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Parkinsonian Disorder

Parkinsonian Syndrome


Presentation

  • In the present study, the sensitivity for the diagnosis of PSP was 84.2%.[academic.oup.com]
  • Of these, another 69 were excluded: 24 patients who upon examination did not present with clear parkinsonian symptoms or who presented with drug-induced parkinsonism, as well as 45 patients (18.7%) who did not have a sufficient bone window for an adequate[peerj.com]
  • In the present study, the NPR was available from 1964 to 2009.[karger.com]
  • Atypical Parkinsonian disorders are progressive diseases that present with some of the signs and symptoms of Parkinson’s disease, but that generally do not respond well to drug treatment with levodopa.[hopkinsmedicine.org]
  • Since SPGR images are more widely available and faster to acquire than DTI, we focus on these for the present work.[journals.plos.org]
Falling
  • Backward falls are common and may occur during the early course of the disease. PSP is not usually associated with tremor, unlike Parkinson’s disease.[hopkinsmedicine.org]
  • Impaired eye movement (downward gaze - damage to oculomotor nucleus) Prominent stare Slowed vertical saccades Falls, often backwards Neck hyperreflexia Hummingbird Sign in MRI due to atrophy of the midbrain tegmentum, with a relatively preserved pons.[quizlet.com]
  • […] in symptoms such as significant orthostatic hypotension (falling blood pressure when standing), erectile dysfunction and incontinence early in the disease.[verywell.com]
  • As dopamine levels fall in a person with PD, their symptoms gradually become more severe.[medicalnewstoday.com]
  • Such balance problems in Parkinson’s disease are associated with a tendency to list or fall backward (retropulsion); in fact, a light push can cause the individual with Parkinson’s disease to continue stepping backward or to even fall down.[apdaparkinson.org]
Fatigue
  • Women who complained of fatigue and sleepiness were more often diagnosed with depression than sleep apnea.[clinicaladvisor.com]
  • Fatigue Fatigue is a complex symptom of Parkinson’s disease that is not fully understood. It is known, however, that fatigue is significantly associated with depression and sleep disorders.[apdaparkinson.org]
  • Fatigue. Many people with Parkinson's disease lose energy and experience fatigue, especially later in the day. The cause isn't always known. Pain.[mayoclinic.org]
  • FATIGUE AND SLEEP DISTURBANCE Fatigue is present in one-third of patients with Parkinson disease at diagnosis, and is associated with severity of illness.[aafp.org]
  • MD, FRCP Professor, Clinical Ageing Reserach Unit Campus for Ageing and Vitality, Newcastle University Newcastle Upon Tyne, UK The defining feature of parkinsonism is bradykinesia, or slowness with decrement and degradation of repetitive movements (“fatigue[movementdisorders.org]
Difficulty Walking
  • Progressive supranuclear palsy Symptoms of PSP include: Difficulty walking Balance problems Recurrent falls that are often backwards Stiffness of the muscles – particularly the neck and trunk muscles Difficulty moving the eyes up and down – this may not[ftdtalk.org]
  • walking and frequent falls early in the course of the disease.[med.umich.edu]
Hypophonia
  • Patients often have one or several of the following signs: Tremor, or rhythmic unintentional movement Rigidity, or stiffness Bradykinesia, or a sense of slowing down in general Hypophonia, or softening of the voice Micrographia, or small handwriting Flexed[med.umich.edu]
  • Other common symptoms include: mask face, stooped posture, increased flexor tone, drooling, shuffling, seborrhea, orthostasis, decreased blinking, soft voice (hypophonia). It is often asymmetrical (especially at the onset). 26-4.[dartmouth.edu]
Mask-like Facies
  • […] characterized by insidious onset of rhythmical muscular tremors at rest (pill-rolling tremor; 4–6 Hz), paucity and slowness of movement (hypokinesia, bradykinesia) and generalized rigidity (cogwheel and lead-pipe rigidity), festinant gait, stooped posture, mask-like[medical-dictionary.thefreedictionary.com]
Hypomimia
  • In addition to a general slowness of movement, the bradykinesia of Parkinson’s disease is typically demonstrated by a reduced or mask-like expression of the face (hypomimia or facial masking), a decreased blink rate of the eyes, and problems with fine[apdaparkinson.org]
Facial Muscle Rigidity
