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Parkinsonism
Parkinsonian Disorder

Presentation

SpaceNext50 Britannica presents SpaceNext50, From the race to the Moon to space stewardship, we explore a wide range of subjects that feed our curiosity about space! [britannica.com]

Evidence of executive dysfunction and motor perseveration was present. [ncbi.nlm.nih.gov]

Entire Body System

  • Falling

    The same was true for patients with sleep-related falling out of bed: they had a mean score of 8.2 on the RBDSQ, whereas patients without sleep-related falls had a mean score of 3.3 (P < .01). [medscape.com]

    Over the years (generally after more than two years), patients develop some clinical features characteristic of classical PSP (see this term) such as abnormalities of eye movements, cognitive dysfunction and falls. [orpha.net]

    […] the patient fall). [parkinsonsdisease.net]

    […] in symptoms such as significant orthostatic hypotension (falling blood pressure when standing), erectile dysfunction and incontinence early in the disease. [verywell.com]

    In PSP, a lurching gait with spontaneous falls is characteristic, so careful monitoring of the patient throughout the examination is important. [ncbi.nlm.nih.gov]

  • Fatigue

    The most frequently (>40%) involved NMSd were psychiatric (61.4%), sleep disorders (52%), gastrointestinal (49.6%), fatigue (44.1%). Objects. [fedoa.unina.it]

    Some of the more common non-movement symptoms of Parkinson’s are: Fatigue Sleep difficulties Restless legs Fatigue Fatigue is a very common issue affecting people living with Parkinson’s. [parkinsonsvic.org.au]

    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]

    Patients may experience slower movement and speech, fatigue, forgetfulness, loss of smell, depression, and sleep disorders. [aapmr.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]

    In the disease’s later stages, a person will have difficulty walking and have very stiff, spastic muscles. Treatment will aim to reduce Parkinson’s symptoms while also treating the accompanying disorder. [medicalnewstoday.com]

    walking and frequent falls early in the course of the disease. [med.umich.edu]

    It causes problems with body motions, including: Tremor (shakiness) Rigidity (muscle stiffness) Slowed body movements Unstable posture Difficulty walking PD develops when certain nerve cells (neurons) in the brain die. [drugs.com]

    Parkinson’s can ultimately cause muscle rigidity and difficulty walking, poor posture, loss of muscle control, hallucinations, and dementia. [healthline.com]

Respiratoric

  • Hypophonia

    PD PRESENTATION • General features • Motor symptoms • Dysarthria • Dysphagia • Hypomimia • Hypophonia • Micrographia • Autonomic and sensory symptoms • Mental status changes 17-03-2015 Dr. T.S. Mohamed Saleem, ANCP, RJP 5 6. [slideshare.net]

    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]

    Characteristically, these patients also develop early hypophonia, hypomimia, and micrographia. [ncbi.nlm.nih.gov]

Jaw & Teeth

  • Hypersalivation

    The possible vegetative symptoms include increased salivation (hypersalivation), a mask-like face due to seborrhea, hyperhidrosis, disorders of bladder depletion, obstipation, erectile dysfunction, and disorders of temperature regulation. [lecturio.com]

Musculoskeletal

  • Muscle Spasticity

    Secondary effects are likely to impact on assessment of spastic muscles. [en.wikipedia.org]

Face, Head & Neck

  • Hypomimia

    Hypomimia can affect both voluntary facial movements (such as a smile) and involuntary ones (such as occurs when a person is startled). [verywellhealth.com]

    Homepage Rare diseases Search Search for a rare disease X-linked parkinsonism-spasticity syndrome Disease definition A rare, genetic, neurological disorder characterized by parkinsonian features (including resting or action tremor, cogwheel rigidity, hypomimia [orpha.net]

    The major symptoms include generalized bradykinesia, generalized rigidity, cogwheeling rigidity, hypomimia, resting distal tremor, axial hypotonia, eye movement disorders, pyramidal tract features, cognitive development delay and severe gross motor delay [preventiongenetics.com]

    PD PRESENTATION • General features • Motor symptoms • Dysarthria • Dysphagia • Hypomimia • Hypophonia • Micrographia • Autonomic and sensory symptoms • Mental status changes 17-03-2015 Dr. T.S. Mohamed Saleem, ANCP, RJP 5 6. [slideshare.net]

