Talk:Parkinson's disease/Archive 5

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Comments by Axl

Following the recent promotion to FA status, I am making further comments on the article here. Axl ¤ [Talk] 09:54, 7 March 2011 (UTC)

From "Prognosis", paragraph 2: "Disability is initially related to motor symptoms and particularly motor complications, which appear in up to 50% of individuals after 5 years of levodopa usage." "5 years" doesn't seem to be "initial". What does "initially" mean in this context? Axl ¤ [Talk] 09:55, 7 March 2011 (UTC)

I have checked source and line fits better in the next sentence, which talks about a medium stage. Moved.--Garrondo (talk) 07:31, 9 March 2011 (UTC)

Several pictures would benefit from alternative text. Axl ¤ [Talk] 10:31, 7 March 2011 (UTC)

Alt texts

I am going to add here alt texts I have added to article for further discussion.--Garrondo (talk) 08:19, 8 March 2011 (UTC)

• Handwriting image: First line of text is "Catherine Metzger" Second line of text is "13 Octobre 1869" (October 13th of 1869; in French). The original description of the text states "The strokes forming the letters are very irregular and sinuous, whilst the irregularities and sinuosities are of a very limited width. On a careful examination of this specimen of writing it will be perceived that the down-strokes are all, with the exception of the first letter, made with comparative firmness and are, in fact, nearly normal — the finer up-strokes, on the contrary, are all tremulous in appearance, and it is to the unsteadiness of these lines that the peculiar character of the writing here is principally due]]
• Walking b&w picture of patient: Black and white picture of male with PD viewed laterally. He has a chair close to him.
• Alpha-synuclein staining: Several brain cells stained in blue. One of them, with a circular form, has a brown smaller circular body inside it. Brown body is approximately one fifth in size of the cell in which it appears.
• Image from PLOS article (showing brainstem in red):Composite of 3 images, 1 in top row (Described in caption as A), 2 in second row (Described in caption as B). Top is a sagittal cut of the brainstem and bottom part of the brain. There are 3 circles superimposed along the brainstem and an arrow linking them from bottom to top one and continuing upward and forward towards the frontal lobes of the brain. A line of text accompanies each circle: lower is "1. Dorsal Motor X Nucleus", middle is "2. Gain Setting Nuclei" and upper is "3. Substantia Nigra/Amygdala". A fourth line of text above the others says "4. ...". The two images at the bottom of the composite are magnetic resonance imaging (MRI) scans, one saggital, one axial, centred at the same brain coordinates (x=-1, y=-36, z=-49). A colored blob marking volume reduction covers most of the brainstem.
• PET image: Sagittal PET scan at the level of the striatum. Hottest areas are the cortical grey matter and the striatum.
• Alt text for lead image: Two black and white line drawings side by side of a man stooped forward with one foot in front of the other (presumably walking). One drawing is from the front and one from the right side. Character shows several signs and symptoms of PD such as a forward flexed posture, a mask-like face, and rigidity in hands.

To keep things moving, I have made some amendments by direct editing to the article with explanations in the edit summaries. Snowman (talk) 20:57, 8 March 2011 (UTC)

Perfect: I only posted them so it is easier to see them.--Garrondo (talk) 07:09, 9 March 2011 (UTC)

Regarding all other images:

• How do I add an alt text to the lead image?
• I am not sure on adequate alt texts for the map and neurosurgery image.
• I do not think the other images (helicopter, Charcot, Ali, Parkin and GDNF) need an alt text: caption is self explanatory.

Some help or feedback with the above 3 issues would be great.--Garrondo (talk) 07:20, 9 March 2011 (UTC)

• Alt parameter used in infobox to add alt text. Snowman (talk) 20:15, 9 March 2011 (UTC)
• Is the helicopter image needed? Snowman (talk) 20:15, 9 March 2011 (UTC)

My opinion: Similarly to other images (chemical structures, PET..) it is not really needed as they do not really add much "content" to the article but neither do any harm and serve to make the article lighter to read and more aesthetic. In the specific case of the helicopter it probably attracts attention of the reader because he does not expect such an image in a disease article and helps to make the point that chemical agents may produce PD even better than a chemical structure which most people (including me) do not understand. In a section such as epidemiology, very hard to illustrate, this is probably as much as you can ask an image.--Garrondo (talk) 07:37, 10 March 2011 (UTC)

Alternative text is supposed to be succinct. The current alt text for the infobox image ("Two black and white line drawings side by side of a man stooped forward with one foot in front of the other (presumably walking). One drawing is from the front and one from the right side. Character shows several signs and symptoms of PD such as a forward flexed posture, a mask-like face, and rigidity in hands.") is much too long. Axl ¤ [Talk] 09:46, 10 March 2011 (UTC)

My suggestion: "Sketches of an elderly man with a stooped posture and blank expression." Axl ¤ [Talk] 09:48, 10 March 2011 (UTC)

It does look like he is having difficult walking in that posture. I have cut the caption down a bit. Alt text needs to explain the image, so I think the very short suggestion above is too short. Snowman (talk) 11:22, 10 March 2011 (UTC)

A possible middle ground: Two sketches of a man (one from the front and one from his right side) with an expressionless face and stooped forward, presumably walking with difficulty. Unsigned by Garrondo (talk)

Or something like that. I have moved the brackets, so that they follow "Two sketches" to which the brackets apply. Snowman (talk) 13:36, 10 March 2011 (UTC)

The alt text from the handwriting picture in "Signs and symptoms" ("First line of text is "Catherine Metzger" Second line of text is "13 Octobre 1869" (October 13th of 1869; in French). The original description of the text states "The strokes forming the letters are very irregular and sinuous, whilst the irregularities and sinuosities are of a very limited width. On a careful examination of this specimen of writing it will be perceived that the down-strokes are all, with the exception of the first letter, made with comparative firmness and are, in fact, nearly normal — the finer up-strokes, on the contrary, are all tremulous in appearance, and it is to the unsteadiness of these lines that the peculiar character of the writing here is principally due."") is much too long. Indeed it contains information that I didn't pick up on viewing the picture. This info, if it contained in/alongside the source, should not be alt text. Axl ¤ [Talk] 09:52, 10 March 2011 (UTC)

How about having it in the caption?: While it will make it a bit long a feel the paragraph is highly illustrating, well written and of historical value.--Garrondo (talk) 07:21, 11 March 2011 (UTC)

An alternative to have it shorter (in caption) could be: "The strokes forming the letters are very irregular and sinuous, whilst the irregularities and sinuosities are of a very limited width. (...) the down-strokes are all, with the exception of the first letter, made with comparative firmness and are, in fact, nearly normal — the finer up-strokes, on the contrary, are all tremulous in appearance (...)."--Garrondo (talk) 07:21, 11 March 2011 (UTC)

Moved some of the info from alt text to caption per above.--Garrondo (talk) 10:46, 21 March 2011 (UTC)

From "alternative text for images": "Alternative text should be short, such as "A basketball player" or "Tony Blair shakes hands with George W. Bush". If it needs to be longer, the important details should appear in the first few words, which helps the screen reader user to skip past the key points. Very long descriptions can be left for the body of the article." Axl ¤ [Talk] 10:20, 12 March 2011 (UTC)

Ongoing comments

From "Prognosis", paragraph 3: "The life expectancy of people with PD is lower than for people who do not have the disease." Would it be reasonable to say: "The life expectancy of people with PD is reduced."? Axl ¤ [Talk] 10:40, 10 March 2011 (UTC)

Looks OK to me. Snowman (talk) 13:38, 10 March 2011 (UTC)

Sounds great: for such kind of comments feel free to be bold and go for it. I have changed it in the article.--Garrondo (talk) 07:27, 11 March 2011 (UTC)

From "History", last paragraph: "Anticholinergics and surgery were the only treatments until the arrival of levodopa". What type of surgery was being performed at that time? Axl ¤ [Talk] 09:39, 21 March 2011 (UTC)

Enhanced with info from secondary article to: Anticholinergics and surgical lesioning of the corticospinal pathway or some of the basal ganglia structures were the only treatments until the arrival of levodopa, which reduced their use dramatically.--Garrondo (talk) 10:43, 21 March 2011 (UTC)

Thanks. Axl ¤ [Talk] 09:38, 22 March 2011 (UTC)

From "Research directions", subsection "Gene therapy": "In 2010 there were four clinical trials using gene therapy in PD." What is the relevance of 2010? Have there been clinical trials of gene therapy prior to 2010? Axl ¤ [Talk] 09:40, 22 March 2011 (UTC)

It is the last date with info in number of trials from a secondary source. It is the closest thing to the present we have.--Garrondo (talk) 09:45, 22 March 2011 (UTC)

Okay. In which case, does this sentence need to be in the article? Why bother to mention the number of gene therapy trials in 2010? Axl ¤ [Talk] 09:59, 22 March 2011 (UTC)

Pending comments by Snowmanradio at FAC

I am going to copy here comments that Snowmanradio still considered pending when FAC was closed, and their related answers, so I or anybody else fixes whenever possible and adequate.--Garrondo (talk) 11:12, 7 March 2011 (UTC)

• Re File:Parkinson surgery.jpg, the "electrode in brain" image. I would like to see expansion of the image description on commons and the caption in the article, as I do not find much there to indicate what the image is about. Is there a burr hole? Is it a general anaesthetic? What is the equipment called? What is happening in the photograph? Where are the surgeons and theatre staff? It might be worth contacting the author. The current caption says; "Placement of an electrode, to be deep-seated in the brain"; however, I have looked at the image at high resolution, and I do not see anything placed in the brain, although something might be about to be put in the brain or something might have been put in the brain earlier. If necessary, see tips on writing a caption in the wiki guidelines. Snowman (talk) 21:19, 28 February 2011 (UTC)

I have taken a look at the user that uploaded the image at commons: the image was uploaded in 2005, was the only contribution of the user, has no edited talk or user page at commons and does not have a user page in English Wikipedia. We will have to assume that we are not going to get any extra info. Since an image of neurosurgical operation is not easy to get; much less specifically of implantation of a DBS I would rather have this image in the article even if the image would be improved with further info.--Garrondo (talk) 15:03, 4 March 2011 (UTC)

Pending. I think that the documentation of this image is inadequate. Suggest try asking at user page on commons. Snowman (talk) 20:07, 4 March 2011 (UTC)

The author has not edited commons since 2005. I have added a little explanation to the caption. Does anyone know what the apparatus that is used to clamp the head it called? Presumably, it is some sort of modified Horsley-Clarke apparatus. Snowman (talk) 13:24, 7 March 2011 (UTC)

• The section "Surgery and deep brain stimulation" should separate destructive surgery with electrode implantation. Presumably, the old surgery was cutting into pathways or nerve centres. I do not know much about this topic; however, the wikilink for "pallidotomy" indicates that this is destructive (a hot electrode is used to obliterate parts of the brain) and looks wrongly placed. I think that the section is fatally flawed. Snowman (talk) 22:03, 28 February 2011 (UTC)

• Pending. Snowman (talk) 20:07, 4 March 2011 (UTC)

Reordered the section to make clearer that there are two types of treatments.--Garrondo (talk) 08:17, 10 March 2011 (UTC)

Much better. It would need a clearer description of a lesion. Snowman (talk) 10:30, 11 March 2011 (UTC)

• "... is unusual before the age of 40 years"; I added this to the introduction some time ago, sourced from Davidson's Principles and Practice of Medicine. I have just noticed, that this fact is not referenced in the article. Please source something like this from one of the reviews and include it in the main body of the article. Snowman (talk) 00:20, 1 March 2011 (UTC)

Epidemiology section says: The mean age of onset is around 60 years, although 5–10% of cases, classified as young onset, begin between the ages of 20 and 50: I believe it is close enough.--Garrondo (talk) 08:34, 1 March 2011 (UTC)

And of course it is referenced (to Sami et al).--Garrondo (talk) 13:55, 3 March 2011 (UTC)

Pending: Probably not common knowledge, so I expect this would need a specific reference. Regret my textbook is older than five years, so not ideal for a reference. Snowman (talk) 20:07, 4 March 2011 (UTC)

