Talk:Parkinson's disease

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Featured article Parkinson's disease is a featured article; it (or a previous version of it) has been identified as one of the best articles produced by the Wikipedia community. Even so, if you can update or improve it, please do so.
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Link request for Parkinson's Science Wikiversity project[edit]

See section above Talk:Parkinson's_disease#Help_request_for_a_Wikiversity_project_on_Parkinson.27s. May I ask someone to put a link to this wikiversity project in an appropriate place into the wikipedia resource page for Parkison's disease? I can't do it myself as the page is locked. We are trying to make the wikiversity project a high quality resource for people wanting to learn about the science behind Parkinson's and for following research progress as it is reported in the scientific literature. We should like to attract contributors to help us assure its quality. Please see V:ParkinsonsScience and assess for yourself what we have achieved so far. Droflet (talk) 11:25, 5 January 2013 (UTC)

Tobacco smokers?[edit]

Some explaination please.Longinus876 (talk) 15:29, 9 January 2013 (UTC)

Would need more details regarding the question. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:50, 9 January 2013 (UTC)
Probably the question derives from the statement in Protective factors that tobacco apparently exerts a protective effect. As far as I know this is an observation for which no detailed explanation exists, though. Looie496 (talk) 19:14, 9 January 2013 (UTC)

Parkinson's disease[edit]

My suggestions for edits to the following items: Under Wikipedia "Parkinson's_disease" page
Motor symptoms
Cardinal symptoms:
Bradykinesia/ akinesia - The sentence 'Bradykinesia is the most disabling symptom in the early stages of the disease' should be deleted or edited to an alternative such as 'Bradykinesia together with postural instability are often disabling motor symptoms and can occur in the early stages of disease'.
- justification: A number of articles have highlighted that non-motor symptoms can be just as disabling. Also, symptoms of postural instability often carry a significant impact on quality of life and functional status.

Changed to: Bradykinesia is commonly a very disabling symptom in the early stages of the disease. I agree that it is not easy to say which is the most disabling (as probably there is not a one most disabling but depends from individual to individual).--Garrondo (talk) 07:59, 20 March 2013 (UTC)

Other symptoms such as 'Neuropsychiatric' and 'Other' symptoms should be placed under a main subheading of 'Non-motor symptoms in Parkinson's disease'.

Disagree: classification as it is now is as valid as a classification that divides symtoms into motor and non-motor.--Garrondo (talk) 07:59, 20 March 2013 (UTC)

It should also include other non-motor symptoms or at the very least, categorise them. e.g. 'Non-motor symptoms are often present at the time of diagnosis and can precede motor symptoms. These symptoms can affect other bodily systems and it is important to acknowledge that people with Parkinson's often do not experience all known associated symptoms. Examples of non-specific non-motor symptoms include hyposmia (loss of sense of smell), anxiety, sleep disturbances, etc'. [1] [2] [3] [4] [5] [6]

Already partly present in the introduction to the symptoms section. It said: Parkinson's disease affects movement, producing motor symptoms.[7] Non-motor symptoms, which include autonomic dysfunction, neuropsychiatric problems (mood, cognition, behavior or thought alterations), and sensory and sleep difficulties, are also common. I have added Some of these non-motor symptoms are often present at the time of diagnosis and can precede motor symptoms. I have not said anything of the sentence Parkinson's often do not experience all known associated symptoms, since this is true for any kind of disease (or do you know any disease where everybody has exactly the same symptoms, specially a neurological one?).--Garrondo (talk) 07:59, 20 March 2013 (UTC)

Under the Wikipedia "Signs_and_symptoms_of_Parkinson's_disease" page (linked to the main page for Parkinson's disease) NEUROPSYCHIATRIC
- an additional sentence should be added after 'Treatment options consist of modifying the dosage of dopaminergic drugs taken each day, adding an antipsychotic drug like quetiapine, or offering carers a psychosocial intervention to help them cope with the hallucinations' and along the lines of 'With regards to antipsychotic medications, the best evidence to date is with clozapine though the risk of side-effects and adverse events necessitate monitoring, thus limiting its practical use. Though quetiapine is widely prescribed, there is little evidence in terms of sustained benefit in the setting of psychosis in Parkinson's.'
- impaired proprioception is not accurate. Proprioception is a definition for 'joint position sense' and I am unaware of any work that specifically examines proprioception. This sentence (entry) should be replaced with 'visuospatial dysfunction'
[9] (talk) 06:37, 20 March 2013 (UTC)Tien K Khoo (Wikipedia username: Khootkheng) Email:

