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Biomedical subjects

William J Weiner

Publications and source records attributed to William J Weiner.

At least 19 recordsLinked to original sources
PubMed2006

Subjective report versus objective measurement of activities of daily living in Parkinson's disease.

We compared subjective self-reports with objective performance ratings of activities of daily living (ADLs) and instrumental ADLs (IADLs) in patients with Parkinson's disease (PD) and identified variables associated with discordance of ratings between these two methods. Seventy-six PD patients completed a modified Older Americans Resources and Services scale, assessing ADLs and IADLs. These results were compared with structured performance tests of walking, eating, dressing, money, and medicine management administered in the clinic. Patient performance was rated on a five-point Likert-type scale, ranging from 1 = no difficulty to 5 = completely unable to perform task. Significant differences were found between patients and clinicians' ratings on all tasks except walking. On the other four tasks, paired group t tests showed that patients reported better function compared with the clinician rating of medication management (1.33 vs. 2.80), eating (1.53 vs. 1.76), dressing (1.64 vs. 1.86), and managing money (1.44 vs. 2.06). A discrepancy was found between patients subjective reporting of ADL and IADL function and objective ratings. Patients overestimated their function on four of five tasks. Further study is necessary to identify whether subjective or objective performance ratings are more reflective of actual daily function.

Activities of Daily Living↗
PubMed2006

Psychosis in Parkinson's disease: case studies.

Psychosis is common in patients who have PD and leads to significant disability. Patients often can be managed with non-pharmacologic interventions or with decreasing doses of anti-parkinsonism medications. If these interventions are insufficient, then atypical antipsychotics should be considered. Clozapine is used in more refractory cases and requires stringent monitoring for agranulocytosis.

Aged↗
PubMed2006

Motor fluctuations in Parkinson's disease.

Parkinson's disease is characterized by progressive slowness in activities of daily living and is the most common cause of parkinsonism, whose symptoms include resting tremor, cogwheel rigidity, and bradykinesia. The introduction of levodopa and its positive effect on motor dysfunction in Parkinson's disease has allowed neurologists to focus on motor fluctuations. "End-of-dose wearing-off" and "morning akinesia" are terms to describe the transition between a patient's relatively normal motor performance when levodopa is effective and when it has transiently lost its effect on motor responses and parkinsonian symptoms reemerge. The choices available to alleviate these motor fluctuations range from altering the patient's levodopa/carbidopa dosing schedule to the addition of other agents to the regimen, including dopamine receptor agonists, catechol-O-methyltransferase inhibitors, monoamine oxidase inhibitors, and amantadine, as well as implementing dietary changes. Therapeutic decisions can be difficult because older agents have not been compared in head-to-head trials to determine which drugs are better than others and the order in which they should be tried or added to the levodopa regimen; however, all of the available treatments provide a good possibility of benefit to the patient. Deep brain stimulation surgery is an option for patients with medically intractable severe motor fluctuations.

Aged↗
PubMed2006

Advances in the diagnosis, treatment, and understanding of Parkinson's disease and parkinsonism.

Highlights from the Twentieth Annual Symposium on the Etiology, Pathogenesis, and Treatment of Parkinson's Disease and Other Movement Disorders October 8, 2006, Chicago, IL. Why do substantia nigra neurons die in patients with Parkinson's disease? Dr. Weiner discusses an interesting hypothesis presented at the 2006 symposium. He also reviews some of the other meeting highlights, including reports on pathologic gambling, the under-recognition of drug-induced parkinsonism, and the latest studies on estrogen replacement therapy, deep brain stimulation, and botulinum toxin.

Botulinum Toxins↗
PubMed2005

A differential diagnosis of Parkinsonism.

Parkinsonism is a common, age-related syndrome, characterized by resting tremor, bradykinesias, rigidity, and postural reflex impairment. Though Parkinsonism is not very difficult to recognize, all Parkinsonism is not created equal and it is important to distinguish among the most common identifiable syndromes. This review discusses the key clinical features of these various syndromes, including Parkinson's disease, progressive supranuclear palsy, multiple system atrophy, corticobasal ganglionic degeneration, Lewy body disease, vascular Parkinsonism, and Parkinsonism with no clear etiology. Symptomatology and diagnostic testing for each syndrome are discussed and 4 typical cases are analyzed to offer clinicians guidance in making a differential diagnosis for Parkinsonism.

Brain↗
PubMed2003

From fruit fly to bedside: translating lessons from Drosophila models of neurodegenerative disease.