Introduction made consistent with text in body of article. Snowman (talk) 18:13, 7 March 2011 (UTC)

• Omission: there is no mention of lead-pipe rigidity. Snowman (talk) 15:11, 3 March 2011 (UTC)

• Pending. An important omission. Snowman (talk) 20:07, 4 March 2011 (UTC)

• Added. Snowman (talk) 16:11, 7 March 2011 (UTC)

• "... abnormalities in ocular pursuit and saccadic movements, and difficulties in directing gaze upward."; jargon. Websites mention blurred vision and double vision, but no mention in article. Snowman (talk) 16:20, 3 March 2011 (UTC)

Websites are NOT reliable sources, Jankovic is. Additionally our article says "such as" which means "some examples but not all problems are named". Regarding ocular pursuit I feel is easy enough to understand. Regarding saccades: clarified.--Garrondo (talk) 08:40, 4 March 2011 (UTC)

Pending: The webpage was a PD society leaflet, and I have no reason to question it. Snowman (talk) 20:17, 4 March 2011 (UTC)

Added with a ref specifically in PD and ophtalmology.--Garrondo (talk) 13:40, 7 March 2011 (UTC)

• Better sense is made out of the references that say or do not say how toxic some substances are or are not in causing PD. Snowman (talk) 16:59, 4 March 2011 (UTC)

Sorry, but I do not understand your comment.--Garrondo (talk) 17:11, 4 March 2011 (UTC)

Evidence of the pesticides and so on. One section says that all evidence is equivocal and then the next says a two fold increase in risk of PD. Snowman (talk) 17:18, 4 March 2011 (UTC)

amphetamines Benzedrine and Dexedrine Paper

I am not sure why it is not appropriate to include this research in the risk factors at this time. What would be acceptable criteria for including this as of now? PablitoRun (talk) 17:50, 8 March 2011 (UTC)

In short: because it has not been considered important in high quality secondary recent sources (mainly general reviews of the disease), so it would be to give undue weight to the issue.--Garrondo (talk) 18:01, 8 March 2011 (UTC)

Main page

I plan to go for the main page for April 11th (World Parkinson's day). Article has 8 points according to the rules for main page requests, so most probably will not have any problems getting there. We can begin to work in a summarized lead here.--Garrondo (talk) 08:45, 9 March 2011 (UTC)--

Below an initial proposal of main page blurb. Please modify it at will. Image could be the same as in the lead of the article.--Garrondo (talk) 07:51, 11 March 2011 (UTC)

Parkinson's disease is a degenerative disorder of the central nervous system. It results from the death of the dopamine-containing cells of the substantia nigra. While most cases are of unknown origin some are due to genetic mutations. Early in the course of the disease, the most obvious symptoms are movement-related, including shaking, rigidity, slowness of movement and difficulty with gait. Cognitive, behavioural, sensory, sleep and emotional problems may also arise. It is more common in the elderly. The pathology of the disease is characterized by the accumulation the alpha-synuclein protein into inclusions called Lewy bodies in neurons, and from insufficient formation and activity of dopamine. Diagnosis is mainly based on symptoms. Modern treatments are effective at managing the early motor symptoms of the disease, mainly through the use of levodopa and dopamine agonists. The disease is named after James Parkinson. April 11, birthday of James Parkinson is considered Parkinson's disease day.

To keep from cluttering this talk page unnecessarily, I've created Talk:Parkinson's disease/Main page and copied the version above into it -- I think it would be better to work there than to continuously edit this talk page. Looie496 (talk) 18:12, 11 March 2011 (UTC)

Your edits there are Ok, but may have to be summarized: blurb can only be 1200 characters. I go away for a week. I will continue with it (and comments above) when I come back.--Garrondo (talk) 07:57, 12 March 2011 (UTC)

I have nominated it.--Garrondo (talk) 09:45, 22 March 2011 (UTC)

Great. Commenting on the proposed main page, I think this picture is perhaps not the right one to use. It is fine for the article, but on the main page it will give readers the thought people with Parkinson's disease are pathetic. I really think we should have something more neutral. The ideal would be a drawing of a tulip. Best of all would be the Karen Painter version, but that is copyrighted and we may not be able to get proper permission to use it. I have noticed some nice photos that would be usable, including the one you placed in the article, and a number on this page that have licenses that are okay for us. I could, if you thinkit would be useful, download one of them and do some graphics wizardry to emphasize its "tulipness". Looie496 (talk) 16:40, 22 March 2011 (UTC)

Gowers's illustration

• 
  From Gowers's 1893 edition
• 
  From Herter's 1907 edition
• 
  From Herter's 1907 edition

Gowers did not exactly drew this without inspiration. He specifically credited St. Leger, stating "The illustrations of which the source is not stated are original, and part of the copyright of the book."[1] In other words, he points St. Leger as the copyright holder of the original source of his drawing. The problem is who is St. Leger? It seems he was a prominent doctor on diseases in those days,[2][3][4] but there is no information otherwise to determine when he died, and what was the original source (photographs, drawings, location of publication, etc). As such, without knowledge about the copyright status in their country of origin, I uploaded these two images onto Wikipedia instead of Commons. Information about St. Leger and the original source are appreciated. Jappalang (talk) 02:06, 25 March 2011 (UTC)

Well spotted. It seems that the infobox caption needs correcting. The images are more than 100 years old, so they are PD copyright and the tag {{PD|old}} can be used on commons. Snowman (talk) 11:00, 1 April 2011 (UTC)

Since it's very likely that St. Leger died before 1941 (55 years after the sketch) there's a good case to be made for uploading these images to the commons ad PD old. ˉˉ^anetode╦╩ 05:12, 8 April 2011 (UTC)

New clue?

Today's buzz around welders' occupationally exposed to metal fumes is interesting, but leaves much unanswered. At issue:

• Criswell SR, Perlmutter JS; et al. (6 April 2011). "Reduced uptake of [18F]FDOPA PET in asymptomatic welders with occupational manganese exposure". Neurology. 76 (epub ahead of print). doi:10.1212/WNL.0b013e3182152830. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |laysummary= ignored (help)
• http://www.montrealgazette.com/health/Parkinson+like+symptoms+found+welders+study/4572143/story.html

Now, I haven't seen the full article, so feel free to trout me, but I don't see why they would focus on Mn amongst all the other (more common) metal fumes, working gases, electric shocks and other factors welders are occupationally exposed to. LeadSongDog come howl! 17:51, 7 April 2011 (UTC)

They pick on MN because there's some very old literature comparing MN toxicity symptoms to PD. Back then it looked like a close enough fit to interest some people. --Snow (talk) 02:50, 23 May 2012 (UTC)

Further on the subject:

• Martin W (6 April 2011). "Fuming over Parkinson disease: Are welders at risk?". Neurology. 76 (epub ahead of print). doi:10.1212/WNL.0b013e31821528ab.{{cite journal}}: CS1 maint: date and year (link)
• Walsh N, Agus ZS, Caputo D (6 April 2011). "Welders at Risk of Neuronal Damage". MedPage Today.{{cite web}}: CS1 maint: multiple names: authors list (link)
• Brooks M (7 April 2011). "Welding Fumes May Cause Early Parkinson-Like Brain Damage". Medscape Medical News.

The medscape piece says the selected welders were mostly longtime shipyard workers, so they must have been exposed to the full toxic stew over the years.LeadSongDog come howl! 18:31, 7 April 2011 (UTC)

And also correlation does not necessarily mean causation. OrangeMarlin ^{Talk• Contributions} 05:51, 11 April 2011 (UTC)

Question

The Motor section, which identifies the 4 common physical symptoms currently has:

Tremor is the most apparent and well-known symptom.[1] It is the most common...

And

Bradykinesia (slowness of movement) is the most characteristic clinical feature of...

Are these descriptions consistent, or can they be better differentiated? Ocaasi ^c 04:15, 11 April 2011 (UTC)

I made a small edit to make it look a bit less confusing. The basic story, as I understand it, is that tremor is the first thing you notice when you look at somebody with PD, but bradykinesia is at least as common and much more debilitating. I'm not confident enough of my understanding to try to fix it myself, though. Anyway thanks for pointing this out. Looie496 (talk) 05:03, 11 April 2011 (UTC)

Looie, your understanding sounds correct. Don't worry about it, it's an FA article that's been reviewed by a lot of smart people. OrangeMarlin ^{Talk• Contributions} 05:49, 11 April 2011 (UTC)

I was under the impression that FA articles should still be improved. It's a contradiction for two separate things to be 'the most common and well known' and 'the most characteristic' without explaining how those superlatives differ. Why wouldn't we want to clarify the seeming overlap between the description of those two symptoms? If this is terminology that smart people are familiar with, we should nonetheless translate it so that everyone else knows what it means too. Ocaasi ^c 06:18, 11 April 2011 (UTC)

The article was written by a neuroscientist and I believe a physician, but I could be wrong. The FA review had a lot of smart people involved. That's what I'm talking about. Of course, you should fix grammar and style issues. But to fundamentally try to change things because you do not understand that genetics IS a Cause makes me wonder. That's all.OrangeMarlin ^{Talk• Contributions} 06:43, 11 April 2011 (UTC)

I'm sure the neuroscientist and physicist are very bright and fully understand the subject. My concern is primarily about writing conventions and lay readers. I did not suggest genetics was not a cause--the opposite actually, that we would mention genetics specifically in the header or sub-header of the Causes section.

Would you mind explaining the question of this thread, how the first 2 of 4 characteristic movement symptoms respectively 'most common and well known' and 'most characteristic', because I find those two descriptions to have significant overlap in a way that is contradictory. I assume this is either an error or that there a less ambiguous way to phrase it. Maybe someone else can explain the difference. Ocaasi ^c 07:04, 11 April 2011 (UTC)

Looie, I think your edit fixed it, at least for now, thanks. Ocaasi ^c 07:33, 11 April 2011 (UTC)

Translate

From the Causes section:

Multiplications have been found in asymptomatic carriers, which indicate that penetrance is incomplete or age-dependent.

Could someone translate this please? Ocaasi ^c 05:36, 11 April 2011 (UTC)

It's extremely clear. That the multiplication of the SNCA allele is found in asymptomatic carriers of the disease, which indicates that the genotype is expressed in a phenotype either incompletely or is age-dependent. Since it's in English, I have no clue what you mean by "translate" unless you're being sarcastic, in which case, I just wasted my time.OrangeMarlin ^{Talk• Contributions} 05:48, 11 April 2011 (UTC)

Encyclopedic writing should be accessible for a broad audience if possible. In technical articles this is not always feasible in every section, but it's often worth trying to find a phrasing which is both precise and also something a lay reader could understand. "Translate" referred to a request for a jargon-free explanation of what that sentence means, to determine if it could be phrased in a way that would let non-medical professionals also understand what it was saying. Do you think that's the wrong approach? Ocaasi ^c 06:22, 11 April 2011 (UTC)

The sentence was perfectly clear. We shouldn't dumb things down to the point where they make no sense. OrangeMarlin ^{Talk• Contributions} 06:39, 11 April 2011 (UTC)

The sentence is perfectly clear if you're a medical or genetics expert, and I have no desire to dumb the sentence down, merely to append a lay paraphrase if possible, so that people without your background can also access the information. Isn't that standard convention in encyclopedic medical writing? Ocaasi ^c 06:44, 11 April 2011 (UTC)

Yes. WE don't write for the lowest common denominator. It reads perfectly clear. OrangeMarlin ^{Talk• Contributions} 19:15, 11 April 2011 (UTC)

Header

Also, the Causes section is almost primarily about genetics. Should the section be renamed Causes and genetics, or something more descriptive (or is that redundant)? Maybe an H3 for Genetics just to alert readers in the table of contents? Ocaasi ^c 05:36, 11 April 2011 (UTC)

Please see WP:MEDMOS. The causes are almost all genetics. OrangeMarlin ^{Talk• Contributions} 05:43, 11 April 2011 (UTC)

Yes, my question was whether we should have a level 3 sub-header for Genetics. I recognize the condition is primarily idiopathic and the other known causes are genetic; a more specific header or sub-header (if MEDMOS standardizes the headers) might make finding this information easier. Do you have an objection to that? Ocaasi ^c 06:48, 11 April 2011 (UTC)

The section is not very long. I would avoid a level 3 header currently. It would only be useful if the section was longer and it discussed multiple other causes. JFW | T@lk 07:59, 11 April 2011 (UTC)

Again, what I said. Oh well, I guess several opinions are required for the editor. OrangeMarlin ^{Talk• Contributions} 19:14, 11 April 2011 (UTC)

Orthostatic hypotension

We wikilink Orthostatic hypotension but an attempt to provide a lay paraphrase of this term in parentheses was reverted. The phrase I used was Orthostatic hypotension (dizziness upon standing). Could someone suggest a different phrase to use or explain why this one would be inappropriate?

