Parkinson's disease (paralysis agitans, PD)

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Introduction

In 1817 James Parkinson, a London physician, described the motor disorder that now bears his name:

'... involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported, with a propensity to bend the trunk forwards, and to pass from a walking to a running pace, the senses and intellects being uninjured.'

Etiology

* symptoms may be present 5-10 years prior to diagnosis of Parkinson's disease[172]

* reduced risk associated with:

* calcium channel blockers[33]

* truncal vagotomy may decrease risk of PD[95]

* beta-2 adrenergic receptor agonists may reduce expression of alpha-synuclein & risk of Parkinson's disease[101]

* increased physical activity (RR=0.79)[118][135]

* high serum cholesterol & LDL cholesterol has a protective effect[92][97] (RR ~0.9 cited)

* maybe vitamin E & vitamin C[147]

* maybe vitamin B12[176]

Epidemiology

  • Incidence: 13-20 cases/100,000
  • lifetime risk 1-2%[15]
  • usual age of onset: 50-70 years; can occur after age 20
  • more common in males, M:F ratio 3:2[15]
  • rare familial forms with autosomal dominant inheritance
  • increased incidence in rural areas, drinking well water
  • a cluster of counties with higher Parkinson's incidence in Midwestern & Southern regions of the country[169]
    • incidence also were elevated in southern California, southeastern Texas, central Pennsylvania, and Florida[169]
  • between 1975 & 1985, water supplies at Camp Lejeune were contaminated with several volatile organic compounds[178]

Pathology

Genetics

History

Clinical manifestations

* major criteria for diagnosis, bradykinesia + at least one other[6] (see diagnostic criteria for Parkinson's disease)

# not L-dopa/carbidopa responsive[15]

Diagnostic criteria

Laboratory

Diagnostic procedures

* reduced retinal ganglion cell-inner plexiform layer thickness & reduced retinal inner nuclear layer thickness may be seen by optical coherence tomography years before diagnosis of Parkinson's disease[179]

Radiology

* detects dopamine transporter (DAT scan)[6]

Complications

* impulse control disorder may be drug-related[6]

Differential diagnosis

* absence of a response to high-dose L-dopa/carbidopa is the strongest predictor of an atypical parkinsonism syndrome[6]

* early symmetric signs/symptoms, early falls, early autonomic disorder, early dementia, rapid progression, cerebellar signs (ataxia) or poor response to Simemet suggest other diagnosis[6]

* gaze palsy (PSP), recent neuroleptic use suggest other diagnosis[6]

* non-motor features of Parkinson's disease are not elicited by pharmaceuticals[6]

Management

* catechol O-methyltransferase (COMT)

Comparative biology

Notes

More general terms

More specific terms

Additional terms

References

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