    […] manifestations: 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 e.g. in writing, manifests as progressive micrographia e.g. in the face, manifests as hypomimia [radiopaedia.org]

  • Mask-like Facies

    Signs include "mask-like" facies and "cog-wheel rigidity." See Also: Neuroleptic Induced Parkinsonism paralysis agitans Parkinson's Disease [behavenet.com]

    […] 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]

Neurologic

  • Tremor

    " "postural tremor," "action tremor," "intention tremor," "jerky tremor," "clinical," and "clinicopathological." [neurologyindia.com]

    BACKGROUND/OBJECTIVE: The fragile X-associated tremor/ataxia syndrome is characterized by intention tremor and ataxia in people who are premutation carriers of the Fragile X gene. [ncbi.nlm.nih.gov]

    Interpretation: Parkinsonian features in FXTAS appear to be characterized as bradykinesia concurrent with cerebellar gait ataxia, postural instability accompanied by intention tremor, and frequent rest tremor, representing distinctive patterns that highlight [ucdavis.pure.elsevier.com]

    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]

    Differential diagnosis Benign essential tremor - far more common; tremor is worse on movement (eg, while trying to hold a cup of tea) and rare while at rest. [patient.info]

  • Bradykinesia

    The association between FMR1 mRNA level and bradykinesia implicates pathophysiological mechanisms which may link FMR1 mRNA toxicity, dopamine deficiency and parkinsonism in FXTAS. [ucdavis.pure.elsevier.com]

    Clinical description The disease manifests during the sixth decade of life with parkinsonism, including bradykinesia, axial and limb rigidity, and occasional tremor. [orpha.net]

    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]

    Two intellectually disabled adults with Angelman Syndrome are reported who developed intermittent episodes of a severe resting tremor, cogwheel rigidity and bradykinesia in their late teens. [ncbi.nlm.nih.gov]

  • Postural Instability

    However, prior studies have examined parkinsonism (defined as having bradykinesia with at least rest tremor or postural instability) mostly in premutation carriers without a diagnosis of FXTAS. [ucdavis.pure.elsevier.com]

    In the early stage of the disease, eye movements are normal and postural instability is not seen. [orpha.net]

    She had no postural instability or gait abnormality. Physical examination was normal. Liver function and cupric tests were normal. Brain MRI T1-weighted sequences, T2 FLAIR, and T1 with gadolinium injection were also normal. [hindawi.com]

    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]

    However, postural instability is not an early PD feature and should alert the clinician of an atypical parkinsonian disorder. [ncbi.nlm.nih.gov]

  • Resting Tremor

    However, prior studies have examined parkinsonism (defined as having bradykinesia with at least rest tremor or postural instability) mostly in premutation carriers without a diagnosis of FXTAS. [ucdavis.pure.elsevier.com]

    Two intellectually disabled adults with Angelman Syndrome are reported who developed intermittent episodes of a severe resting tremor, cogwheel rigidity and bradykinesia in their late teens. [ncbi.nlm.nih.gov]

    tremor at rest or benign tremulous parkinsonism.[1] The most common site of RT is the upper limb. [neurologyindia.com]

    Common characteristics include akinesia, expressed as slowness and paucity of movement (eg, decreased arm swing or facial expression) and difficulty in initiating movement, and are associated with rigidity with or without resting tremor. [jamanetwork.com]

    Main features are resting tremor, rigidity and bradykinesia[7]: Tremor at 4-6 Hz is seen at rest and, if not immediately apparent, may be induced by concentration - eg, asking the patient to recite months of the year backwards. [patient.info]

  • Akinesia

    Akinesia (Abnormal movement) Probably the most disabling symptom of Parkinson’s is a general lack or slowness of voluntary movements. This is called akinesia and is often seen in association with the rigidity or stiffness of the muscles. [parkinsonswa.org.au]

    In hypo- or akinesia, the patient’s gait is marked by small steps and a stooped torso. The arms swing less, usually on one side. [lecturio.com]

    Keywords: Atypical parkinsonian disorders, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, dementia with lewy body, nocturnal manifestations, REM behavioral disorder, nocturia, nocturnal akinesia, hallucinations DOI [content.iospress.com]

    Common characteristics include akinesia, expressed as slowness and paucity of movement (eg, decreased arm swing or facial expression) and difficulty in initiating movement, and are associated with rigidity with or without resting tremor. [jamanetwork.com]