WP:MEDMOS When mentioning technical terms (jargon) for the first time, provide a short plain-English explanation in parentheses if possible. If the concept is too elaborate for this, wikilink to other articles (or Wiktionary entries). For terms related to anatomical position, you can link to Anatomical terms of location, e.g. lateral. Alternatively, if the technical word is not used again in the article, it may be appropriate to use plain English and place the technical term within brackets. The etymology of a word can be interesting and can help the reader understand and remember it. Provide links only where they may help the readers and are reasonably focused on the topic.

Ocaasi ^c 07:20, 11 April 2011 (UTC)

Note, I replaced it with Orthostatic hypotension (low blood pressure upon standing). Ocaasi ^c 07:52, 11 April 2011 (UTC)

The majority of orthostatic hypotension causes no symptoms at all. At the same time, it may lead to ligtheadedness and sometimes blackouts. JFW | T@lk 07:54, 11 April 2011 (UTC)

That's what I said. But of course, what the hell do I know. Oh wait, I do know. Ocaasi...you're getting tendentious.OrangeMarlin ^{Talk• Contributions} 19:13, 11 April 2011 (UTC)

Redundant statement of specific gene causality

The Causes section includes:

PD traditionally has been considered a non-genetic disorder; however, around 15% of individuals with PD have a first-degree relative who has the disease. At least 5% of people are now known to have forms of the disease that occur due to a mutation of one of several specific genes.

Mutations in specific genes have been conclusively shown to cause PD. These genes include... (italics added)

I previously removed the topic sentence of the latter paragraph (Mutations in...) because the sentence immediately prior implies the same thing. Is there a reason to objection to that change? Ocaasi ^c 07:58, 11 April 2011 (UTC)

Sounds perfect now. Unless you require 25 other opinions. OrangeMarlin ^{Talk• Contributions} 19:11, 11 April 2011 (UTC)

Your snark aside, it still doesn't make sense. We use a topic sentence in the second paragraph as if the statement is novel, but it was just mentioned literally in the preceding sentence. Are the genes that have been conclusively shown to cause PD the same ones described among the 5% of people who have genetically cause-PD? If so, then we can use a transitional pronoun, "Mutations in these genes... The genes include". Or we could just put "conclusively" in the sentence mentioning the 5% and cut out the topic sentence entirely. If not, we need to distinguish better that the 5% specific genes are different or not conclusively linked to particular genes. So it's either ambiguous or redundant, and should read better either way once it's cleared up. If you don't care for this kind of grammatical improvement, maybe someone else should respond. Ocaasi ^c 09:45, 13 April 2011 (UTC)

I agree with you that the wording should be improved. These are difficult things to state accurately, though, and I think it would be dangerous to try to reword the material without first consulting the sources to figure out what the actual facts are that the paragraph should be expressing. Regards, Looie496 (talk) 16:25, 13 April 2011 (UTC)

Festination

The article uses an interwiki link to wikt:festination. I previously pointed that to festination but we actually have a stub on festinating gait. Is there a reason we would link to Wikitionary rather than our own article on the subject? Ocaasi ^c 08:02, 11 April 2011 (UTC)

Fixed it. OrangeMarlin ^{Talk• Contributions} 19:10, 11 April 2011 (UTC)

Neuropsychiatric

Would these sentences be improved by the proposed revisions? Current text: Prevalence of dementia increases in relation disease of the duration, going up to 80%. Proposed revision: Prevalence of dementia increases in relation to the duration of the disease, going up to 80%. Current text: ...higher probability of attending a nursing home. Proposed revision (1): ...higher probability of needing nursing home care. Or, proposed revision (2): ...higher probability of moving to a nursing home. (Tbeut (talk) 15:56, 11 April 2011 (UTC))

Sure. I made changes along the lines you suggested (plus a bit of copy-editing). Looie496 (talk) 17:19, 11 April 2011 (UTC)

Would the article be more informative if a subsection about Learning and Memory be added? As of now the section briefly talks about cognitive dysfunction and broadly talks about memory recall issues. I propose that this section would specifically discuss types of memories that are effected and not effected by PD?

Memory and learning

Non-declarative memory

There are some aspects of learning and memory that are altered due to PD. Generally the non- declarative system appears to be more effected by the disease. One form of non-declarative memory which is significantly compromised is probabilistic category learning. Probabilistic category learning is a type of learning that also is comprised of procedural memory and employs feedback . This type of learning has been argued to be heavily reliant on the structures of the basal ganglia specifically the striatum. Since this the pathology of PD affects these very same structures it has been illustrated that individual PD perform significantly worse than controls on this type of task . However, there is evidence that individuals with PD are able perform just as well as controls on probablistic category learning if they are given a form of the task that does not employ feedback .

Declarative memory

Declarative memory is demonstrated to be fairly well intact extensively within in individuals with Parkinson's disease . One task that is believed to tap into declarative memory is the concurrent discrimination task (CDT). The CDT is deterministic in nature, meaning a consistent answer is mapped to a set of specific stimuli. In addition the CDT requires the correct choice within multiple pairs of stimuli to be learned simultaneously and employs feedback. Research has supported that individuals with PD are no different than controls when performing this task . But this is only be true if the participant is aware that the goal of the task is to learn the correct choice for each pair. If the participants are unaware of the goal they perform significantly worse than controls . Dtuladhar (talk) 18:14, 5 November 2012 (UTC)

Ice Cream

Would it be worth mentioning that Parkinson's patients eat consume a higher than typical quantity of ice cream? Ref: http://www.rimed.org/medhealthri/2010-03/2010-03-91.pdf Kevink707 (talk) 22:16, 12 April 2011 (UTC)

In my opinion that would not be worth mentioning, especially given the preliminary nature of the findings. Looie496 (talk) 22:22, 12 April 2011 (UTC)

However, it sounds like the only good reason to have PD. Lots of ice cream. I want cookie dough. Chocolate chocolate-chip would be nice too.  :) OrangeMarlin ^{Talk• Contributions} 01:09, 13 April 2011 (UTC)

Possible Cause of Parkinson's Discovered?

Headlines:

Ulcer-Causing Bacteria May Trigger Parkinson's

Mouse study finds stomach ulcer-causing microbes may also affect brain

Ref: http://www.usnews.com/science/articles/2011/05/23/ulcer-causing-bacteria-may-trigger-parkinsons —Preceding unsigned comment added by 12.183.217.250 (talk) 20:21, 24 May 2011 (UTC)

Studies in mice often do not show similar results in humans. To add this to the article would be extremely premature.-gadfium 21:02, 24 May 2011 (UTC)

paragraph concerning Heiko Braak's theory, moving here for discussion

I am moving the following newly added material here for discussion.

The possible progression of Parkinson's from the ENS to the CNS, proposed by Heiko Braak<ref>Hawkes C.H., Del Tredici K. and Braak H. (2007). Review: Parkinson's disease: a dual-hit hypothesis. Neuropathology and Applied Neurobiology, 33, 599–614.</ref>, is a topic of current study<ref name="pmid20856865">{{cite journal |author=Lebouvier T, Neunlist M, Bruley des Varannes S, Coron E, Drouard A, N'Guyen JM, Chaumette T, Tasselli M, Paillusson S, Flamand M, Galmiche JP, Damier P, Derkinderen P. |title=Colonic biopsies to assess the neuropathology of Parkinson's disease and its relationship with symptoms. |journal=PLoS One. |year=2010 |month=September |pmid=20856865}}</ref><ref name="pmid20098733">{{cite journal |author=Pan-Montojo F, Anichtchik O, Dening Y, Knels L, Pursche S, Jung R, Jackson S, Gille G, Spillantini MG, Reichmann H, Funk RH |title=Progression of Parkinson's disease pathology is reproduced by intragastric administration of rotenone in mice |journal=PLoS One. |year=2010 |pmid=20098733 |url=http://www.ncbi.nlm.nih.gov/pubmed/20098733}}</ref><ref name="pmid19067353"/>.

I note that that reputable sources exist to support a mention of these ideas, for example PMID 19712093. The Braak paper may also be a MEDRS-level source; however the three listed at the end are clearly not. Even if the sentence is acceptable for the article, though, it is too nebulous as currently written to be understood by a reader. In my view it would at the least need to be altered to make some assertion that a reader can understand, i.e., stating the gist of Braak's idea and summarizing the reaction to it. Looie496 (talk) 23:26, 13 July 2011 (UTC)

I was directed to the concept via a less supported update to Treatment of Parkinson's disease, an edit which I attempted to massage but for which one might find more appropriate actions. My goal with this addition was to throw up some sources and text to see if anyone else could help work to determine the merit of including information regarding the theory. Perhaps it is appropriate for there to exist a reciprocal link between the Braak theory page and the PD main article? Aeth909 (talk) 17:01, 19 July 2011 (UTC)

The theory of Heiko Braak et al is surely interesting enough for scientists to work on, but it may not yet have reached enough prominence to be mentioned in our Parkinson's disease article. Somebody could add a paragraph to our Heiko Braak article about this, because it is obviously relevant there. (At present the Braak article only includes one sentence on his theory). This Google Scholar result shows 82 hits on the 2007 paper by Hawkes, Del Tredici and Braak. These guys hypothesize an unknown pathogen and a route of entry into the body. If they eventually find a *real* pathogen, they'll probably be famous. EdJohnston (talk) 00:20, 27 September 2011 (UTC)

New pubs

A couple of new primary pubs out

• Vilariño-Güell C; et al. (15 July 2011). "VPS35 Mutations in Parkinson Disease". American Journal of Human Genetics: 162–7. doi:10.1016/j.ajhg.2011.06.001. {{cite journal}}: Explicit use of et al. in: |author= (help); External link in |laysummary= (help); Unknown parameter |Issue= ignored (|issue= suggested) (help); Unknown parameter |Volume= ignored (|volume= suggested) (help)
• Zimprich A; et al. "A Mutation in VPS35, Encoding a Subunit of the Retromer Complex, Causes Late-Onset Parkinson Disease". American Journal of Human Genetics. 89 (1): 168–75. doi:10.1016/j.ajhg.2011.06.008. {{cite journal}}: Explicit use of et al. in: |author= (help)

Stages

The progress of Parkinson's is conventionally divided into five stages as described here, but the article doesn't mention them, although there are multiple mentions of "earlier" and "later" stages. Are they worth adding, or is the classification now discredited? Jpatokal (talk) 11:55, 25 September 2011 (UTC)

Since the symptoms form a continuous progression, those five stages are somewhat artificial, so there would have to be a much better source to show that this convention is widespread. Looie496 (talk) 15:21, 25 September 2011 (UTC)

They are called "Hoehn & Yahr stages", and like many systems of this kind they are coarse, somewhat insensitive, yet in very widespread use clinically. --PaulWicks (talk) 15:00, 26 September 2011 (UTC)

And turns out we have an article for them already! Hoehn and Yahr scale. Jpatokal (talk) 23:18, 26 September 2011 (UTC)

Early treatment may forestall clinical progression. PMID 20297870

Hauser RA.

Early pharmacologic treatment in Parkinson's disease.

Am J Manag Care. 2010 Mar;16 Suppl Implications:S100-7.

