TABLE 2 - uploaded by Joseph Jankovic
Content may be subject to copyright.
Source publication
In his 1817 ''An Essay on the Shaking Palsy,'' James Parkinson recorded many features of the condition that now bears his name (1). Parkinson emphasized the tremor at rest, flexed posture, festinating gait (Fig. 1), dysarthria, dysphagia, and constipation. Charcot and others later pointed out that the term paralysis agitans used by Parkinson was in...
Context in source publication
Context 1
... tremor at rest (4-6 Hz) is the typical parkinsonian tremor, most patients also have tremor during activity, and this postural tremor (5-8 Hz) may be more disabling than the resting tremor. Postural tremor without parkinsonian features and without any other known etiology is often diagnosed as essential tremor (Table 2). Isolated postural tremor clinically identical to essential tremor, however, may be the initial presentation of PD, and it may be found with higher-than- expected frequency in relatives of patients with PD (44). ...
Citations
... Today, PD is seen as a heterogeneous multi-systemic disorder with clinically distinct MS and non-motor symptoms (NMS) (Klingelhoefer & Reichmann, 2017) with the appearance of MS (Tremor, Rigidity, Akinesia and Postural instability/TRAP) allowing the clinical diagnosis of PD (Jankovic, 2003;Rodriguez-Oroz et al., 2009). So far, several attempts to replicate the resting tremor in PD mouse models have failed with the exception of motor and gait alterations being well documented in the sub-acute MPTP regime (Wang et al., 2012). ...
Parkinson's disease (PD) is a heterogeneous multi‐systemic disorder unique to humans characterized by motor and non‐motor symptoms. Preclinical experimental models of PD present limitations and inconsistent neurochemical, histological, and behavioral readouts. The 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine (MPTP) mouse model of PD is the most common in vivo screening platform for novel drug therapies; nonetheless, behavioral endpoints yielded amongst laboratories are often discordant and inconclusive. In this study, we characterized neurochemically, histologically, and behaviorally three different MPTP mouse models of PD to identify translational traits reminiscent of PD symptomatology. MPTP was intraperitoneally (i.p.) administered in three different regimens: (i) acute—four injections of 20 mg/kg of MPTP every 2 h; (ii) sub‐acute—one daily injection of 30 mg/kg of MPTP for 5 consecutive days; and (iii) chronic—one daily injection of 4 mg/kg of MPTP for 28 consecutive days. A series of behavioral tests were conducted to assess motor and non‐motor behavioral changes including anxiety, endurance, gait, motor deficits, cognitive impairment, circadian rhythm and food consumption. Impairments in balance and gait were confirmed in the chronic and acute models, respectively, with the latter showing significant correlation with lesion size. The sub‐acute model, by contrast, presented with generalized hyperactivity. Both, motor and non‐motor changes were identified in the acute and sub‐acute regime where habituation to a novel environment was significantly reduced. Moreover, we report increased water and food intake across all three models. Overall, the acute model displayed the most severe lesion size, while across the three models striatal dopamine content (DA) did not correlate with the behavioral performance. The present study demonstrates that detection of behavioral changes following MPTP exposure is challenging and does not correlate with the dopaminergic lesion extent. image
... Prodromal symptoms: Hyposmia[18] (a reduced ability to smell and to detect odors); Constipation[56]; Facial hypomimia[51]; Voice changes ...
Parkinson’s disease (PD) affects millions of people worldwide, it dramatically affects the
brain areas’ structure and functions. Therefore, it causes a progressive decline of cognitive, functional and behavioral abilities. These changes in the brain result in the degradation of motor skills’ performances. Handwriting is a daily task combining cognitive,
kinesthetic and perceptual-motor abilities. Thus, any change in the brain areas affects
directly on the aspects of handwriting. For this purpose, many researchers have studied
the possibility of using the handwriting alterations caused by PD as diagnostic signs, in
order to develop an autonomic and reliable Diagnosis Aid System which could strongly
detect this pathology at an early stage. This intelligent system could help in assessing and
controlling the evolution of PD, and consequently, in the improvement of the patients’
quality of life. This paper aims at presenting a literature review of the most relevant
studies conducted in the area of the on line handwriting analysis, in order to support PD.
Starting by the typical followed procedure which consists of handwriting data acquisition,
used materiel, proposed tasks, feature extraction, and finally data analysis. Indeed,
according to all the investigated studies, dynamic handwriting analysis is a powerful,
noninvasive, and low-cost tool to effectively diagnosis PD. In conclusion of the paper,
future directions and open issues are highlighted.
... The dopaminergic underpinnings of the motor symptoms of PD are very well investigated and characterized (J. Jankovic, 2008;Joseph Jankovic, 2003), however there are a host of less studied, non-motor symptoms, such as depression, that are likely underscored by other neurotransmitters. ...
