Parkinson disease case study

Case study level 3 - Not what you first thought multiple morbidity in older people - acute confusional state, dehydration and Parkinson s disease... 

Chris Cairns and Nina Barnett Case study level 1 - It is important to be regular constipation and the older person 409 Case study level 2 - Puffing away makes you lose your puff treatment of chronic obstructive pulmonary disease 411 Case study level 3 - Not what you first thought multiple morbidity in older people - acute confusional state, dehydration and Parkinson s disease 412 Case study level Ma - Eating is not the only problem treatment of stroke and its complications in the older person 414 Case study level Mb - Hearts and bones 416... 

Case Study 3 ChemopalUdectomy in Patients with Parkinson s Disease Using Direct Interstitial Infusion... 

In the United States there are about one million people who suffer from Parkinson disease (one person in 100 over the age 60), and each year 50,000 new cases are reported. The elderly are most vulnerable to the condition, with men showing a greater tendency toward the disease than women. In about 10% of cases, symptoms of the disease begin to show when patients are in their 40s, but in the majority of cases most symptoms appear occur after age 50. Parkinson disease symptoms are most pronounced in patients between the ages of 70 and 80. While there is no cure for the disease and the factors responsible for the brain damage are not fully understood, the mechanism of brain-cell deterioration and the brain chemicals involved has been carefully studied. 

On the other hand, these results have been disputed in another report, with authors in common with the previous report. They presented four case studies, three men and one woman, aged 49-87 years, who had had Parkinson s disease for 8-17 years the longest duration was in the youngest patient (29). All four were taking levodopa (300-1500 mg/day) plus a decarboxylase inhibitor. All four reported sudden irresistible sleep episodes, even during conversations two also complained of sleepiness distinct from these attacks. Two of the patients also had... 

Neurodegenerative diseases (NDDs) are those in which the irreversible deteriorization of neurons affects movement and/or memory. A number of these diseases have been associated with neurotoxic chemical exposures. These include Parkinson s disease, Alzheimer s disease, amyotrophic lateral sclerosis (also called motor neuron disease), and multiple sclerosis. NDDs and their associations with neurotoxic exposures are introduced here. Specific examples and case studies are discussed in the following sections. 

The following case studies are of patients with Alzheimer s disease, Parkinson s disease, depression, bipolar disorder and epilepsy. 

As described previously, the first commercial application of asymmetric hydrogenation was the Monsanto process for the manufacture of L-Dopa, developed by Knowles (Equation 10.23). L-Dopa is used to treat Parkinson s disease. For these reasons, Halpem and Brown studied the mechanism of this enantioselective process, and the results of these studies were particularly enlightening about how physical organic principles apply to asymmetric catalysis. This process was used as a case study in Chapter 14 to present how enantioselectivity is controlled. The findings are reiterated briefly here. 

Healy, D. G., Abou-Sleiman, P. M., Lees, A. J. etal. Tau gene and Parkinson s disease a case-control study and metaanalysis. /. Neurol. Neurosurg. Psychiatr. 75 962-965, 2004. 

On the one hand, the biochemical study of the neuro-pathological lesions led to the identification of their main molecular components. On the other hand, the study of rare, familial forms of Alzheimer s disease, frontotemporal dementia and Parkinson s disease led to the identification of gene defects that cause inherited variants of the different diseases. Remarkably, in these cases, the defective genes have been found to encode or increase the expression of the main components of the neuropathological lesions. It has therefore been established that the basis of the familial forms of these diseases is a toxic property conferred by mutations in the proteins that make up the filamentous lesions. A corollary of this insight is that a similar toxic property may also underlie the much more common, sporadic forms of the diseases. 

CA024 Benedetti, M. D., J. H. Bower, D. M. Maraganore, S. K. MacDonnell, B. J. Peterson, J. E. Ahlskog, D. J. Schaid, and W. A. Rocca. Smoking, alcohol, and coffee consumption preceding Parkinson s disease a case-control study. Neurology 2000 55(9) 1350-1358. 

Kellner CH, Beale MD, Pritchett JT, et al Electroconvulsive therapy and Parkinson s disease the case for further study. Psychopharmacol Bull 30 495-500, 1994 Kellner M, Wiedemann K, Kiieg J-C, et al Effects of the dopamine autoreceptor agonist roxindole in patients with depression and panic disorder (abstract). Neuropsychopharmacology 10 1018, 1994... 

Several studies have identified a genetic link in cases of familial Parkinson s disease, in a number of different families (77-85). A genetic mutation in the Parkin gene is responsible for the onset of disease in these families, with the typical degeneration of the substantia nigra and occurrence of Lewy bodies. In individuals with Parkinson s disease due to this genetic mutation, the average age of onset is between 35 and 40 years old (reviewed in Ref. 86). 

Rheumatoid arthritis has been reported to be associated with RLS in up to 25 % of cases [43], but serological analysis of 68 RLS patients failed to find association with rheumatological serologies [44], The same holds true for diabetes, often reported in association with RLS however, a recent extensive clinical study did not find a significantly higher prevalence of RLS in diabetic patients [44], Neuropathies associated with rheumatoid arthritis and diabetes may be the cause of RLS in these patients. In patients with end-stage kidney disease, reports showed a mild or overt (from moderate to severe) RLS in up to 62 % of cases [45,46], No correlation with iron levels or other uremia characteristics such as a decrease in parathormone levels has been found [46], Parkinson s disease (PD) has frequently been associated with... 

In addition to acute and chronic schizophrenia, the neuroleptics are sometimes used in the management of mania, delirium, and severe agitation, whatever the cause of these symptom complexes. It must be noted that unlike parkinsonism, where a definite dysfunction in the DA system has been established, for schizophrenia and other psychiatric diseases, no unequivocal evidence has yet been presented to prove that there is a disturbance of the DA system (e.g., dopaminergic overactivity or receptor hypersensitivity). In untreated schizophrenics the production of DA metabolites is normal. Conflicting results have been obtained in studies of the DA receptors in schizophrenics (11,12,13), but in the case of patients who have not received neuroleptics, the receptor density and affinity appear to be normal (13). The "dopamine hypothesis" in these disorders derives from the beneficial effects of drugs that block DA receptors. 

---