PURPOSE OF REVIEW: Fly models have been developed for a variety of neurodegenerative disorders, and the field is beginning to harness the power of Drosophila genetics to dissect pathways of disease pathogenesis and identify targets for therapeutic intervention. In this review, we emphasize the most recent accomplishments and chart the potential rewards in translating lessons from Drosophila models to clinical therapeutics. RECENT FINDINGS: The conservation of human disease genes in the Drosophila genome forms the basis for several recent investigations of the normal biological functions of genes implicated in neurodegenerative disease. In addition, transgenic approaches continue to expand the list of diseases modeled in Drosophila that now includes Parkinson's disease, Alzheimer's disease, Huntington's disease, and several spinocerebellar ataxias. Studies based on these models suggest that protein folding and degradation pathways play an important role in Parkinson's disease and the polyglutamine repeat disorders, and that kinases and apoptotic pathways may modulate neurodegeneration in tauopathies. SUMMARY: Ongoing genetic studies with Drosophila neurodegenerative disease models promise to enhance our understanding of disease pathogenesis and generate target lists for future investigational research and drug development. The next challenge will be distilling a growing number of possible targets into a shortlist for fast-track drug design and clinical trials. With the advent of neurodegenerative disease models, the fruit fly is rapidly assuming a unique niche in bench to bedside research.

Amyloid beta-Protein Precursor↗
PubMed2002

Acupuncture therapy for the symptoms of Parkinson's disease.

Interest in alternative medical treatments, including acupuncture, is increasing. Alternative treatments must be subjected to the same objective standards as all medical treatments. A non-blinded pilot study of the safety, tolerability, and efficacy of acupuncture (ACUPX) for the symptoms of (PD) was performed. Twenty PD patients (mean age, 68 years; disease duration, 8.5 years; Hoehn and Yahr [H&Y] stage, 2.2; Unified Parkinson's Disease Rating Scale score [UPDRS], 38.7) each received acupuncture treatments by a licensed acupuncturist. All patients were treated with two acupuncture treatment sessions per week. The first seven patients received 10 treatments and the last 13 patients 16 treatments. Patients were evaluated before and after ACUPX with the Sickness Impact Profile (SIP); UPDRS; H & Y; Schwab and England (S & E); Beck Anxiety Inventory (BAI); Beck Depression Inventory (BDI); quantitative motor tests, including timed evaluations of arm pronation supination movements, finger dexterity, finger movements between two fixed measured points, and the stand-walk-sit test; and a patient questionnaire designed for the study. Following ACUPX, there were no significant changes in the UPDRS, H&Y, S&E, BAI, BDI, quantitative motor tests, total SIP or the two SIP Dimension scores. Analysis of the 12 SIP categories not corrected for multiple comparisons revealed a post-ACUPX improvement in the sleep and rest category only (P = 0.03). On the patient questionnaire, 85% of patients reported subjective improvement of individual symptoms including tremor, walking, handwriting, slowness, pain, sleep, depression, and anxiety. There were no adverse effects. ACUPX therapy is safe and well tolerated in PD patients. A range of PD and behavioral scales failed to show improvement following ACUPX other than sleep benefit, although patients reported other discrete symptomatic improvements. A broad battery of tests in PD patients suggested that ACUPX resulted in improvement of sleep and rest only. This finding needs to be verified using more in-depth and controlled evaluation of ACUPX for PD-related sleep disturbance.

Activities of Daily Living↗
PubMed2002

Psychiatric symptoms in Parkinson's disease.

Aside from the well-known triad of resting tremor, postural instability, and bradykinesia, Parkinson's disease (PD) patients may also develop psychiatric illness as a part of their disease. The psychiatric symptoms may be as disabling as the movement disorder, but are often amenable to treatment. We review the most recent investigations of mood disorders, anxiety disorders, and hallucinations/ psychosis in PD. We then highlight new treatment studies for hallucinations/psychosis in PD.

Aged↗
PubMed2002

Transient movement disorders and multiple sclerosis.

Movement disorders associated with multiple sclerosis (MS) are uncommon, except for tremor. We report two patients with relapsing-remitting MS, who developed either dystonia or chorea during clinical exacerbation of their MS. The movement disorders resolved during treatment with adrenocorticotropin hormone (ACTH). Acute exacerbations of MS may be associated with transient movement disorders, which are responsive to ACTH.

Adrenocorticotropic Hormone↗