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Parkinson's disease (PD) is one of the most frequent neurodegenerative disorders with a prevalence close to 2% after the age of 65 years and is characterized by rest tremor, rigidity and bradykinesia. Pathologically, there is a loss of dopaminergic cells in the substantia nigra and there are Lewy body eosinophilic inclusions in the substantia nigra, locus ceruleus, nucleus basalis, hypothalamus, cerebral cortex, cranial nerve motor nuclei and the autonomic nervous system. The aetiology of PD remains poorly understood and while both environmental and genetic causes have been sought, the aetiology is likely to involve an interplay between these factors. Early and accurate diagnosis is important for counselling, appropriate therapy, neuroprotection and inclusion of patients in research studies. Levodopa remains the 'gold standard' treatment for early stage PD and, in patients with later stage disease who suffer from a combination of disease progression and motor complications, a dopamine agonist is frequently employed with surgical intervention representing a further, possible treatment modality. Trends in mortality rates show an increase for older PD patients but a decline for those in younger age groups but the longevity and complex physical and psychological morbidities associated with PD impose a considerable burden on health services which is set to increase further as the population ages and as patients rightly demand better, more effective health care for their disease.
The current volume has been prepared in the manner of a major, comprehensive and authoritative review of the current status of our knowledge of Parkinson's disease. The book opens in Part One with a thorough overview on diagnosis within Chapter 1, with Chapters 2 & 3 being concerned with olfaction in Parkinsonism and the clinical application of functional imaging. Part Two of the text, through Chapters 4, 5 & 6, is dedicated to the detailed documentation of the scientific evidence and expert opinion base for medical intervention in early and late disease, the criteria for surgical intervention and a listing and analysis of the surgical trials of lesioning and deep brain stimulation in PD. In Part Three, Chapters 7, 8 & 9 are concerned with the neuropsychiatric elements of the disease process with Part Four presenting a discussion of the uroneurological aspects of PD. Part Five and Part Six of the volume, through Chapters 11-15 are dedicated to particularly extensive overviews of the dimensions of efficiency and effectiveness in the organisation and delivery of clinical services for PD with the final part, Part Seven, concluding the volume with a consideration of quality of life in PD and a review of the currently emerging therapeutic innovations and developments which are anticipated to prove of value in modifying the disease process and improving the outcomes of clinical care. |
