Monoamine oxidase inhibitors

MAOB-Is prevent the breakdown of dopamine in the brain and inhibit the re-uptake of dopamine at the presynaptic receptor (see 58). Enzyme inhibition is irreversible and therefore activity resumes only after new enzyme has been formed. They can be used as an early monotherapy and can prolong the time before levodopa is needed by approximately 9 months. In later disease adjunctive MAOB-I therapy can alleviate dose-related fluctuations and end-of-dose deterioration. A randomized,...

Evaluation and treatment of communication disorders

Referral to a speech and language therapist for early intervention with communication impairments, particularly dysarthria, should be considered for a variety of reasons O Effective speaking strategies may be learned with greater ease before the severity of dysarthria increases. O Early participation in speech therapy may foster later successful intervention. O Even a mild dysarthria can have a significant functional impact on an individual's communication abilities. O Completion of a...

Flasqpd

This is the first assessment tool designed for screening of appropriate DBS (deep brain stimulation) surgical candidates (101). There is a five-section questionnaire with questions assessing O Criteria for the diagnosis of PD. O Potential contraindications to DBS surgery (e.g. abnormal eye movements, abnormal cognitive reflexes, autonomic failure). O General patient characteristics (e.g. age, duration of symptoms). O Favourable unfavourable characteristics with regard to DBS surgery (e.g....

Coenzyme Q10

CoQ10 is an antioxidant and a component of the energy-producing electron transport chain of mitochondria. It is currently being investigated as a neuro-protective agent. A double-blind, placebo-controlled pilot study in PD found that high doses of CoQ10 (1200 mg day) were associated with a reduced rate of deterioration in motor function from baseline over 16 months. This result should be considered preliminary and further studies will be required. A futility study, sponsored by the NIH, is...

Swallowing disorders in PD

125 Oropharyngeal swallow mechanism.Critical structures of the oropharynx and cervical oesophagus involved in swallowing. O Oral-stage deficits may include drooling, increased oral transit time, repetitive tongue pumping motions with the posterior tongue remaining elevated, and premature spillage of the bolus. O Pharyngeal-stage problems include pharyn-geal swallow delay, the presence of pharyn-geal residue after the swallow, laryngeal penetration, and aspiration. O Oesophageal-stage swallowing...

Atypical antipsychotic AA agents

The choice of an AA agent is based largely on its ease of use and side-effect profile, as most antipsychotic agents, with few exceptions, have comparable efficacy in improving psychosis. The main difference in the antipsychotic agents lies in their propensity to worsen motor functioning in this frail and already vulnerable population. Thus far, six drugs have been marketed in the USA and Europe as 'atypical' clozapine, risperi-done, olanzapine, quetiapine, ziprasidone, and aripiprazole. The...

Apomorphine USA

Initiation of apomorphine requires titration in the medical office, which can take up to 3-4 hr. Education and training are provided to the patient and the caregiver (109). More than one visit may be required for titration. The patient presents to the clinic in an 'off medication state, having discontinued PD medication by 10 pm the evening before the scheduled titration visit. 109 Apomorphine titration. A physician assistant educating a young Parkinson patient, who is experiencing motor...

Patient support programmes

E parkinson apanet.org.es w www.apanet.org.es e parkinsonforbundet.kansli telia.com w www.parkinsonforbundet.se c o Department of Neurology National Taiwan University Hospital No 7 Chung-shan South Road Taipei 100 t 886 2 23123456 ext 5343 f 886 2 23418395 Parkinson's Disease Society National Office 215 Vauxhall Bridge Road, London, SW1V 1EJ t 020 7931 8080 f 020 7233 9908 020 7963 9360 e enquiries parkinsons.org.uk w www.parkinsons.org.uk European Parkinson's Disease Association (EPDA) 4...

The Neuropsychiatric Inventory NPI

The NPI evaluates behavioural abnormalities that occur in demented patients (96). It exists in two forms, one for nursing home residents and one for those at home. It assesses behaviour in 10 categories. Each is either present, in which case seven or eight 96 Neuropsychiatric Inventory.The scoring is undertaken by the carer rather than the patient and takes account of distress experienced by the carer because of the patient's behaviours. questions are asked in follow-up, or absent, in which...

Info

Posture Parkinson Retropulsion

Concentrated in the limbic area (emotional, cognitive, some endocrine function) Clozapine has high selectivity for D4 In PD there is degeneration of the dopaminergic neurones in the pars compacta of the substantia nigra. The loss of dopaminergic neurones leads to reduced inhibition of the indirect neurones and less inhibition from the decreased activity of the GPe there is thus increased activity in the STN and increased stimulation of the GPi via the indirect pathway, and diminished inhibition...

Dementia Rating Scale DRS

This instrument is used to assess dementia in a wide range of neuropsychological conditions. It was originally developed to assess change in cognition in patients with dementia, but can be used to screen for dementia. The scale is divided into five subsections O Attention. Initiation perseveration. Construction. Conceptualization. Memory. The scale takes about 20-30 minutes to complete. The maximum score is 144, with one point awarded for each task that is correctly performed. In tire revised...

