"constipation: often an early symptom pre-dating the cardinal features"
"Parkinson disease was first described by British physician James Parkinson (1755-1824) in his 1817 seminal work "An Essay on the Shaking Palsy" 14. In this work he describes a 'shaking palsy' as an "involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forward, and to pass from a walking to a running pace; the senses and intellects being uninjured" 14. Remarkably, other than his comment regarding dementia not being a feature of the disease, his original clinical descriptions are still accurate after more than 200 years."
"Idiopathic Parkinson disease is encountered in elderly patients and is common, seen in 2-4% of all individuals older than 65 years of age (with an average prevalence of 1.6% - US population study) 22. In younger age groups, Parkinson disease is much less common, and can be described as either:"
"REM sleep behavioural disorder: often an early symptom predating the cardinal features"
"e.g. in the gait, manifests as a festinating and shuffling short-steppage gait, that characteristically has freezing, turning en bloc, and reduced arm swing"
"The majority of cases (85-90%) of Parkinson disease are sporadic (i.e. idiopathic). However, 10-15% of patients have a positive family history 1. Rarely, there are familial forms of Parkinson disease caused by genetic mutations (e.g. LRRK2) 21. Interestingly depending on which genes are involved, various clinical features are more or less prominent (e.g. Kufor-Rakeb syndrome)."
"Even more interestingly, not all mutations result in Lewy bodies. For example, juvenile Parkinson disease has been linked to mutations in the PARK2 gene, which encodes for Parkin. In normal individuals, Parkin is involved in ubiquitination of alpha-synuclein (the main component of Lewy bodies) and allows the formation of Lewy bodies. However, in patients with juvenile Parkinson disease, its function is impaired, and the formation of Lewy bodies is impossible. This finding suggests that Lewy bodies cannot be thought of as synonymous with, and causative of Parkinson disease. Perhaps even Lewy bodies play a protective role in other forms of Parkinson disease, which manifests 20-40 years later 1."
Expected headings
"I-123 ioflupane SPECT"
"Parkinson disease (PD), also known as idiopathic Parkinson disease (iPD), is a neurodegenerative disease and movement disorder characterised by bradykinesia, rigidity and resting tremor due to progressive degeneration of dopaminergic neurones in the substantia nigra."
"dementia is clinically evident before, concurrently or at most within 12 months of onset of parkinsonian symptoms 2"
"The majority of cases (85-90%) of Parkinson disease are sporadic (i.e. idiopathic). However, 10-15% of patients have a positive family history 1. Rarely, there are familial forms of Parkinson disease caused by genetic mutations (e.g. LRRK2) 21. Interestingly depending on which genes are involved, various clinical features are more or less prominent (e.g. Kufor-Rakeb syndrome)."
"There is also some evidence to support a "dual hit" pathogenesis implicating an infective agent travelling retrogradely from the bowel via the vagus nerve into the brainstem triggering the accumulation of alpha-synuclein 23,24. In support of this theory is that truncal vagotomy seems to have a protective effect 23,24."
"There is significant overlap between many neurodegenerative diseases, and Parkinson disease is no exception. Clinically the differential includes 1,3:"
"Parkinson disease was first described by British physician James Parkinson (1755-1824) in his 1817 seminal work "An Essay on the Shaking Palsy" 14. In this work he describes a 'shaking palsy' as an "involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forward, and to pass from a walking to a running pace; the senses and intellects being uninjured" 14. Remarkably, other than his comment regarding dementia not being a feature of the disease, his original clinical descriptions are still accurate after more than 200 years."
"Parkinson disease was first described by British physician James Parkinson (1755-1824) in his 1817 seminal work "An Essay on the Shaking Palsy" 14. In this work he describes a 'shaking palsy' as an "involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forward, and to pass from a walking to a running pace; the senses and intellects being uninjured" 14. Remarkably, other than his comment regarding dementia not being a feature of the disease, his original clinical descriptions are still accurate after more than 200 years."