Abstract

Early treatment of Parkinson's disease (PD) affords an opportunity to forestall clinical progression. Levodopa is the most effective treatment for PD motor signs and symptoms, but its use is associated with the development of motor fluctuations and dyskinesias. Because of this, levodopa use is commonly withheld until the patient experiences functional disability. Other medications are available for the treatment of early PD and can be initiated at or near the time of diagnosis. Monoamine oxidase type B (MAO-B) inhibitors provide mild symptomatic benefit, delay the need for levodopa, are very well tolerated, and may provide long-term disease-modifying effects. Dopamine agonists provide moderate symptomatic benefit, delay the need for levodopa, and cause fewer motor complications than levodopa. Compared with levodopa, however, dopamine agonists cause more somnolence and sudden-onset sleep as well as impulse control disorders. The treatment of early PD depends in part on the individual patient's anticipated risk of side effects and the degree of motor improvement required. Physicians should also consider the early use of MAO-B inhibitors in light of their very good tolerability and the recent evidence suggesting long-term disease-modifying effects.

PMID 20297870

Free full text: http://www.ajmc.com/publications/supplement/2010/A280_10mar_Parkinsons/A280_10mar_Hauser/ — Preceding unsigned comment added by 99.190.133.143 (talk) 13:57, 5 November 2011 (UTC)

is parkinsons an immune systems disease — Preceding unsigned comment added by 108.52.90.217 (talk) 03:47, 15 November 2011 (UTC)

Surgical treatment: Pallidotomy

My brother-in-law was diagnosed with Parkinson's while in his 30's, and was very successfully treated by Dr. Iacono (now deceased) with a bilateral pallidotomy. Here's a link to a Brian Huston video documentary on his surgery and the aftermath. I'm surprised that this treatment is so seldom mentioned but the result's in Don's case were spectacular. Solarbuddy (talk) 19:45, 2 December 2011 (UTC)

dead link

ref 87 is dead--Gacelo (talk) 13:43, 11 April 2012 (UTC)

Protective Factors

Recent studies have indicated that certain calcium channel blockers (such as Isradipine) provide a protective factor against Parkinson's disease. It might be worth including in this section, if enough sources can be located. Here's one: American Academy of Neurology --Dulcimerist (talk) 07:51, 8 May 2012 (UTC)

Here are some additional sources, in case anyone is interested in adding a brief mention of certain calcium channel blockers providing a protective factor against Parkinson's disease:

Calcium Channel Blockers Reduce Parkinson Disease Risk

L-type calcium channel blockers and Parkinson disease in Denmark

Use of calcium channel blockers and Parkinson's disease

Although the studies seem to be preliminary, a carefully-worded sentence stating the early findings would likely be noteworthy and of interest to this article. Parkinson's disease isn't my area of expertise, so I'd rather see someone else make this edit. Any thoughts or comments here would be greatly appreciated. Thanks! --Dulcimerist (talk) 19:21, 22 May 2012 (UTC)

We typically use secondary sources while these appear to be primary sources. We will need to wait for a review article to be published. --Doc James (talk · contribs · email) 00:11, 23 May 2012 (UTC)

Edit request on 12 May 2012

Photomicrograph of the dorsal motor nucleus of the vagus nerve (DmX) in a transverse section along the upper medulla shown to be affected by the abnormally deposited alpha synuclein as part of intraneuronal Lewy bodies found. DmX is one of the earliest sites affected by synuclein deposition in Parkinson's disease.

144.82.216.16 (talk) 00:58, 12 May 2012 (UTC)

This article is already quite long, chunked up with images, and the source for the text in the image caption is a study, not a secondary review. Discussion is needed on 1) whether to use the image;, 2) where to place it; 3) and whether the text in the caption can be supported by a secondary review. See WP:OWN#Featured articles, WP:WIAFA and WP:MEDRS. Unless a secondary source mentions this as an important finding, it's not clear to me that this image adds anything to a Featured article. SandyGeorgia (Talk) 14:47, 12 May 2012 (UTC)

Hello, I am Suraj, the user who uploaded the image and requested its induction in this article. To be honest, yes, this may not be relevant to an encyclopedic article, but rather a scientific one. So I now think that I could revoke the request. If anyone else feels this may be inducted, I am okay with that too. The paper I cited as reference to the caption is the most widely cited paper in Parkinson's pathology in the past 10 years, and was the first paper to propose the now well established theory of a caudo-rostral (lower to higher level) spread of Lewybody pathology in a Parkinson's patient's brain; anyone working on Parkinson's pathology would be familiar with Braak & Del-Tredici's work. It was the historicity of the paper that prompted me to cite it although I totally agree that a secondary source is more relevant to Wiki. Hence I suggest this reference instead : Braak, Heiko; Del-Tredici, Kelly; Schmidt, Werner J.; Reith, Maarten E. A. (eds.) (2005). "Presymptomatic and Symptomatic Stages of Intracerebral Inclusion Body Pathology in Idiopathic Parkinson's Disease". Dopamine and Glutamate in Psychiatric Disorders. Humana Press. pp. 475–502. doi:10.1007/978-1-59259-852-6_20. ISBN 978-1-59259-852-6. {{cite book}}: |first4= has generic name (help). It is left to the wiki editors to do the needful now. Thank you.--144.82.216.16 (talk) 05:43, 14 May 2012 (UTC)

Might fit better on a subpage which yet needs to be created such as Pathophysiology of Parkinson's disease Doc James (talk · contribs · email) 00:15, 23 May 2012 (UTC)

Image in the lead

@re the image caption. Its in copyright violation and is inappropriate for sufferers as its pre medication pre modern imagery, its archaic --HumusTheCowboy (talk) 01:15, 23 May 2012 (UTC)

An image from 1886 is not a copyright violation. Do you have a better one with which to replace it? I do not see how it is inappropriate? Also we typically refer to "people with Parkison's diseases" rather than sufferers as not all people suffer. Doc James (talk · contribs · email) 05:18, 23 May 2012 (UTC)

Re suffering. Well thats subjective, can you ref one person with PD who is not suffering? Its an awful old pic IMHO. Better none than that. RE pic it has some copyright issues. Do not copy this file to Wikimedia Commons. This file is free content in the United States but non-free or potentially non-free in its country of origin. Wikimedia Commons only accepts files that are public domain in both the country of origin and the United States --HumusTheCowboy (talk) 11:15, 23 May 2012 (UTC)

It is potentially not free in its country of origin. If someone was to investigate they may find that it is suitable for commons. Doc James (talk · contribs · email) 11:32, 23 May 2012 (UTC)

Misdiagnosis

The diagnosis of Parkinson's disease continues to be challenging with misdiagnosis rates as high as 20-30% in early stages. I have a journal reference --HumusTheCowboy (talk) 02:26, 23 May 2012 (UTC)

Sure feel free to provide it for others to consider. Doc James (talk · contribs · email) 05:29, 23 May 2012 (UTC)

In health this is a high misdiagnosis rate. Significant. --HumusTheCowboy (talk) 11:17, 23 May 2012 (UTC) http://www.ncbi.nlm.nih.gov/pubmed/12464118 --HumusTheCowboy (talk) 11:17, 23 May 2012 (UTC)

Fairly close to what we have below.--Doc James (talk · contribs · email) 11:30, 23 May 2012 (UTC)

Not really. I dont think you appreciate the difference. The misdiagnosis rate concerns new cases and is significant due to these people being prescribed medications whose side effects mimic PD, making it self confirming. Autopsies merely confirm the figures. The high rate is remarkable and concerning --HumusTheCowboy (talk) 03:19, 24 May 2012 (UTC)

Not referenced

This below in italics is not found in the accompanying reference. Not there at all Accuracy of diagnostic criteria evaluated at autopsy is 75–90%, with specialists such as neurologists having the highest rates. --HumusTheCowboy (talk) 02:33, 23 May 2012 (UTC)

I managed to find it within the journal reffed in the section called "Diagnostic criteria" --Doc James (talk · contribs · email) 05:30, 23 May 2012 (UTC)

Er no, this is there: A study that included 100 patients who underwent biopsy after clinical diagnosis using the UK Parkinson’s Disease Society Brain Bank criteria found that 76% of patients met the pathological criteria; when the diagnostic criteria were retrospectively applied, accuracy improved to 82% In a later study of the brains of patients examined by neurologists, diagnostic accuracy was considerably higher (91–92%) Its not the same at all. This is an encyclopedia, so it should be accurate. --HumusTheCowboy (talk) 11:08, 23 May 2012 (UTC)

Yes. Altered the text to "Accuracy of diagnostic criteria evaluated at autopsy is 75–90%, depending on the study looked at." Doc James (talk · contribs · email) 11:19, 23 May 2012 (UTC)

Better but should read 76% -92% --HumusTheCowboy (talk) 11:24, 23 May 2012 (UTC)

And now, it does. Plus, the wording has been changed to remove the ending preposition and clarify the source says the accuracy of the postmortem diagnosis rises with the training level of the evaluator. — UncleBubba ^{( T @ C )} 04:52, 24 May 2012 (UTC)

excellent --HumusTheCowboy (talk) 01:40, 26 May 2012 (UTC)

Another external reference

A new learning project which is relevant to this topic has been started in Wikiversity: http://en.wikiversity.org/wiki/Portal:The_Science_Behind_Parkinson%27s. Please have a look at it. WP editors may be interested in adding material to the WV project. But please put in a link to it on this page. (My user name on Wikiversity is Droflet.) Jtelford (talk) 16:06, 11 September 2012 (UTC)

Help request for a Wikiversity project on Parkinson's

A group of us are looking for help in continuing the development of a Wikiversity learning project. I hope this is appropriate place to contact wikipedians who might be interested in giving assistance or spreading the word. The project is The Science Behind Parkinson's. I invite you to visit it to look at its aims and state of development. We have, in fact, got a lot of material on it already. But we want more people to join us in developing it and making it a valuable resource particularly for those affected by Parkinson's who want to understand more about the science underlying the condition.

It would be good if you could also suggest other ways in which we could find other people who would be interested in helping with its development. I am prepared to write individually to all the active wikipedians on the Neuroscience project if that is the best way of contacting relevant people but I don't want to be accused of spamming! Thanks. My user name on Wikiversity is Droflet. Please write on my user talk page there, http://en.wikiversity.org/wiki/User_talk:Droflet or on my user talk page here on wikipedia. Droflet (talk) 22:15, 19 May 2013 (UTC)

Edit request on 18 October 2012

Edit the line: In recent years it has been the major Parkinson's fundraiser in the U.S., providing $140 million in funding between 2001 and 2008.

The Fox Foundation has funded $304 million in Parkinson's research. Source: https://www.michaeljfox.org/

38.121.141.2 (talk) 20:03, 18 October 2012 (UTC)

 Not done. The reference you provide does not give a time frame, so our number is still correct. The Fox Foundation may have funded $304 million over it's entire lifespan, but not between 2001 and 2008. gwickwire | Leave a message 00:43, 19 October 2012 (UTC)

Unreffed

Moved here as unreffed and if references are found should probably go on a subpage of this one.

