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The bare essentials
Parkinson's disease
  1. Andrew Lees
  1. Correspondence to A Lees, Professor of Neurology and Director of the Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1, UK; alees{at}ion.ucl.ac.uk

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Parkinson's disease is a progressive neurodegenerative disorder characterised by slowness of initiation of, and a progressive reduction in, the speed and amplitude of sequential movements (ie, motor decrement or decay), with muscular rigidity and a coarse slow pill rolling rest tremor. The pathological signature most frequently associated with this clinical picture is severe loss of pigmented neurons in the ventrolateral tier of the pars compacta of the substantia nigra with the presence of distinctive α synuclein immunoreactive inclusions in surviving nigral neurons (Lewy bodies).

Epidemiology

In the UK:

  • ▶. prevalence about 1/800, annual incidence 1/8000

  • ▶. 1% of people over the age of 65 years are affected

  • ▶. a general practitioner will have three to four patients at any one time

  • ▶. median age of onset is 60 years, with a slight male preponderance

  • ▶. disease onset to death is about 15 years, twice the number of observed to expected deaths (standardised mortality ratio 2:1).

The disorder is no respecter of race or creed Literary and historical precedents to Parkinson's seminal description suggest it is unlikely to be a post-industrial disease. In common with other neurodegenerative diseases, increasing age is the major risk factor although 15% of cases present before the age of 45 years and the incidence may decrease somewhat in the ninth decade of life. Genetic factors are now considered to significantly increase risk.

Habitual non-cigarette smokers are twice as likely to develop the illness as smokers and there may also be a mildly increased risk to men who do not take any caffeine, perhaps related to dopamine's role in reward pathways, rather than due to a protective effect of nicotine or coffee. Loose associations with rural living, middle age, obesity and lack of exercise, well water ingestion and pesticide exposure have also been reported. Environmental toxins such as …

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