Talk:Parkinson's disease/Archive 4

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Useful "knol"

In the google wikipedia-like knol there is an interesting article on PD: See: [1]. Since it's license is CC atribbution 3 compatible with wikipedia we could copy useful parts from it. It has been written by a physician with an interest in movement disorders. Although it has few references we could easily find refs for it. Bests.--Garrondo (talk) 15:45, 15 September 2009 (UTC)

Pop culture ignorance

What about adding something about how pop culture thinks of Parkinson's as a "funny" disease like tourette's syndrome? --Phil1988 (talk) 01:09, 30 September 2009 (UTC)

Could you give some suggestion of sources that discuss that attitude? Looie496 (talk) 19:52, 1 October 2009 (UTC)

Creation of signs and symptoms secondary article

In the past few months I have been improving the signs and symptoms section. Now it is fully referenced and quite exhaustive. I am planning to summarize it and create a secondary article since it is really too long. Bests.--Garrondo (talk) 09:42, 1 March 2010 (UTC)

Done.--Garrondo (talk) 12:26, 2 March 2010 (UTC)

Not really fair on tourettes sufferers —Preceding unsigned comment added by 89.145.198.172 (talk) 15:19, 7 November 2010 (UTC)

??? Why? Not sure what these article and subarticle have to do with tourette syndrome...--Garrondo (talk) 20:19, 7 November 2010 (UTC)

Merges

Shortly after creating Signs and symptoms of Parkinson's disease I found Non-motor symptoms of Parkinson's disease. Both of them have a lot of overlap in content with the former having additional content to the latter since it has a broader coverage. I believe the article "non motor symptoms" should be merged into the more general "signs and symptoms". Additionally the signs and symptoms subsection is now a summary of the signs and symptoms article. Anybody opposing?

Bests.--Garrondo (talk) 08:37, 3 March 2010 (UTC)

It is done.--Garrondo (talk) 18:50, 3 March 2010 (UTC)

classification

I've created this section to discuss whether we should merge Parkinson plus syndrome into this article--Robert Treat (talk) 05:49, 10 September 2009 (UTC).

I agree: at this point the parkinson's plus article is of very low quality and would not probably improve in the short term since it receives around 60 visits a day. Nevertheless in the process of merging references should be added; since at this point it has none. Bests.--Garrondo (talk) 07:19, 10 September 2009 (UTC)

I disagree. The Parkinson's article is about idiopathic parkinsonism, and we need a very clear distinction between PD and its related movement disorders. This page could assume the format of a disambiguation page, but I disagree that it should disappear just because it's of low quality. JFW | T@lk 20:30, 12 September 2009 (UTC)

No merge: They are different. For example; "Dementia with Lewy bodies" has a completely different pathology to "Parkinsons disease". Snowman (talk) 00:10, 2 October 2009 (UTC)

Looks like it needs expansion, but a merge isn't on the cards - am tidying up the merge messages as done. Lee∴V (talk • contribs) 14:49, 23 July 2010 (UTC)

Comments on classification

I might have found a typo? 3rd Paragraph of the "Classification" secion. 1st 2 Sentences read: "These Parkinson-plus diseases may progress more quickly than typical idiopathic Parkinson disease. If cognitive dysfunction occurs before or very early in the course of the movement disorder, then DLBD may be suspected." As far as I can tell, this is the first time "DLBD" appears in the article, so I suspect it is supposed to be "dementia with Lewy bodies (DLB)". If I wasn't so sleep deprived right now, I would probably make that edit on the main page myself.

Additionally, the 4th paragraph is not entirely clear: "The usual anti-Parkinson's medications are typically either less effective or completely ineffective in controlling symptoms; patients may be exquisitely sensitive to neuroleptic medications like haloperidol, so correct differential diagnosis is important."

I would suggest adding "Parkinson-plus diseases" somewhere in there for those of us that have gotten a little bit lost in the medical terminology, and multiple acronymed types of Parkinson-plus diseases. Perhaps: "The usual anti-Parkinson's medications are typically either less effective or completely ineffective in controlling symptoms of Parkinson-plus diseases; patients may be exquisitely sensitive to neuroleptic medications like haloperidol, so correct differential diagnosis is important." 24.180.99.144 (talk) 17:57, 22 August 2010 (UTC)bill.landis@gmail.com

I have been working on the article for a few months improving section by section, but I have not yet attacked the classification section. However I spect to do it soon, and most probably I would change it dramatically, reducing much of the information on parkinson plus, since there is already an article for it. On the other hand any comments on the other sections would be most welcome. --Garrondo (talk) 19:48, 22 August 2010 (UTC)

The following wording in the Classifications section makes no sense to me: "having PD also characteristics of the former:" Gypsydoctor (talk) 02:32, 2 October 2010 (UTC)

Bicycle riding

Kinesia paradox. [2]. - Kittybrewster ☎

Wow... the video is amazing.--Garrondo (talk) 14:21, 29 April 2010 (UTC)

Picture of James Parkinson

I can't bring myself to believe that James Parkinson died as early as 1824 when there's a Daguerreotype/Photograph available of him. Either that or the guy in the picture isn't him. Does anyone have the solutuion? Marco :-0 Bonteburg (talk) 10:48, 12 April 2010 (UTC)

I have found the following in an historical review article in a journal (see PMID 17664408): His modesty and decency are reflected by the fact that, although, during his life he was held in respect in both medical and geological circles, no portrait has as yet come to light. Parkinson also chose to write his critical and often acerbic polemical pamphlets under the nom de plume of Old Hubert, although this may have been more to preserve his anonymity in turbulent times.