Locus	Gene	Function	Mutations	Clinical Presentations	Neuropathology	Age at onset
PARK1	SNCA (α-synuclein)	Unknown synaptic function	Duplications	Ideopathic PD; some postural tremor; slow progression	LBs	Mid 20 - 30
			Triplications	PD; PD with dementia;diffuse LBs disease;aggressive course	LBs and Lewy neurites; ± glial inclusions; hippocampal CA2 and CA3 loss	Mid 20's - 30's
			A53T, A30P E46K	Idiopathic PD; early on set parkinsonism and diffuse LBs	LBs and LNs; ± tau inclusions; amyloid plaques	30 - 60
PARK2	Parkin	E3 ubiquitin ligase	200+ possible mutations including: - Inactivating somatic mutations - Frequent intragenic deletions	Early on set Parkinsonism; slow progression PD	variable presence of LBs	Juvenile to 40
PARK5	UCHL1	hydrolase and ligase		PD	Unknown	30 - 50
PARK6	PINK1	mitochondrial Ser-Thr Kinase	40+ mutations -Mostly point mutations -Deletions on C-terminus Kinase domain	Parkinsonism	Unknown	30 - 50
PARK7	DJ-1	oxidative stress response?	-10 point mutations including C46A, C53A, C106 & WT regions - Large deletion in L166P	Early on set Parkinsonism	Unknown	20 - 40
PARK8	LRRK2 (dardarin)	unknown protein kinase		PD	Diffuse LBs; LNs; ± tau inclusions; ± amyloid plaques	40 - 60

Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:51, 29 October 2012 (UTC)

Have moved this content to a subpage. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:46, 29 October 2012 (UTC)

Parkinson's disease dravidian cure in chintharmony system ±

×It is cruel to assert Parkinson's disease is incurable. Dravidian chintharmony system offered cures from time imemmorial in India.Number of physicians can be counted in fingers. In aAustralia a Chiropractor Noel Batten offers cures. — Preceding unsigned comment added by Vasu.jayaprasad (talk • contribs) 12:59, 7 November 2012 (UTC)

Link request for Parkinson's Science Wikiversity project

See section above Talk:Parkinson's_disease#Help_request_for_a_Wikiversity_project_on_Parkinson.27s. May I ask someone to put a link to this wikiversity project in an appropriate place into the wikipedia resource page for Parkison's disease? I can't do it myself as the page is locked. We are trying to make the wikiversity project a high quality resource for people wanting to learn about the science behind Parkinson's and for following research progress as it is reported in the scientific literature. We should like to attract contributors to help us assure its quality. Please see V:ParkinsonsScience and assess for yourself what we have achieved so far. Droflet (talk) 11:25, 5 January 2013 (UTC)

Tobacco smokers?

Some explaination please.Longinus876 (talk) 15:29, 9 January 2013 (UTC)

Would need more details regarding the question. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:50, 9 January 2013 (UTC)

Probably the question derives from the statement in Protective factors that tobacco apparently exerts a protective effect. As far as I know this is an observation for which no detailed explanation exists, though. Looie496 (talk) 19:14, 9 January 2013 (UTC)

Parkinson's disease

My suggestions for edits to the following items: Under Wikipedia "Parkinson's_disease" page
Motor symptoms
Cardinal symptoms:
Bradykinesia/ akinesia - The sentence 'Bradykinesia is the most disabling symptom in the early stages of the disease' should be deleted or edited to an alternative such as 'Bradykinesia together with postural instability are often disabling motor symptoms and can occur in the early stages of disease'.
- justification: A number of articles have highlighted that non-motor symptoms can be just as disabling. Also, symptoms of postural instability often carry a significant impact on quality of life and functional status.

Changed to: Bradykinesia is commonly a very disabling symptom in the early stages of the disease. I agree that it is not easy to say which is the most disabling (as probably there is not a one most disabling but depends from individual to individual).--Garrondo (talk) 07:59, 20 March 2013 (UTC)

Other symptoms such as 'Neuropsychiatric' and 'Other' symptoms should be placed under a main subheading of 'Non-motor symptoms in Parkinson's disease'.

Disagree: classification as it is now is as valid as a classification that divides symtoms into motor and non-motor.--Garrondo (talk) 07:59, 20 March 2013 (UTC)

It should also include other non-motor symptoms or at the very least, categorise them. e.g. 'Non-motor symptoms are often present at the time of diagnosis and can precede motor symptoms. These symptoms can affect other bodily systems and it is important to acknowledge that people with Parkinson's often do not experience all known associated symptoms. Examples of non-specific non-motor symptoms include hyposmia (loss of sense of smell), anxiety, sleep disturbances, etc'.

Already partly present in the introduction to the symptoms section. It said: Parkinson's disease affects movement, producing motor symptoms. Non-motor symptoms, which include autonomic dysfunction, neuropsychiatric problems (mood, cognition, behavior or thought alterations), and sensory and sleep difficulties, are also common. I have added Some of these non-motor symptoms are often present at the time of diagnosis and can precede motor symptoms. I have not said anything of the sentence Parkinson's often do not experience all known associated symptoms, since this is true for any kind of disease (or do you know any disease where everybody has exactly the same symptoms, specially a neurological one?).--Garrondo (talk) 07:59, 20 March 2013 (UTC)

Under the Wikipedia "Signs_and_symptoms_of_Parkinson's_disease" page (linked to the main page for Parkinson's disease) NEUROPSYCHIATRIC
- an additional sentence should be added after 'Treatment options consist of modifying the dosage of dopaminergic drugs taken each day, adding an antipsychotic drug like quetiapine, or offering carers a psychosocial intervention to help them cope with the hallucinations' and along the lines of 'With regards to antipsychotic medications, the best evidence to date is with clozapine though the risk of side-effects and adverse events necessitate monitoring, thus limiting its practical use. Though quetiapine is widely prescribed, there is little evidence in terms of sustained benefit in the setting of psychosis in Parkinson's.'
PERCEPTION
- impaired proprioception is not accurate. Proprioception is a definition for 'joint position sense' and I am unaware of any work that specifically examines proprioception. This sentence (entry) should be replaced with 'visuospatial dysfunction'
132.234.251.230 (talk) 06:37, 20 March 2013 (UTC)Tien K Khoo (Wikipedia username: Khootkheng) Email: khootkheng@yahoo.com

Welcome. We typically only use secondary sources as references here per WP:MEDRS especially for a major topic like this. I see some of your refs are secondary sources while others are not. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:44, 20 March 2013 (UTC)

Thanks for all your comments. I have added some of the info as explained above, but if you disagree we may discuss how to add some more info. I am going to post these other comments in its appropiate talk page and see what we can do about them. Best regards, and lets hope you continue contributin.--Garrondo (talk) 07:59, 20 March 2013 (UTC)

Image

A. Schematic initial progression of Lewy body deposits in the first stages of Parkinson's disease, as proposed by Braak and colleagues
B. Localization of the area of significant brain volume reduction in initial PD compared with a group of participants without the disease in a neuroimaging study, which concluded that brain stem damage may be the first identifiable stage of PDneuropathology Jubault T, Brambati SM, Degroot C; et al. (2009). Gendelman, Howard E. (ed.). "Regional brain stem atrophy in idiopathic Parkinson's disease detected by anatomical MRI". PLoS ONE. 4 (12): e8247. doi:10.1371/journal.pone.0008247. PMC 2784293. PMID 20011063. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)

I am not sure this image is really due weight. It is from a primary research paper look at 23 PD patients and 19 controls. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:30, 19 May 2013 (UTC)

I have reverted the elimination of the image. Reasons you stated were two-fold:

1-Few participants: This might be valid if it were to use it as a source of content, but it is not. We are not using as a primary source in this sense, but as graphic example of something stated in a secondary source (Braak staging) that has received much more proof than this specific plos article. We could in this sense simply use the top half of the image (which a schema of braak staging) e, but IMO the voxel based morphometry analysis has further value as an example since it is a real one.

2-Blurriness: This is a faulty critique probably from a lack of knowleadge on how voxel based morphometry is performed. In VBM subjects are normalized to a template (usually the Montreal Neurological Institute) which comes from the mean of around a 100 individual brains. The intensity of the signal in each brain voxel is compared between the group of controls and patients. If there are significant voxels they are usually superimposed on a template for visualization. Such normalization template is by itself blurry since it indicates the probability of a structure being a structure. Since some people do not like it per blurriness what they do is to superimpose results to a normal brain that is similar to the mean values of this template, however this brain is as false as the blurry one (or even more, since it is not the true template into which images in the analyisis have been normalized). Botton line: the image is technically perfect as it is.

--Garrondo (talk) 10:42, 19 May 2013 (UTC)

My understanding is that as a general principle, we don't apply the same sourcing criteria to images as to text. Given the extreme difficulty of obtaining images that are licensed in a way we can use, it wouldn't be practical to do so. (After several years of looking I'm still in the market for a good usable electron micrograph of a synapse.) Of course we don't want to deliberately use images that we know are misleading, but beyond that we are often in the position of using whatever we can get. Looie496 (talk) 15:00, 19 May 2013 (UTC)

Edit request on 20 May 2013

Parkinsons UK support website

LDowding (talk) 10:20, 20 May 2013 (UTC)

Per WP:ELNO we do not add national support websites. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:42, 20 May 2013 (UTC)

Apologies

My apology for my recent edit; in doing a check for some recent problematic edits, I accidentally started editing an old revision and missed that I was doing so. Thanks to Garrondo for catching my error. --Nat Gertler (talk) 16:06, 4 June 2013 (UTC)

Replace local image with commons image

Existing image

Commons image

Please replace this problematic en:specific image used in {{Infobox disease}}:

•  File:Paralysis agitans (1907, after St. Leger).png

with the following image from commons:

•  File:Sir William Richard Gowers Parkinson Disease sketch 1886.svg

Thanks in advance. 67.101.5.45 (talk) 04:57, 7 June 2013 (UTC)

Why is the image problematic? In my opinion, the one we have looks better. Looie496 (talk) 05:33, 7 June 2013 (UTC)

History of the image (As far as I remember": The image would be in the public domain in most countries if had been drawed by Gowers, however since he says "after St Legers" it is plaussible that it was a derivative work. Since I do not think that St. Leger is known nor is his death time, so the image is in the PD in the US because it was first published before 1923. I believe that at the moment of uploading the image these images had to be uploaded better to the English wikipedia only. Does this make sense (all from memory, so not really sure). --Garrondo (talk) 07:55, 7 June 2013 (UTC)

Not done: no reply to questions. Mdann52 (talk) 12:47, 26 June 2013 (UTC)

Classification of Parkinsonian diseases

Under classification the disorders of multiple system degeneration are referred to as Parkinson plus syndrome. I believe the more current term is atypical parkinsonian syndrome (or just multiple system degeneration). "Atypical" is the term used in Harrison's principle of medicine 18th (latest edition) and in many other up to date manuals. Anxiey (talk) 19:28, 17 June 2013 (UTC)

Notable cases

I removed a couple of names from that section; my edit was reverted. Let me therefore start a discussion.

The basic problem is that when names begin to be added to a section like this in an uncontrolled way, the list keeps growing and growing until it is way out of proportion to the rest of the article. To prevent this, the policy has been that names should only added of people who not only have Parkinson's, but have a particularly notable connection with the disease. The three names listed for a long time were Michael J. Fox, Davis Phinney, and Muhammad Ali. Fox and Phinney both have very actively supported PD research; Ali has actively promoted PD awareness. Names with weaker connections should go into List of people diagnosed with Parkinson's disease, but they do not belong here. Looie496 (talk) 15:42, 17 September 2013 (UTC)

Sorry I'm a classic newbie and didn't read the talk page first, I made a paragraph regarding Billy Connolly's recent diagnosis to the notable cases, then came on to the talk page to let people know what I had done and if someone could check my work just to make sure it was ok, I then came across this note, so I'm sorry there are a few edits with my name on it, whilst deleting my paragraph I managed to make a mess, then remembered the undo under history so article is now as it was before I started, apologies and I will check talk pages first in future. Again my apologies, lesson learntAmanda138a (talk) 05:42, 22 September 2013 (UTC)

Suggested edit

I suggest to add the following (underneath CAUSES > GENETICS)::

A mutation in the sodium-potassium pump (ATP1A3 gene) can cause rapid onset dystonia parkinsonism (Cannon C (2004). "Paying the Price at the Pump: Dystonia from Mutations in a Na+/K+-ATPase". Neuron. 43 (2): 153–154. doi:10.1016/j.neuron.2004.07.002. PMID 15260948. {{cite journal}}: Unknown parameter |month= ignored (help)). The parkinsonism aspect of this disease is thought to be attributable to malfunctioning Na⁺
-K⁺
pumps in the basal ganglia; the dystonia aspect is thought to be attributable to malfunctioning Na⁺
-K⁺
pumps in the cerebellum (that act to corrupt its input to the basal ganglia) (Calderon DP, Fremont R, Kraenzlin F, Khodakhah K (2011). "The neural substrates of rapid-onset Dystonia-Parkinsonism". Nature Neuroscience. 14 (3): 357–65. doi:10.1038/nn.2753. PMC 3430603. PMID 21297628. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)). In the cerebellum, the mutation likely disrupts Purkinje cell activity: the Na⁺
-K⁺
pump has been shown to control and set the intrinsic activity mode of cerebellar Purkinje neurons (Forrest MD, Wall MJ, Press DA, Feng J (2012). "The Sodium-Potassium Pump Controls the Intrinsic Firing of the Cerebellar Purkinje Neuron". PLoS ONE. 7 (12): e51169. doi:10.1371/journal.pone.0051169. PMC 3527461. PMID 23284664. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)).

