Quantification of the Cardinal Signs of Parkinsonism and of Associated Disability in Spouses of Sufferers

Abstract

Work on the causation of idiopathic parkinsonism is limited by relying on gross clinical definition and lack of studies in the old. A prognostic index for parkinsonism, based on hypo/bradykinesia of gait, had considerably higher values in spouses of 20 aged suffers, who had been cohabiting for about half a century, than in 40 controls. Postural abnormality, measured by standing sway and foot separation during walking, was also greater in these spouses. Marked differences remained after correction for relevant covariates. A blinded rigidity rating was greater in the spouses of sufferers, tremor rating was not. The differences found are difficult to explain by selective mating, learned or reactive behaviour. This suggests that environmental causative influences operate in adult life.

Blood profile holds clues to role of infection in a premonitory state for idiopathic parkinsonism and of gastrointestinal infection in established disease

“…The relative lymphopenia in spouses complements our finding of marked differences (physiological/psycho-motor/dermatological) relevant to parkinsonism between spouses, cohabiting with probands for half-a-century, and control couples [12,33,49,50]. Those spouses were, on average, a short, albeit highly significant, 'distance-down-the-pathway'.…”

“…Serum immunoglobulin concentrations were contrasted between 120 probands (12 men, 12 women per decade, 40-89 years) and 205 controls (≥12 each gender per decade, 30-89 years). The relationship of presence/absence of features of clinically-possible or -probable IP to concentration was explored in controls, as was that of a continuous measure of hypokinesia, mean-stride-length at free-waking-speed [33]. Any differential effect of Helicobacter anti-urease antibody-status was examined.…”

Leukocyte-subset counts in idiopathic parkinsonism provide clues to a pathogenic pathway involving small intestinal bacterial overgrowth. A surveillance study

“…Whereas spouses of IP-patients have been used as controls, we find they are an important source of pathogenic clues [27,44]. The prevalence of hydrogen-breath-test positivity in spouses was similar to that in IP-patients.…”

“…That of specificity ‘in cause’ should be treated cautiously, since the scheme evokes more than one driving factor. Moreover, specificity may be masked, in a disease with a long prodrome, by classifying as ‘unaffected’ or true negatives those progressing towards the diagnostic threshold [17,27,44] and/or in whom the causal factor will first manifest as another condition (eg. prodromal peptic ulceration in IP).…”

“…Stride-length and speed are analysed: values refer to ‘steady-state’, editing out any build-up at start of walk, tail-off at end. Stride-length usefully defines treatment effects and, when corrected for relevant demographic/anthropometric characteristics, discriminates well between those with and without diagnosed parkinsonism [44]. …”