Welcome. We typically only use secondary sources as references here per WP:MEDRS especially for a major topic like this. I see some of your refs are secondary sources while others are not. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:44, 20 March 2013 (UTC)
Thanks for all your comments. I have added some of the info as explained above, but if you disagree we may discuss how to add some more info. I am going to post these other comments in its appropiate talk page and see what we can do about them. Best regards, and lets hope you continue contributin.--Garrondo (talk) 07:59, 20 March 2013 (UTC)
  1. ^ Cheon, S. M., Ha, M. S., Park, M. J. and Kim, J. W. (2008) 'Nonmotor symptoms of Parkinson's disease: prevalence and awareness of patients and families', Parkinsonism Relat Disord, 14(4), pp. 286-90
  2. ^ Chaudhuri, K. R., Prieto-Jurcynska, C., Naidu, Y., Mitra, T., Frades-Payo, B., Tluk, S., Ruessmann, A., Odin, P., Macphee, G., Stocchi, F., Ondo, W., Sethi, K., Schapira, A. H., Martinez Castrillo, J. C. and Martinez-Martin, P. (2010) 'The nondeclaration of nonmotor symptoms of Parkinson's disease to health care professionals: an international study using the nonmotor symptoms questionnaire', Mov Disord, 25(6), pp. 704-9
  3. ^ Buskova, J., Klempir, J., Majerova, V., Picmausova, J., Sonka, K., Jech, R., Roth, J. and Ruzicka, E. (2011) 'Sleep disturbances in untreated Parkinson's disease', Journal of Neurology, 258(12), pp. 2254-225
  4. ^ Brown, R. G., Landau, S., Hindle, J. V., Playfer, J., Samuel, M., Wilson, K. C., Hurt, C. S., Anderson, R. J., Carnell, J., Dickinson, L., Gibson, G., van Schaick, R., Sellwood, K., Thomas, B. A. and Burn, D. J. (2011) 'Depression and anxiety related subtypes in Parkinson's disease', J Neurol Neurosurg Psychiatry, 82(7), pp. 803-9
  5. ^ Barone, P., Antonini, A., Colosimo, C., Marconi, R., Morgante, L., Avarello, T. P., Bottacchi, E., Cannas, A., Ceravolo, G., Ceravolo, R., Cicarelli, G., Gaglio, R. M., Giglia, R. M., Iemolo, F., Manfredi, M., Meco, G., Nicoletti, A., Pederzoli, M., Petrone, A., Pisani, A., Pontieri, F. E., Quatrale, R., Ramat, S., Scala, R., Volpe, G., Zappulla, S., Bentivoglio, A. R., Stocchi, F., Trianni, G. and Dotto, P. D. (2009) 'The PRIAMO study: A multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease', Mov Disord, 24(11), pp. 1641-9
  6. ^ Khoo TK, Yarnall AJ, Duncan GW, Brooks DJ, Barker RA, O’Brien JT and Burn DJ. ‘The spectrum of non-motor symptoms in early Parkinson’s disease. Neurology 2013; 80(3):276-81
  7. ^ Cite error: The named reference Jankovic2008 was invoked but never defined (see the help page).
  8. ^ Friedman JH. Parkinson's disease psychosis 2010: A review article. Parkinson'sm & Related Disorders 2010;16:553-560
  9. ^ Diederich, N.J., Raman, R., Leurgans, S. and Goetz, C.G. (2002)'Progressive worsening of spatial and chromatic processing deficits in Parkinson disease', Arch Neurol, 59(8), pp. 1249-52


