Parkinson Disease: Anderson K

Miyasaki JM, Shannon K, Voon V, Ravina B, Kleiner-Fisman G, Anderson K, Shulman LM, Gronseth G, Weiner WJ, Anonymous00046. · University of Toronto, Canada. · Neurology. · Pubmed #16606910 No free full text.

Abstract: OBJECTIVE: To make evidence-based treatment recommendations for patients with Parkinson disease (PD) with dementia, depression, and psychosis based on these questions: 1) What tools are effective to screen for depression, psychosis, and dementia in PD? 2) What are effective treatments for depression and psychosis in PD? 3) What are effective treatments for PD dementia or dementia with Lewy bodies (DLB)? METHODS: A nine-member multispecialty committee evaluated available evidence from a structured literature review using MEDLINE, and the Cochrane Database of Health and Psychosocial Instruments from 1966 to 2004. Additional articles were identified by panel members. RESULTS: The Beck Depression Inventory-I, Hamilton Depression Rating Scale, and Montgomery Asberg Depression Rating Scale should be considered to screen for depression in PD (Level B). The Mini-Mental State Examination and the Cambridge Cognitive Examination should be considered to screen for dementia in PD (Level B). Amitriptyline may be considered to treat depression in PD without dementia (Level C). For psychosis in PD, clozapine should be considered (Level B), quetiapine may be considered (Level C), but olanzapine should not be considered (Level B). Donepezil or rivastigmine should be considered for dementia in PD (Level B) and rivastigmine should be considered for DLB (Level B). CONCLUSIONS: Screening tools are available for depression and dementia in patients with PD, but more specific validated tools are needed. There are no widely used, validated tools for psychosis screening in Parkinson disease (PD). Clozapine successfully treats psychosis in PD. Cholinesterase inhibitors are effective treatments for dementia in PD, but improvement is modest and motor side effects may occur.

Skidmore F, Anderson K, Fram D, Weiner W. · Department of Neurology, University of Florida, Gainesville, Florida 32605, USA. · Mov Disord. · Pubmed #17712851 No free full text.

Abstract: Camptocormia describes a severe forward-flexion at the waist. Originally used in reference to a conversion disorder seen in military personel (Souques and Rosanoff-Saloff, Rev Neurol 1915, 22, 937; Rosen and Frymoyer, Spine 1985, 10, 325; Miller and Forbes, Br J Psychiatry 1990, 157, 765; Perez-Sales, Arch Phys Med Rehabil 1990, 71, 1078; Sinel and Eisenberg, Rev Rhum Mal Osteoartic 1992, 59, 169; Miller and Forbes, Mil Med 1990, 155, 561; Belgrano and Giordano, Rev Neurol 1947, 79, 25-35), the term has been adapted to describe severely flexed postures observed in Parkinson disease (Djaldetti et al., Mov Disord 1999, 14, 443), other basal ganglia disorders (Nieves et al., Mov Disord 2001, 16, 177; Reichel et al., Nervenarzt 2001, 72, 281), and muscular disease (Delcey et al., Rev Med Intern 2002, 23, 144; Van Gerpen, Mov Disord 2001, 16, 358). Although rare, psychogenic camptocormia is seen in civilian populations, presenting diagnostic challenges. We describe a patient whose initial history and examination suggested a psychogenic etiology for his camptocormic posture. A multidisciplinary approach elucidated the patient's motivations and emotional state, and has been helpful in management of this patient.