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Biomedical subjects

W J Mutch

Publications and source records attributed to W J Mutch.

At least 19 recordsLinked to original sources
PubMed1992

Specialist clinics: a better way to care?

A questionnaire on the development of specialist clinics was distributed to the members of the Association of British Neurologists and completed by 104 members (85 consultants). Half of the respondents already ran a specialist clinic. The same proportion felt that a Parkinsonism clinic would be useful despite the fact that only 20% stated that they would run one. It is argued that specialist clinics facilitate the effective management of conditions such as Parkinson's disease, especially if supported by a specialist nurse or other appropriate staff.

Comprehensive Health Care↗
PubMed1992

Time trends and geographical variation in Parkinson's disease in Scotland.

Parkinson's disease is a common and disabling condition which principally affects the elderly. The time and space distribution of Parkinson's disease has been examined to determine if it provides clues as to aetiology and factors affecting its distribution. Previous studies have used mortality data, data from epidemiological studies, and prescribing information particularly with regard to the use of levodopa. These studies have looked within countries and between countries.

Aged↗
PubMed1991

A screening and alerting questionnaire for parkinsonism.

A self-administered eight-symptom questionnaire on parkinsonism was completed by 35 patients known to have parkinsonism and 88 controls independently selected by a local general practice. The presence of shaking and difficulty opening things/doing small buttons were the commonest positive responses among the cases (27/35). While a shuffling walk and difficulty turning in bed were the least frequent positive responses among the cases, they were also the two questions least likely to be positive in the control group. The question on shaking was the most discriminating between cases and controls. When the question on a shuffling walk was added, a positive answer to questions correctly identified 91% of cases and 92% of controls. These questions can form the basis of an alerting/screening questionnaire for parkinsonism and could be useful in screening smaller targeted populations such as a general practice list.

Aged↗
PubMed1990

Parkinson's disease in Aberdeen: survival after 3.5 years.

The increasing age of the general population and of patients suffering from Parkinson's disease suggests that a reappraisal of mortality rates and factors related to increased mortality should be carried out. A 3.5 year follow-up of a whole population sample of 267 patients and 233 controls matched by age, sex and general practitioner, yielded a relative mortality rate of 2.35 (99%-confidence interval: 1.60-3.43). Factors predicting death within the follow-up period were: cognitive impairment, old age, late age of onset, long history of smoking, lower blood pressure, and a variety of signs, symptoms and sequelae of Parkinson's disease associated with decreased mobility. However, age less than 70 years, age of onset before 66 years, absence of kyphosis or normal Webster posture score, mild impairment on the Hoehn & Yahr scale (1-2), or no impairment in a 10-question mental status questionnaire (9-10), were not associated with an increased risk of death.

Aged↗
PubMed1990

Mortality and causes of death in idiopathic Parkinson's disease: results from the Aberdeen whole population study.

Two hundred and forty-nine patients with Parkinson's disease previously examined by Mutch et al 1,2 were followed up three and a half years after the original study. Cognitive impairment, age, some postural signs and symptoms of Parkinson's disease and high scores on the Hoehn and Yahr scale predicted premature death. Patients were more likely to die from respiratory infections than controls. Respiratory diseases as cause of death recorded on the death certificate were not related to kyphosis, posture scores or Hoehn and Yahr scores before death. The hypothesis is advanced that death of respiratory causes might be associated with signs of general autonomic dysregulation.

Aged↗
PubMed1990

Clinical features predicting dementia in idiopathic Parkinson's disease: a follow-up study.

We followed up, after 3 1/2 years, a whole population cohort of 249 patients with Parkinson's disease (PD) 1st examined in 1983 to 1984. Of the survivors, 23.6% qualified for a DSM III-R diagnosis of dementia. In univariate tests, age, certain items of the Webster scale, the Hoehn and Yahr scale, a 10-question mental status questionnaire, and a history of smoking were associated with a diagnosis of dementia 3 1/2 years later. Logistic regression with DSM III-R diagnosis (demented versus nondemented) as the dependent variable, and age and symptom scales for PD as predictor variables, revealed that PD symptoms predicted dementia even after controlling for age. We conclude that dementia is probably more common in PD patients than would be expected in the general population and is associated with the severity of PD symptoms and signs independently of age.

Age Factors↗
PubMed1989

Finger tremor in Parkinson's disease.

Finger tremor was investigated in 20 patients (age range 54-88 yr) diagnosed as suffering from idiopathic Parkinson's disease and six controls of a similar age and no known neurological abnormality. In nine of the patients tremor was not clinically obvious. When the tremor of these patients was recorded immediately after voluntary movement and subjected to instrumental analysis there were consistently observable differences from the controls. Such analysis may have diagnostic potential when there is clinical uncertainty. Surface EMG recordings were obtained from four patients. One patient had a large resting tremor with obvious reciprocating activity in flexors and extensors; in the others who had no symptomatic tremor there was reciprocating activity only after movement, and this died away in a few seconds as the induced tremor disappeared.

Aged↗
PubMed1989

Does idiopathic parkinsonism in Aberdeen follow intrauterine influenza?

