Parkinson’s Disease

Parkinson’s Disease
Review of Pathophysiology, Diagnosis
Historical Perspective
Dr. James Parkinson (1755-1828)
1817
“involuntary tremulous motion”
“pass from a walking to a running pace”
“shaking palsy”


Epidemiology
Average incidence is 20 per 100,000 in North America
1 Million affected in the United States
50,000 new cases per year
Cost estimated to exceed $5.6 Billion annually
Average age of onset 62.5
Men and women affected equally
Genetic Link
African-Americans and Asians less likely than Caucasians to develop Parkinson’s
Caffeine and smoking shows some protective effects
Pathophysiology

Imbalance of dopamine and acetylcholine
Loss of 80 to 90% of dopaminergic production in the substantia nigra
Lewy Bodies

Characteristic Problems
Micrographia-small handwriting
Hypomimia-decreased facial animation
Hypophonia-soft speech
Dysarthria-unclear pronunciation
Dyspnea-labored breathing
Festination-Shuffling gait

Pharmacotherapy
Levodopa
Dopamine agonists
COMT inhibitors
Amantadine
Anticholinergics
Selegiline

References
Cosgrove, G. Rees, Eskandar, Emad N., Shinobu, Leslie A. “Surgical Treatment of Parkinson Disease.” JAMA December 26, 2001;286:3056-3059.
Dipiro, Joseph T., ed. Pharmacotherapy Fourth Edition. Stamford, Connecticut: Appleton & Lange, 1999.
“Early Parkinson’s Disease: Dopamine Agonists Have Increasingly Important Role in Symptom Management.” Drug Ther Perspect 2001;17(17):5-9.
Faulkner, Thomas P. “Parkinson’s Disease.” 7 December 1999. http://www.onu.edu/user/FS/tfaulkner/parkinso.html 23 May 2002.
Hermanowiez, Neal. “Management of Parkinson’s Disease.” Postgraduate Medicine 2001;110(6):15-28
Korczyn, Amos D. “Hallucinations in Parkinson’s Disease.” Lancet 2001;358(9287):1031-1032.
Lindvall, Olle. “Stem Cell Transplantation.” Lancet 2001;358(Supplement);s47.
Nicholl, David. “Parkinson’s Disease.” 22 April, 1998. http://medweb.bham.ac.uk/http/depts/clin_neuro/teaching/tutorials/parkinsons/parkinsons1... 27 May, 2002.
Ninds. “Parkinson’s Disease-Hope Through Research.” http://accessible.ninds.nih.gov/health_and_medical /pubs/parkinson_disease_htr.htm
Referenced on 5/27/02.
Stephenson, Joan. “Exposure to Home Pesticides Linked to Parkinson Disease.” JAMA June 21, 2000;283(23):3055-3058.