Tolcapone

Another predominantly peripherally acting COMT inhibitor, indicated for wearing off symptoms of PD. Available in two doses 100 mg and 200 mg (USA only). It has a longer half-life than entacapone and is recommended to be taken no more than three times daily. May also cause diarrhoea generally after 1 month often requiring discontinuation of the drug. There have been three reported cases of acute liver failure potentially associated with tolcapone use. Therefore, frequent monitoring of liver...

R

Normal putamen and caudate activity is seen in the postsynaptic system in PD (a). This differs from presynaptic dopamine activity, which is abnormal in PD. Abnormal (reduced) activity is seen postsy-naptically in conditions such as multiple system atrophy (b). However these changes are more evident in later stage disease. In routine clinical practice, postsynaptic dopamine imaging does not reliably distinguish conditions such as MSA from PD. O A positive...

Parkinson Psychosis Rating Scale PPRS

This is the first scale aimed only at measuring psychotic symptoms in PD, and it correlates with other, accepted scales for the measurement of psychosis. Patients are scored 1 (absent) to 4 (severe) on the following six items O Visual hallucinations. O Illusions and misidentification of persons. O Paranoid ideation. O Sleep disturbances. O Confusion. O Sexual preoccupation. In addition, a Global Functional Impairment score is measured from the carer report. Each severity term is described for...

Contributors

Grosset, BSc MBChB MD FRCP Consultant Neurologist Katherine A. Grosset, MBChB MRCGP(1989) MD Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK Hubert H. Fernandez, MD Michael S.Okun,MD McKnight Brain Institute, University of Florida, Movement Disorders Fellow Joseph H. Friedman, MD Department of Clinical Neurosciences, Brown Medical School, NeuroHealth Parkinson's Disease and Movement Disorders Center, Warwick, Rhode Island, USA Department of Psychiatry and...

Parkinsons disease facts and figures

Pineal Symbolism

Parkinson's disease (PD) was first formally described by James Parkinson in an 1817 report (earlier records include a Shakespeare character with the condition). He described tremor, gait disorder, and brady-kinesia which he confused with paralysis, contributing to the misnomer 'paralysis agitans'. He was a general practitioner in Shoreditch, England. His observations were based on six cases - two of whom he met in the street and one of whom he had only seen from a distance. Prevalence of...

Introduction

The use of complementary therapies by PD patients is very common. Rajendran et al. (2001) found that 40 of PD patients surveyed used complementary therapies including vitamins, herbs, massage, and acupuncture. Little scientific evidence exists regarding the safety and efficacy of most of these alternative treatments for PD. A conservative estimate is that, in 1997, out-of-pocket expenditures for complementary medicine for PD patients in the USA was 27 billion. The use of herbal remedies and...

National support organizations

E norman.marshall parkinsonsaustralia. org.au Parkinson's Society Rio de Janeiro Av. Bosque da Saude 1.155 - Sao Paulo t f 011 578 8177 e asparkin netway.com.br w www.parkinson.org.br e pavel.kner email.cz w www.parkinson-cz.net Kirke V rlosevej 26-1 Verlose 3500 t +45 39 27 15 55 f +45 39 18 20 75 e dansk parkinson.dk w www.parkinson.dk Suomen Parkinson-liittory The Finnish ParkinsonAssociation Erityisosaamiskeskus Suvituuli (Rehabilitation Centre) Suvilinnantie 2 PL 905 Turku 20101 t1 +358 2...

Continuous dopaminergic stimulation

Duodopa Pump Dutch

Natural dopamine is released constantly without significant day-night (diurnal) variations. Dopamine replacement therapy should ideally replicate this, but the short duration of levodopa when given orally does not fulfil this need. Oral DAs have a longer duration of action, and help to smooth out the motor fluctuations inherent to levodopa therapy. Longer-acting oral DAs (e.g. ropinirole prolonged release) allow once-daily dosing, while transdermal, subcutaneous, and enteral routes (levodopa as...

Dysphagia

Chewing and swallowing difficulties. Choking, and or aspiration of foods, liquids, refluxed stomach contents, and saliva. Unfavourably impacts on energy and nutrient intake O Unplanned weight loss. O Malnutrition. O Aspiration pneumonia. Management. Referral to a speech and language therapist for a swallowing evaluation and modified food consistency if needed. If the speech and language therapist determines thickened liquids or pureed foods are needed, the individual should be referred to a...

Drug treatment of Parkinsons disease

Parkinson Prevention

Currently available drug treatments provide symptomatic benefit none is proven as neuroprotective. Treatment is initiated when required from a functional viewpoint (this is variable between patients, and the decision requires patient and often carer input). Treatment is started at a variable point after the onset of symptoms (note symptom onset usually predates diagnosis). There are several initial treatment choices, each with advantages and disadvantages. The main choices are levodopa (with...

Diagnostic testing and neuroimaging

Levodopa and apomorphine challenge tests may help to determine whether a patient is responsive to dopaminergic therapy (40). Levodopa challenge score the patient before and 60 min after a single high dose of levodopa (e.g. 250 mg). (Levodopa is given in the usual way in conjunction with a dopa-decarboxylase inhibitor, as Sinemet (co-careldopa) or Madopar (co-beneldopa), in a standard-release formulation). Apomorphine challenge score the patient before and 20 minutes after sequential doses of...