Prevalence of Parkinsonian Signs and Associated Mortality in a Community Population of Older People

Bennett, David A.; Beckett, Laurel A.; Murray, Anne M.; Shannon, Kathleen M.; Goetz, Christopher G.; Pilgrim, David; Evans, Denis A.

doi:10.1056/nejm199601113340202

Cited by 571 publications

(411 citation statements)

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“…Mild parkinsonian signs (MPS) occur in 15 to 52 % of elders, even in the absence of parkinsonian syndromes (Bennett et al 1996). Though MPS have been considered by some to be benign signs of aging, investigators have reported their association with functional disability (Fleischman et al 2007;Louis et al 2005b), depression (Uemura et al 2013), and dementia (Louis et al 2004(Louis et al , 2010.…”

Section: Introductionmentioning

confidence: 99%

Contributions of mild parkinsonian signs to gait performance in the elderly

Allali

Mahoney

2014

AGE

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Mild parkinsonian signs (MPS) and gait abnormalities are common in aging, but the association between MPS and objective gait measures is not established in the elderly. This study aims to identify the link between MPS and quantitative gait measures, as well as to determine the pathogenesis of MPS in nondemented community-dwelling older adults without idiopathic Parkinson's disease or other parkinsonian syndromes. Three hundred seventy-four non-demented older adults (mean age, 76.44±6.71 years, 57 % women) participated in this study, where comprehensive neurological and medical assessments were conducted. We defined MPS based on the presence of any one of bradykinesia, rigidity, or rest tremor. Velocity and spatial, temporal, and variability gait parameters were recorded using an instrumented walkway. The associations of MPS and gait parameters as well as the relationship of individual MPS with medical illnesses were assessed with linear regressions controlling for key covariates. Participants with MPS walked slower and with disturbed spatial and variability components of gait compared to those without MPS. Bradykinesia was associated with worse spatial and variability gait parameters. This association was only significant for axial bradykinesia, but not for the presence of bradykinesia in the limbs. Cerebrovascular disease (β=.20, p<.01) was associated with bradykinesia, whereas cardiovascular disease (β=.15, p<.05) was associated with rigidity. Among MPS, bradykinesia but not rigidity or tremor was associated with worse quantitative gait performance in older adults. Cerebrovascular disease, a preventable condition, was specifically associated with bradykinesia.

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Section: Introductionmentioning

confidence: 99%

Contributions of mild parkinsonian signs to gait performance in the elderly

Allali

Mahoney

2014

AGE

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“…These dopaminergic neurons project to distant sites in the subcortical grey matter known as the neostriatum, which is a critical area for the control of voluntary movement. Epidemiological studies have demonstrated that aging is the strongest risk factor for developing PD, with approximately 30% of persons with a mean age of 75 years 1,2 and more than 50% of persons older than 85 years exhibiting parkinsonian signs. 1 The typical signs of PD, namely bradykinesia, rigidity, motor freezing, resting tremor, difficulty in initiating movement, postural instability, incoordination, and difficulty with speech and swallowing are common in older persons with and without idiopathic PD.…”

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confidence: 99%

“…Epidemiological studies have demonstrated that aging is the strongest risk factor for developing PD, with approximately 30% of persons with a mean age of 75 years 1,2 and more than 50% of persons older than 85 years exhibiting parkinsonian signs. 1 The typical signs of PD, namely bradykinesia, rigidity, motor freezing, resting tremor, difficulty in initiating movement, postural instability, incoordination, and difficulty with speech and swallowing are common in older persons with and without idiopathic PD. [1][2][3] Corresponding to these changes, there is loss of the nigrostriatal dopamine system integrity with age, [4][5][6] with a linear decline in the number of pigmented (i.e., dopamine) neurons in the substantia nigra, 5,[7][8][9] with greater losses in patients with the disease.…”