A study is presented which fails to replicate a recent report that peak years of birth of patients later developing Parkinson's disease are related to the influenza pandemics of the period 1890-1930. The years of birth of a whole population cohort of 243 patients suffering from Parkinson's disease examined in Aberdeen in 1983 and reexamined in 1986/7 were compared with deaths due to influenza in the City of Aberdeen in the years 1900-1930. Although a significant peak of Parkinson births (compared with the age profile of the Aberdeen population in 1983) occurred in 1902, there appeared to be no systematic relationship between Parkinson births and influenza deaths. In addition, no season of birth effect could be detected in a comparison with 232 matched controls. The presence of peaks of birth years, for whatever aetiological reason, is of significance to epidemiological studies in that prevalence estimates may be influenced by the year of study relative to these mini-cohorts.

Aged↗
PubMed1988

Does the Wartenberg pendulum test differentiate quantitatively between spasticity and rigidity? A study in elderly stroke and Parkinsonian patients.

The results of applying the Wartenberg pendulum test to the assessment of muscle tone in populations of stroke and Parkinsonian patients are described. The test was able to distinguish between increased muscle tone of the spastic or rigid type. The Parkinsonian patients showed a marked reduction of the maximum velocity of the leg swing, with the relaxation index tending to a value of about one. In contrast the affected limb of stroke patients showed a lesser reduction of the velocity of the swing, the relaxation index tending to a value of less than one.

Aged↗
PubMed1986

Parkinson's disease: disability, review, and management.

Data from a descriptive study of idiopathic Parkinson's disease were analysed aimed at getting a clearer picture of the impact of the disease on the community and the help available to patients and carers. Altogether 267 patients aged 40-92 were identified, and the median duration of disease in those in whom this could be assessed was 7.2 years. Of the 267 patients, 204 (76.4%) were living in the community, 51 alone. A total of 201 patients were taking levodopa, 29 out of 102 had retired early, and 60 out of 84 (71.4%) had given up driving. Most patients had symptoms at the time of study, and signs such as bradykinesia, rigidity, impaired speech, and abnormal gait were often moderate or severe. Of 214 patients whose disease was assessed using the scoring system of Hoehn and Yahr, 78 (36.4%) had grade 4 and 23 (10.7%) grade 5 disability. Despite this, however, 105 of 265 patients (39.6%) were not subject to regular medical review and only 57 of 227 patients (25.1%) had been seen by an occupational therapist, 16 (7.0%) by a physiotherapist, and 10 (4.4%) by a speech therapist. Patients with Parkinson's disease may benefit from regular medical review and being seen by therapists.

Adult↗
PubMed1986

Parkinson's disease in a Scottish city.

In a detailed community study the total prevalence of idiopathic Parkinson's disease in Aberdeen was 164.2/10(5) of the population. The age and sex specific prevalence rose to 2657.8/10(5) (2.7%) of men and 2071.0/10(5) (2.0%) of women aged over 84. The mean age at onset, irrespective of sex, was 65.3 years (SD 12.6) and varied little compared with similar studies over the past 25 years. Half of patients were independent but 78/225 (34.7%) were considerably disabled and 23/225 (10.2%) were confined to bed or a wheelchair. Disability increased with age and also with a low minimental state questionnaire score. The score was less than or equal to 7/10 (graded 0-10) in 93/252 (37%) of patients and less than 5/10 in 28/252 (11%). Parkinson's disease remains a common and disabling condition in the community.

Adult↗
PubMed1985

Is it a hypo? Knowledge of the symptoms of hypoglycaemia in elderly diabetic patients.

Knowledge of the symptoms of hypoglycaemia was assessed in 161 elderly diabetic patients using insulin or a sulphonylurea. Nine percent knew no symptoms. Patients on insulin and those with poorer control had significantly greater knowledge (p less than 0.01). Those reporting episodes of hypoglycaemia had significantly greater knowledge of some symptoms. Knowledge decreased with age, but was not related to sex, duration of diabetes or living alone. Patients and relatives had similar knowledge and education of both needs to be improved.

Aged↗
PubMed1985

The relationship between Parkinson's disease and dementia. A study using proton NMR imaging parameters.

The value of the spin lattice relaxation time (T1) obtained during nuclear magnetic resonance imaging of the brain was studied in patients with idiopathic Parkinson's disease, with and without dementia. T1 increases significantly in the basal ganglia and cerebral white matter of the demented and non-demented groups. T1 of the cerebral white matter correlates with the severity of dementia.

Aged↗
PubMed1980

Reversible mild diabetes in children after treatment with chlorpropamide.

In 9 patients with juvenile-onset chemical diabetes treated with oral chlorpropamide, oral or intravenous assessments of carbohydrate tolerance were made regularly three weeks after withdrawal of therapy. 6 patients with sequential intravenous tests achieved statistically significant reversal of their carbohydrate intolerance and have remained normal for an average of 5.6 years (range 1-11 years). 2 patients who subsequently required insulin therapy were maintained in remission for 3.5 years and 5 years, respectively. There appears to be a group of young patients with chemical diabetes who achieve significant remission with sulphonylurea therapy.

Administration, Oral↗