Loss of midbrain dopaminergic neurons is well characterized to underlie the motor symptoms of Parkinson’s Disease (PD). There are, however, a host of non-motor, and often devastating PD symptoms and less is known about how these symptoms are mediated by neurotransmitters. Serotonin neurochemistry is linked to various aspects of the disease such as PD-associated depression, levodopa (L-Dopa) induced depression and L-Dopa induced dyskinesia (LID). Depression and LID significantly reduce quality of life for PD patients so understanding serotonin neurotransmission in PD models is of great merit for reducing these symptoms. Here we use niche, fast electrochemistry paired with mathematical modeling and machine learning to, for the first time, robustly evaluate serotonin in vivo in real time in a toxicological model of Parkinsonism, 1-methyl-4-phenyl-1,2,3,6- tetrahydropyridine (MPTP). Mice treated with an acute MPTP paradigm had lower concentrations of in vivo , evoked and ambient serotonin in the hippocampus, consistent with the clinical comorbidity of depression with PD. These mice did not chemically respond to an SSRI, as strongly as did control animals, following the clinical literature showing that antidepressant success during PD is highly variable. Following levodopa (L-DOPA) administration, using a novel machine learning analysis tool, we see a dynamic shift from evoked serotonin release to dopamine release. We hypothesize that this finding shows, in real time, that serotonergic neurons uptake L-DOPA and produce dopamine at the expense of serotonin, supporting the significant clinical correlation between L-DOPA and depression. Finally, we find that this post L-DOPA dopamine release is less regulated, staying in the synapse for longer. This finding, perhaps to lack of autoreceptor control, may underlie the clinical presentation of LIDS. For the first time, this work shows the chemical intricacies of serotonin and how this modulator underlies several important non-motor deficits of PD, opening up new avenues of study for ultimately alleviating these symptoms.
... In addition, flexed posture and freezing (motor blocks) have been included among classic features of Parkinsonism, with PD as the most common form. Because of the diverse profiles and lifestyles of those affected by PD, motor and nonmotor impairments should be evaluated in the context of each patient's needs and goals [7]. Patients with Parkinson's disease appear to be at increased risk for a variety of cognitive and psychiatric dysfunctions. ...
Objectives: This present study was to evaluate the clinical profile and prevalence of non motor symptoms in Parkinson’s disease patients on the basis of various system involvements. Methods: Detail history, clinical examination and relevant investigations were performed to all cases of Parkinson’s disease patients. The diagnosis of Parkinson’s disease was confirmed by UKPDS Brain Bank Criteria. Neurological examination was conducted for MMSE scores and H and Y staging. Results: Data was analyzed by using simple statistical methods with help of Ms-Office software. Data was tabulated and percentages were calculated. Conclusions: Parkinson’s disease was commonly occurred in old age male populations. Most of the cases had H & Y stage 2. Non motor symptoms were progressed as the stage of Parkinson’s disease progressed. Nausea, unsatisfactory bowel voiding and constipation were common gastrointestinal symptoms. Decreased libido, orthostatic hypotension, nocturia and hypo/hyper Sexuality were common autonomic dysfunction. Insomnia, Restless Leg and Behavioural limb movements were common sleep disorders. Dementia, attention deficit, anhedonia and apathy were common neuropsychiatric symptoms seen in patients with Parkinson’s disease. Common sensory symptoms were unexplained Pain (Paraesthesia) and hyposmia. Other common symptoms of Parkinson’s disease patients had swelling of leg, falls and weight gain. Hence early diagnosis, management and awareness are essential for improvement of quality of life of patients with Parkinson’s disease. Keywords: Parkinson’s disease, non motor symptoms, Hoehn & Yahr stage, UKPDS Brain Bank Criteria
... In the context of postural function of skeletal muscles and stabilization of body segments, elastic properties of the skeletal musculature and muscle tension are tightly related to regulatory and cytoskeletal proteins. Even though postural muscular activity is rather small, it is worth stressing that any posture is not passive and specific small activity of neck, trunk and limb muscles determines resting tension, axial tone, individual postural attitudes, facial expression, etc. (Jankovic, 2003;Gurfinkel et al., 2006;Wright et al., 2007;Caneiro et al., 2010). Long-lasting maintenance of postural muscle activity (minutes or even hours) is associated with low energy cost. ...
