Data on the incidence of Parkinson's disease (PD) and atypical parkinsonian syndromes (APS) in East European countries and Asia are limited. The objective of this prospective population-based study was to determine the incidence of PD and APS in the Russian population. The study area was a large district of Moscow with a population of 1,237,900 inhabitants. Multiple sources of case ascertainment were used to identify incident cases of PD and APS between July 2006 and December 2008. All incident cases were examined by a specialist and followed up prospectively to confirm the diagnosis. The age-standardized incidence rates per 100,000/year were 9.03 [95% confidence interval (CI) 8.01-10.15] for PD, 0.11 (95% CI 0.03-0.23) for multiple system atrophy, 0.14 (95% CI 0.08-0.21) for progressive supranuclear palsy, and 0.02 (95% CI 0.01-0.12) for corticobasal degeneration. The age-standardized male-to-female ratio of PD was 0.87 for all ages and 1.46 for those aged 60 and older. A high proportion of new cases with PD (34%) and APS (50%) had comorbid depressive symptoms. Given the rapid growth of the elderly population in Eastern Europe and Asia, the epidemiology of PD and APS in these regions should be investigated in greater depth. The incidence of PD in our study was slightly lower than in studies of Western populations and the male-to-female ratio was closer to those reported in studies from Asia. The clinical implication of our study is that it highlights the need for better diagnosis and treatment of depression in early stages of PD.

Holistic management of Parkinson’s disease, now recognised as a combined motor and nonmotor disorder, remains a key unmet need. Such management needs relatively accurate definition of the various stages of Parkinson’s from early untreated to late palliative as each stage calls for personalised therapies. Management also needs to have a robust knowledge of the progression pattern and clinical heterogeneity of the presentation of Parkinson’s which may manifest in a motor dominant or nonmotor dominant manner. The “advanced” stages of Parkinson’s disease qualify for advanced treatments such as with continuous infusion or stereotactic surgery yet the concept of “advanced Parkinson’s disease” (APD) remains controversial in spite of growing knowledge of the natural history of the motor syndrome of PD. Advanced PD is currently largely defined on the basis of consensus opinion and thus with several caveats. Nonmotor aspects of PD may also reflect advancing course of the disorder, so far not reflected in usual scale based assessments which are largely focussed on motor symptoms. In this paper, we discuss the problems with current definitions of “advanced” PD and also propose the term “complex phase” Parkinson’s disease as an alternative which takes into account a multimodal symptoms and biomarker based approach in addition to patient preference.

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‘Levodopa Phobia’ is under-recognised in Parkinson’s disease but can cause profound detrimental clinical complications if left to continue. Several types can be encountered in clinical practice and can be driven by a misplaced fear of levodopa-induced dyskinesias, other gastrointestinal side effects and also the theoretical notion that levodopa may be toxic to dopaminergic neurons in the brain. The condition can be underpinned by a sense of strong influence from the physicians or carers who are unwilling to prescribe or consider levodopa, and also high levels of anxiety or even impulsive compulsive traits in patients who have been influenced by available literature or social media-based information. If unrecognised, the clinical issue may lead to motor deterioration and related muscle contractures leading to social isolation as well as a range of non-motor symptoms. In some, there may be emergence of intrusive impulse control disorders because of reliance on only dopamine agonists related to the fear of taking levodopa. Four cases illustrate the different patterns of ‘Levodopa Phobia’ in this study. Management of levodopa phobia is complex and includes recognition and skilled neuropsychological interventions to break the misperceptions about the complications of levodopa therapy.

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Процесс образования свободных радикалов относит-ся к универсальным механизмам жизнедеятельности лю-бой живой клетки. Их основным источником является процесс трансформации кислорода в митохондриях. По-ступающий в клетку кислород подвергается полному вос-становлению до воды. Однако в процессе аэробного мета-болизма при неполном восстановлении кислорода в каче-стве промежуточных продуктов образуются свободные радикалы (СР). Они представляют собой различные по атомному составу химические вещества, общей особенно-стью которых является наличие неспаренного электрона на одной из их орбит. В результате этого СР являются не-стабильными веществами, обладающими высокой хими-ческой активностью. Свободные радикалы при контроли-руемом образовании играют важную физиологическую роль: регуляция сосудистого тонуса, проведение возбуж-дения, участие в реакциях воспаления, механизмах репа-рации, элиминации отживших клеток [6,12,43]. В то же время избыточное образование СР ассоциируется с пато-логическими процессами. Интенсификация свободнора-дикальных процессов в организме может быть вызвана как усилением образования активных форм кислорода (АФК), свободных радикалов и низкомолекулярных эн-догенных проокcидантов, так и снижением эффективно-сти действия биологических систем утилизации и деток-сикации АФК и СР. Образование СР могут провоциро-вать различные процессы, сопровождающие жизнедея-тельность организма: стрессы, ионизирующее излучение, токсины и т.д. СР участвуют в патогенезе большого коли-чества заболеваний -ишемии, сахарного диабета, череп-но-мозговой травмы, онкологии, атеросклероза, катарак-ты, преждевременного старения, болезни Паркинсона (БА), болезни Альцгеймера, хореи Гентингтона [14, 26, 44].