Mindfulness Based Intervention

I intend to add the folllowing sentence in the Other treatments section, last paragraph, after the Tai Chi sentence and before the fava beans.

There is clinical evidence that mindfulness-based interventions increase gray matter density for Parkinson patients. It will be referenced with the following bibliography Pickut, Barbara A (2013-12). "Mindfulness based intervention in Parkinson's disease leads to structural brain changes on MRI: A randomized controlled longitudinal trial". Clinical neurology and neurosurgery. 115 (12): 2419–2425. doi:10.1016/j.clineuro.2013.10.002. ISSN 1872-6968. PMID 24184066. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)--Gciriani (talk) 21:36, 19 February 2014 (UTC)

We use secondary sources per WP:MEDRS not primary sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:59, 19 February 2014 (UTC)

Thanks for the MEDRS guidelines. These guidelines also say that: In other situations, such as randomized controlled trials, it may be helpful to temporarily cite the primary research report, until there has been time for review articles and other secondary sources to be written and published. If you prefer we can use the wording suggested by the guidelines: A 2013 Belgian study found that mindfulness-based interventions increase gray matter density for Parkinson patients.--Gciriani (talk) 22:33, 19 February 2014 (UTC)

Yes but this is not that case. This is a very well researched area and we should wait for a proper independent review article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:38, 19 February 2014 (UTC)

I think the article I referenced first, is exactly an article of proper independent review; the first peer-reviewed illustration of mindfulness-based interventions for Parkinson appeared in 2010 (see after this paragraph), then in 2013 a randomized control trial gave physiological evidence of the change.Fitzpatrick, Lee (2010-06). "A qualitative analysis of mindfulness-based cognitive therapy (MBCT) in Parkinson's disease". Psychology and psychotherapy. 83 (Pt 2): 179–192. doi:10.1348/147608309X471514. ISSN 2044-8341. PMID 19843353. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

Which is the review? Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:31, 20 February 2014 (UTC)

What I mean is that the 2013 Belgian study is the proof of the pudding. But that's beside the point, because even the Wikipedia guidelines, encouraging secondary sources, allow for primary sources. The fact that the disease is very well researched means that new findings and understanding of the disease will keep surfacing, therefore a finding of behavioral sciences corroborated by findings with physiological means constitutes ads to the body of research related to Parkinson worthy of being mentioned.--Gciriani (talk) 07:43, 20 February 2014 (UTC)

Secondary sources give us proof of notability. If it is not in a secondary source it is of questionable notability. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:58, 20 February 2014 (UTC)

I agree with Doc James. This is a primary research study and therefore not a good source for this article. Looie496 (talk) 16:34, 20 February 2014 (UTC)

JAMA

In this week's neurologically themed issue of JAMA, this review on therapeutics in PD: doi:10.1001/jama.2014.3654 JFW | T@lk 09:20, 23 April 2014 (UTC)

Semi-protected edit request on 10 June 2014

This figure displays only the structure of the parkin ubiquitin-like domain, not the entire parkin protein:

PDB rendering of Parkin (ligase)

The structure of full-length parkin was published in 2013 in the journal Science (Trempe et al, 2013, Science, 340, 1451). (Disclaimer: I am the co-first author of this publication). The PDB code for the new structure is 4K95. I suggest that the page editor should replace the figure by this new PDB rendering of pdb 4K95:

Rendering of parkin crystal structure, pdb code 4K95.

Thank you, Jean-François Trempe McGill University < Jftrempe (talk) 14:09, 10 June 2014 (UTC)

• Not done: Please make your request for a new image to be uploaded to Files For Upload. Once the file has been properly uploaded, feel free to reactivate this request to have the new image used. — {{U|Technical 13}} ^{(e • t • c)} 16:17, 10 June 2014 (UTC)

Done Thanks! Older and ... well older (talk) 04:02, 13 June 2014 (UTC)

Role of MRI techniques in diagnosis

I suggest that the text about diffusion MRI be removed or expanded because there are many techniques that have been reported to be useful at discriminating between typical and atypical parkinsonism. — Preceding unsigned comment added by Gcastellanos (talk • contribs) 20:54, 12 August 2014 (UTC)

Semi-protected edit request on 14 August 2014

Another recent actor who will/is bringing awareness to Parkinson disease is Robin McLaurin Williams (http://seattletimes.com/html/nationworld/2024310022_apxrobinwilliams.html).

Hansmrtn (talk) 19:01, 14 August 2014 (UTC)

Not done: per below. Cannolis (talk) 03:19, 15 August 2014 (UTC)

Robin Williams, great ape communicator?

People with parkinsonism who have increased the public's awareness include actor Michael J. Fox, Olympic cyclist Davis Phinney, professional boxer Muhammad Ali and actor, comedian and great ape communication ambassador[2][3][4] Robin Williams by way of public awareness fostered by his wife Susan Schneider in the wake of the suicide abetted by his concomittant depression[5][6][7][8][9].

(emphasis added)

William's animal advocacy isn't relevant enough to Parkinson's for the lead section. It makes the sentence difficult to read. Might be more appropriate in the body. Chosing either "actor" or "comedian" (perhaps actor-comedian?) would improve clarity as well.

Not sure Furthermore, I'm not sure that Williams should be cited here in the first place. He was only just diagnosed Parkinson's before his death, and hasn't been involved in any advocacy. (See also: Amanda138a's earlier comment[5].) The connection is strong now because of his recent death, but that may not last.

Finally, "comorbid" is a more accurate term than "concomitant."

Helenaglory (talk) 23:03, 14 August 2014 (UTC)

The Great Ape mention and links are totally irrelevant in this article. They might be relevant in an article on Williams, but are off-topic here. LaMona (talk) 07:22, 15 August 2014 (UTC)

That section should not morph into a list of every famous person who had Parkinson's disease. It should be restricted to people who have helped to educate the public about the disease. Even if good documentation was available for Robin Williams having it, he doesn't fit that description. Looie496 (talk) 12:14, 15 August 2014 (UTC)

Light therapy

I am about to remove a newly added paragraph about light therapy, and would like to explain why first. The basic problem is that all of the cited sources are primary studies, as defined in WP:MEDRS, and therefore aren't suitable for use in a medical article except in special circumstances. That's a sufficient reason, but I'll also note that in addition to being primary, they are weak methodologically, as the outcome assessments were not blinded (as far as I can tell). One way or another, this material is not suitable for a featured article. Looie496 (talk) 02:38, 22 January 2015 (UTC)

Yes need better refs. Doc James (talk · contribs · email) 02:56, 22 January 2015 (UTC)

Request for minor edit to Research > Animal models section

2nd sentence:

The appearance of parkinsonian symptoms in a group of drug addicts in the early 1980s who consumed a contaminated batch of the synthetic opiate MPPP led to the discovery of the chemical MPTP, whose metabolite MPP+ causes a parkinsonian syndrome in non-human primates as well as in humans

5th sentence:

Transgenic rodent models that replicate various aspects of PD have been developed.[112] Drosophila models also exist — Preceding unsigned comment added by Elwiemo (talk • contribs) 08:51, 27 March 2015 (UTC)

References

Very interesting finding on levodopa-induced dyskenisias

The content in the following paragraph (pasted from FOSB) should definitely be covered in the article when a review comes out that covers the 2015 study. This study will, without a doubt, be covered in a review sometime very soon because, to my knowledge, this is the first non-experimental drug (Levetiracetam) that has been found to reduce ΔFosB expression in any group of dopaminergic projection neurons (in the case, the nigrostriatal pathway). (redacted because I apparently can't read - it was coadministered and simply reduced the induction of its expression, not repressed the gene - the latter would be a huge deal) That's kind of a big deal, although it's still an animal study. That said, ΔFosB appears to have a crucial role (technically causal role, although that really just means it's at a bottleneck in the signaling cascade) in the development of levodopa-induced dyskinesias in humans since this species-specific evidence is basically the same as what has been demonstrated for ΔFosB in addiction.

ΔFosB overexpression in the striatum (via viral vectors) produces involuntary movements (dyskinesias) akin to those seen in chronic levodopa treatment of Parkinson's disease in animal models. Striatal ΔFosB is overexpressed in rodents and primates with dyskinesias; postmordem studies of individuals with Parkinson's disease that were treated with levodopa have also observed similar striatal ΔFosB overexpression. Levetiracetam, an antiepileptic drug which has been demostrated to reduce the severity of levodopa-induced dyskinesias, has been shown to dose-dependently decrease striatal ΔFosB expression in rats, although the signal transduction involved in this effect is unknown.
— FOSB

References

Seppi333 (Insert 2¢ | Maintained) 23:37, 27 March 2015 (UTC)

In the early state of research. Doc James (talk · contribs · email) 23:48, 27 March 2015 (UTC)

That's fairly obvious, although this article has Parkinson's disease#Research with a subsection Parkinson's disease#Animal models (also, Parkinson's disease#Gene therapy is sort of relevant as well since it's a section about viral vectors, which is what was used to demonstrate the causal role of striatal ΔFosB overexpression in the induction of rat dyskinesias). This is where this content should be included when a review is available. Seppi333 (Insert 2¢ | Maintained) 23:56, 27 March 2015 (UTC)

Helping tools

I don't know, it should be in this article or not.

Parkinson patient is difficult to do hand writing, initially the patient can do it, but finally s/he will write smaller and smaller and cannot be read anymore. The latest helping tool for Parkinson patient is vibrating pen which the vibration counter the Parkinson tremor. (Mariella Moon. "Vibrating pen makes it easier for Parkinson's patients to write". Retrieved March 31, 2015.) Gsarwa (talk) 14:15, 31 March 2015 (UTC)

Interesting, but I'm afraid we would need a better source than a blog post. Looie496 (talk) 14:22, 31 March 2015 (UTC)

Costs

The price and American who is diagnosed with Parkinson’s disease each year is astounding. The medication costs alone for an individual can cost on average $2,500 per year. On top of the individual cost per person, it is believed that the United States pays roughly $25 billion per year in terms of treatments, social security payments, and the loss of income for each person who suffers from Parkinson’s disease. (Parkinson’s Disease Foundation) 67.176.88.244 (talk) 22:46, 29 April 2015 (UTC) Amanda Collins

Editing a featured article

Dr.Ashlesh.P, could you please read the links and information which pops up in the edit screen when editing this article? Thanks, SandyGeorgia (Talk) 14:13, 1 May 2015 (UTC)

SandyGeorgia Thanks for your suggestion; it seems i have already gone through those guidelines.Dr.Ash 06:26, 5 May 2015 (UTC)

It would be helpful if you would propose your edits on talk. Also, please sign your talk page entries by entering four tildes ( ~~~~ ) after them. SandyGeorgia (Talk) 14:37, 2 May 2015 (UTC)

Dr.Ashlesh.P, you don't seem to have read the links in the message above. Could you please do so, and refrain from introducing markup errors into a Featured article? Please discuss your edits on talk. SandyGeorgia (Talk) 12:55, 5 May 2015 (UTC)

Make this article more readable

Parkinson's disease is a hot topic of research in this era of neuroscience. Soon researchers will find a cure to this neurodegenerative disorder. Wikipedia being an open encyclopedia which allows millions of researchers and doctors like me to edit this article for betterment of humanity. But this is a Herculean task and requires many reviewers who should possess broad outlook on this topic. I suggest that this article should be neat and paragraphs should be justified.Dr.Ash (talk) 06:52, 6 May 2015 (UTC) All those "experts" kindly make a note of this suggestion.SandyGeorgia

Thanks for starting a discussion here. The general view among most of those who have thought about it is that justification is actually a bad thing, because it makes text harder to read. It is particularly problematic for narrow displays. But in any case my view is that individual articles should not handle this in an idiosyncratic way: we should either justify the lead in all articles (which could be handled automatically) or in no articles. Individual articles should not be inserting markup in order to alter the justification. Looie496 (talk) 13:47, 6 May 2015 (UTC)

GI symptoms

Review in Lancet Neurology doi:10.1016/S1474-4422(15)00007-1 JFW | T@lk 14:26, 20 May 2015 (UTC)

Let's watch for secondary sources on causation (GI tract, vagus nerve)

http://neurosciencenews.com/parkinsons-gastrointestinal-tract-neurology-2150/

'Parkinson’s May Begin in Gut and Spread to the Brain Via the Vagus Nerve

'New research indicates that Parkinson’s disease may begin in the gastrointestinal tract and spread through the vagus nerve to the brain. . . . The research has presented strong evidence that Parkinson’s disease begins in the gastrointestinal tract and spreads via the vagus nerve to the brain. Many patients have also suffered from gastrointestinal symptoms before the Parkinson’s diagnosis is made. The image is for illustrative purposes only.

