Windsor Parkinson Meeting April 23, 2013

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Parkinson Society Southwestern Ontario.png Parkinson SW rgb EN.jpg

Parkinson home.jpg . . Welcomes Guest Speaker : Dr. Michael Winger is a Neurologist



Parkinson Disease Update Windsor Parkinson Support Group 23 April 2013

Dr. Michael Winger Medical Director District Stroke Center Windsor Essex County.

Interesting Facts about PD Why should we be concerned?

  • Second most common neurodegenerative disease

behind Alzheimer's Disease.

Left to Right Pat St. Pierre, MSW,RSW,
Dr. Michael Winger , Tracey Jones
  • Approximately affects 1200 people in our area.
  • 1% risk above age 60 but 4% above age 80.
  • Average age of diagnosis is 60 but 10% are

younger.

  • Costs Canada 2 billion dollars per year with

1 50,000 people afflicted.

  • 3O-4O % people will become cognitively impaired.

What exactly is PD?

  • Although it may seem obvious in more advance

cases, the diagnosis needs expertise, patience and judicious testing.

  • Tremor
  • Slowness of movement
  • Stiffness
  • Problems with posture, balance and walking
  • Even in the best hands the initial clinical diagnosis

is accurate in 75-80 % of the cases


What exactly is PD?

  • Although it may seem obvious in more advance

cases, the diagnosis needs expertise, patience and judicious testing.

  • Tremor
  • Slowness ol movement
  • Stiffness
  • Problems with posture, balance and walking
  • Even in the best hands the initial clinical diagnosis

is accurate in 75-80 % of the cases

Can I be tested for PD?

  • It is a clinical diagnosis made by your doctor but

sadly there is no confirmatory blood test , scan or imaging.

  • It is not strictly an inherited disease like

Huntington's Disease but in 10% of patients there is an apparent positive family history.

  • Genetic testing is not useful and only done in

younger patients with a strong family history. This is not OHIP insured.

What are the Risk Factors for PD?

Parkinson Disease

  • Genetic
  • Head trauma
  • Sleepwalking *
  • Abnormalities of smell

and taste *

  • Abnormalities of bowel

and bladder *

  • Smoking, coffee and

rural location

  • We don't know why most

people get PD

Parkinsonism

  • Strokes
  • Hydrocephalus
  • Medications
  • Toxins
  • Genetics

Good Communication is Critical

  • Early on the diagnosis maybe tentative but it should

become obvious with time.

  • Both the doctor rand the patient must exercise

patience.

  • Our first responsibility is make sure that a

potentially correctable problem is not missed.

  • Our next responsibility is too minimize any

symptoms without causing extra problems.

PD is a Complicated Condition

Motor Involvement

  • Tremor
  • Slowness
  • Stiffness
  • Balance

Non-motor Involvement

  • Memory loss
  • Depression and anxiety
  • Trouble passing urine
  • Constipation
  • Low blood pressure
  • REM sleep disorder
  • Sleep apnea
  • Drooling
  • Osteoporosis
  • These problems are all

less obvious

What medications are available for PD?

Motor Synptoms

  • Dopamine agonist
  • L-DOPA ( lR and CR )
  • Azilect
  • Amantidine
  • Protein redistribution diet

is seldom used and can be tedious.

Non-Motor Involvement

  • Bowel land bladder
  • . Cholinesterase inhibitor
  • Ant-depressant
  • BP management
  • Sleep disorders
  • Exercise and yoga
  • Encourage social interaction

How is decision made about medication?

  • Treat an impairment or disability as there is a

difference between what you may want to treat and something that you need to treat.

  • Define the goals ol therapy with reasonable

expectations on both sides

  • Pharmacotherapy depends on the stage ol the PD

and no two patients are exactly the same.

What are the surgical options for PD?

  • Ablative surgery
  • DBS
DBS 1.jpg
  • No role for stem cell therapy
  • Timing is everything for intervention but is only

applicable to a minority of patients.

Are there predictive factors for PD?

  • There is no holy grail

for prognostication

  • Tremor
  • Gait problems
  • Dementia
  • Age
  • Trouble swallowing
  • Labile BP

The Team Approach

  • GP / NP
  • Neurologist
  • Urologist *
  • Sleep specialist
  • Internist *
  • Psychologist / psychiatrist *
  • Geriatrician *
  • Physiotherapist *
  • Patient and family
Some information links below.
Go to www.wikipedia.org wikipedia.org

You may direct your questions and comments about his page to Rick's Clicks
Use Rick's online contact form HERE.


Windsor Parkinson’s Support Group



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