Unless we are sure that this man is the James Parkinson that described the disease we can not have its image in the article. Until then I am going to remove the image. Bests.--Garrondo (talk) 13:36, 27 July 2010 (UTC)

Proposed name change

This is now recognised as a condition rather than a disease. In UK it is now known as "Parkinson's". Kittybrewster ☎ 13:19, 29 April 2010 (UTC)

I do not really understand your proposal... Nevertheless names follow nomenclature of the ICD-10, which talks about Parkinson's disease. Bests.--Garrondo (talk) 13:56, 29 April 2010 (UTC)

I have reverted your changes per above. See Wikipedia:Manual of Style (medicine-related articles). Bests.--Garrondo (talk) 14:08, 29 April 2010 (UTC)

Notable sufferers

The manual of style for medical articles (See WP:MEDMOS) says about notable sufferers: Articles on medical conditions often include lists of notable individuals who have (or had) the disease. This may be manageable if the disease is rare. For common conditions, it can become a distraction from the main article and contain much unreferenced and dubious material. If you do include such a list, ensure your entry criteria are well defined so that future editors may know if their additions are welcome. One restriction that some editors favour is to include only those individuals who have lastingly affected the popular perception of a condition, such as through public awareness campaigns or enduring media coverage.

• Parkinson's disease is clearly a common disease.
• The list has grown over time and it is clearly not manageable
• The list is completely unreferenced and may have therefor innacuracies.
• There is no entry criteria at all.
• I doubt that most of these people have lastingly affected the popular perception of a condition (specially since most people won't have heard in their lifes from many of them).

I have decided to eliminate the whole section and move it here. If somebody wants to search for references veryfing that some or all of them had PD such editor could create a secondary article with them. Nevertheless I think that to include any of them in the main article s reference where it is said that they have influenced the perception of the disease would also have to be found. I would say that right now the only two that merit inclusion are Fox and Phiney, since at least it is said that they have created two foundations... (I am even in doubt for the latter, but it can be discussed in the future). Bests.--Garrondo (talk) 12:40, 17 May 2010 (UTC)

Notable sufferers

(Information taken from article the 17th of april 2010 and left here so a secondary subarticle can be created in the future if the info is correctly referenced)

In addition to Michael J. Fox and Davis Phinney, famous sufferers include the late Pope John Paul II, baseball manager Sparky Anderson, playwright Eugene O'Neill, political commentator Michael Kinsley, author Nicholas Bethell, artist Salvador Dalí, hockey player Brent Peterson, boxer Muhammad Ali, basketball player Brian Grant, evangelist Billy Graham and former U.S. Attorney General Janet Reno. Political figures suffering from it have included Adolf Hitler (not confirmed), Francisco Franco, Deng Xiaoping and former Prime Minister of Canada Pierre Trudeau. Numerous actors have also been afflicted with Parkinson's such as: Terry-Thomas, Deborah Kerr, Kenneth More, Vincent Price, Jim Backus and Michael Redgrave. Helen Beardsley (of Yours, Mine and Ours fame) also suffered from this disease toward the end of her life. James Doohan also suffered from Parkinson's disease, and later, Alzheimer's. Director George Roy Hill (The Sting, Butch Cassidy and the Sundance Kid) also suffered from Parkinson's disease. Rabbi Nosson Tzvi Finkel, the Head Rabbi of the Jerusalem Mir Yeshiva, also suffers from this disease. The film Awakenings (starring Robin Williams and Robert De Niro and based on genuine cases reported by Oliver Sacks) deals sensitively and largely accurately with a similar disease, postencephalitic parkinsonism.

