Geographic Variation in Prescription Patterns of Parkinson's Disease Medications

Abstract

The most striking observation was marked atrophy with neural loss and gliosis in the caudate nucleus and putamen and, to a lesser extent, in the nucleus accumbens and globus pallidus (GP; patchy distribution, no clear rostrocaudal gradient). The neuropil showed rarefaction, vacuolation, scattered brown pigment, and marked reactive astrocytosis. Dopaminergic fibers in the striatum were well preserved as found using tyrosine hydroxylase immunohistochemistry. Tau immunohistochemistry showed thorn-shaped astrocytes in subpial and perivascular spaces at the base of the brain, consistent with aging-related tau astrogliopathy (ARTAG) 4 and sparse mediobasal NFTs. Hypothalamic perivascular taupositive neuritic dystrophy was consistent with sex-related tauopathy. ARTAG and sex-related tauopathy have no known clinical correlates.Autopsy findings were compatible with MLS. Mild Alzheimer's-type changes (Braak NFT III, Thal amyloid I), mild ARTAG, and hypothalamic perivascular dystrophy were considered coincidental.Only three other autopsies are reported with MLS. [5][6][7] Selective striatal atrophy, a mainly unaffected SN, an unaffected thalamus, and absence of Lewy bodies were described. Our results are similar. However, we performed more extensive immunohistochemistry to investigate the presence of other proteinopathies.Neuropathological hallmarks of MLS are atrophy of the caudate nucleus and putamen and, to a lesser extent, of the GP with dilated lateral ventricles, normal SN, normal dopaminergic neurons, and no distinctive neuronal or glial inclusions (α-synuclein, TDP-43, p62; tau: only age-related changes).

Difference in rural and urban Medicare prescription pattern for Parkinson’s disease in Hawai‘i

“…Urban prescribers prescribed more levodopa and less dopamine agonist compared to rural providers when examining the distribution of PD medication. This pattern mirrored our recent study results analyzing Medicare Part D prescriber data for PD medications across the 50 states of the U.S. States: states with higher proportion of neurologists had a higher proportion of levodopa prescriptions (Pearson correlation coefficient of 0.82) [26] .…”