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Biomedical subjects

J R Playfer

Publications and source records attributed to J R Playfer.

At least 19 recordsLinked to original sources
PubMed2002

The therapeutic challenges in the older Parkinson's disease patient.

The information explosion in Parkinson's disease challenges the individual clinician to apply available knowledge to the management of individual patients. The application of current algorithms and guidelines is not straightforward in the older patient. Decision analysis reveals that clinical decisions may be simple, complex or chaotic. The more factors that have to be taken into account in making a decision, the more that decision moves from being evidence-based to intuitive. Decisions are made within conceptual frameworks. The dominant models in Parkinson's disease are biomedical or rehabilitation-based. Although the rehabilitation model lacks a sound evidence base, it is the principles of rehabilitation that dominate the management of the older patient. Analysis of the decisions made in a Parkinson's disease clinic demonstrates that the doctor's role is complex and many decisions taken are not evidence-based. Parkinson's disease is not a simple movement disorder but a neuro-psychiatric complex. The incurable nature and chronicity of the disease dictate the need for multidisciplinary working. Quality of life studies reveal wide variations in the expectations and needs of patients. Studies of the impact and costs of the disease put the cost of drugs into perspective. Studies in Parkinson's disease can involve very different populations. A cohort of elderly patients shows significant differences from the populations who are selected to participate in multi-centre trials. There is an increasing challenge for geriatricians to ensure that pragmatic trials are undertaken. Psychiatric problems - dementia, depression, and hallucinations - are common in the elderly and best management of these problems is unclear. Choices in drug regimes need to take into account the complex interactions between ageing, comorbility and Parkinson's disease.

Age Factors↗
PubMed2000

The contribution of apraxic speech to working memory deficits in Parkinson's disease.

This article links two formerly separate areas of research associated with Parkinson's disease (PD): speech and memory. It is proposed that speech deficits occur in PD not merely at the level of muscular control, as is commonly termed dysarthria, but also at the level of speech planning and programming, more aptly described as a form of apraxia. It is further argued that PD patient groups exhibit small deficits in verbal span, and the link between apraxic speech and verbal span is elucidated via Baddeley's (1986) model of working memory. An experiment is described in which aspects of speech of 36 PD and 43 healthy control subjects were rated and classified, and measures of span and articulation rate for words of different syllable lengths were taken. Twenty-three PD subjects had dysarthric speech, while 14 of them had apraxic speech, which was associated with lower memory span scores for longer words. It is concluded that apraxic speech can be a source of reduced memory span in PD. In addition to implications for rehabilitation and therapeutic work with PD sufferers, these findings advance our theoretical understanding of the Parkinsonian syndrome.

Adult↗
PubMed2000

Understanding memory for faces in Parkinson's disease: the role of configural processing.

It has previously been reported that unfamiliar face recognition memory is impaired in Parkinson's disease (PD) [(Dewick, H. C., Hanley, J. R., Davies, A. D. M., Playfer, J. R. & Turnbull, C. J., Perception and memory for faces in Parkinson's disease. Neuropsychologia, 1991, 29, 785-802), (Haeske-Dewick, H. C., Are perception and memory for faces influenced by a specific age at onset factor in Parkinson's disease? Neuropsychologia, 1996, 34, 315-320), (Levin, B. E., Llabre, M. M. & Weiner, W. J., Cognitive impairments associated with early Parkinson's disease. Neurology, 1989, 39, 557-561)]. In the work reported here, we consider the possible mechanisms that might underlie this impairment. 28 PD patients and 28 controls were given a two-part test of recognition memory for words and faces, and two perceptual tests to measure their configural and componential processing ability. We found that PD patients were significantly worse than controls on the recognition memory test for faces, but not when the stimuli were words. In addition, PD patients were significantly impaired relative to controls on the closure test (FCT) used to measure configural processing, but there was no difference between the two groups on a test of componential processing ability. Multiple regression analyses revealed that even after accounting for the influence of age, intelligence and level of depression, configural processing ability was the important predictor of unfamiliar face recognition memory in Parkinson's disease. There was no effect of Parkinson's disease specific variables on either face recognition or FCT performance. In addition, some recently diagnosed patients were poor at face recognition. It is suggested that face configuration skills may be affected very early in the course of Parkinson's disease, and that this may be connected to the fact that considerable nigrostriatal degeneration and alteration in brain neurotransmitter levels occur before the clinical symptoms of PD appear.

Aged↗
PubMed2000

The role of entacapone in the management of Parkinson's disease.

Catechol-O-methyltransferase (COMT) inhibition is an important advance in the treatment of Parkinson's disease. This consensus statement provides guidelines for the optimal use of the only currently available COMT inhibitor, entacapone (Comtess, Orion Pharma (UK) Ltd, Newbury, Berkshire).