Many of those mentioned here are perhaps not so notable because they began to show symptoms or were diagnosed in their old age, but I was very surprised to see that Muhammad Ali was not mentioned in the article. His lighting the Olympic flame in Atlanta in 1996 was, I believe, memorable enough to warrant his inclusion here, but perhaps time has already left him behind. Which brings me to a second point: I expected to see more about causes-- in the case of Ali, repeated head trauma. I came to this article after reading about Michael J. Fox, having always wondered about the cause of his Parkinson's. There was talk a few years ago about excessive use of cocaine causing or contributing to early-onset Parkinson's, and for actors in the 80s and 90s, this would not have been a surprising finding. However, I've never seen this even mentioned in relation to Fox. I have great admiration for him and I only hope that if drug use were a causative factor in his illness, he would talk about it as a warning to young people. Lisapaloma (talk) 00:42, 17 October 2010 (UTC)

On a cursory overview, I find that Parkinson's is adequately mentioned in the relevant articles but cannot find any reference to cocaine abuse in relation to ether article, but even if it were so, it would require a reliable source independent of these people to make a cogent connection. Please feel free to cite, but at present I just don't see it. Rodhullandemu 00:54, 17 October 2010 (UTC)

I would say that many of today's notable sufferers have decided not to start their own foundations because they see the size and scope of the Fox Foundation. [Brian Grant] and [Andy Grove] have both stated they felt they could do more by working through the MJFF then starting something from scratch. Jhbarr (talk) 22:15, 17 February 2011 (UTC)

I move here a few lines on the pope since they are referenced, but he has hardly changed perception of the disease. It can be nevertheless discussed if others think otherwise: Pope John Paul II was also diagnosed with the illness, although the Vatican administration kept this a secret until 2003..--Garrondo (talk) 07:16, 4 March 2011 (UTC)

L-DOPA vs levodopa

Looks like there's a bit of trade name / chemical name mixup going on. Shouldn't the section in the article be 'L-DOPA' and mention levodopa as a commercial version. There's a few articles that might need addressing too.. levodopa already redirects to L-DOPA, but I notice there is Levodopa-induced dyskinesia, Carbidopa/levodopa and a potential Benserazide/levodopa. These might need to be renamed, the carbidopa/levodopa might even be merged back into carbidopa - for example the benserazide article already discusses its combined use so the extra article might not be needed... Lee∴V (talk • contribs) 15:09, 23 July 2010 (UTC)

You are completely right... It was me who did this by mistake (I have to say that I did not even know that levodopa was the trade name)... It would be great if you could fix the article, while I work on the history section. Bests.--Garrondo (talk) 18:23, 23 July 2010 (UTC)

I am hunting around t'internet - not so sure now, the terms seems interchangeable .. am digging further.. Lee∴V (talk • contribs) 10:48, 26 July 2010 (UTC)

From the L-DOPA article discussion page: This article should be called L-DOPA. L-DOPA is the common, scientific name for a chemical which exists as a biosynthetic precursor to dopamine and can also be synthesized in the lab. Levadopa is the INN for synthetic L-DOPA intended for use as a pharmaceutical. Since this article is about the substance as a chemical (structure, synthesis, etc.), the natural biological properties (synthesis, function, etc.), and its use as a pharmaceutical (role in Parkinsons, dosing, etc.) we should use the most general name, not the pharmaceutical specific one.: I would say that if correct here we could use both as synonims and even premier the use of the levodopa term (since is the pharmaceutical name). Nevertheless in no case is the brand name. The only case were we should mandatorily use L-DOPA is when talking about "natural sources of L-DOPA". Bests.--Garrondo (talk) 11:40, 26 July 2010 (UTC)

Since levodopa is the INN I have tried to use levodopa when talking about the drug and L-DOPA (and not L-dopa) when talking about the endogenous substance. I would try to be consistent in the future.--Garrondo (talk) 11:58, 26 July 2010 (UTC)

I think you've been consistent, its a slippery issue ...! I have elicited further discussion at the pharmacology Project (Wikipedia_talk:WikiProject_Pharmacology#Levodopa ) for rurther ideas! Lee∴V (talk • contribs) 13:37, 27 July 2010 (UTC)

Sorry about the delay, have added 'When used in a pharmaceutical context, the INN designation 'levodopa' is normally used.' to l-dopa article. It all looks to be in order and the conversation was - don't worry too much as long as we are consistent. Lee∴V (talk • contribs) 11:18, 24 August 2010 (UTC)

Resolved

Possible protective effect of CoQ10

I added the following (21-July-2010):

"A 2002 study in 80 Parkinson’s disease patients found 1200mg/day of coenzyme Q10 reduced the disease progression by 44%. "

but it was removed (for dubious reasons) discussed on my talk page. Shouldn't we qualify rather than delete ? Rod57 (talk) 14:35, 6 August 2010 (UTC)

Biomarkers

A lot of current PD research seems to involve looking for biomarkers. I expected to find something about that here. I hope someone will add a section on this. Gypsydoctor (talk) 13:22, 4 October 2010 (UTC)

New source on research

"No New Parkinson Disease Drug Expected Anytime Soon" 16 Aug 2010 has info on drug targets and animal models. Rod57 (talk) 07:57, 13 October 2010 (UTC)

Heading towards FA

I have been rewriting the pathophisiology section with the intention of taking the article to FAC as soon as possible. Today I have greatly simplyfied the pathology subsection since it was too much specific (proof is that its contents were not covered at all in the main seminal reviews already in the article). Since its content had some possible useful sources and content I paste it here so it does not get lost in the history of the article, and if ever a pathophisioloy subarticle is created it can be integrated there. Content is:

