Parkinsons Disease Case
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Parkinson’s Disease Presentation and epidemiology.Parkinson’s disease (PD) is a common progressive neurodegenerative disorder characterised by the cardinal motor signs of resting tremor, bradykinesia, rigidity and in the later stages postural reflex impairment [J Jankovic] . Numerous non-motor symptoms occur at all stages of disease, and in advanced stages cognitive and neuropsychiatric symptoms often develop [J Jankovic] It is the second most common neurodegenerative disease after Alzheimers [wildefeldt] and affects males more than females in a 3:2 ratio [wildefeldt]. Approximately 1% of the NZ population [CARADOC-DAVIES] are afflicted and over 7 million worldwide(Yao, Hart, & Terzella, 2013) with global projections estimate PD to surpass 9 million by the year 2030 [wildefeldt]. The disease becomes increasingly common as people age with average age of disease onset between 40-80 years of age [wildefeldt]. PD carries a two-fold increased relative risk for mortality [wildefeldt] and a 5 times increased risk to sustain fall-related injury [wildefeldt]]. [CARADOC-DAVIES] – Is the prevalence of parkinsons disease in nz really changingEtiological Risk FactorsThe etiology of PD remains uncertain though there are considerable epidemiological relations suggesting a likely involvement of both genetic and environmental protective and risk factors [wildefeldt].. There is strong evidence for an inverse relationship of PD with smoking habit (50% decreased risk) [wildefeldt]. , evidence for coffee consumption is moderate [wildefeldt]., and fairly moderate for ‘high serum uric acid concentration’[wildefeldt].]. Also light-moderate alcohol consumption may possibly confer a weak protective effect [wildefeldt].]The greatest risk factor for PD is increased age [wildefeldt].]. Monogenetic causes are currently indicated in at least 5% of PD cases though this is likely to increase as research progresses. About 20 genes have been identified so far and new causal genes are being discovered at a rate of one every 3-6 months [RABIN] . A familial component infers a 2-3% increased risk of developing PD in an individuals lifetime [wildefeldt].]. First degree relatives of PD patients have an ‘estimated two-fold to sevenfold increased relative risk for PD’[Shulman]. The vast majority of cases involve a genetic predisposition rather than monogenetic cause. This genetic predisposition when combined with environmental factors can lead to the development of PD, though there currently exists little information on gene-environment interactions [wildefeldt].]. Environmental factors seemingly associated with PD are herbicides and pesticides. There is conflicting evidence though generally pesticides showed a stronger and more consistent association, insecticides in particular [wildefeldt]. Dietary factors do not appear to contribute to PD though tentative evidence points to a detrimental effect in milk or dairy product consumption, particularly in men [wildefeldt].
[Shulman] – Parkinsons disease: Genetics and Pathogenesis [RABIN] –