Composite of three images, one in top row (referred to in caption as A), two in second row (referred to as B). Top shows a mid-line sagittal plane of the brainstem andcerebellum. There are three circles superimposed along the brainstem and an arrow linking them from bottom to top and continuing upward and forward towards the frontal lobes of the brain. A line of text accompanies each circle: lower is "1. Dorsal Motor X Nucleus", middle is "2. Gain Setting Nuclei" and upper is "3. Substantia Nigra/Amygdala". A fourth line of text above the others says "4. ...". The two images at the bottom of the composite are magnetic resonance imaging (MRI) scans, one saggital and the other transverse, centred at the same brain coordinates (x=-1, y=-36, z=-49). A colored blob marking volume reduction covers most of the brainstem.
A. Schematic initial progression of Lewy body deposits in the first stages of Parkinson's disease, as proposed by Braak and colleagues
B. Localization of the area of significant brain volume reduction in initial PD compared with a group of participants without the disease in a neuroimaging study, which concluded that brain stem damage may be the first identifiable stage of PDneuropathology[1]

I am not sure this image is really due weight. It is from a primary research paper look at 23 PD patients and 19 controls. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:30, 19 May 2013 (UTC)

I have reverted the elimination of the image. Reasons you stated were two-fold:
1-Few participants: This might be valid if it were to use it as a source of content, but it is not. We are not using as a primary source in this sense, but as graphic example of something stated in a secondary source (Braak staging) that has received much more proof than this specific plos article. We could in this sense simply use the top half of the image (which a schema of braak staging) e, but IMO the voxel based morphometry analysis has further value as an example since it is a real one.
2-Blurriness: This is a faulty critique probably from a lack of knowleadge on how voxel based morphometry is performed. In VBM subjects are normalized to a template (usually the Montreal Neurological Institute) which comes from the mean of around a 100 individual brains. The intensity of the signal in each brain voxel is compared between the group of controls and patients. If there are significant voxels they are usually superimposed on a template for visualization. Such normalization template is by itself blurry since it indicates the probability of a structure being a structure. Since some people do not like it per blurriness what they do is to superimpose results to a normal brain that is similar to the mean values of this template, however this brain is as false as the blurry one (or even more, since it is not the true template into which images in the analyisis have been normalized). Botton line: the image is technically perfect as it is.
--Garrondo (talk) 10:42, 19 May 2013 (UTC)
My understanding is that as a general principle, we don't apply the same sourcing criteria to images as to text. Given the extreme difficulty of obtaining images that are licensed in a way we can use, it wouldn't be practical to do so. (After several years of looking I'm still in the market for a good usable electron micrograph of a synapse.) Of course we don't want to deliberately use images that we know are misleading, but beyond that we are often in the position of using whatever we can get. Looie496 (talk) 15:00, 19 May 2013 (UTC)

Edit request on 20 May 2013[edit]

Parkinsons UK support website

LDowding (talk) 10:20, 20 May 2013 (UTC)

Per WP:ELNO we do not add national support websites. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:42, 20 May 2013 (UTC)


My apology for my recent edit; in doing a check for some recent problematic edits, I accidentally started editing an old revision and missed that I was doing so. Thanks to Garrondo for catching my error. --Nat Gertler (talk) 16:06, 4 June 2013 (UTC)

Replace local image with commons image[edit]

NoCommons.svg Existing image
Commons Autopatrolled.svg Commons image

Please replace this problematic en:specific image used in {{Infobox disease}}:

with the following image from commons:

Thanks in advance. (talk) 04:57, 7 June 2013 (UTC)

Why is the image problematic? In my opinion, the one we have looks better. Looie496 (talk) 05:33, 7 June 2013 (UTC)
History of the image (As far as I remember": The image would be in the public domain in most countries if had been drawed by Gowers, however since he says "after St Legers" it is plaussible that it was a derivative work. Since I do not think that St. Leger is known nor is his death time, so the image is in the PD in the US because it was first published before 1923. I believe that at the moment of uploading the image these images had to be uploaded better to the English wikipedia only. Does this make sense (all from memory, so not really sure). --Garrondo (talk) 07:55, 7 June 2013 (UTC)

Not done: no reply to questions. Mdann52 (talk) 12:47, 26 June 2013 (UTC)

classification of Parkinsonian diseases[edit]

Under classification the disorders of multiple system degeneration are referred to as Parkinson plus syndrome. I believe the more current term is atypical parkinsonian syndrome (or just multiple system degeneration). "Atypical" is the term used in Harrison's principle of medicine 18th (latest edition) and in many other up to date manuals. Anxiey (talk) 19:28, 17 June 2013 (UTC)

Notable cases[edit]

I removed a couple of names from that section; my edit was reverted. Let me therefore start a discussion.