Excessive accumulations of iron, which are toxic to nerve cells, are also typically observed in conjunction with the protein inclusions. Iron and other transition metals such as copper bind to neuromelanin in the affected neurons of the substantia nigra. Neuromelanin may be acting as a protective agent. The most likely mechanism is generation of reactive oxygen species. Iron also induces aggregation of synuclein by oxidative mechanisms. Similarly, dopamine and the byproducts of dopamine production enhance alpha-synuclein aggregation. The precise mechanism whereby such aggregates of alpha-synuclein damage the cells is not known. The aggregates may be merely a normal reaction by the cells as part of their effort to correct a different, as-yet unknown, insult. Based on this mechanistic hypothesis, a transgenic mouse model of Parkinson's has been generated by introduction of human wild-type alpha-synuclein into the mouse genome under control of the platelet-derived-growth factor-β promoter. A recent view of Parkinson's disease implicates specialized calcium channels that allow substantia nigra neurons, but not most neurons, to repetitively fire in a "pacemaker" like pattern. The consequent flooding of calcium into these neurons may aggravate damage to mitochondria and may cause cell death. One study has found that, in experimental animals, treatment with a calcium channel blocker isradipine had a substantial protective effect against the development of Parkinson's disease.

--Garrondo (talk) 11:29, 22 October 2010 (UTC)

Associations

Searching for secondary sources on PD advocacy associations I have found few to none. Therefore I have decided to eliminate most of the info on them which from my point of view was self-promotional (until a secondary source states that such info is notable), leaving only that info that was in secondary sources. I have also left the name of the two associations that were already in the article as examples of associations even if there is no secondary info for them. --Garrondo (talk) 17:11, 25 October 2010 (UTC)

In glancing at the article to assess this, I realized that there is no mention of Muhammad Ali. I think he is as notable a victim as Michael J. Fox, or even more so. Looie496 (talk) 22:14, 25 October 2010 (UTC)

First of all: he was notable as a boxer, I doubt that as much as PD sufferer, but we could search for references which say that he was notable as a person with the disease. Secondly and more important. Ali suffered from parkinsonism but not PD: his symptoms were a direct consequence of boxing and as such are not covered by this article, which according to secondary sources, defines PD as idiophatic (primary), common presentation, of parkinsonism. Ali suffered from secondary parkinsonism (dementia pugilistica).--Garrondo (talk) 07:08, 26 October 2010 (UTC)

I might have answered too quickly: After some searching I see now that both Ali and his wife had made public appeareances to talk about the disease, that there is a Muhammad Ali parkinson's center and that several articles talk about him suffering PD... On the other hand is also true that several pubmed articles say that he had parkinsonism due to boxing and not exactly PD. I'll try to integrate all the info soon. Thanks for the interest.--Garrondo (talk) 07:42, 26 October 2010 (UTC)

I have given it a try. I will add the references soon.--Garrondo (talk) 11:34, 26 October 2010 (UTC)

To set a rule: From WP:MEDMOS on notable sufferers: f you do include such a list, ensure your entry criteria are well defined so that future editors may know if their additions are welcome. One restriction that some editors favour is to include only those individuals who have lastingly affected the popular perception of a condition, such as through public awareness campaigns or enduring media coverage. Idea would be to include only those that have been notable as PD sufferers, independently of whether they were notable of not before diagnosis. In this sense at the moment we have two inclusions which created foundations for PD which have been covered in secondary sources. New additions should be considered on a one to one basis against sources stating how they have affected the perception of a condition.--Garrondo (talk) 07:08, 26 October 2010 (UTC)

Not that it's needed at this point, and of course youtube is not a usable source, but just to make his notability as a Parkinson syndrome sufferer clear, it might be worth watching this video. Looie496 (talk) 21:12, 26 October 2010 (UTC)

In one word: wow.--Garrondo (talk) 06:13, 27 October 2010 (UTC)

I have changed image to a photo of Ali, since Fox's picture had copyright issues and there were no other high quality images of him.--Garrondo (talk) 06:45, 27 October 2010 (UTC)

Image problem

We have a probably copyright problem with an image. Image is: File:PET scan Parkinson's Disease.jpg. Description states that it was created by NASA. However while it appears in a document by NASA at no point it is said that it was created by them. In addition it seems an internal document for a lection. Moreover I do not think that NASA is interested in performing PET scans to parkinson's disease patients. I participated in a discussion with a similar image 2 years ago in the Alzheimer's disease article: See here. For the moment I am going to eliminate image from article and I have asked an administrator for help about how to proceed.--Garrondo (talk) 07:46, 29 October 2010 (UTC)

