Parkinson Disease: Thurman DJ

Thurman DJ, Stevens JA, Rao JK, Anonymous00002. · National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. · Neurology. · Pubmed #18250292 No free full text.

Abstract: OBJECTIVE: To develop a practice parameter for screening methods and assessments of risk for falls pertaining to patients likely to be seen in neurology practices. METHODS: Relevant literature was systematically reviewed and strength of evidence classified based on the American Academy of Neurology's criteria (Level A: established; Level B: probable; Level C: possible). RESULTS: An increased risk of falls is established among persons with diagnoses of stroke, dementia, and disorders of gait and balance (Level A) and probable among patients with Parkinson disease, peripheral neuropathy, lower extremity weakness or sensory loss, and substantial vision loss (Level B). A history of falling in the past year strongly predicts the likelihood of future falls (Level A). Screening measures have been developed to further assess risks of falls, including functional assessments that may be useful (Levels B and C). Several of these assess overlapping neurologic functions--i.e., gait, mobility, and balance--and there is insufficient evidence to assess whether they offer benefit beyond that provided by a standard neurologic examination. CONCLUSIONS: Patients with neurologic or general conditions associated with an increased risk of falling should be asked about recent falls and further examined for the presence of specific neurologic deficits that predict falls, which include gait and balance disorders; deficits of lower extremity strength, sensation, and coordination; and cognitive impairments. If substantial risks of falls are identified, appropriate interventions that are described in other evidence-based guidelines may be considered.

Hirtz D, Thurman DJ, Gwinn-Hardy K, Mohamed M, Chaudhuri AR, Zalutsky R. · National Institutes of Neurological Disorders and Stroke/National Institutes of Health, Bethesda, MD 20892, USA. · Neurology. · Pubmed #17261678 No free full text.

Abstract: OBJECTIVE: To estimate the current incidence and prevalence in the United States of 12 neurologic disorders. METHODS: We summarize the strongest evidence available, using data from the United States or from other developed countries when US data were insufficient. RESULTS: For some disorders, prevalence is a better descriptor of impact; for others, incidence is preferable. Per 1,000 children, estimated prevalence was 5.8 for autism spectrum disorder and 2.4 for cerebral palsy; for Tourette syndrome, the data were insufficient. In the general population, per 1,000, the 1-year prevalence for migraine was 121, 7.1 for epilepsy, and 0.9 for multiple sclerosis. Among the elderly, the prevalence of Alzheimer disease was 67 and that of Parkinson disease was 9.5. For diseases best described by annual incidence per 100,000, the rate for stroke was 183, 101 for major traumatic brain injury, 4.5 for spinal cord injury, and 1.6 for ALS. CONCLUSIONS: Using the best available data, our survey of a limited number of disorders shows that the burden of neurologic illness affects many millions of people in the United States.