From ancient Greece to nowadays, research on posture control was guided and shaped by many concepts. Equilibrium control is often considered part of postural control. However, two different levels have become increasingly apparent in the postural control system, one level sets a distribution of tonic muscle activity (“posture”) and the other is assigned to compensate for internal or external perturbations (“equilibrium”). While the two levels are inherently interrelated, both neurophysiological and functional considerations point toward distinct neuromuscular underpinnings. Disturbances of muscle tone may in turn affect movement performance. The unique structure, specialization and properties of skeletal muscles should also be taken into account for understanding important peripheral contributors to postural regulation. Here, we will consider the neuromechanical basis of habitual posture and various concepts that were rather influential in many experimental studies and mathematical models of human posture control.
... O termo bradicinesia foi usado pelo médico James Parkinson em 1817 para descrever um dos principais sintomas cardinais da DP [22]. Posteriormente foi descoberto que além da bradicinesia a DP é caracterizada por outros sinais e sintomas motores, como: tremor de repouso, rigidez e instabilidade postural [23]. ...
... Os pacientes com a DP também apresentam a inicialização da marcha (IM) alterada. A IM é a tarefa funcional de executar a transição de uma postura de pé para o andar cíclico [23,24]; é uma tarefa desafiadora para o sistema de controle postural, pois envolve uma coordenação precisa entre postura, equilíbrio, geração de impulso e movimento a partir de uma condição estática e estável para a marcha continuamente instável [23,25]. A IM é controlada por um programa motor [52] e requer um controle preciso para realizar a transição de uma posição estática estável para uma marcha cíclica instável. ...
... Os pacientes com a DP também apresentam a inicialização da marcha (IM) alterada. A IM é a tarefa funcional de executar a transição de uma postura de pé para o andar cíclico [23,24]; é uma tarefa desafiadora para o sistema de controle postural, pois envolve uma coordenação precisa entre postura, equilíbrio, geração de impulso e movimento a partir de uma condição estática e estável para a marcha continuamente instável [23,25]. A IM é controlada por um programa motor [52] e requer um controle preciso para realizar a transição de uma posição estática estável para uma marcha cíclica instável. ...
Parkinson's disease (PD) is a neurodegenerative disorder with progressive motor symptoms. PD is among the most prevalent neurodegenerative diseases in older adults. With the increase in life expectancy, it is estimated that by 2020 more than 40 million of people worldwide will have PD. PD causes pathophysiological changes that produce typical neurological symptoms, also called cardinal signs, such as bradykinesia, muscle stiffness, rest and postural tremor. Currently the diagnosis of PD is purely clinical, there is no exam, quantitative test or biomarker capable of indicating the disease diagnosis. In general, PD is assessed using subjective scales, the most commonly used is the Unified Parkinson's Disease Rating Scale (UPDRS), which is divided into four parts to serve as a guide in the motor and non-motor evaluation of the patient. PD treatment is mostly symptomatic and it aims to maintain and improve functional independence and reduce patient discomfort. The treatment options are: drugs (e.g. levodopa), surgeries (e.g. deep brain stimulation), and rehabilitation therapies. Although PD still does not have cure, many research focuses on the development of objective techniques and tools to aid in diagnosis, especially in the early disease diagnosis. Studies indicate that early diagnosed patients have reduced disease progression and delayed fall episodes; these factors may provide greater longevity to the patient.
In order to make possible the objective disease diagnosis by means of quantitative tools, several
studies are dedicated to develop and evaluate sensors for this purpose. There are several sensors
that can be used to quantify the PD motor signs, and the choice of these is made according to the
objectives of the current studies, and the particularities of the patient. The most commonly used
sensors include the inertial sensor, which is capable of tracking one or more limbs of the patient in
three-dimensional space, so as to transform the patient’s movements that are imperceptible to the
human naked eye into quantitative values. We hope that the information presented in this chapter
is useful for those who are looking for up-to-date information on PD. The content presented
here is the result of the literature review and the experience of the authors who work in research,
rehabilitation and treatment of PD.
... • Outrossim, a trajetória para o que foi consolidada como Instituto Butantan, se confunde -em alguns aspectos -com o rito percorrido pelo Instituto Oswaldo Cruz 23 . Cada qual guardando suas particularidades, mas comungando questões comuns, a saber: surto de peste bubônica nos portos brasileiros; necessidade de vacinas e soros para diferentes mazelas e regiões; florescimento da medicina sani- tária; delineamento das políticas em saúde pública; desenvolvimento das ciências biomédicas; avanços da saúde coletiva brasileira e, uma característica em especial, a implementação da pesquisa médica experimental no Brasil. ...
... O termo bradicinesia foi usado pelo médico James Parkinson em 1817 para descrever um dos principais sintomas cardinais da DP [22]. Posteriormente foi descoberto que além da bradicinesia a DP é caracterizada por outros sinais e sintomas motores, como: tremor de repouso, rigidez e instabilidade postural [23]. ...
