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University of Groningen Radiotracer Imaging in PD Eshuis, Sietske Aleida

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University of Groningen Radiotracer Imaging in PD Eshuis, Sietske Aleida University of Groningen Radiotracer imaging in PD Eshuis, Sietske Aleida IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2009 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Eshuis, S. A. (2009). Radiotracer imaging in PD: value of in vivo presynaptic dopaminergic measures in animal models and human disease. [s.n.]. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date: 27-09-2021 Parkinson’s disease: symptoms and age 2dependency S.A. Eshuis, K.L. Leenders Dept of neurology, University Medical Center, Groningen, The Netherlands Abbreviated according to chapter 68: “Parkinson’s disease: symptoms and age dependency” appeared in Functional Neurobiology of Aging; Edited by Patrick R. Hof and Charles V. Mobbs, 2001 Publisher: Academic Press, San Diego, CA, USA Chapter 2 regel 1 regel 2 regel 3 regel 4 regel 5 regel 6 regel 7 regel 8 regel 9 regel 10 regel 11 regel 12 regel 13 regel 14 regel 15 regel 16 regel 17 regel 18 regel 19 regel 20 regel 21 regel 22 regel 23 regel 24 regel 25 regel 26 regel 27 regel 28 regel 29 regel 30 regel 31 regel 32 regel 33 regel 34 regel 35 regel 36 regel 37 regel 38 regel 39 30 Parkinson’s disease: symptoms and age dependency Epidemiology of Parkinson’s Disease (PD) regel 1 regel 2 Parkinson’s disease is one of the most frequent neurodegenerative diseases, which mainly regel 3 affects the elderly. To estimate incidence and prevalence of PD, some problems need to regel 4 be mentioned. No perfect ante mortem diagnostic test for PD exists and the most reliable regel 5 diagnostic method is expert neurologic examination at regular time intervals. In autopsy regel 6 Chapter 2 studies, the diagnosis of PD before death has been found to be incorrect in about 24% regel 7 of cases39. Essential tremor may account for 10% - 40% of the false-positive diagnoses of regel 8 PD. In contrast PD may be misdiagnosed as depression, or in the very elderly, “normal” regel 9 aging. Other neurodegenerative disorders, like progressive nuclear palsy (PSP) or multiple regel 10 system atrophy (MSA) may not be distinguished easily from PD early in the course of regel 11 the disease. Many “atypical” parkinsonian syndromes were only recognised in the past regel 12 several decades and probably have been classified as PD in early reports. regel 13 regel 14 Incidence and prevalence of Parkinson’s disease regel 15 Several studies have been performed to estimate the frequency of PD. The overall incidence regel 16 is estimated to be 20 / 100 000 per year, and raises to about 1% of persons over 50 regel 17 years of age32, 78 and even higher when older9. regel 18 Prevalence of PD varies from 10 to 405 per 100 000 population. This variation may be regel 19 due to differences in case-finding procedures, in diagnostic criteria, in accessibility of regel 20 medical services and in the age distribution of populations. Most frequently prevalence is regel 21 about 100 - 187 per 100 00059. As for incidence, prevalence rises almost exponentially regel 22 after age 50. By the eighth decade, prevalence in Europe and North America is estimated regel 23 to be between 1000 and 3000 per 100 000 persons88. This is confirmed by the Rotterdam regel 24 Study: prevalence figures were 0.3% for those aged 55 to 64 years, 1.0% for those aged regel 25 65 to 74 years, 3.1% for those aged 75 to 84 years and 4.3% for those aged 85 to 94 regel 26 years. Among women aged 95 to 99 years, prevalence was 5.0%16. In some studies an regel 27 apparent decrease in late life is seen. This is probably due to ascertainment and diagnosis regel 28 difficulties in this population, rather than an actual decline in disease frequency. regel 29 regel 30 Mortality regel 31 In Hoehn and Yahr’s series mortality ratio in patients with primary parkinsonism regel 32 was 2.9 times that expected in the age-matched population38. In a more recent study regel 33 of parkinsonian patients the overall risk for death, adjusted for age and sex, was 2.0 regel 34 times that of persons without parkinsonism4. Since the introduction of more effective regel 35 antiparkinsonian medication, especially levodopa, mortality has decreased in younger regel 36 parkinsonian patients. However in older parkinsonian patients an