I have just found the following notice in the index of the tutorial from where the image was taken:I GET MANY REQUESTS FOR PERMISSION TO USE ILLUSTRATIONS FROM THE TUTORIAL, OR ACTUAL COPIES THEREOF. ABOUT 95% OF THOSE YOU SEE WERE EXTRACTED OFF THE INTERNET (AND I HAVE INEXACT RECORDS OF THEIR SOURCE); THE OTHER 5% CAME FROM MY PERSONAL COLLECTION WHICH I HAVE SINCE GIVEN AWAY. I AM THEREFORE UNABLE TO FILL ANY REQUESTS INCLUDING PERMISSIONS, SO PLEASE DON'T SEND ANY.: So now it is clear that it is a copyright infrigement.--Garrondo (talk) 07:56, 29 October 2010 (UTC)

I have nominated it for deletion at commons: interested users see here.--Garrondo (talk) 10:51, 4 November 2010 (UTC)

Wording

A few suggestions

• Do not like the term "sufferer" even worse than patient IMO.
• We should us generic not brand names first ( see the image )
• Some of the images have formatting problems on my screen.

--Doc James (talk · contribs · email) 14:58, 4 November 2010 (UTC)

I'll fix the sufferers and generic issues later or tomorrow. Regarding formatting: No idea why that occurs. I have no problems. Thanks for the help copy-editing.--Garrondo (talk) 17:27, 4 November 2010 (UTC)

I have eliminated the word "sufferer" (and even the use of the verb suffer in some cases). I have also reduced the use of patient, and tried to leave it we were specifically talking about a patient-physician relationship. Regarding the generic: in this case I disagree, since the preparation is "stalevo", which is a specific combination of entacapone, levodopa and carbidopa. Nevertheless I am going to add to caption, a commercial preparation combining entacapone, levodopa and carbidopa, and put the name in italics per manual of style.--Garrondo (talk) 08:25, 5 November 2010 (UTC)

Link suggestion

can we please add this link? Study: Brain 'energy crisis' may spark Parkinson's, Associated press, via usatoday website, 11/4/10. --Steve, Sm8900 (talk) 15:53, 4 November 2010 (UTC)

It's really not suitable for this article -- in place of a long explanation of why not I'll point you to WP:MEDRS. Also as a general rule, important information should always be added to the text of an article rather than by inserting external links. The last thing we want is for Wikipedia articles to turn into link farms. Looie496 (talk) 16:07, 4 November 2010 (UTC)

Could you add the European Parkinson's Disease Association to the external links? — Preceding unsigned comment added by EPDA (talk • contribs) 09:06, 10 December 2010 (UTC)

I suppose you refer to the website. I have taken a look at the site and has quite a lot of info, which would never be included in this article even if FA, therefore it qualifyies for inclusion. I have added it to the article. Thanks.--Garrondo (talk) 10:13, 10 December 2010 (UTC)

Commonest form of parkinsonism?

From "Classification", paragraph 1: "Parkinson's disease is the most common form of parkinsonism", referenced to Jankovic and Poewe. This is, I think, a questionable statement. Vascular parkinsonism contributes a significant proportion of parkinsonism. Axl ¤ [Talk] 10:44, 5 November 2010 (UTC)

This article indicates that vascular parkinsonism accounts for 4.4–12%, but with the caveat that true incidence are prevalence are not known. Axl ¤ [Talk] 10:46, 5 November 2010 (UTC)

I have been taking a look at the refs. It seems I messed the refs because it does not appear in the sources given, but it does in the Sami's lancet article (I have corrected it in the article): it specifically says: Parkinsonism describes a syndrome characterised by rigidity, tremor, and bradykinesia, of which Parkinson’s disease is the main cause.; although it gives no ref for it. Nevertheless I would say that the source you gives does not contradict the lancet article: Vascular parkinsonism accounts up to 12% but, that still leaves quite a lot of space for PD to be the most common... Even so I will try to find another source for that.--Garrondo (talk) 13:08, 5 November 2010 (UTC)

The book by Jankovic and Tolosa on PD and movement disorders (See here (I have the 5th, spanish edition) reviews differential prevalence according to origin of parkinsonism, and all of the primary articles reviewed by them give the higher rates to PD and much lower to other causes including vascular parkinsonism. Some of the primary articles reviewed in such book are: PMID 15007123, PMID 11087781, PMID 10768625. I will add the book and chapter as soon as I can for stronger sourcing of the statement.--Garrondo (talk) 13:40, 5 November 2010 (UTC)

Okay, thanks for looking closer at the sources. Axl ¤ [Talk] 10:00, 6 November 2010 (UTC)

Nope: thanks to your comment: now we have a much more complete ref and no doubts on the issue :-)--Garrondo (talk) 10:33, 6 November 2010 (UTC)

Mycrography image

I was thinking of an image for the symptoms section, and I thought of a writting by a PD patient with micrography. I do not have such kind of image, but maybe somebody is capable of getting one directly from a patient. Best image would be a short text with some rule on it to show scale... --Garrondo (talk) 20:13, 8 November 2010 (UTC)