The basic problem is that when names begin to be added to a section like this in an uncontrolled way, the list keeps growing and growing until it is way out of proportion to the rest of the article. To prevent this, the policy has been that names should only added of people who not only have Parkinson's, but have a particularly notable connection with the disease. The three names listed for a long time were Michael J. Fox, Davis Phinney, and Muhammad Ali. Fox and Phinney both have very actively supported PD research; Ali has actively promoted PD awareness. Names with weaker connections should go into List of people diagnosed with Parkinson's disease, but they do not belong here. Looie496 (talk) 15:42, 17 September 2013 (UTC)

Sorry I'm a classic newbie and didn't read the talk page first, I made a paragraph regarding Billy Connolly's recent diagnosis to the notable cases, then came on to the talk page to let people know what I had done and if someone could check my work just to make sure it was ok, I then came across this note, so I'm sorry there are a few edits with my name on it, whilst deleting my paragraph I managed to make a mess, then remembered the undo under history so article is now as it was before I started, apologies and I will check talk pages first in future. Again my apologies, lesson learntAmanda138a (talk) 05:42, 22 September 2013 (UTC)


I suggest to add the following (underneath CAUSES > GENETICS)::

A mutation in the sodium-potassium pump (ATP1A3 gene) can cause rapid onset dystonia parkinsonism [2]. The parkinsonism aspect of this disease is thought to be attributable to malfunctioning Na+
pumps in the basal ganglia; the dystonia aspect is thought to be attributable to malfunctioning Na+
pumps in the cerebellum (that act to corrupt its input to the basal ganglia) [3]. In the cerebellum, the mutation likely disrupts Purkinje cell activity: the Na+
pump has been shown to control and set the intrinsic activity mode of cerebellar Purkinje neurons [4].

Mindfulness Based Intervention[edit]

I intend to add the folllowing sentence in the Other treatments section, last paragraph, after the Tai Chi sentence and before the fava beans.

There is clinical evidence that mindfulness-based interventions increase gray matter density for Parkinson patients. It will be referenced with the following bibliography Pickut, Barbara A; Wim Van Hecke, Eric Kerckhofs, Peter Mariën, Sven Vanneste, Patrick Cras, Paul M Parizel (2013-12). "Mindfulness based intervention in Parkinson's disease leads to structural brain changes on MRI: A randomized controlled longitudinal trial". Clinical neurology and neurosurgery 115 (12): 2419–2425. doi:10.1016/j.clineuro.2013.10.002. ISSN 1872-6968. PMID 24184066.  --Gciriani (talk) 21:36, 19 February 2014 (UTC)

We use secondary sources per WP:MEDRS not primary sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:59, 19 February 2014 (UTC)

Thanks for the MEDRS guidelines. These guidelines also say that: In other situations, such as randomized controlled trials, it may be helpful to temporarily cite the primary research report, until there has been time for review articles and other secondary sources to be written and published. If you prefer we can use the wording suggested by the guidelines: A 2013 Belgian study found that mindfulness-based interventions increase gray matter density for Parkinson patients.--Gciriani (talk) 22:33, 19 February 2014 (UTC)

Yes but this is not that case. This is a very well researched area and we should wait for a proper independent review article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:38, 19 February 2014 (UTC)

I think the article I referenced first, is exactly an article of proper independent review; the first peer-reviewed illustration of mindfulness-based interventions for Parkinson appeared in 2010 (see after this paragraph), then in 2013 a randomized control trial gave physiological evidence of the change.Fitzpatrick, Lee; Jane Simpson, Alistair Smith (2010-06). "A qualitative analysis of mindfulness-based cognitive therapy (MBCT) in Parkinson's disease". Psychology and psychotherapy 83 (Pt 2): 179–192. doi:10.1348/147608309X471514. ISSN 2044-8341. PMID 19843353. 

