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

We have carried out a systematic review of the case files of 242 donors with pathologically verified Parkinson's disease at the Queen Square Brain Bank for Neurological Disorders in an attempt to corroborate the data-driven subtype classification proposed by Lewis and colleagues (Heterogeneity of Parkinson's disease in the early clinical stages using a data driven approach. J Neurol Neurosurg Psychiatry 2005; 76: 343-8). Cases were segregated into earlier disease onset (25%), tremor dominant (31%), non-tremor dominant (36%) and rapid disease progression without dementia (8%) subgroups. We found a strong association between a non-tremor dominant disease pattern and cognitive disability. The earlier disease onset group had the longest duration to death, and greatest delay to the onset of falls and cognitive decline. Patients with a tremor dominant disease pattern did not live significantly longer than non-tremor dominant patients and showed no difference in mean time to onset of falls and hallucinations. Rapid disease progression was associated with older age, early depression and early midline motor symptoms, and in 70% of the cases, tremulous onset. The non-tremor dominant subgroup had a significantly higher mean pathological grading of cortical Lewy bodies than all other groupings (P < 0.05) and more cortical amyloid-beta plaque load and cerebral amyloid angiopathy than early disease onset and tremor dominant groups (P = 0.047). An analysis of cases with pathologically defined neocortical Lewy body disease confirmed the link between bradykinetic onset, cognitive decline and Lewy body deposition in the neocortex. Although neuropathological examination failed to distinguish the other subtypes, the classification scheme was supported by an analysis of clinical data that were independent of the basic subgroup definitions.
 ...
PMID:A clinico-pathological study of subtypes in Parkinson's disease. 1975 3

Parkinson's disease (PD) is a neurodegenerative disorder with highly heterogeneous clinical manifestations. This fact has prompted many attempts to divide PD patients into clinical subgroups. This could lead to a better recognition of pathogenesis, improving targeted treatment and the prognosis of PD patients. The aim of the present study was to obtain cerebrospinal fluid (CSF) samples in PD patients and to search for a relationship between neurodegenerative CSF markers (tau protein, beta-amyloid(1-42) and index tau protein/beta-amyloid(1-42)) and the clinical subtypes. PD patients were divided into three subgroups: early disease onset (EDO), tremor-dominant PD (TD-PD), and non-tremor dominant PD (NT-PD) according to the previously published classification. Neurodegenerative markers in the CSF were assessed in these three groups of patients suffering from PD (EDO-17, TD-15, NT-16 patients) and in a control group (CG) of 19 patients suffering from non-degenerative neurological diseases and 18 patients with Alzheimer's disease (AD). The NT-PD patients were found to have significantly higher levels of CSF tau protein and index tau/beta than the control subjects and other Parkinsonian subgroups, but no significant differences in these markers were found between AD and NT-PD patients. In the context of more rapid clinical progression and more pronounced neuropathological changes in the NT-PD patient group, our results corroborate the opinion that CSF level of tau protein may be regarded as a potential laboratory marker of the presence and severity of neurodegeneration.
 ...
PMID:Tau protein and beta-amyloid(1-42) CSF levels in different phenotypes of Parkinson's disease. 2189 60

Clinical outcome and relevance of genetic and epidemiological factors were evaluated in 161 patients with idiopathic Parkinson's disease (PD) with regard to onset symptoms [tremor (T) vs non-tremor (NT)], to clinical classification into tremor-dominant (TD), alkineto-rigid (AR), and equivalent (EQ) subtypes, and to disease onset before the 45th year of age (EO) and after age 69 (LO). Patients were investigated by questionnaire-based personal interview and clinical examination. Allegedly symptomatic first-degree relatives were examined personally or had sufficient medical documentation to allow neurological diagnosis. Disease course was more favorable in T than in NT, in TD than in AR or EQ, and in EO compared with LO. Among EO and LO patients, clinical subtypes TD, AR and EQ were not differently distributed. Frequency of first-degree relatives with PD or essential tremor and any epidemiological variable tested were not elicited differently between TD, AR and EQ patients, with the exception that TD reported more frequent premorbid travelling. EO patients reported higher frequencies of premorbid head trauma and rural living than LO patients. The more favorable disease prognosis of patients with predominant tremor at presentation and of patients with early disease onset is corroborated. Clinical subgroups do not differ in genetic and epidemiological factors.
...
PMID:The relevance of clinical subtypes for disease course, family history and epidemiological variables in Parkinson's disease. 2428 31