' “We have conducted a registry study of almost 15,000 patients who have had the vagus nerve in their stomach severed. Between approximately 1970-1995 this procedure was a very common method of ulcer treatment. If it really is correct that Parkinson’s starts in the gut and spreads through the vagus nerve, then these vagotomy patients should naturally be protected against developing Parkinson’s disease,” explains postdoc at Aarhus University Elisabeth Svensson on the hypothesis behind the study. . . . Our study shows that patients who have had the the entire vagus nerve severed were protected against Parkinson’s disease. Their risk was halved after 20 years. However, patients who had only had a small part of the vagus nerve severed where not protected. This also fits the hypothesis that the disease process is strongly dependent on a fully or partially intact vagus nerve to be able to reach and affect the brain,” she says.

'Many patients have also suffered from gastrointestinal symptoms before the Parkinson’s diagnosis is made.'

-- Jo3sampl (talk) 22:11, 6 July 2015 (UTC)

Skin

doi:10.1136/practneurol-2015-001107 - review of the cutaneous associations and complications. JFW | T@lk 08:25, 17 July 2015 (UTC)

Lancet seminar

doi:10.1016/S0140-6736(14)61393-3 May be used for updating. JFW | T@lk 17:06, 1 September 2015 (UTC)

Semi-protected edit request on 8 September 2015

In addition to cognitive and motor symptoms, PD can impair other body functions. Sleep problems are a feature of the disease and can be worsened by medications. Symptoms can manifest as daytime drowsiness, disturbances in REM sleep, or insomnia. A systematic review shows that sleep attacks occur in 13.0% of patients with Parkinson's disease on dopaminergic medications. Wongplusma (talk) 23:05, 8 September 2015 (UTC)

 Done. Comment: Journal is peer-reviewed. Editorial and submission documentation can be found on the website. Last sentence was added to the Other section. Modified paragraph into three separate paragraphs due to the length of the sleep section. Inomyabcs (talk) 05:42, 9 September 2015 (UTC)

References

Parkinson can be detected chemically

http://www.bbc.com/news/uk-scotland-34583642

Very interesting and surely worth mentioning in the article? CodeCat (talk) 15:43, 22 October 2015 (UTC)

That's very intriguing, but the sourcing isn't yet on a level that we can use in this article. We'll have to see whether this is validated by further research. Looie496 (talk) 16:05, 22 October 2015 (UTC)

Citations in the lede

Hey Looie496. We often don't put citations in the lede if claims in the lede are repeated and supporded by citations in the body of the article. Are the claims in the last paragraph of the lede repeated and supported in the body? If so, can we take them out of the lede? Or, alternatively, for consistency, should we back up all the lede claims with citations?

(I actually personally prefer citing claims both in the lede and the body, because I suspect most readers don't read the whole article.) --Anthonyhcole (talk · contribs · email) 02:29, 23 November 2015 (UTC)

I think specific numerical statements should always be cited regardless of where they appear, so I left in one of the cites. I shifted the others, though. I also completely removed the last sentence of the lead -- it was an incorrect (and poorly referenced) statement that somehow crept in while nobody was paying attention. I think I had better give this article a thorough read-through to look for other such things. Looie496 (talk) 12:32, 23 November 2015 (UTC)

Iraqi Parkinson's and 1971 Methyl-mercury disaster

Is there no research looking into why Iraq has the largest incidence in the world? I was concurrently looking into mercury poisoning which preferentially targets the same two brain regions as parkinson's (SN and LC) and has nearly identicial symptoms, especially mental and sleep, and came across the largest mercury poisoning incident in history, the 1971 iraq poison grain disaster. Doctors at the time estimated 100,000 cases of brain damage. 97.86.59.46 (talk) 00:24, 28 November 2015 (UTC)

Nearly identical symptoms? The symptoms of mercury poisoning hardly have any overlap with those of PD. In any case these thoughts are not useful for this article unless they are supported by reliable and reputable sources. 13:49, 28 November 2015 (UTC)

Semi-protected edit request on 11 November 2015

For ICD-10, F02.3 is dementia developed during Parkinson's. It's a secondary complication which is probably from the disease but it's not the disease. That is G20. So it might not be something you want included in the codes for the disease. At the least, you might want to check with a specialist as its not a very well defined category at this time and seems like a place-holder in the ICD-10 coding.

Hope this helps.

The Flag Nerd (talk) 22:08, 11 November 2015 (UTC)

Not done: please provide reliable sources that support the change you want to be made. a boat that can float! (happy holidays) 14:55, 2 December 2015 (UTC)

BMJ reviewers

BMJ, the company owned by the British Medical Association and publisher of The BMJ and other prestigious medical journals has invited experts to review this article for accuracy, completeness, neutrality and up-to-dateness. As a part of their introductory tutorial they'll introduce themselves below. Anthonyhcole (talk · contribs · email) 13:36, 16 November 2015 (UTC)

Great! If there's anything I can do to help, please let me know. Looie496 (talk) 13:44, 16 November 2015 (UTC)

Will do, Looie496. Peter has emailed the reviewers with links to the reviewer guidelines and tutorial, so we'll probably be seeing some action soon. --Anthonyhcole (talk · contribs · email) 14:32, 23 November 2015 (UTC)

Hello, my name is Mark Kuijf and I am a neurologist from the Maastricht University Medical Center (MUMC) in the Netherlands and happy to help review the page on Parkinsons's disease. Kuijf (talk) 16:01, 7 December 2015 (UTC)

Hi Mark. Looking forward to your review. Looie496 (talk) 23:16, 7 December 2015 (UTC)

Hi Mark. Welcome!

Would you please create your "user page", describing any potential conflicts of interest? To create your user page, click here. We define potential conflicts in the reviewer tutorial.

I have created a section below for your review. Click [edit source] next to your heading below. Please separate each criticism by creating bullet points. That is, put each criticism on a new line beginning with an asterisk; like this:

* Blah blah blah

* Blah blah blah

* Blah blah blah

It will look like this:

• Blah blah blah
• Blah blah blah
• Blah blah blah

If you have any questions, Looie496 and I will be happy to help. --Anthonyhcole (talk · contribs · email) 02:44, 8 December 2015 (UTC)

Semi-protected edit request on 10 December 2015

Please add at the end of the Genetics section the following text: Many of these genetic factors, such as LRRK2, GBA, SMPD1, SNCA, PARK2, PINK1, PARK7, SCARB2, and others, are involved in the autophagy-lysosome pathway, and some lysosomal storage disease have a high coincidence with Parkinsonism.[6] This is why drugs that induce lysosomal secretion were proposed as potential treatments of some forms of Parkinson's disease.[7]Dx.doi.org/10.1093/brain/awu076 Jochdohle (talk) 10:35, 10 December 2015 (UTC)

I am open to the possibility of including something like that, but I think it would have to be written more accessibly to be useful to most readers of this article. How about something like, Several of these genetic factors are involved in the function of lysosomes, intracellular organelles that break down proteins and other large molecules. This observation has led to suggestions that some forms of Parkinsonism might be caused by lysosome malfunctions resulting in failure of the cells to properly break down alpha-synuclein.? Looie496 (talk) 14:21, 10 December 2015 (UTC)

Sounds good to me! — Preceding unsigned comment added by Jochdohle (talk • contribs) 14:49, 10 December 2015 (UTC)

Already done: According to the page's protection level you should be able to edit the page yourself. If you seem to be unable to, please reopen the request with further details. @Jochdohle: Thanks for discussing your suggestion here. You became autoconfirmed while this request was open, and you should now be able to edit the article yourself (you already have). Cheers. Ivanvector 🍁 (talk) 17:14, 10 December 2015 (UTC)

Ambrexol

I'm about to undo a pair of edits and would like to explain why first. The edits add, "It was suggested that Ambroxol, a drug that stimulates lysosomal secretion, could be protective in some forms of Parkinson's disease where the function of lysosomes is impaired. (refs)" I was okay with the previous edits adding material about lysosomes, because that concept seems to be getting a lot of attention recently, but this material seems premature. The editorial cited as the first reference is quite tentative about it, and even to some degree disparaging; the second reference is actually a primary source and not compatible with WP:MEDRS. Unless there is a case that this idea is getting substantial attention I don't think it belongs in this article yet. Looie496 (talk) 13:31, 11 December 2015 (UTC)

infobox, emedicine links, and YOPD

I've noticed that the infobox has three emedicine links, but they all point to the same page when I use my browser. I remember they used to have a link to a young-onset page, but don't seem to anymore. Here is a link to a medscape article on this subject, http://misc.medscape.com/pi/android/medscapeapp/html/A1154474-business.html --Robert Treat (talk) 19:55, 27 December 2015 (UTC)

Editing Parkinson's disease

Hi Anthony. I am one of the expert reviewers who has been asked by the BMJ to provide input on the Parkinson's disease article. I have been through it in great detail. There are many problems that need revision. There are several inaccuracies and statements that tend to mislead the reader. Also the field has advanced and there are many comments that are out of date and are now simply wrong or need further explanation. To provide a commentary on each and every one of these and expect that the Wikipedia staff would be able to edit the section or statement according to my recommendation (further requiring me to review the edited version to make sure the changes were correct or accurate) would take far too long. I would like to be able to provide editing to the text directly (as I would if I were editing a manuscript providing input to my coauthors) using Word with the Track Changes (this would allow the staff to see the changes and perhaps understand why the changes have been made). I tried to cut and paste the first parts of the chapter that I have already edited below for you to see the changes but it simply accepts the entire text without differentiating between the old and new. If at all possilbe would like to be able to work in Word rather than on the Wikipedia website since this allows me to work offline while traveling. Please advise me how best this process can work if my attempt fails. Thanks. AEL (lang@uhnresearch.ca) AETLang (talk) 02:52, 11 January 2016 (UTC)

Hello Dr Lang! I'll email you and perhaps you could forward the Word document to me. I can then make a "diff" (a page that shows the difference between the original and corrected document. --Anthonyhcole (talk · contribs · email) 03:39, 11 January 2016 (UTC)

Semi-protected edit request on 22 January 2016

TTR123456 (talk) 16:15, 22 January 2016 (UTC)

Parkinson's can also lead to stabbing issues, also Parkinson's and Louie Body Dementia can run along side each other

Not done: please provide reliable sources that support the change you want to be made. --allthefoxes ^(Talk) 19:28, 22 January 2016 (UTC)

Semi-protected edit request on 8 February 2016

Thank you for this article. I noticed that in the first section, in the overview of Parkinson's disease, the final line does not mention singer Linda Ronstadt as one of the notable people who have increased awareness of the disease. I would like to suggest you add her name. If you Google her, you will find enough evidence to support such an edit.

