Review

Parkinson Disease: Research Update and Clinical Management

Authors: Thomas Fritsch, PhD, Kathleen A. Smyth, PhD, Maggie S. Wallendal, MSW, Trevor Hyde, PhD, Gary Leo, DO, David S. Geldmacher, MD

Abstract

More than 1 million people in the United States have Parkinson disease (PD), more than are diagnosed as having multiple sclerosis, amyotrophic lateral sclerosis, muscular dystrophy, and myasthenia gravis combined. PD affects approximately 1 in 100 Americans older than 60 years. It burdens patients, their care partners, and the overall healthcare system. This article reviews the epidemiology, clinical features, putative environmental risk and protective factors, neuropathological aspects, heterogeneity, medical management, and recent studies regarding genetics and PD. The article suggests that based on new research, the prevalence of PD varies in different regions of the United States. Some progress has been made in identifying the risk and protective factors of PD, and a newly emphasized area of study in PD is genetics. Patient care recommendations, based on American Academy of Neurology practice guidelines, are outlined to show the state of contemporary medical management of PD and related disorders.

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References

1. De Lau LLL, Breteler MMB. Epidemiology of Parkinson’s disease. Lancet Neurol 2006; 5: 525–535.
 
2. Wright Willis A, Evanoff BA, Lian M, et al. Geographic and ethnic variation in Parkinson disease: a population-based study of US Medicare beneficiaries. Neuroepidemiology 2010; 34: 143–151.
 
3. de Rijk M, Tzourio C, Breteler MM, et al. Prevalence of parkinsonism and Parkinson’s disease in Europe: the EUROPARKINSON Collaborative Study. European community concerted action on the epidemiology of Parkinson’s disease. J Neurol Neurosurg Psychiatry 1997; 62: 10–15.
 
4. Jankovic J. Pathophysiology and clinical assessment, in Pahwa R, Lyons KE (eds): Handbook of Parkinson’s Disease, 4th ed. New York, Informa Healthcare, 2007, pp 49–75.
 
5. Pahwa R, Lyons KE. Handbook of Parkinson’s Disease. New York, Informa Healthcare, 2007.
 
6. Jancovik J, Kapadia AS. Functional decline in Parkinson disease. Arch Neurol 2001; 58: 1611–1615.
 
7. Marras C, Rochon P, Lang AE. Predicting motor decline and disability in Parkinson disease.  Arch Neurol 2002; 59: 1724–1728.
 
8. Alves G, Wentzel-Larsen T, Aarsland D, et al. Progression of motor impairment and disability in Parkinson disease. Neurology 2005; 65: 1436–1441.
 
9. Zgaljardic DJ, Borod JC, Foldi NS, et al. An examination of executive dysfunction associated with frontostriatal circuitry in Parkinson’s disease. J Clin Exp Neuropsychol 2006; 28: 1127–1144.
 
10. Miyasaki JM, Shannon K, Voon V, et al. Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review). Neurology 2006; 66: 996–1002.
 
11. Crum RM, Anthony JC, Bassett SS, et al. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA 2012; 307: 883–985.
 
12. Geldmacher DS. Dementia with Lewy bodies: diagnosis and clinical approach. Cleve Clin J Med 2004: 71; 789–800.
 
13. Kulisevsky J, Pagonabarraga J, Pascual-Sedano B, et al. Prevalence and correlates of neuropsychiatric symptoms in Parkinson’s disease without dementia. Mov Disord 2008; 23: 1889–1896.
 
14. Bronnick K, Aarsland D, Larsen JP. Neuropsychiatric disturbances in Parkinson’s disease clusters in five groups with different prevalence of dementia. Acta Psychiatr Scand 2005; 112: 201–207.
 
15. Dewey RB. Autonomic dysfunction and management, in Pahwa R, Lyons KE (eds): Handbook of Parkinson’s Disease, 4th ed. New York, Informa Healthcare, 2007, pp 77–90.
 
16. Haehner A, Boesveldt S, Berendse HW, et al. Prevalence of smell loss in Parkinson’s disease—a multicenter study. Parkinsonism Relat Disord 2009; 15: 490–494.
 