increase during the last regel 37 few decades in mortality is found. In the United States between 1962 and 1984, mortality regel 38 regel 39 31 Chapter 2 regel 1 decreased for persons younger than age 70, but increased for persons of 75 years and regel 2 older49. This is confirmed by Morens et al67, who found that after age 60, PD-associated regel 3 mortality rates appeared to increase logarithmically. This increase in mortality rate was regel 4 not attributable to age alone. Increased age-related PD mortality was associated with regel 5 both absolute age and duration of illness longer than 10 years. Between the ages of 70 regel 6 and 89 years, parkinsonian patients had a two- to three-fold increase in the risk of dying, regel 7 corresponding to a mortality ratio of 2.567. In a study of Louis et al54 risk of mortality was regel 8 higher in parkinsonian patients (rate ratio = 2,7) after adjusting for baseline age, years of regel 9 education, sex, ethnicity and smoking status. It was even higher when PD was combined regel 10 with dementia (rate ratio = 4.9). In fact dementia is a significant predictor of death in PD57. regel 11 A high base-line score of extrapyramidal signs was most associated with increased risk regel 12 of mortality among the patients with PD. After subanalysis of the different extrapyramidal regel 13 signs, severe bradykinesia was the motor manifestation that most highly correlated with regel 14 increased mortality54. The Sydney multicentre study found increased mortality risk among regel 15 parkinsonian men, whereas this was not significantly different for women, compared to regel 16 the general Australian population. Predictors of mortality, according to this study, are age regel 17 at onset and progression rate. Several studies have shown that the effects of levodopa regel 18 on mortality are apparent in the early years of the disease. In contrast, despite levodopa regel 19 therapy, mortality is rising in a later stage of the disease12, 17. Data from the DATATOP cohort regel 20 suggests that carefully selected patients with early PD without co-morbidity have normal life regel 21 expectancy when adequately treated and frequently seen by consulting physicians1. This regel 22 is confirmed by Tanner and Ben-Shlomo88. For persons with PD diagnosed before the age regel 23 of 60, they found a relative survival similar to that of the general population, in contrast to regel 24 people with an older age at diagnosis, who showed a lower relative survival88 . regel 25 Pneumonia is the most common cause of death, probably due to immobility and increased regel 26 risk of aspiration1. Death from cerebrovascular disease is increased as well35. Some studies regel 27 have suggested a reduced risk of death from cancer in parkinsonian patients35, 42, but other regel 28 studies did not confirm this91. regel 29 regel 30 Regional and racial variation regel 31 Estimates of prevalence vary widely depending on geographical location. A Northwest regel 32 to Southeast gradient is suggested49 and PD prevalence appears to be highest in Europe regel 33 and North America, whereas rates in Japan, China and Africa are markedly lower. In regel 34 the USA PD prevalence is much lower among blacks. Already in 1972, Kessler found a regel 35 higher frequency of PD for whites compared with blacks43, 44. In a survey of PD in New regel 36 York, age-adjusted prevalence rates were lower for blacks than for whites and Hispanics. regel 37 Surprisingly however incidence rates were highest among black men, but these incidence regel 38 rates were otherwise comparable across sex and ethnic groups. By ethnic group, the regel 39 32 Parkinson’s disease: symptoms and age dependency cumulative incidence was higher for blacks than for whites and Hispanics, but more regel 1 deaths occurred among incident black patients. These findings could result from a delay regel 2 in diagnosis due to limited access to appropriate health services among these people60. regel 3 Some studies however show similar rates for African-American, Asian-American and regel 4 European-American subjects67. In a study among a cohort of American men of Japanese or regel 5 Okinawan ancestry, epidemiological data are in general in accord with those from Europe regel 6 Chapter 2 and the United States. Incidence data are 5- to 10-fold higher at each age stratum than regel 7 age-specific incidence figures from China.
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