Genetics

From the section "Causes", subsection "Genetic", paragraph 1: "At least between 5 and 10% of the patients are now known to have monogenic forms of the disease." Wouldn't it make more sense to say "At least 5% of the patients are now known to have monogenic forms of the disease."? Axl ¤ [Talk] 10:00, 13 November 2010 (UTC)

Sources says between 5 and 10: I suppose there is no clear agreement. Nevertheless I am going to carry on with your proposal.--Garrondo (talk) 11:31, 13 November 2010 (UTC)

From "Causes", "Genetic", paragraph 2: "A number of specific genetic mutations causing PD have been discovered.... SNCA ... UCH-L1 ... etc." Does everyone with these mutations get PD? Or are they risk factors? If so, by how much is the risk increased? Axl ¤ [Talk] 10:03, 13 November 2010 (UTC)

They are very related to the disease. They cause familial PD. This does not mean that everybody who has them will suffer the disease, althought it is quite probable. The article already gives numbers to 2 of them: SNCA have been found in non symptomatic carriers leading to the conclussion that penetrance is incomplete or age-dependent; LRRK2: The penetrance of the G2019S mutation ranges between 28% at age 60 and 75% at age 80 with sex having no effect. Giving the penetrance of each of them I believe will be exccesive for the article. I am going to add an "over-simplified introductory" sentence saying: In most cases carriers of such mutations will develop PD.--Garrondo (talk) 11:31, 13 November 2010 (UTC)

Thanks for clarifying. However I don't think that "carriers" is a good choice of word. It has a specific meaning in genetics. Axl ¤ [Talk] 09:45, 15 November 2010 (UTC)

What do you mean? I think we are using it correctly: people who carry the mutation. Could you clarify your comment? Thanks.--Garrondo (talk) 10:32, 15 November 2010 (UTC)

A genetic carrier has the gene associated with the disease, but does not have any symptoms. If a "carrier" develops the disease, he is not a carrier. Axl ¤ [Talk] 09:47, 17 November 2010 (UTC)

I have changed the wording. Axl ¤ [Talk] 10:00, 17 November 2010 (UTC)

Ok. I thought that it meant that he carried the gene, independently of whether he had symptoms. Many thanks for all the copy-edit and useful comments.--Garrondo (talk) 10:52, 17 November 2010 (UTC)

GA Review

This review is transcluded from Talk:Parkinson's disease/GA2. The edit link for this section can be used to add comments to the review.

I have made some relatively minor contributions to this article, but I don't think they are extensive enough to disqualify me from reviewing it. I intend to be a bit more rigorous than usual for a GA review, since there is a plan to submit the article for FA in the near future. My own experience at FAC is that the process there tends to obscure content issues and focus more on details of form, so I am going to try to be especially careful about getting the content right. It will take me a while to make my way through the whole article -- I will add items as I go.

Reviewer: Looie496 (talk) 18:14, 23 November 2010 (UTC)

Hey Looie, many thanks for reviewing the article, specially if it is a FA directed review... I have to say that I first thought of you as a probable reviewer and it is good news that you have decided to do so. I will try to fix comments as fast as I can, although I am quite busy in real life..., anyway if the intention is to have an almost FA when the review ends neither of us should feel much time pressure.--Garrondo (talk) 21:04, 23 November 2010 (UTC)

The lead

• The first thing that occurs to me is that because this is a relatively common disease, it would be good to make clear right from the start that non-motor symptoms such as dementia do not become obvious until quite advanced stages of the disease.

Done.--Garrondo (talk) 21:11, 23 November 2010 (UTC)

• The distinction between PD and parkinsonism is clearly defined, but I am afraid that readers may find it hard to understand. I think it would be preferable in the first paragraph to define PD without reference to parkinsonism, and then in the second paragraph introduce the term as a name for a broader range of conditions.

Done: I have simply eliminated mention of parkinsonism in the lead and left it for the classification section.--Garrondo (talk) 21:11, 23 November 2010 (UTC)

Continued

After a delay I'm starting through. I'm actually not finding much wrong in terms of content, and mainly am doing copy-editing as I go. (If I seem to be introducing mistakes, please feel free to fix them.) Looie496 (talk) 19:19, 30 November 2010 (UTC)

Everything looks fine. Thanks for that.--Garrondo (talk) 19:28, 30 November 2010 (UTC)

• Signs and symptoms: neuropsychiatric: I think the second paragraph could be expanded here. The list of symptoms is a bit too condensed to be easily grasped. In particular, I doubt most readers will know what "set shifting" is.