Antiparkinson Agents↗
PubMed1999

A case of coprophagia presenting with sialadenitis.

PRESENTATION: a 94-year-old woman with dementia was admitted to an acute geriatric ward with increasing confusion and falls. On two occasions she developed submandibular masses. Faeces were aspirated from her mouth and a diagnosis made of recurrent submandibular sialadenitis secondary to coprophagia. OUTCOME: the submandibular mass settled with antibiotics and oral care. Coprophagia was not observed on the ward, but faecal smearing was noted. With regular toileting, this behaviour ceased and sialadenitis did not recur.

Aged↗
PubMed1998

Gastroesophageal reflux in patients fed by percutaneous endoscopic gastrostomy (PEG): detection by a simple scintigraphic method.

OBJECTIVES: Gastroesophageal scintigraphy has been described as a sensitive and accurate way to detect and quantitate gastroesophageal reflux (GER). Our objectives here were to evaluate the usefulness of a modified scintigraphic technique in the detection of GER and lung aspiration in patients fed by percutaneous endoscopic gastrostomy (PEG), and to assess the incidence of GER after insertion of PEG. Further, we sought to examine whether or not the underlying cause of dysphagia plays any significant part in the causation of GER. METHODS: Twenty-two patients, 13 with neurological dysphagia and nine with mechanical dysphagia, were studied. Each patient received 25 MBq of Tc-99m-tin colloid in orange juice followed by 300 ml of normal saline through the PEG tube. Dynamic and static images were taken immediately and at 4 h over esophagus, stomach, and lungs. RESULTS: Twelve patients (10 with neurological dysphagia) had GER and one had aspiration into the lungs. In all but one patient GER occurred in the immediate postprandial period. CONCLUSIONS: Scintigraphy is useful in assessing GER in PEG-fed patients. We also note that GER is a major problem in patients with PEG, especially in those with neurological dysphagia.

Adult↗
PubMed1997

Parkinson's disease.

Parkinson's disease is a common disabling disease of old age. The diagnosis of idiopathic Parkinson's disease is based on clinical signs and has poor sensitivity, with about 25% of patients confidently diagnosed as having the disease actually having other conditions such as multi-system atrophy and other parkinsonism-plus syndromes. Benign essential tremor and arteriosclerotic pseudo-parkinsonism can easily be confused with Parkinson's disease. The cause of Parkinson's disease remains unknown. Speculative research highlights the role of oxidative stress and free radical mediated damage to dopaminergic cells. Parkinson's disease is the one neurodegenerative disorder in which drugs have been demonstrated to be of value. There is now a wide variety of drugs and formulations available, including anticholinergics, amantidine, L-dopa, dopamine agonists including apomorphine, selegiline and soon to be available catechol-O-methyltransferase inhibitors. Disabling side-effects of treatment, fluctuations, dyskinesias and psychiatric problems require strategic use of the drugs available. There is an increasing potential for neurosurgical intervention.

Aged↗
PubMed1996

Gait disturbance in Alzheimer's disease: a clinical study.

Gait disturbance is common in patients with Alzheimer's disease (AD). The aim of this study was to analyse the clinical gait syndromes of patients with AD using Nutt's classification. Fifty-five patients who satisfied the NINCDS-ADRDA criteria for probable AD and 55 controls were recruited from a geriatric and a psychogeriatric unit. Patients with classical musculoskeletal or neurological syndromes causing gait disturbance were excluded. A standardized neurological examination was carried out in all subjects. Twenty-two (40%) patients and ten (18%) controls had a higher level gait disorder (p < 0.01). The pattern of gait disturbance in AD patients varied according to the stage of the disease. Cautious gait was the commonest gait disorder in AD patients with mild dementia, while frontal gait disorder was the commonest disturbance in patients with severe dementia. The prevalence of frontal release signs (gegenhalten or any primitive reflex) was highest among patients with frontal gait disorder.

Activities of Daily Living↗
PubMed1994

A comparison of two techniques for ankle jerk assessment in elderly subjects.

The reported prevalence of absent ankle jerks in elderly people varies greatly. This variation may be due to differences in the method of testing. Eight physicians examined 12 patients for the presence of ankle jerks using two techniques: plantar strike and tendon strike. Both intra-observer agreement (kappa 0.47 vs 0.20; p = 0.01) and inter-observer agreement (0.57 vs 0.21; p < 0.001) were greater with plantar strike. Reliability of ankle jerk assessment was greater for more experienced examiners. Differences in technique may explain some of the discrepancy between studies examining the prevalence of absent ankle jerks in elderly people.