Which is the review? Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:31, 20 February 2014 (UTC)

What I mean is that the 2013 Belgian study is the proof of the pudding. But that's beside the point, because even the Wikipedia guidelines, encouraging secondary sources, allow for primary sources. The fact that the disease is very well researched means that new findings and understanding of the disease will keep surfacing, therefore a finding of behavioral sciences corroborated by findings with physiological means constitutes ads to the body of research related to Parkinson worthy of being mentioned.--Gciriani (talk) 07:43, 20 February 2014 (UTC)

Secondary sources give us proof of notability. If it is not in a secondary source it is of questionable notability. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:58, 20 February 2014 (UTC)
I agree with Doc James. This is a primary research study and therefore not a good source for this article. Looie496 (talk) 16:34, 20 February 2014 (UTC)


In this week's neurologically themed issue of JAMA, this review on therapeutics in PD: doi:10.1001/jama.2014.3654 JFW | T@lk 09:20, 23 April 2014 (UTC)

Semi-protected edit request on 10 June 2014[edit]

This figure displays only the structure of the parkin ubiquitin-like domain, not the entire parkin protein:

PDB rendering of Parkin (ligase)

The structure of full-length parkin was published in 2013 in the journal Science [5]. (Disclaimer: I am the co-first author of this publication). The PDB code for the new structure is 4K95. I suggest that the page editor should replace the figure by this new PDB rendering of pdb 4K95:

Rendering of parkin crystal structure, pdb code 4K95.

Thank you, Jean-François Trempe McGill University < Jftrempe (talk) 14:09, 10 June 2014 (UTC)

  • Red information icon with gradient background.svg Not done: Please make your request for a new image to be uploaded to Files For Upload. Once the file has been properly uploaded, feel free to reactivate this request to have the new image used. — {{U|Technical 13}} (etc) 16:17, 10 June 2014 (UTC)
Yes check.svg Done Thanks! Older and ... well older (talk) 04:02, 13 June 2014 (UTC)

Role of MRI techniques in diagnosis[edit]

I suggest that the text about diffusion MRI be removed or expanded because there are many techniques that have been reported to be useful at discriminating between typical and atypical parkinsonism. — Preceding unsigned comment added by Gcastellanos (talkcontribs) 20:54, 12 August 2014 (UTC)

Semi-protected edit request on 14 August 2014[edit]

Another recent actor who will/is bringing awareness to Parkinson disease is Robin McLaurin Williams (

Hansmrtn (talk) 19:01, 14 August 2014 (UTC)

Red information icon with gradient background.svg Not done: per below. Cannolis (talk) 03:19, 15 August 2014 (UTC)

Robin Williams, great ape communicator?[edit]

People with parkinsonism who have increased the public's awareness include actor Michael J. Fox, Olympic cyclist Davis Phinney, professional boxer Muhammad Ali and actor, comedian and great ape communication ambassador[2][3][4] Robin Williams by way of public awareness fostered by his wife Susan Schneider in the wake of the suicide abetted by his concomittant depression[5][6][7][8][9].

(emphasis added)

William's animal advocacy isn't relevant enough to Parkinson's for the lead section. It makes the sentence difficult to read. Might be more appropriate in the body. Chosing either "actor" or "comedian" (perhaps actor-comedian?) would improve clarity as well.

Not sure Furthermore, I'm not sure that Williams should be cited here in the first place. He was only just diagnosed Parkinson's before his death, and hasn't been involved in any advocacy. (See also: Amanda138a's earlier comment[1].) The connection is strong now because of his recent death, but that may not last.

Finally, "comorbid" is a more accurate term than "concomitant."

Helenaglory (talk) 23:03, 14 August 2014 (UTC)

The Great Ape mention and links are totally irrelevant in this article. They might be relevant in an article on Williams, but are off-topic here. LaMona (talk) 07:22, 15 August 2014 (UTC)
That section should not morph into a list of every famous person who had Parkinson's disease. It should be restricted to people who have helped to educate the public about the disease. Even if good documentation was available for Robin Williams having it, he doesn't fit that description. Looie496 (talk) 12:14, 15 August 2014 (UTC)