I will have to think out how to implement this. Sometimes it is hard to find balance between depth of content and summary and lay styles. I'll probably expand it without adding new info, so it is easier to understand.--Garrondo (talk) 19:28, 30 November 2010 (UTC)

That's basically what I had in mind. Looie496 (talk) 19:34, 30 November 2010 (UTC)

More or less done. I have mainly copied the definition from the executive function article and broken text into several sentences. What do you think? --Garrondo (talk) 21:01, 1 December 2010 (UTC)

• Causes: I think this section and the following would be much easier for readers to understand it they began with some prefacing material. The thing that readers need to be told is that the form of neural damage responsible for PD is very clearly understood and has been known for decades -- it is caused by damage to a small midbrain area called the substantia nigra, specifically to cells there that synthesize the chemical dopamine. Anything that damages these cells can produce the set of symptoms known as parkinsonism. For example the drug MPTP, intended by its creators as a hallucinogen similar to LSD, turned out to be toxic to nigral dopamine cells and caused a number of people who took it to develop permanent parkinsonian symptoms. Or something along those lines.

I disagree this time: That is too similar to pathophisiology. In addition damage to midbrain is the cause of parkinsonism, but more a consequence of parkinson's disease, which in the classification section has already been defined as "idiopathic parkinsonims". It would be an incongruence to say that an idiopathic disease has a known cause. I feel I will leave it as it is.--Garrondo (talk) 20:44, 1 December 2010 (UTC)

Continued again

• Classification There is a point here that I think ought to be brought out, but I don't know the PD literature well enough to say whether it is sourceable. The point is that the definition of PD as "idiopathic parkinsonism" creates problems for researchers, because it means that as soon as you have identified the cause, what you are looking at is no longer Parkinson's disease. Looie496 (talk) 17:35, 14 December 2010 (UTC)

Yeap, but right now it is the definition, with the exception of genetic cause. It was defined so to eliminate all secondary parkinsonisms such as traumatic, epileptic, vascular... I suppose that if one day exact cause of primary parkinsonism is known definition will have to be changed.--Garrondo (talk) 21:27, 14 December 2010 (UTC)

• Signs and symptoms I don't understand "under-appreciated". Looie496 (talk) 17:36, 14 December 2010 (UTC)

With under-appreciated I meant that they received less attention than deserved. Nevertheless simply eliminated.

• Neuropsychiatric I think it is important to emphasize that for most patients, cognitive symptoms do not become obvious until advanced stages, if at all. We need to keep in mind that many people will read this article because they have to interact with somebody with PD. If we give them the expectation that the person they are dealing with is probably mentally impaired, we are doing a disservice. Looie496 (talk) 17:43, 14 December 2010 (UTC)

Agreed. I have moved the possibility of having cognitive symptoms to later in the sentece to reduce their weight.

• Causes I suggest removing "A viral theory has been proposed", or at least making it very clear that this is a small-minority view. Looie496 (talk) 17:48, 14 December 2010 (UTC)

Agreed. Removed.

• Genetic The word "monogenic" is unfamiliar to me. Looie496 (talk) 17:49, 14 December 2010 (UTC)

Mono-: prefix meaning only one. Monogenic: due to only one gene. Probably synonim of monogenetic. Reworded for clarity

• Physiology I have made some adjustments in wording, but there are two points I will bring up here. First, the abbreviation GPe is used without being defined. Second, the explanation of direct and indirect pathways refers to the putamen. To my understanding this applies to the entire striatum, not just the putamen. Looie496 (talk) 18:06, 14 December 2010 (UTC)

I'll try to look at the references, but if I have to tell you the thruth phisiology is far from being my area of expertise and I am always unsure when editing these kind of sections. I do not know if it will be way too much to ask, but if you are interested you could try to check it out against the reviews provided as sources before taking it to FAC, and improve it at your will.

Fixed the first comment: GPe defined. Second will take me more time.

Done with the second comment. It has been some time, but I have been away during Christmas. I have been taking a look at several references and you are correct. References talk about striatum in general. Changed. Thanks for the catch.

• Pathology Can we say "forebrain" rather than "prosencephalon"? Even to neuroscientists this term is much more familiar. Looie496 (talk) 18:08, 14 December 2010 (UTC)

Sure. Done

• Diagnosis The sentence "Common presentations of the disease are usually easily diagnosed, however diagnosis can be difficult..." gives the impression of contradicting itself. Looie496 (talk) 18:14, 14 December 2010 (UTC)

Longer explanation for clarity. I hope it helps.

• Management The first paragraphs mentions "on and off periods" without explaining what this phrase means, and the terms have not been used earlier. Looie496 (talk) 18:31, 14 December 2010 (UTC)

Too tired to work on this today. I will look at it tomorrow.

Done: Changed to "while controlling fluctuations of the response to medication".

Thanks a lot Looie for your useful comments. It is great to have a review such as this one. Bests.--Garrondo (talk) 21:27, 14 December 2010 (UTC)

Continued again, again

Sorry for the long delay -- I am always a bit disfunctional in November and December, but I'll try to get through the rest of it quickly.

