Planning a Patient-Centered Parkinson’s Disease Support Program: Insights from Narrative Medicine

Background: We desired relevant information from patients with Parkinson’s disease (PD) and their caregivers for help in planning a long-term support program. Methods: We compared 3 ap-proaches: 1) a standard needs assessment questionnaire, the Camberwell assessment of need in the elderly, 2) an open-ended listing of needs, and 3) participation in a narrative medicine program in which health care professionals were involved. Results: On the questionnaire, patients reported physical needs as the most important while their caregivers were more concerned about psychological needs. The open-ended listings revealed additional needs, particularly access to re-liable information about PD and to opportunities to participate in clinical research. The narrative medicine process yielded a number of new insights and proposed solutions, particularly related to the heterogeneity of needs across individuals, the importance of providing hope, and the fact that caregivers expressed that their needs had been largely neglected. Participation in the narrative medicine sessions led to an increase in measured empathy by health care professionals, an im-provement in measured depression among PD patients, but a worsening of measured depression among the caregivers. Conclusions: We have identified important needs and potential solutions to be considered in providing long-term support to patients with PD and their caregivers.

Tai Chi in Parkinson’s Disease: A Preliminary Randomized, Controlled, and Rater-Blinded Study

Background: Given the limited benefits of current treatments for Parkinson’s disease (PD), inter-ventions that might provide supplementary benefits would be of value. The traditional Chinese medicine practice of Tai Chi has been said to improve some aspects of PD, particularly imbalance. Methods: Preliminary randomized, controlled, and rater-blinded clinical trial of Tai Chi, focusing on its effects on global motor, daily function, mood and quality of life. Subjects continued their standard medical therapy and were randomly assigned to Tai Chi (16 weekly classes, expert trainer, practice at home between classes) or no Tai Chi (control group) in a 2:1 ratio. The primary outcome measure was the total motor score of the Unified Parkinson’s Disease Rating Scale (UPDRS) and this was scored by an experienced rater who was blinded to the treatment assignment. The same rater scored the Schwab and England Activities of Daily Living Scale. The patient-completed Geriatric Depression Scale, PD (quality of life) Questionnaire-39, and fall diary were also analyzed. Results: 44 subjects participated with 29 assigned to Tai Chi and 15 serving as controls. Tai Chi was well-tolerated. Seven subjects withdrew prior to completion (2 from Tai Chi, 5 from control). We found no significant difference between treatment groups in the change in scores from baseline to end of intervention for any of the scales. Trends toward a benefit of Tai Chi were observed for individual UPDRS items (depression, finger tapping, hand movements, posture). Conclusions: Tai Chi does not appear to improve global measures in patients with PD. The practice may have benefits for PD, but these appear to be largely restricted to specific motor tasks and perhaps mood rather than being a global functional response. More study is needed to clarify and establish efficacy.

Pseudoparkinsonism: A review of a common nonparkinsonian hypokinetic movement disorder

This article reviews the syndrome pseudoparkinsonism, a movement disorder described in the literature that resembles parkinsonism but differs qualitatively. Patients with this disorder have apraxic slowness, paratonic rigidity, frontal gait disorder and elements of akinesia that, taken together, may be mistaken for true parkinsonism. Pseudoparkinsonism appears to be common and is most often due to Alzheimer’s disease or vascular dementia. It seems that patients with even mild cognitive deficits can present with pseudoparkinsonism and that the primary dementing disorder may be overlooked. The authors emphasize the importance of pseudoparkinsonism and implications for clinical diagnosis, treatment and research.

Mild cerebrospinal fluid pleocytosis in a Parkinson’s disease patient with deep brain stimulation

Mild cerebrospinal fluid pleocytosis in a Parkinson’s disease patient with deep brain stimulation.

Phenotypical statin-associated immune-mediated necrotizing myositis with histological features of inclusion body myositis

Introduction:Statin-associated immune-mediated necrotizing myositis(IMNM)is a rare but distinct idiopathic inflammatory myopathy(IIM)that requires early recognition and intervention to prevent irreversible muscle damage.It is typically characterized by active statin use,elevated creatinine kinase(CK)levels,proximal muscle weakness,and at times,a positive 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase(HMGCR)antibody.Treatment includes immediate discontinuation of the statin and may include corticosteroids,intravenous immunoglobulin(IVIG),and/or immunosuppressive therapy.Inclusion body myositis(IBM),another distinct IIM,also presents with elevated CK levels but with insidious onset of distal upper and proximal lower extremity weakness and is typically refractory to treatment.Case Description:A 64-year-old female patient presented with proximal muscle weakness,elevated CK levels,and a positive HMGCR antibody in the setting of statin use with muscle pathology suggestive of both statinassociated IMNM and IBM.She responded to subcutaneous methotrexate and a slow prednisone taper over several months,however,will require close monitoring for symptoms associated with either disease.Conclusion:In conclusion,we report a case of muscle weakness with muscle pathology demonstrating both statin-associated IMNM and IBM.This case highlights the importance of understanding the clinical and pathological features of statin-associated IMNM and IBM.