Deep waters.
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Adaptation, Psychological↗
Biomedical subjects
S C Conley
Publications and source records attributed to S C Conley.
Parkinson's disease--the shaking palsy. Underlying factors, diagnostic considerations, and clinical course.
Parkinson's disease is a progressive neurologic disorder without cure. About 1% of the US population over 50 years of age is afflicted. Loss of dopaminergic neurons originating in the substantia nigra is the typical pathologic feature. It is theorized that both genetic and environmental factors have a role in the etiology of the disease. The classic tetrad of parkinsonian signs includes tremor, rigidity, bradykinesia, and disturbances in posture and gait. Initial signs and symptoms can be subtle and nonspecific. As the disease progresses, vocal, neurologic, autonomic, and psychiatric complications may develop. Mortality rates have not changed in 30 years despite new therapy. Differentiating true Parkinson's disease from other causes of parkinsonism can be challenging but is crucial to outcome.
Diagnosis, Differential↗
Medical and surgical treatment of Parkinson's disease. Strategies to slow symptom progression and improve quality of life.
Despite new medical and surgical therapy, mortality rates for Parkinson's disease remain unchanged. Nevertheless, symptom progression can be slowed and quality of life improved with current methods of treatment. Levodopa is the most effective drug for Parkinson's disease, but its long-term use is associated with significant motor complications. Dopamine agonists hold promise because of more sustained stimulation of dopamine receptors and possibly an antioxidant effect. Selegiline, amantadine, and anticholinergics are still used but must be employed with caution in the elderly. COMT inhibitors may be useful adjuncts to levodopa therapy but are plagued with serious adverse effects. Goals of therapy in patients less than 60 years of age include sparing levodopa therapy and providing neuroprotection. For patients 60 years and older, goals include maintaining cognitive status and treating symptoms. Surgical treatment includes globus pallidus internal-segment pallidotomy, deep brain stimulation, and fetal nigral transplantation. These hold promise for the future.
Age Factors↗