No problem... December is a horrible month in RL for everybody. :-)--Garrondo (talk) 09:50, 7 January 2011 (UTC)

• Causes Shouldn't there be at least a short discussion of possible environmental causes? I know that none have been conclusively identified but many have been suggested. I have also heard some people say that they believe that dopamine cells tend to die naturally with age more rapidly than other neurons and therefore almost everybody who lives long enough will eventually become Parkinsonian, but I'm not aware of any literature relating to that idea. Looie496 (talk) 18:19, 6 January 2011 (UTC)

Well, I have given this a lot of thought and I still not decide myself. The thing is that I have tried to follow sources, and sources have two different approaches: since environmental factors are not proven as causes but only have appeared as risk factors in epidemiological studies, with no known mechanism for the risk-increasing; in many sources they talk about them in the epidemiology section as I have done, while others talk about them in the causes section. I prefer to leave them in epidemiology. Maybe I should add a sentence pointing from the causes section to the epidemiology section. What do you think?

• Physiology I have taken the liberty of rewriting the second paragraph, which I thought included too much detail and was not understandable by a broad audience. This is the part of this topic that I understand best so I'm pretty sure I got it basically right, but feel free to edit, or to revert back to the other version if you think I'm completely off the mark. Looie496 (talk) 18:47, 6 January 2011 (UTC)

Sounds great... It is the part you know best, and the part I know less, so your help is great.

• Pathology "affecting up to 70% of the cells" -- can you check on this? My understanding is that the level of dopamine cell loss can be much higher. In fact I thought that symptoms were minimal until dopamine loss exceeds 90%. Looie496 (talk) 18:51, 6 January 2011 (UTC)

I know. I have also read such numbers. The picture I made in my mind was that they are talking here about any kind of cells and not only dopaminergic. I am quite sure that the number is 70 in the source, but I will check it on monday (need access to journals at work)

• Levodopa I think it would be good to explain that the concept underlying L-Dopa treatment is to compensate for the loss of dopamine cells by inducing the remaining cells to produce more dopamine. This approach works for a while but eventually fails when the few remaining cells reach the limits of their metabolic capabilities. Furthermore as this limit is approached, the behavior of the hyperstimulated cells becomes more and more erratic, causing uncontrollable fluctuations in the levels of dopamine in the system. Looie496 (talk) 19:10, 6 January 2011 (UTC)

Are you referring to the management section?

Yes.

• Prognosis Shouldn't L-DOPA be change to levodopa in this section, for consistency with the rest of the article? Looie496 (talk) 18:04, 7 January 2011 (UTC)

Yes. Done. Good catch

• Risk factors and protective factors The sentence reading "Toxins that have been consistently related to the disease are certain pesticides and herbicides, with exposure doubling the risk" is not good. It needs to make it clearly what sort of exposure it is talking about -- or else it could say something like with exposure increasing the risk by as much as a factor of two. Looie496 (talk) 22:36, 7 January 2011 (UTC)

Included your proposal.

• Research directions I found this section quite difficult to understand, and in the process of copy-editing, have added some introductory statements that I hoped would make it clearer to non-experts. Please check that I haven't screwed up, and revise anything that seems incorrect or poorly stated. Looie496 (talk) 19:24, 11 January 2011 (UTC)

Sounds Ok, although it would be great to have a ref for the first paragraph. Also many thanks for the ce of the history section.--Garrondo (talk) 08:07, 12 January 2011 (UTC)

• Advocacy It would be nice to include a picture of the tulip symbol is a usable one can be found. Looie496 (talk) 18:51, 13 January 2011 (UTC)

I can take a look into commons, although I believe I already did and found nothing.--Garrondo (talk) 19:01, 13 January 2011 (UTC)

While there is a specific symbol, in general red tulips are widely used as symbols. I have added a photo of a red tulip. Best I could found.--Garrondo (talk) 19:10, 13 January 2011 (UTC)

Passing

At this point I am sufficiently satisfied to promote the article to GA. I wouldn't say that it is perfect, but I feel that it is an article that Wikipedia can be proud of and that somebody who wants to know about PD can read with great benefit. Thanks for putting up with the very lengthy review process. Looie496 (talk) 17:54, 15 January 2011 (UTC)

Agent Orange Exposure in the Military

Parkinson's Disease is a disease officially linked to the exposure of Agent Orange for VA Benefit Claims.

http://www.publichealth.va.gov/exposures/agentorange/conditions/parkinsonsdisease.asp —Preceding unsigned comment added by 165.83.90.214 (talk) 23:05, 7 December 2010 (UTC)

Wikipedia is not the place to give medical or social recommendations: Accordingly I have eliminated part of your comment. Nevertheless the information you provide is of great interest for the article and I will try to include it as soon as possible. --Garrondo (talk) 08:54, 8 December 2010 (UTC)

Done: I have added the review on evidence and the website you provide. Many thanks for your helpful comment.--Garrondo (talk) 08:54, 8 December 2010 (UTC)