 years). This could be due to the lower resistance to the disease process in the senile group. Extrapyramidal signs, especially rigidity, were found in over 60% of all patients and in practically all patients with advanced dementia. Tremor was found in three patients only. Four presenile (11%) and two senile (6%) patients had epileptic seizures. All patients had abnormal EEG recordings, mainly in form of diffuse slowing. A positive correlation was found between the EEG abnormality and the severity of dementia in AD but not in SDAT. However, the difference between the correlation coefficients in AD and SDAT was insignificant. Between EEG and the duration of the disease there was no correlation. EEG was not more abnormal in very severe dementia than in severe dementia. Other findings were similar in AD and SDAT. It is concluded that it is artificial to separate AD and SDAT at the age of 65 and that they clinically compose a single entity. This entity could well be called Alzheimer's disease.
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PMID:Alzheimer's disease and senile dementia of Alzheimer type. A comparative study. 711 68

A study of 100 Day Hospital patients showed that 26 elderly patients with mild Senile Parkinsonism and varying degrees of dementia had subclinical tremor with the same frequency as Parkinson's Disease and distinguishable by amplified recordings from those of Parkinson's Disease and Senile Tremor. A significant history of cerebro-vascular disease was obtained in one-half of these patients. The recording of tremor is shown to be of value in diagnosing Parkinsonism and in assessing response to treatment.
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PMID:Tremor and senile parkinsonism. 720 98

An examination was developed for patients with PD. The four major signs--rigidity, tremor, bradykinesia, and gait disorder--were assessed through a series of specific maneuvers. Each sign was allocated a number of points reflecting its relative value. The scores for each of the major signs were added to yield a total score. There was a correlation between total score and stage of PD. Involuntary movements, functional disability, and dementia were assessed separately. The examination could be performed rapidly without special equipment and was particularly useful in evaluating patients exhibiting the "on-off" effect.
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PMID:Evaluation of Parkinson's disease. 739 19


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