Parkinson's disease in long-term-care facilities

Item does not contain fulltextRadboud University, 1 september 2017Promotores : Bloem, B.R., Koopmans, R.T.C.M. Co-promotores : Tissingh, G., Poels, P

[Non-motor symptoms of Parkinson's disease]

Item does not contain fulltextParkinson's disease has traditionally been viewed as a disease with only motor features. Nowadays, a wide variety of non-motor symptoms and signs are also recognised as being characteristic of the disease. Non-motor symptoms, most importantly autonomic dysfunction, neuropsychiatric symptoms and sleep problems, are prevalent in virtually all Parkinson's disease patients and influence the quality of life more than the motor symptoms. Patients may visit a variety of health care professionals, but non-motor symptoms are often missed, because physicians do not explicitly ask patients about them or do not recognise them as being part of the disease. Knowledge of non-motor symptoms is important to avoid unnecessary additional testing. Specific treatment options are available, as described in the Dutch multidisciplinary guidelines on Parkinson's disease

Prevalence and Prescribed Treatments of Orthostatic Hypotension in Institutionalized Patients with Parkinson's Disease

Paroxysmal Cerebral Disorder

Applause sign in advanced Parkinson's disease

Contains fulltext : 139053.pdf (publisher's version ) (Closed access)BACKGROUND: The 'applause sign' a tendency to continue applauding in response to instructions to clap three times was described in 1995 and was considered specific to degenerative disease, especially to atypical parkinsonian disorders. In early phase Parkinson's disease (PD) the sign has been reported positive as well. In late stage PD it is unknown whether and to what extent the sign may be elicited and it remains unknown if and to what degree the sign correlates to cognitive impairment and PD related dementia. METHODS: Nursing home residents with PD (MMSE >17) were included. All patients underwent the clapping test and were tested for cognitive disturbance by making use of accepted clinimetrics (MMSE and Scopa-cog). T-testing was performed with the hypothesis that patients expressing the applause sign would score lower on the MMSE or Scopa-cog. RESULTS: Seventy three nursing home residents (mainly Hoehn and Yahr 4/5) with a mean disease duration of 10 years and a mean age of 78.7 years were included. The applause sign was found positive in 15 of 73 residents (20.5%). Residents expressing the applause sign had significantly lower mean scores on the MMSE (25.1 vs 22.9 points, p < 0.006) and Scopa-cog (14.8 vs 12.0 points, p < 0.039). CONCLUSIONS: The applause sign is present in late stage PD and correlates with a higher degree of cognitive impairment as established with accepted clinimetric tests. A higher degree of frontal lobe involvement explains the presence of the applause sign

Diagnostic accuracy of Parkinson's disease and atypical parkinsonism in nursing homes

Item does not contain fulltextINTRODUCTION: Management of Parkinson's disease (PD) and atypical parkinsonism in nursing homes depends on a timely and accurate diagnosis. However, little is known about the diagnostic accuracy of these parkinsonian syndromes in nursing homes. We examined this issue in a large group of Dutch nursing home residents. METHODS: Twelve large nursing home organizations in the Netherlands accounting for 100 nursing homes with a total population of 5480 residents participated. Residents with PD or atypical parkinsonism were identified according to their nursing home medical chart diagnosis. Additionally, local pharmacists provided a list of all residents using antiparkinson medication. We compared the admission diagnosis to a clinical diagnosis made in the study, based upon interview and detailed neurological examination by movement disorders experts. Diagnoses were based on accepted clinical criteria for PD and atypical parkinsonism. RESULTS: In the total population of 5480 residents, 258 had previously been diagnosed with a form of parkinsonism according to their medical record. In 53 of these residents (20.5%) we changed or rejected the diagnosis. Specifically, we found no parkinsonism in 22 of these 53 residents (8.5% of all patients with suspected parkinsonism). In the remaining 31 residents (12%), we established a new diagnosis within the parkinsonian spectrum. CONCLUSIONS: In a large population of Dutch nursing home residents, 20% of diagnoses within the parkinsonian spectrum were inaccurate. Almost 9% of residents had inadvertently received a diagnosis of parkinsonism. Better recognition of parkinsonism in nursing homes is important, because of the consequences for management and prognosis

Parkinson's disease in Dutch nursing homes.

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DESA1002 'Continuous City' Jonathan Kim

LOCATION: TUNIS BLOCK REFERENCE: F14 DESIGNED BUILDING: APARTMENT CONCEPT - To give the people a suitable, residential living space in response to the congestion and density in between the buildings of Tunis. DESIGN IDEAS - To separate the space between the residents of the building and the public by passers, I have elevated my apartment floor levels. - In regards to giving more living space, I have extruded the external walls of my building without expanding the perimeter of the ground floor plan. WINDOWS - The windows consist of both circular and rectangular shapes. Much of their size and location have been decided upon the way the sun enters the building. Hence the lower level windows are a lot larger than the ones above as they are not as exposed to direct sunlight. - In reference to my digital design, there are dome like covers, overhanging the circular windows so as to prevent sunlight from entering the upper half of the building to ensure a cooler interior space. APARTMENT FEATURES - Courtyard Through the study of Tunisian living spaces, the central courtyard is recognised as characteristic of the residential building. This open space allows for ventilation and light to enter the interior space of the apartment. - Two entrances are placed on both sides of the building. - These entrances lead to stairs, while at ground level they open up to the courtyard. STRUCTURE AND MATERIAL - My building is of column and slab construction with white concrete as the main material. FLOOR PLAN - Each level consists of four units. Each of these units feature: A porch which faces the courtyard, three bedrooms and a kitchen which surround this porch, and a lounge room with two toilets all placed along the exterior sides of the building

Dynamic Light Scattering Based Microelectrophoresis: Main Prospects and Limitations

Microelectrophoresis based on the dynamic light scattering (DLS) effect has been a major tool for assessing and controlling the conditions for stability of colloidal systems. However, both the DLS methods for characterization of the hydrodynamic size of dispersed submicron particles and the theory behind the electrokinetic phenomena are associated with fundamental and practical approximations that limit their sensitivity and information output. Some of these fundamental limitations, including the spherical approximation of DLS measurements and an inability of microelectrophoretic analyses of colloidal systems to detect discrete charges and differ between differently charged particle surfaces due to rotational diffusion and particle orientation averaging, are revisited in this work. Along with that, the main prospects of these two analytical methods are mentioned. A detailed review of the role of zeta potential in processes of biochemical nature is given too. It is argued that although zeta potential has been used as one of the main parameters in controlling the stability of colloidal dispersions, its application potentials are much broader. Manipulating surface charges of interacting species in designing complex soft matter morphologies using the concept of zeta potential, intensively investigated recently, is given as one of the examples. Branching out from the field of colloid chemistry, DLS and zeta potential analyses are now increasingly finding application in drug delivery, biotechnologies, physical chemistry of nanoscale phenomena and other research fields that stand on the frontier of the contemporary science. Coupling the DLS-based microelectrophoretic systems with complementary characterization methods is mentioned as one of the prosperous paths for increasing the information output of these two analytical techniques