Dear just_another_hill_to_climb Trigger finger often is a term to describe and abnormal finger posture in which the 2nd knuckle seems to catch, making it difficult to make a fist or hold an object. In some instances this is related to parkinsonism - particularly if you had an abnormal posture in the hand. You may wish to google the term, "striatal hand" to see if those photos are similar to the posture you are experiencing.View Thread
Hi, lovedogs 1955 To me that suggests that you may be right eye dominant, but have a vision problem in that eye - perhaps a cataract?
So, I like the idea of a "Did you Know" column. How about homework for everybody?
We will ask our friends at WebMD to think about the best format to use for this type of posting, and for them to collect suggestions for a column topic, and I will try to do a column every month. If I get behind, I will ask some of my friends and colleagues to chip in. Please let me know what you think.View Thread
Dear AN_248640 I apologize for my delay. I thought I had answered this question. You are correct, we worry much less about the "cheese effect" or increased blood pressure with foods containing tyramine. This concern is more relevant with an MAO-I type A inhibitor, while PD drugs rasagiline and selegiline are MAO-I type B inhibitors.View Thread
Dear Lee, You are correct that RBD association with PD, is in a older aged cohort - which I think is good for you. I also cannot answer your concern about whether you are at increased risk for PD, but my guess: not likely to increase your risk.
Study of the older group is because that is the population. I searched pubmed to see if there is a better answer. Below is the best I could do.
Sleep Med. 2011 Mar;12(3):278-83. doi: 10.1016/j.sleep.2010.07.022. Epub 2011 Feb 12. Changing demographics in REM sleep behavior disorder: possible effect of autoimmunity and antidepressants. Ju YE, Larson-Prior L, Duntley S. Source Washington University Multidisciplinary Sleep Medicine Center, USA. Abstract BACKGROUND: Rapid eye movement (REM) sleep behavior disorder (RBD) has been described predominantly in elderly men and in association with neurodegenerative disease. But an increasing proportion of cases in recent reports and in clinical practice do not fit this description; thus we sought to describe a current RBD population and possibly identify new subgroups with RBD. METHODS: Records of 115 consecutive patients with polysomnogram-confirmed RBD at an academic sleep center were retrospectively reviewed. RESULTS: Male to female ratio was 2:1, and 1.25:1 for early-onset (age <50) cases. Mean age at diagnosis was 53.7±16.4years. Most (60%) cases were idiopathic, and neurodegenerative disease was coincident primarily in older men. Autoimmune disease was unexpectedly common in women (20%) particularly in the 30-49 age groups (40%). Antidepressant use was frequent (46.1%), especially in early-onset cases (57.8%). CONCLUSIONS: RBD is diagnosed more equally between men and women and in younger individuals than previously reported. While neurodegenerative disease is frequently co-incident with RBD in older men, most women and early-onset cases have "idiopathic" RBD. High prevalence of autoimmune disease among women with RBD suggests an intriguing link between immune dysfunction and RBD. A high rate of antidepressant use provides support for a potentially causal role for antidepressants in RBD.View Thread
Hi, Worn1 There are some pockets of PD research in the area of vision. Below is an excerpt on vision work from a review I wrote for International Journal of Neuroscience:
Visual Disturbances Impaired visual acuity, contrast sensitivity, color discrimination, temporal sensitivity, motion perception, peripheral visual field sensitivity, visual processing, ocular surface irritation, altered tear film, decreased blink rate, and decreased convergence amplitudes are common in PD [85, 86>. Electrophysiologic testing suggests retinal ganglion cell impairment plays a role in the loss of acuity, and prolonged visual evoked potentials and abnormal electroretinographic patterns are seen [87>. Interestingly, both of these neurophysiologic assessments respond to levodopa [88, 89>. Motor disturbances have been attributed to visual hallucinations, double vision and estimating spatial relations, and most often produced freezing of gait [90>.View Thread
It can be. Do you notice any double vision when looking near or far? Or is your vision clearer when you cover one eye? If either are true, you may wish to talk with your neurologist or ophthalmologistView Thread
Dear cheney13, You may have three causes of tremor: PD tremor is one at rest, and usually affects one side more than the other - (left leg and hand, sounds like this) Essential Tremor (ET) is usually an action tremor, and affect both sides of the body fairly equally. Many people notice this when they are trying to eat or use tools (key in a door, etc) Drug induced tremor: some drugs for bipolar disorder (lithium and valproic acid (Depakote)) cause a tremor that can be at rest and with action. Lithium usually causes a fairly fast tremor, while valproic acid usually causes a slower one. There are also drugs classified as major tranquilizers that can cause parkinsonism and tremor. I would very concerned about this being the cause of your tremor and restless leg symptoms. A partial list of likely drugs for bipolar disorder includes aripiprazole, respiridone, olanzapine, perphenazine, thioridizine, etc. Please review all of your medicines for this potential risk.
If you are not on a medication that may cause parkinsonism, then I think you may have PD, and I would recommend talking with your doctor about treatment options.View Thread
Dear An_250062, Thank you for your kind words. These are extremely difficult issues, but you have every right to make decisions with accurate information. As a physician, my highest priority would be to know the patient's wishes. If your Mother is able to discuss, ask her if she wants to have more aggressive treatment. If, yes, or if you believe she would, pursue admission for IV antibiotics.
These are questions that you may wish to bring to the physicians caring for your mother:
1) If we treat her UTI, will her confusion and hallucinations get better? (Like before)
2) If so, how can we prevent these UTI's in the future? Would a catheter help? Do we need to change her other medications?
I think if those questions are answered, you will be able to develop a plan.
ps: I once had a friend say to me: "Since you are confused, I will use small words." Do not let a medical vocabulary cloud your understanding of a doctor statement!View Thread
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