17. Ponsen MM, Stoffers D, Twisk JWR, et al. Hyposmia and executive dysfunction as predictors of future Parkinson’s disease: a prospective study. Mov Disord 2009; 24: 1060–1065.
 
18. Kumar S, Bhatia M, Behari M. Sleep disorders in Parkinson’s disease. Mov Disord 2002; 17: 775–781.
 
19. Mehta SH, Morgan JC, Sethi KD. Sleep disorders associated with Parkinson’s disease: role of dopamine, epidemiology, and clinical scales of assessment. CNS Spectrums 2008; 13: 6–11.
 
20. Yuan-Yang L, Siegel JM. Physiological and anatomical link between Parkinson-like disease and REM sleep behavior disorder. Mol Neurobiol 2003; 27: 137–151.
 
21. Priyadarshi A, Khuder SA, Schaub EA, et al. Environmental risk factors and Parkinson’s disease: a meta-analysis. Environ Res 2001; 86: 122–127.
 
22. Priyadarshi A, Khuder SA, Schuab EA, et al. A meta-analysis of Parkinson’s disease and exposure to pesticides. Neurotoxicology 2000; 21: 435–440.
 
23. Hernán MA, Takkouche B, Caamano-Isorna F, et al. A meta-analysis of coffee drinking, cigarette smoking, and risk of Parkinson’s disease. Ann Neurol 2002; 52: 276–284.
 
24. Johnston JA, Ward CL, Kopito RR. Aggresomes: a cellular response to misfolded proteins. J Cell Biol 1998; 143: 1883–1898.
 
25. Hawkes CH, Del Tredici K, Braak H. Review: Parkinson’s disease: a dual-hit hypothesis. Neuropathol Appl Neurobiol 2007; 33: 599–614.
 
26. Dickson DW, Fujishiro H, Delledone A, et al. Evidence that incidental Lewy body disease is pre-symptomatic Parkinson’s disease. Acta Neuropathol 2008: 115; 437–444.
 
27. Kalaitzakis ME, Graeber MB, Gentleman SM, et al. Controversies over the staging of α-synuclein pathology in Parkinson disease. Acta Neuropathol 2008; 116: 125–128.
 
28. Pahwa R, Factor SA, Lyons KE, et al. Practice parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review). Neurology 2006; 66: 983–995.
 
29. Ferman TJ, Smith GE, Boeve BF, et al. DLB fluctuations: specific features that reliably differentiate DLB from AD and normal aging. Neurology 2004; 62: 181–187.
 
30. Suchowersky O, Reich S, Perlmutter J, et al. Practice parameter: diagnosis and prognosis of new onset Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006; 66: 968–975.
 
31. Suchowesky O, Gronset G, Perlmutter J, et al. Practice parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review). Neurology 2006; 66: 976–982.
 
32. Clarke CE. Medical management of Parkinson’s disease. J Neurol Neurosurg Psychiatry 2002; 72: i22–i27.
 
33. Goodwin VA, Richards SH, Taylor RS, et al. The effectiveness of exercise interventions for people with Parkinson’s disease: a systematic review and meta-analysis. Mov Disorder 2008; 23: 631–640.
 
34. LSVT: rehabilitative therapy for people with Parkinson’s. http://www.lsvtglobal.com. Accessed June 14, 2012.
 
35. Ebersbach G, Ebersbach A, Edler D, et al. Comparing exercise in Parkinson’s disease: the Berlin LSVT BIG study. Mov Disord 2010; 25: 1902–1908.
 
36. Hackney ME, Earhart GM. Tai chi improves balance and mobility in people with Parkinson disease. Gait Posture 2008; 28: 456–460.
 
37. Fuzhong L, Harmer P, Fitzgerald K, et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med 2012; 366: 511–519.
 
38. Klein C, Schlossmacher MG. The genetics of Parkinson disease: implications for neurological care.Neurology 2006; 2: 136–146.
 
39. Kroll C. Statistics on Parkinson’s. http://www.pdf.org/en/parkinson_statistics. Accessed April 30, 2012.