    Parkinsonian symptoms include akinesia, muscle rigidity, slow "pill-rolling" tremor, and festinating gait. Signs include "mask-like" facies and "cog-wheel rigidity." See Also: Neuroleptic Induced Parkinsonism paralysis agitans Parkinson's Disease [behavenet.com]

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]

A diagnostic workup for MG was not performed due to a lack of clinical features suggestive of MG, such as fatigability or diurnal fluctuation. Moreover, the short-lasting clinical symptoms observed were not compatible with MG. [e-jmd.org]

Treatment

Management and treatment There is no treatment curing the disease. Some patients present a moderate response to levodopa that improves bradykinesia and rigidity. [orpha.net]

Treatment Vascular parkinsonism does not respond well to the typical medications used to treat Parkinson's disease. [bcm.edu]

The primary treatment for this type of parkinsonism is weaning off of the offending medication, if possible. [apdaparkinson.org]

Dental Treatments Dental hygienists should be aware of PD patients’ vulnerability and special needs in order to implement strategies that may ensure a caring and effective treatment. [hindawi.com]

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]

Prognosis

Movement Disorders p. 42-64 June 2004, Vol.10, No.3 doi: 10.1212/01.CON.0000293567.17705.8e Article Article Related Links Abstract The diagnosis of the atypical parkinsonian disorders is relevant in clinical practice since prognosis and treatment of patients [journals.lww.com]

Prognosis Difficulties in breathing and swallowing, and infections are the main causes of death, generally 6-12 years after onset of the disease. The documents contained in this web site are presented for information purposes only. [orpha.net]

Early diagnosis and detection of PSP-P are critical, as it differs from PD in its response to treatment and prognosis. Many studies have been published on quantitative MRI measurements of the brainstem structure as a useful PSP-P marker. [mdsabstracts.org]

Our results confirm the dire prognosis of these diseases in this cohort, with a relatively high observed age at onset. [n.neurology.org]

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]

Etiology

Etiology PSP is a 4R tauopathy composed of a preponderance of four-repeat tau isoforms and a characteristic biochemical profile (doublet tau 64 and tau 69). The MAPT H1-clade specific sub-haplotype, H1c, is a risk factor for this disease. [orpha.net]

Upon disturbance of this balance, cells might accumulate and form tumors, leading to cancers of many forms; or, they may die prematurely causing cell death as occurs in the etiology of neurodegenerative diseases. [bits-pilani.ac.in]

Etiology of Parkinson’s Disease Etiology of Idiopathic Parkinson’s Syndrome In most cases, no particular cause can be assigned to idiopathic Parkinson’s disease. [lecturio.com]

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]

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]

Summary Epidemiology Prevalence is unknown. Clinical description The disease manifests during the sixth decade of life with parkinsonism, including bradykinesia, axial and limb rigidity, and occasional tremor. [orpha.net]

Epidemiology[4] Parkinson's disease is the second most common neurodegenerative disorder after Alzheimer's disease. [patient.info]

EPIDEMIOLOGY Parkinson’s disease afflicts about 7 million people around the world and around 1 million in the United States, making it the second most common neurodegenerative disorder after Alzheimer’s disease. [biotechnologyforums.com]

Pathophysiology

The association between FMR1 mRNA level and bradykinesia implicates pathophysiological mechanisms which may link FMR1 mRNA toxicity, dopamine deficiency and parkinsonism in FXTAS. [ucdavis.pure.elsevier.com]

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]

While the pathophysiology is unclear, decreased dopamine levels and dopamine dysregulation were hypothesized to play a role [30, 34, 35]. [hindawi.com]

Prevention

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]

Treating underlying conditions, such as stroke or infections, can reduce symptoms or prevent the condition from getting worse. If symptoms make it hard to do everyday activities, the provider may recommend medicine. [medlineplus.gov]

Treatment for atypical Parkinsonism symptoms Because PD medication response is poor in these syndromes, treatment focuses on symptom management – e.g. physical therapy for fall prevention, speech therapy to maximize communication, swallow therapy to prevent [apdaparkinson.org]

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]

That’s why it’s unclear how you can prevent the disease. Each year, researchers investigate why Parkinson’s occurs and what can be done to prevent it. [healthline.com]

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