Mortality in Parkinson's disease and its association with dementia and depression.

OBJECTIVE: To compare the mortality rate in Parkinson's disease (PD) with a control group without PD, and to assess the relationship between mortality and features of PD. MATERIAL AND METHODS: Ninety PD patients and 50 controls, mortality ascertained at 11 years follow-up. RESULTS: The hazard ratio (HR) for mortality in PD patients compared with controls was 1.64 (95% CI: 1.21-2.23). Multivariate analysis showed age, dementia and depression were independent predictors of mortality but age at onset of PD and severity of neurological symptoms were not. The HR for age was 1.09 (95% CI: 1.05-1.13), for dementia 1.94 (95% CI: 1.26-2.99), and for depression 2.66 (95% CI: 1.59-4.44). CONCLUSION: Mortality in PD is increased compared with controls. Psychological variables are important predictors of mortality in PD.

A 10-year study of the incidence of and factors predicting dementia in Parkinson's disease.

OBJECTIVE: To compare the incidence of dementia in PD with that of a control group without PD, and to assess the relationship between dementia and other features of PD. METHODS: The authors recruited 83 patients with PD and 50 controls, all without dementia at initial assessment, and assessed them at regular intervals over a maximum period of 122 months. Dementia was diagnosed according to objective criteria, and included a judgment by researchers masked to subject group and to variables putatively associated with dementia. RESULTS: Seventeen patients fulfilled dementia criteria; no controls did so. The cumulative proportion of PD patients becoming demented by 112 months was 0.38 (95% CI 0.20 to 0.55), or 42.6 cases per 1000 years of observation. Univariate analyses showed that incident dementia in patients with PD was associated with older age at entry into the study, greater severity of neurologic symptoms, longer duration of PD, greater disability, and male sex. The association of age at onset of PD with incident dementia was of only borderline significance. Multivariate analysis found that age at entry into the study and severity of motor symptoms were significant predictors of dementia but duration of PD and age at onset of PD were not. CONCLUSIONS: Dementia in PD is likely to reflect interaction of the neuropathology of the basal ganglia and age-related pathology. The findings do not support the division of PD into early and late-onset cases.

Facial expressions and Parkinson's disease.

Patients with Parkinson's disease (PD) and matched control subjects were photographed posing a range of facial expressions. The same subjects were later asked to identify the posed expressions of the other subjects. They were also asked to rate the quality of expressions posed by the control subjects after being told what each expression was. Expressions posed by healthy control subjects were more readily identifiable than expressions posed by Parkinson's patients, but the two groups did not differ in their ability to recognize facial expressions or in the goodness ratings they gave, and their error patterns were closely similar. There was no significant difference between the groups on other tests of face processing or on ratings of emotionality except for greater reported anxiety in the Parkinson's patients. We conclude that although patients with PD have reduced facial expressiveness, there is no apparent diminution in their comprehension of facial expressions or their day-to-day experience of emotion.

Diagnoses are not diseases.

The psychiatric community seems determined to ground its medical legitimacy on principles that confuse diagnoses with disease. If mental illnesses are diseases of the CNS, they are diseases of the brain, not the mind. If mental illnesses are the names of (mis)behaviour, they are forms of behaviour, not diseases. Psychiatric metaphors have the same role in medicine as religious metaphors have in theology. Religion is, among other things, the institutionalised denial of a finite life. Psychiatry is, among other things, the institutionalised denial of the tragic nature of life: individuals who want to reject the reality of free will and responsibility can medicalise life, and entrust its management to health professionals. Psychiatrists have succeeded in persuading the scientific community, the courts, the media, and the general public that the conditions they call mental disorders are diseases, that is, phenomena independent of motivation or will. The more firmly psychiatrically based ideas take hold of the collective American mind, the more foolishness and injustice they generate. Long ago, the law makers agreed to let psychiatrists literalise the metaphor of mental illnesses. Thus, the Americans With Disabilities Act (AWDA), scheduled to be fully implemented by July 1992, covers claustrophobia, personality problems, and mental retardation, though unlike DSM-III-R it excludes kleptomania, pyromania, compulsive gambling, and transvestism. The literal language of psychiatry allows motivated actions to be called 'disease'. Other examples of behaviour for which psychiatrists have disease names, and which AWDA implicitly accepts as genuine diseases, include dysmorphophobia, multiple personality disorder, frotteurism, hypoactive sexual desire disorder, and fractitious disorder with physical symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)