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Degenerative Diseases of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
James A. Mastrianni, Elizabeth A. Harris
In addition to the above cardinal features, the following motor signs are frequently associated with parkinsonism: Gait abnormalities: freezing, festinating, short/shuffling steps, slower speed.Flexed posture of limbs, neck, and trunk.Masked facial features (hypomimia), decreased blink rate.Progressively smaller handwriting (micrographia).Softer speech (hypophonia).
The Role of Fecal Microbiota Transplantation in Neurological Diseases
Published in David Perlmutter, The Microbiome and the Brain, 2019
Thomas Borody, John Bienenstock
Parkinson’s disease is a neurological condition characterized by abnormalities of movement including tremors, muscle stiffness, a mask-like facial appearance, micrographia, dysphagia, and a constellation of other symptoms. Based on autopsy evidence, Braak et al. (2003) and others postulated that Parkinson’s begins in the gut with abnormal alpha-synuclein inclusions detectable in Meissner’s (submucous) and Auerbach’s (myenteric) plexus in the gut. This may be the cause or simply a marker of Parkinson’s.112 From here, alpha-synuclein is capable of traveling via neuronal streaming up the vagus nerve; interestingly, total vagotomy has been shown to be associated with a reduced incidence of Parkinson’s disease.
A history of Parkinson’s disease
Published in Jeremy Playfer, John Hindle, Andrew Lees, Parkinson's Disease in the Older Patient, 2018
Unfortunately, over the next 45 years, Parkinson’s treatise on the shaking palsy received little attention in England. During this period, however, Wilhelm Von Humboldt, in his letters from 1828 until his death in 1835, gave one of the clearest clinical descriptions of the condition by a patient. He described a resting tremor, akinesia, and was the first to describe micrographia. He called the problems in writing a ‘special clumsiness’, which he attributed to a disturbance in executing rapid complex movements. He described ‘internal tremor not visible by others, which causes a distortion of the continuity of my movements’. He insisted that he was not suffering from a disease, but the effects of accelerated ageing.9
Exploring the ability of strength and dexterity tests to detect hand function impairment in individuals with Parkinson’s disease
Published in Physiotherapy Theory and Practice, 2023
Cintia C. G. Alonso, Paulo B. de Freitas, Raquel S. Pires, Dalton L. De Oliveira, Sandra M. S. F. Freitas
In general, the tests requiring hand/digits dexterity (i.e. JTHFT and 9HPT) showed a good diagnostic performance to discriminate individuals with PD from healthy controls, with the JTHFT being more sensitive and the 9HPT more specific. Among the JTHFT subtests, only the writing subtest was not sensitive to detect differences between individuals with PD and controls. The other tests, except the stacking checkers subtest, showed AUCs above 0.8, indicating an excellent discrimination capacity for five JTHFT subtests. The finding that individuals with PD and controls presented similar writing performances contradicts the findings of other studies (San Luciano et al., 2016; Stanley et al., 2010; Wang, Wang, Zou, and Nakamura, 2012). In the present study, participants were instructed to copy a sentence as fast and accurately as possible and they may have prioritized accuracy over speed while copying a sentence. Therefore, we conclude that a timed test requiring the copy of a sentence cannot differentiate patients and controls. These findings corroborate the ones from Mak et al. (2015) who found only a marginal difference between PD and control groups. However, we should acknowledge that writing a sentence and analyzing the words’ structure could provide valid information, as many individuals with PD show a smaller handwriting letter size (micrographia) than healthy controls (De Oliveira et al., 2020; Smits et al., 2014). Writing words with smaller letters could have led individuals with PD to perform the writing subtest with similar times compared to controls. As we followed the standardized instructions of the JTHFT, we were interested in the time to perform the task and, unfortunately, did not keep the sentences written by the participants in this study for posterior analysis. Consequently, we were unable to confirm the presence of micrographia in the writing of the patients. Hence, we suggest that subsequent studies consider the letters’ size when using the JTHFT writing subtest, having it as a covariate, either to confirm or reject this supposition.