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The Causes and Management of Parkinson's

Dr. Doug MacMahon,

Geriatrician and Senior Lecturer, Cornwall Health Trust, UK.

Excerpts from the presentation made at the Parkinson’s Patient Information Day in UCD’s O’Reilly Hall on April 17, 2004. With thanks to Dr. MacMahon for permission to use this material.

Environmental

For example, living in an area with well water; living downstream of a wood processing factory or logging operation.

 

Genetic

Dr. MacMahon said that even where there was “a genetic predisposition”, it still seemed to be sporadic in occurrence. He used by way of example the Contursi Kindred, who had a genetic marker for PD, but in whom there were only 41 people in four generations who had PD.

There is also some current interest in the apparently lower incidence amongst cigarette smokers and coffee drinkers

 

He spoke about an Iowa Kindred where some of their family have Essential Tremor (ET), and thought that it and Parkinson’s “might be different manifestations of the same disease”. He added that the “genetic variation here is not quite fully understood”. He noted that how one develops PD “is not fully understood”.

 

Demographics

 

In the UK, he said, the “number of 85 year olds and up is set to double in the next ten years, with the same picture expected in other countries, and if you add in rise in age profile, add in the rise in the incidence of PD with age... “Therefore it is important to find a treatment that cures rather than relieves symptoms”.

Stages

He broke the progression of PD up into the following stages:

Symptoms of PD

But is it Parkinson’s?

In 75% of people, it is Parkinson’s; in the others, the causes are "Atypical Parkinsons" or "Parkinsonism" - vascular, Multiple System Atrophy (MSA) or Progressive Supranuclear Palsy (PSP), or it could be drug induced.

But, is it really Parkinson’s?

“Problems with the waterworks”, coordination, eyes, falling, dementia, were all cited by Dr. MacMahon as reasons to investigate further.

He says that, using a PET scan or a DAT scan, to see inside the Substantia nigra, they can now see the differences between some of the conditions. Vascular Parkinsonism, for instance, shows up on a CT scan. A DAT scan shows loss of dopaminergic function as the result of a stroke.

He commented on Drug Induced Parkinsonism, saying that “Stemetil is the one drug to look for if a patient presents with Parkinsonism.”

The Management of PD in the later stages

The Complex Care Stage

Drug Treatment:

Management of PD at this stage

Palliative Care

A gentle comment on current practices in regard to palliative care: “Recognise dignity if it becomes too difficult to try and control it with drugs or surgery.”

Institutional care is so much more expensive that Dr. MacMahon recommends keeping patients at home if at all possible.

Finally, he recommends that the patient and doctor should work together as a team, and that doctors and nurses should update their knowledge of PD.

Some Concluding Remarks

 

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