Our objective was to study the placebo response in Parkinson's disease (PD). We conducted a literature search in which placebo response was measured in all studies of PD from 1969 to April 1996. Strict criteria were defined to include or exclude published reports in our survey. The Parkinson Study Group database for Deprenyl & Tocopherol Antioxidative Therapy of Parkinsonism (DATATOP) was reviewed and placebo "responders" were compared to placebo "nonresponders" by age, race, religion, level of education, duration of PD, and gender. A significant difference between the efficacy of placebo and that of active drug was reported in 61% (22 of 36) of the articles meeting the required criteria; DATATOP analysis showed no statistically significant epidemiologic differences between 140 placebo responders and 58 placebo nonresponders except in PD effect on current job. Although there is clearly a placebo response in PD patients, our review suggests that the variation in placebo response does not correlate with demographic factors such as age, gender, religion, level of education, or duration of PD.

Female↗

PubMedDate not supplied

Is altropane SPECT more sensitive to fluoroDOPA PET for detecting early Parkinson's disease?

BACKGROUND: Positron emission tomography (PET) cameras are expensive and scarce, and the tests are non-reimbursable. A less costly and more available test such as a single photon emission computed tomography (SPECT) may be helpful in the diagnosis of early or atypical Parkinson's disease (PD) if its sensitivity is comparable to a PET scan. Altropane is an iodinated form of the N-allyl analog of WIN 35,428 which acts as a dopamine transport inhibitor. When radiolabeled with the gamma emitting isotope [123I], altropane serves as a SPECT ligand with high affinity and selectivity for the dopamine transporter. It is a good marker for dopamine neurons and is useful in detecting PD. MATERIAL AND METHODS: We describe 2 patients with typical, early PD and their [123I]-altropane SPECT and [18F]-6-flouroDOPA PET scan results which were performed within a three-month interval. PET studies were performed using a PC-4096 scanner (Scanditronix AB, Sweden) with 15 axial slices and resolution of 6 mm FWHM. The SPECT acquisitions were performed on a MultiSPECT gamma camera (Siemens, Hoffman Estates, IL) equipped with fan-beam collimators with an intrinsic resolution of 4.6 FWHM (for Case 1) and a DSI Ceraspect camera with an annular crystal, with resolution of approximately 6.4 mm FWHM (for Case 2). RESULTS: Both patients, aged 54 and 38 years, had a one-year history of intermittent right hand tremor with right arm rigidity and hypokinesia and bradykinesia on fine finger movements. A significant and sustained improvement of their parkinsonian symptoms was noted using a dopamine agonist. SPECT and PET scans showed non-diagnostic fluoroDOPA PET scans with clear unilateral striatal reduction of tracer uptake contralateral to their parkinsonian side on altropane SPECT scans. CONCLUSIONS: Altropane SPECT may be an accessible and sensitive imaging modality for detecting early PD. Further and more controlled studies are needed to define its potential role in detecting presymptomatic, early and atypical PD cases.

Adult↗

PubMedDate not supplied

Experience of a geriatric crisis intervention screening team.

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Crisis Intervention↗

PubMedDate not supplied

Substituting clozapine for olanzapine in psychiatrically stable Parkinson's disease patients: results of an open label pilot study.

Psychosis induced by the standard drugs for treating idiopathic Parkinson's disease (PD) occurs, in the long term, in approximately 5-8% of patients. Until the development of atypical antipsychotic drugs, treatment of this psychosis was extremely limited and unsatisfactory. Clozapine has been reported to be an effective and well-tolerated treatment for this problem. Clozapine, however, is a difficult drug to use as a result of the monitoring system mandated by the Food and Drug Administration because of the potential for agranulocytosis. Treatment with risperidone has been shown to be poorly-tolerated. This article reports on the authors' open label experience with the newest atypical antipsychotic, olanzapine, and the switching of stable patients from clozapine to olanzapine. Nine of twelve subjects were unable to make the transition because of worsened parkinsonism. Most subjects preferred taking clozapine, despite the onerous monitoring procedure.

Aged↗