... Os pacientes com a DP também apresentam a inicialização da marcha (IM) alterada. A IM é a tarefa funcional de executar a transição de uma postura de pé para o andar cíclico [23,24]; é uma tarefa desafiadora para o sistema de controle postural, pois envolve uma coor- denação precisa entre postura, equilíbrio, geração de impulso e movimento a partir de uma condição estática e estável para a marcha continuamente instável [23,25]. A IM é controlada por um programa motor [52] e requer um controle preciso para realizar a transição de uma posição estática estável para uma marcha cíclica instável. ...
... Tremors may occur at several parts of the body such as the hands, jaw, lips and legs. About 50% of PD patients are reported to have tremors during the 978-1-5090-4568-6/16/$31.00 c 2016 IEEE early onset of the disease, while 15% of them do not report any tremors throughout the disease progression [8]. ...
Parkinson's disease is recognized as the second most common neurodegenerative disorder, after Alzheimer's, however, diagnosis remains a challenging task with no gold standard clinical test available. The use of machine learning (ML) techniques has been seen across a wide array of applications in bioinformatics, including biomarker discovery and validation. Biomarkers are defined as an objective measure of biological parameters that can diagnose a disease, monitor its progression, or predict therapeutic pathologies. Biomarkers range from genetic and biochemical, to neuroimaging and clinical. Biomarker identification is a sequential and repetitive process that consists of many critical steps, including data-preprocessing, feature extraction, model selection and biomarker validation. This paper provides an overview of the symptoms of Parkison's disease, both motor and non-motor, as well as a description of the state-of-the-art biomarkers currently in use. Additionally, the paper provides a synopsis showcasing the several subdivisions of the discovery and validation process.
... Parkinson's disease (PD), also known as paralysis agitans, is a disorder that causes degeneration of the central nervous system, with characteristic features of tremor or impaired muscle coordination (Parkinson, 2002; Jankovic, 2007; Bartels & Leenders, 2009). PD is the second most prevalent neurodegenerative disorder following Alzheimer's disease, with growing social and economic costs (de Lau & Breteler, 2006 ). ...
Objective: The purpose of this study was to analyze the effects of freezing of gait and visual information
on the static postural control ability in patients with Parkinson's Disease (PD) during the bipedal stance
with feet together.
Method: This study included a total of 36 patients with PD; the freezer group included 17 PD patients
(age: 69.3±6.2 yrs, height: 159.6±9.0 cm, weight: 63.4±9.78 kg) and the nonfreezer group included 19 PD
patients (age: 71.4±5.6 yrs, height: 155.8±7.1 cm, weight: 57.7±8.6 kg). Static postural control ability was
analyzed using variables of center of pressure (COP) and dividing by mediolateral, anteroposterior, and
integration factors during a bipedal stance with the eyes open and closed.
Results: Freezers and nonfreezers showed increases in anteroposterior velocity, mediolateral velocity,
averaged velocity, and mediolateral 95% edge frequency when visual information was blocked. Additionally,
freezers had greater anteroposterior range, 95% confidence ellipse area, and COP anteroposterior mean
position than nonfreezers.
Conclusion: Freezers and nonfreezers showed a reduction in static postural control ability when visual
information was blocked. Additionally, the results of this study found a significant difference in static
postural control ability between freezers and nonfreezers with PD. In particular, anteroposterior range,
95% confidence ellipse area, and COP anteroposterior mean position might be used to distinguish between
freezers and nonfreezers with PD.
... In this paper, we focus on ET and PD conditions, which impact more than 11 million people in the US [1]. ET manifests in people in the form of uncontrolled oscillations, most notably during muscle usage [5][6][7], while PD causes four main symptoms: resting tremor, slowness of movement, stiffness or rigidity of the extremities, and impaired balance and coordination [8][9][10]. The presence of the above-mentioned motor symptoms for both ET and PD can have a range of effects on quality of life, from discomfort, embarrassment, and depression to severe impairment hampering daily activities, including handwriting. ...
Movement disorders associated with Essential Tremor (ET) and Parkinson’s disease (PD) can negatively impact use of the upper limb for many precision tasks, including handwriting. Both ET and PD can be assessed through clinical tests which are, however, relatively subjective. This assessment approach possesses inherent logistical and resolution limitations. To address this, here we present objective computerized metrics intended to assess and quantify the extent to which static writing samples display the effects of ET and PD. Specifically, these metrics are tested in their ability to measure tremor by comparing unaffected writing samples with those affected by artificially induced tremor on healthy subjects, and also by comparing healthy writing samples with symptomatic writing samples collected from PD patients reporting micrographia. Our findings indicate that the presented metrics can be utilized for assessment, leading to a toolset capable of objectively monitoring static handwriting changes associated with symptom variations in ET and/or PD patients.
Copyright © 2015 by ASME Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