Aged↗
PubMed1994

How convincing is the evidence for cognitive slowing in Parkinson's disease?

The issue of whether or not Parkinson's disease (PD) patients process information more slowly than normal is unresolved. Across a range of paradigms the evidence for slowing is scant, and many show no slowing. Even the results of a single experimental paradigm can be conflicting; some studies have obtained evidence for slowed memory scanning in subgroups of PD patients whereas others have not. The present study sought the cause of these discrepant results. Old-old (n = 11) and young-old (n = 7) PD subjects and controls (n = 16, n = 9) completed both fixed and varied set versions of the memory scanning task. No evidence for slowing in PD was found. These results indicated that PD did not interact with age or task version in its effects on information processing rates in the memory scanning task. It was concluded that PD patients do not have any cognitive slowing that is detectable with the memory scanning task.

Aged↗
PubMed1994

Routine outpatient L-dopa monitoring in elderly patients with Parkinson's disease.

In an attempt to improve the therapeutic drug management of patients with Parkinson's disease, plasma L-dopa concentrations were measured by high-performance liquid chromatography and related to the post-dose time with reference to an established therapeutic range of 0.3-1.6 mg/l. The response to treatment was also assessed. One hundred and three samples were obtained at morning clinics from 53 elderly patients (mean age 72.5 years) taking an L-dopa/decarboxylase inhibitor combination. L-Dopa concentrations ranged from 0.01 to 3.6 mg/l. Fifty-nine values were within, 39 values were below and five values were above the therapeutic range. Three values were at or below the lower limit of the assay and probably indicated poor compliance. L-Dopa concentration was significantly negatively correlated with post-dose time for the dosage groups of 50 mg (p = 0.04), 100 mg (p = 0.0013), 200-250 mg (p = 0.055) and for the combined data (p = 0.005). Post-dose times were from 35 to 400 min, with the majority greater than 90 min, and it is likely that most of these corresponded to the post-peak phase of L-dopa absorption. There was a tendency for a good response to treatment to occur with values within and above the therapeutic range and for dyskinesia to be more common above the therapeutic range. It was concluded that plasma L-dopa measurement at known post-dose time, 90-360 minutes after the morning dose, can identify non-compliance, patients at risk of dose related side-effects and give useful information about the suitability of the L-dopa dose.

Aged↗
PubMed1993

Measuring L-dopa in plasma and urine to monitor therapy of elderly patients with Parkinson disease treated with L-dopa and a dopa decarboxylase inhibitor.

We have established a method for measuring L-dopa in plasma and urine, including the metabolites dopamine and L-dopac, using separation by ion-pair reversed-phase HPLC and quantification with an electrochemical detector. The assay was applied to the therapeutic monitoring of elderly patients with established Parkinson disease being treated with L-dopa plus a dopa decarboxylase inhibitor. Plasma L-dopa was evaluated in relation to dosage and postdose sampling time in 71 outpatients with Parkinson disease. L-Dopa concentrations were greatest in the patients taking the highest dosages prescribed and decreased significantly with increasing time after postdose sampling. Comparison of plasma L-dopa concentrations with a published therapeutic range established by intravenous administration of L-dopa was helpful in assessing the suitability of each patient's drug dosage, assessing patients' compliance, and avoiding overdosage but was not useful in the overall clinical assessment of progression of disease or of the long-term therapeutic response. Urine measurements confirmed the plasma concentrations but showed no further advantage. The recommended time for sample collection is between 1.5 and 3 h after the first morning dose. Plasma is the preferred matrix but if blood sampling is difficult, particularly from elderly/infirm individuals, an untimed urine collection could be used.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1992

Concentrations of vitamins A, C and E in elderly patients with Parkinson's disease.

Concentrations of the naturally occurring antioxidant vitamins A, C and E were measured in 27 patients with Parkinson's disease and 16 age-matched control subjects, from a similarly disabled patient group. There was no significant difference in the serum concentrations of vitamins A and E in the two groups. Vitamin C was significantly higher (P < 0.05) in the Parkinson's disease group, however, the mean leucocyte vitamin C concentration in the control group was low (101 nmol/10(8) WBCS) compared to established data in healthy young individuals (119-301 nmol/10(8) WBCS). There was no correlation between the severity or duration of Parkinson's disease and concentrations of vitamins A, C and E. There is therefore no evidence from this study that a deficiency of these antioxidants contributes to the onset or progress of Parkinson's disease.

Aged↗
PubMed1988

Hypercalcaemia in a patient with non-secretory myeloma.

A case of severe hypercalcaemia associated with a non-secretory multiple myeloma in the absence of skeletal deposits is described. The importance of considering this condition in the differential diagnosis of hypercalcaemia in the elderly is discussed.

Aged↗