Pain in Parkinson's disease: analysis and literature review.

Pain is a common problem faced by Parkinson's disease (PD) patients. Despite its impact and disabling effects pain is still frequently overlooked. In this study we analyze a representative sample of peer reviewed literature for the prevalence and types of pain in PD, the impact and significance of pain in the quality of life of the PD patient and the challenges inherent in the diagnosis and management of pain in PD patients. We compared and analyzed the findings of articles indexed in the PubMed database which looked at symptoms reported by large cohorts of PD patients. These articles all reported the incidence, nature and quality of pain in these patients and described the effects of pain on quality of life and generally were cross-sectional, retrospective or case-control studies, though a major pharmacoepidemiological design study was also analyzed. Results of our analysis showed that the pain was prevalent in 59.77% of PD patients. Five different types of pain were reported by PD patients--dystonia, musculoskeletal pain, nerve/nerve root pain, primary/central pain and according to some, akathisia. Patients who reported pain symptoms were also significantly more likely to report associated depression and a decreased quality of life. Many PD patients also reported poor management of pain and lower analgesic use than would be expected. We further discuss some of the possible approaches toward the development of a treatment algorithm regarding the management of pain in PD. We conclude that pain in is an under-recognized and under treated symptom in PD patients. Effective management of pain in PD patients would significantly improve their quality of life. Our analysis is in line with current thinking that identifies PD is much more of a multisystem disease with non-motor symptoms than previously thought.

Impact of cognitive dysfunction on drooling in Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is commonly characterized by its motor symptoms such as resting tremor, rigidity, bradykinesia and postural instability; however, some of the most debilitating symptoms of this disease are non-motor ones such as dementia and sialorrhea (drooling). Drooling is caused by impaired swallowing and it can have a significant impact on the quality of life. However, it is still unclear whether cognitive dysfunction could exacerbate drooling. We wanted to examine if any relationship existed between drooling and dementia in PD patients. Identifying the correlation will aid physicians to screen and initiate early management of drooling in the course of PD. This can possibly lead to improvements in the quality of life in these patients. METHODS: In this retrospective study, we investigated the prevalence of drooling in 314 PD patients and further compared the difference in the prevalence of drooling in patients with dementia and without dementia. In addition, we studied the impact of gender on drooling in this patient population. RESULTS: Our results show that a significant correlation exists between drooling and dementia in our sample of PD patients. Furthermore, in males, the correlation between the prevalence of drooling and dementia was found to be clinically significant as compared to the female population. CONCLUSION: Our findings suggest that drooling is a major concern in the course of PD and should therefore be addressed early and more aggressively in patients with dementia.

Prevalence of blepharospasm and apraxia of eyelid opening in patients with parkinsonism, cervical dystonia and essential tremor.

The objective of this study was to determine the prevalence of blepharospasm (BSP), with and without apraxia of eyelid opening (AEO), in patients with parkinsonism, cervical dystonia (CD), and essential tremor (ET). BSP, with or without AEO, is associated with parkinsonism. There have been several reports of BSP in other dystonic conditions, but few looked at the incidence of BSP in ET patients. This study included 659 patients of which 357 had parkinsonism (276 idiopathic Parkinson's disease (IPD) and 81 atypical parkinsonism (57 progressive supranuclear palsy; 11 multiple system atrophy 13 corticobasal degeneration)), 274 had ET, 22 had CD, and 6 had spinocerebellar ataxia. Our results indicate that BSP (with or without AEO) was more prevalent in atypical parkinsonism (6 out of 81, 7.41%) than IPD (9 out of 276, 3.26%). The study also followed 10 (of the 28) patients with BSP to screen for the development of other movement disorders - of these, 2 developed Parkinson's disease. We conclude then that BSP is common in parkinsonism and that BSP is more prevalent in atypical parkinsonism. We also conclude that BSP is not a common feature in ET patients (0 out of 274 patients reported BSP symptoms).