  • Facial muscle rigidity can also partly or completely account for the "masked facies."[dartmouth.edu]
Tremor
  • The tremor (shaking body parts) of Parkinson disease appears during rest of the limb and disappears or weakens during active movement. Additionally, Parkinson's disease cause walking problems and slow movements.[medical-dictionary.thefreedictionary.com]
  • PSP is not usually associated with tremor, unlike Parkinson’s disease.[hopkinsmedicine.org]
  • We found that clinical presentation (presence of tremor-dominant disease) did not seem to affect disease detection in the NPR.[karger.com]
  • The tremors are usually rhythmic or pendulous in nature. Essential tremor usually affects the hands and feet, but voice tremors and head tremors are also seen. The condition may be severely disabling in the long term.[news-medical.net]
Bradykinesia
  • […] certain antipsychotic drugs (e.g. perazine, phenothiazines, butyrophenones and depot preparations); characterized by insidious onset of rhythmical muscular tremors at rest (pill-rolling tremor; 4–6 Hz), paucity and slowness of movement (hypokinesia, bradykinesia[medical-dictionary.thefreedictionary.com]
  • Bradykinesia Greek for “slow movement,” bradykinesia is a frequent symptom of Parkinson’s disease and related movement disorders.[apdaparkinson.org]
  • Bradykinesia and rigidity are additive in hindering movement and are usually present together. Bradykinesia is, however, not dependent on or necessarily proportional to rigidity, and vice versa.[dartmouth.edu]
  • Subtle “bradykinesia” has been reported to occur in the “normal elderly” population, but this may reflect a non-specific slowness rather than bradykinesia as defined above.[movementdisorders.org]
Postural Instability
  • Postural Instability More pronounced in the later stages, postural instability includes the inability to maintain a steady, upright posture or to prevent a fall.[apdaparkinson.org]
  • Cerebellar ataxia was assessed using the Parkinson’s plus scale [ 34 ] and postural instability using the Postural Instability and Gait Disorder (PIGD) scale [ 35 ] ( Table 1).[journals.plos.org]
  • Parkinson disease (PD) is a neurological malady that causes tremors, bradykinesia, muscle rigidity, and postural instability. It affects about 1-2% of adults over the age of 60. Idiopathic Parkinson disease is more commonly seen in males.[clinicaladvisor.com]
  • Terminology To be diagnosed with Parkinson’s Disease, someone must have two of four symptoms: rigidity, bradykinesia (slow movement), tremor, or postural instability.[brainsupportnetwork.org]
Resting Tremor
  • Parkinsonism is a broad term that refers to a group of neurological conditions that present with combinations of motor problems including resting tremor, rigidity, flexed posture, “freezing”, loss of postural reflexes and slowness of movement.[verywell.com]
  • The cardinal motor signs and symptoms of PD, include the characteristic clinical picture of resting tremor, rigidity, akinesia, and impairment of postural reflexes. It evolves slowly.[movementdisorders.org]
  • They include A tremor that occurs in one hand while the muscles are relaxed (a resting tremor) Stiff muscles Slow movements Difficulty maintaining balance and walking The disorders that cause parkinsonism may also cause other symptoms or variations of[merckmanuals.com]
Shuffling Gait
  • Parkinson's disease. par′kin·so′ni·an (-sō′nē-ən) adj. parkinsonism [pär′kənsəniz′əm] Etymology: James Parkinson a neurological disorder characterized by tremor, muscle rigidity, hypokinesia, a slow shuffling gait, and difficulty in chewing, swallowing[medical-dictionary.thefreedictionary.com]
  • Can cause problems with slowness, shuffling gait and thinking problems. Head CT or MRI may be helpful in determining this.[nwpf.org]
  • Parkinson’s disease is characterized by rigidity of muscles, facial immobility, tremors and a shortened “shufflinggait. Eventually, the patient may be unable to cope with ADL and may have to depend on a caregiver.[news-medical.net]
  • They may also develop a shuffling gait. Facial expression : This can become fixed, due to changes in the nerves that control facial muscles. Voice : There may be a tremor in the voice, or the person may speak more softly than before.[medicalnewstoday.com]
  • Later, steps may become slow and small, and a shuffling gait (festination) may appear. Gait problems in Parkinson’s disease can also include a tendency to propel forward with rapid, short steps (propulsion).[apdaparkinson.org]