Best,

Michael Jortner Los Angeles mjortner@earthlink.net

Mjortner (talk) 03:47, 8 February 2016 (UTC)

Not done: She is not mentioned anywhere in the article. Per WP:LEAD, we summarize the article at the beginning. Things not in the article should not be included in the summary section. EvergreenFir (talk) Please {{re}} 20:07, 9 February 2016 (UTC)

Parkinson's Disease Biomarkers

There is a new article being written at Parkinson's Disease Biomarkers. Could some active and knowledgeable editors at this page please check and see if any of that information is relevant to this article? If it is, you may want to add it to Parkinson's disease, or link the two articles together. Thanks. Bradv 21:10, 11 April 2016 (UTC)

Nice catch. It is by a student editor - I have userified it User:Suhasini66/Parkinson's Disease Biomarkers. Hopefully the student will come here and discuss how the article should fit with existing content. Jytdog (talk) 23:26, 11 April 2016 (UTC)

Let them know on their talk page, please. Bradv 23:29, 11 April 2016 (UTC)

I did on the article talk page - will now leave a note on their talk page too. Jytdog (talk) 23:39, 11 April 2016 (UTC)

New Standalone Article

Hi! I'm actually working on creating a Parkinson's Disease Biomarkers article. I noticed that there wasn't a biomarker section in this article, so I wanted to create a standalone article. Could you take a look at it when you have the time? I would greatly appreciate the input. It's titled "User:Suhasini66/Parkinson's Disease Biomarkers" for now. Suhasini66 (talk) 00:23, 12 April 2016 (UTC)Suhasini

Minor edit

Last words of the intro section should become: "late" professional boxer Muhammed Ali SSoheilHosseini (talk) 01:06, 7 June 2016 (UTC)

Sufferers

Mohammed Ali, Michael J. Fox and David Phinney are listed as people through whom public awareness increased. I don't know if the author failed to list Pope John Paul II because the Pope didn't choose to become an activist for Parkinson's, but I dare say that his bout with Parkinson's was far more famous, even in the English-speaking world, than David Phinney's! — Preceding unsigned comment added by 96.95.24.246 (talk) 21:11, 15 August 2016 (UTC)

Statement

"The possible roles of sodium and potassium in PD has been reviewed."

Does not really provide any useful information so I have removed.

References

--Doc James (talk · contribs · email) 14:46, 28 May 2016 (UTC)

Semi-protected edit request on 30 August 2016

{{edit semi-protected} I would like to amend the depression and anxiety section, while there is some evidence that PD is associated with depression and anxiety, there is also a LOT of research which does not show any correlations, I would like to present examples of such research. Please let me know if I can proceed and how)} All-Ku (talk) 18:00, 30 August 2016 (UTC)

We cite content about health to recent (last five years) literature reviews published in good journals or statements by major medical/scientific bodies, per WP:MEDRS. Would you please provide the sources you would like to cite? Jytdog (talk) 18:11, 30 August 2016 (UTC)

There have been peer-reviewed journal articles. Here are some of the sources: http://onlinelibrary.wiley.com/doi/10.1002/mds.21803/full. This is a large meta-analysis which shows that the prevalence rates are approximately 10% higher in those with Parkinson's disease, than the general population. However, here is another study, which is a peer-reviewed study of the NIHS database which does not show such correlations between depression and PD. This particular study used a disabled comparison group. Thus, these studies together show marginal relationships between depression and PD. I was hoping to provide percentage data, and potential other mechanisms (e.g. disability), in spite of theoretical relationships of Dopamine and NE being responsible for these potential relationships. This is newer research. Therefore, I am only trying to provide a fuller picture. https://journals.uncc.edu/ujop/article/view/321/0. ) — Preceding unsigned comment added by All-Ku (talk • contribs) 18:25, 30 August 2016 (UTC)

the first source is very much the right kind (systematic review plus meta-analysis in high quality journal) but is 9 years old; the second is a primary source from a low quality journal. Neither of these is what we look for. Jytdog (talk) 18:36, 30 August 2016 (UTC)

using this pubmed search, some more recent high quality sources include PMID 24190780 (2013); PMID 24239733 (2014); PMID 24780824 (2014); PMID 25313989 (2014); PMID 25724804 (2015) Jytdog (talk) 18:46, 30 August 2016 (UTC)

someone needs to fix this article then with better sources, so if you can flag it, then please do so. I do not have the time, but currently it is not fully accurate. Many studies being cited are not differentiating apathy and depression when determining the 1/3 prevalence rates; there are no newer meta-analyses that I could locate. The prevalence rates are variable by studies and thus are best addressed by meta-analytic procedures. Also that study I mentioned included apathy and disability as factors in the analyses; these are now considered separate constructs which the DSM may not distinguish. Therefore, someone please edit this page with more time and care in regards to depression and apathy in PD. It needs work — Preceding unsigned comment added by All-Ku (talk • contribs) 18:53, 30 August 2016 (UTC)

Thanks for noting that stuff; we will see what we can do! Jytdog (talk) 19:42, 30 August 2016 (UTC)

Additions to "Prevention"

I would like to add the following to the "Prevention" section:

Meta-analyses have confirmed that tobacco use is associated with a lower incidence of Parkinson's disease (Noyce et al., 2012). In studies of the effects of secondhand smoke on the incidence of Parkinson's, children exposed to parents' cigarette smoke had a 27% lower risk of Parkinson's (O'Reilly et al., 2009), and risk was inversely related to years exposed in nonsmokers (Nielsen et al., 2012). It has been suggested that nicotine derived from the Nicotiana species of the Solanaceae family of plants, which includes Capsicum and Solanum species (peppers, tomatoes, potatoes, and eggplants), may also be beneficial in reducing Parkinson's risk without the harmful effects of cigarette smoke (Nielsen et al., 2013), though further research is needed to strengthen this causal inference.

Nielsen, S. S., Franklin, G. M., Longstreth, W. T., Swanson, P. D., & Checkoway, H. (2013). Nicotine from edible Solanaceae and risk of Parkinson disease. Annals of Neurology, 74(3), 472–477. http://dx.doi.org/10.1002/ana.23884

Nielsen, S. S., Gallagher, L. G., Lundin, J. I., Longstreth, W. T., Jr., Smith-Weller, T., Franklin, G. M., . . . Checkoway, H. (2012). Environmental tobacco smoke and Parkinson's disease. Movement Disorders, 27(2), 293–296. http://dx.doi.org/10.1002/mds.24012

Noyce, A. J., Bestwick, J. P., Silveira-Moriyama, L., Hawkes, C. H., Giovannoni, G., Lees, A. J., & Schrag, A. (2012). Meta-analysis of early nonmotor features and risk factors for Parkinson disease. Annals of Neurology, 72(6), 893–901. http://dx.doi.org/10.1002/ana.23687

O’Reilly, E. J., Chen, H., Gardener, H., Gao, X., Schwarzschild, M. A., & Ascherio, A. (2009, March 15). Smoking and Parkinson's disease: Using parental smoking as a proxy to explore causality. American Journal of Epidemiology, 169(6), 678–682. http://dx.doi.org/10.1093/aje/kwn388

Thank you!

ErinMOBrien (talk) 21:59, 13 September 2016 (UTC)

We really rely on PMIDS - listing them below

Nielsen 2013 = PMID 23661325 PMC 4864980 - primary source, not OK per MEDRS

Nielsen 2012 = PMID 22095755 PMC 3289937 - primary source, not OK per MEDRS

Noyce 2012 = PMID 23071076 PMC 3556649 - secondary source, OK per MEDRS

O'Reilly 2009 = PMID 19131566 PMC 2727210 - primary source, not OK per MEDRS

I'll have a look at the Noyce paper. Thanks! Jytdog (talk) 22:14, 13 September 2016 (UTC)

See also

IMHO there should be a See also section that includes People with Parkinson's or the IMHO cumbersomely-named article to which it redirects. From common sense and from previous discussions on this page, readers have an interest in knowing who is or has been afflicted by Parkinson's. A few of them, e.g. Muhammad Ali and Michael J. Fox are well-known individuals who are widely known to be Parkinson's sufferers. There are many more individuals who are notable but not widely known to have Parkinson's. Lou Sander (talk) 00:37, 16 September 2016 (UTC)

just argh. Jytdog (talk) 00:44, 16 September 2016 (UTC)

Semi-protected edit request on 20 September 2016

A new technology called high intensity focused ultrasound has recently been used to treat tremor in patients with Parkinson's disease. With this new method ultrasound waves are focused to the thalamus and thus cause thalamotomy through an intact skull without any incisions, without a burr hole and without implantation of a pacemaker. This procedure uses MRI guidance in order to localize the thalamus. The ultrasound waves cause gradual warming of the tissue until there is ablation, seen clinically as resolution of tremor. During the procedure the patient is awake. Thus if there are any adverse effects, the area of the thalamus that is treated can be adjusted before there is ablation. Favorable responses have so far been reported in Parkinson's disease patients followed for up to two years. [?]

Schlesinger I, Eran A, Sinai A, Erikh I, Nassar M, Goldsher D, Zaaroor M. MRI Guided Focused Ultrasound Thalamotomy for Moderate-to-Severe Tremor in Parkinson's Disease. Parkinsons Dis. 2015; 2015:219149. doi: 10.1155/2015/219149. Epub 2-Sep-2015Mariatsiounas (talk) 11:52, 20 September 2016 (UTC)</ref>

Thanks for your suggestion! The sourcing guideline for content about health is WP:MEDRS - it says that we use literature reviews published in good journals or statements from major medical/scientific bodies. The source you provide there is a research article and we can't use that. Best regards Jytdog (talk) 12:08, 20 September 2016 (UTC)

New Edit Request - July 14 2016

In the last paragraph of the initial summary 55 million is given as the number of global cases, in Epidemiology it's listed as 7 million. These should be validated and reconciled.

Thanks, 199.230.203.254 (talk) 20:10, 14 July 2016 (UTC)Mike

reference

Also, in the paper of reference 9, on page 31, the "Prevalent cases in 2013 (× 1000)" for PD is 5866·3, which is about 5.8 million, rather than 55 million. The difference is huge. Could somebody double check this number? — Preceding unsigned comment added by 137.132.125.228 (talk • contribs) 13:56, 11 October 2016 (UTC)

Expert review

Ok then, see this. Let's start looking at these and implementing....Cas Liber (talk · contribs) 06:17, 20 October 2016 (UTC)

• Regarding their first point, a summary of the use of the term paralysis agitans seems important to add. Reading this. Cas Liber (talk · contribs) 06:22, 20 October 2016 (UTC)

IMO a discussion of the term belongs in the body not the lead. We already have the term in the infobox which is sufficient their. In the first sentence is undue weight. Doc James (talk · contribs · email) 20:13, 20 October 2016 (UTC)

Ok, it was an important term but is mainly a historical one (surprised it is still used in coding). One expert wants it in, but everyone else wants it out of the lead. I could go either way. So it's an out then. I do think a sentence or two more on the use of the term is important for the History section though. OTOH, might start by including it at History of Parkinson's disease, where it is not discussed much either and work backwards. I do note this article is at 51 kb prose now...Cas Liber (talk · contribs) 12:35, 25 October 2016 (UTC)

The more I think about the size of the parent article, the more I am content to leave in the daughter article, which I have added to. Cas Liber (talk · contribs) 12:55, 25 October 2016 (UTC)

Sounds good. Doc James (talk · contribs · email) 18:55, 25 October 2016 (UTC)

I'm curious about the status of this project. For example, is anyone aware of what approximate % of the expert reviewer's comments were incorporated into the article? Thanks. Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 16:51, 2 December 2016 (UTC)

Hi User:Soupvector, I see your name listed at User:Anthonyhcole/sandbox as a facilitator. What's your insight on this process/how much there is left that is still actionable, if you don't mind? Thanks! Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 15:27, 5 December 2016 (UTC)

The answer is probably not too much. I will write something more detailed later today once have had another look at it. Cas Liber (talk · contribs) 20:27, 5 December 2016 (UTC)