mentioning

confidence: 99%

“…1 The typical signs of PD, namely bradykinesia, rigidity, motor freezing, resting tremor, difficulty in initiating movement, postural instability, incoordination, and difficulty with speech and swallowing are common in older persons with and without idiopathic PD. [1][2][3] Corresponding to these changes, there is loss of the nigrostriatal dopamine system integrity with age, [4][5][6] with a linear decline in the number of pigmented (i.e., dopamine) neurons in the substantia nigra, 5,[7][8][9] with greater losses in patients with the disease. Although the mechanisms underlying the death of dopamine neurons are not fully known, several have been suggested, including mitochondrial DNA deletions [10][11][12] and complex 1 mutations, 13 subtelomeric methylation, 14 decreased vascular endothelial growth factor (VEGF) 15 and Nurr1 levels 16 , increased a-synuclein, 17,18 and decreased estrogen levels, 19,20 to provide some examples.…”

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confidence: 99%

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Cellular Repair in the Parkinsonian Nonhuman Primate Brain

Redmond

Weiss

Elsworth

et al. 2010

Rejuvenation Research

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Parkinson disease (PD) is a neurodegenerative disorder that provides a useful model for testing cell replacement strategies to rejuvenate the affected dopaminergic neural systems, which have been destroyed by aging and the disease. We first showed that grafts of fetal dopaminergic neurons can reverse parkinsonian motor deficits induced by the toxin, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), validating the feasibility of cellular repair in a primate nervous system. Subsequent clinical trials in Parkinson patients showed encouraging results, including long-term improvement of neurological signs and reduction of medications in some patients. However, many experienced little therapeutic benefit, and some recipients experienced dyskinesias, suggesting a lack of regulated control of the grafts. We have since attempted to improve cell replacements by placing grafts in their correct anatomical location in the substantia nigra and using strategies such as co-grafting fetal striatal tissue or growth factors into the physiologic striatal targets. Moreover, the use of fetal cells depends on a variable supply of donor material, making it difficult to standardize cell quality and quantity. Therefore, we have also explored possibilities of using human neural stem cells (hNSCs) to ameliorate parkinsonism in nonhuman primates with encouraging results. hNSCs implanted into the striatum showed a remarkable migratory ability and were found in the substantia nigra, where a small number appeared to differentiate into dopamine neurons. The majority became growth factor-producing glia that could provide beneficial effects on host dopamine neurons. Studies to determine the optimum stage of differentiation from embryonic stem cells and to derive useful cells from somatic cell sources are in progress.

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“…EPS of variable severity were reported in 15% of community-based subjects who were 65-74 years old, and in 52% of those over 85 years of age. 76 In contrast, clinically evident parkinsonism (two or more of the cardinal motor signs) in a similar population is lower, at around 3%. 77 Parkinsonian signs may occur in association with mild cognitive impairment without evidence of overt neurological disorder, 78 and may predict incident dementia.…”

Section: Diagnosismentioning

confidence: 97%

Parkinson's disease – pathology, aetiology and diagnosis

Macphee

Stewart

2012

Rev. Clin. Gerontol.

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SummaryParkinson's disease is a progressive neurodegenerative condition. There is an increasing incidence and prevalence with advancing age and more cases are predicted as the population ages. Because of likely differing aetiology, genetics and pathology in individual patients, as well as confounding co-morbidities, diagnosis can be difficult even for specialists. We present an overview of the pathology, aetiology and differential diagnosis of Parkinson's disease in older people. The importance of specialist medical input in diagnosis is emphasized.

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Prevalence of Parkinsonian Signs and Associated Mortality in a Community Population of Older People

Abstract: Parkinsonism is very common among people over the age of 65, and its prevalence increases markedly with age. Parkinsonism is associated with a twofold increase in the risk of death, which is strongly related to the presence of a gait disturbance.

Cited by 571 publications

References 34 publications

Contributions of mild parkinsonian signs to gait performance in the elderly

Contributions of mild parkinsonian signs to gait performance in the elderly

Cellular Repair in the Parkinsonian Nonhuman Primate Brain

Parkinson's disease – pathology, aetiology and diagnosis

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