Workup

  • Blood-based NfL might consequently be included in the diagnostic workup of patients with parkinsonian symptoms in both primary care and specialized clinics.[ncbi.nlm.nih.gov]
  • If the twins remained suspects after the second screening, they were invited to a clinical workup (phase III, see below).[karger.com]
  • "This easily accessible biomarker of axonal degeneration may improve the diagnostic workup of patients with parkinsonian symptoms in specialized clinics as well as in primary care settings."[medpagetoday.com]

Treatment

  • RBD was fully or substantially controlled with nightly clonazepam treatment in 89% (24/27) of patients in both groups. Thus, RBD can be the heralding manifestation of Parkinson's disease in a substantial subgroup of older male RBD patients.[ncbi.nlm.nih.gov]
  • Atypical Parkinsonism Treatment Although research is deepening medical understanding of these disorders, atypical Parkinsonian disorders are progressive and as yet there are no treatments that effect a cure.[hopkinsmedicine.org]
  • Pleuropulmonary and retroperitoneal fibrosis What are some dopaminergic treatments? Non-ergot Dopamine Agonists e.g.[quizlet.com]

Prognosis

  • What is the prognosis for Wolff-Parkinson-White syndrome? The prognosis for Wolff-Parkinson-White syndrome is excellent. Discussion with your physician can help navigate the treatment options that are available.[medicinenet.com]
  • They do not respond as well to dopaminergic treatments and generally have a worse prognosis compared to typical Parkinson’s disease.[movementdisorders.org]
  • The early display of autonomic dysfunction is believed to anticipate a worse prognosis. [6, 7] Patients with parkinsonism typically have asymmetric tremor, bradykinesia, rigidity, and postural instability.[emedicine.medscape.com]
  • While symptoms of Parkinson's disease and atypical parkinsonian disorders may overlap, the prognosis is very different, they noted.[medpagetoday.com]

Etiology

  • CONCLUSIONS: Population-based national health registers are valid data sources in epidemiological studies of PD or parkinsonian disorder etiology but are less suitable in studies of incidence or prevalence. Copyright 2012 S. Karger AG, Basel.[ncbi.nlm.nih.gov]
  • The etiology of parkinsonian disorders is complex, and the causative factors are largely unknown [ 1 ]. Diagnoses are primarily clinical as there are no diagnostic biomarkers.[karger.com]
  • Research on prodromal symptoms of Parkinson’s disease (PD), including olfactory impairment and RBD, helps dissect disease etiology in this open access review by Honglei Chen in: J. Parkinsons Dis. , Vol 8:1, 2018.[journalofparkinsonsdisease.com]
  • Back to Top Conclusion The understanding of the etiology and neurobiology of PD continues to evolve.[clevelandclinicmeded.com]
  • UMAE Centro Médico Nacional de Occidente; Movement Disorders Clinic, Neurology at IMSS Click here for Patient Education Secondary parkinsonism refers to a group of disorders that have features similar to those of Parkinson disease but have a different etiology[msdmanuals.com]

Epidemiology

  • BACKGROUND: Swedish population-based national health registers are widely used data sources in epidemiological research. Register-based diagnoses of Parkinson's disease have not been validated against clinical information.[ncbi.nlm.nih.gov]
  • References de Lau LM, Breteler MM: Epidemiology of parkinson’s disease. Lancet Neurol 2006;5:525–535. Sorensen HT, Sabroe S, Olsen J: A framework for evaluation of secondary data sources for epidemiological research. Int J Epidemiol 1996;25:435–442.[karger.com]
  • Epidemiology [ 4 ] Parkinson's disease is the second most common neurodegenerative disorder after Alzheimer's disease.[patient.info]
  • SCA-3 and SCA-17 in particular can have these findings. [4] Epidemiology The exact incidence of MSA is not known; many experts believe that the disorder is underrecognized.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiological mechanisms underlying Pisa syndrome have not been fully explained.[ncbi.nlm.nih.gov]
  • Pathophysiology Although the exact cause of MSA evades understanding, many pathophysiologic mechanisms have been uncovered. Iron and ferritin levels appear to be increased in the substantia nigra and striatum.[emedicine.medscape.com]
  • P values of Results Patient characteristics We allocated patients who were eventually diagnosed with essential tremor (ET) in the group of parkinsonism, because of the pathophysiologic resemblance with PD ( Fekete & Jankovic, 2011 ; Louis & Ottman, 2013[peerj.com]
  • Because it is reversible and not progressive or fatal, very little is known of the pathophysiology.[dartmouth.edu]

Prevention

  • This is encouraging news as the need for a reliable, accurate and affordable biomarker is essential in order to make real headway towards a cure or at least a drug regime which could prevent progression (if we could diagnose PD before any damage becomes[eastmidlands-rsn.org]
  • Such risk factor modification in essence helps alter the natural course of the disorder, as prevention of further strokes prevents further worsening of already established parkinsonism.[bcm.edu]
  • Prevention Using appropriate protection when using pesticides and other toxins may help reduce the risk of PD. It is not possible to prevent Parkinson's disease, but research has shown that some lifelong habits may help to reduce the risk.[medicalnewstoday.com]
  • Can Wolff-Parkinson-White syndrome be prevented? Wolff-Parkinson-White syndrome cannot be prevented, but can be treated in the vast majority of people.[medicinenet.com]
  • Prevention Because the cause of Parkinson's is unknown, proven ways to prevent the disease also remain a mystery. Some research has shown that regular aerobic exercise might reduce the risk of Parkinson's disease.[mayoclinic.org]

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