Objective
To present the International Parkinson and Movement Disorder Society (MDS) Clinical Diagnostic Criteria for Parkinson9s disease.
Background
Although several diagnostic criteria for Parkinson9s disease have been proposed, none have been officially adopted by an official Parkinson society. Moreover, the commonest-used criteria, the UK brain bank, were created more than 25 years ago. In recognition of the lack of standard criteria, the MDS initiated a task force to design new diagnostic criteria for clinical Parkinson9s disease.
Methods/Results
The MDS-PD Criteria are intended for use in clinical research, but may also be used to guide clinical diagnosis. The benchmark is expert clinical diagnosis; the criteria aim to systematize the diagnostic process, to make it reproducible across centers and applicable by clinicians with less expertise. Although motor abnormalities remain central, there is increasing recognition of non-motor manifestations; these are incorporated into both the current criteria and particularly into separate criteria for prodromal PD. Similar to previous criteria, the MDS-PD Criteria retain motor parkinsonism as the core disease feature, defined as bradykinesia plus rest tremor and/or rigidity. Explicit instructions for defining these cardinal features are included. After documentation of parkinsonism, determination of PD as the cause of parkinsonism relies upon three categories of diagnostic features; absolute exclusion criteria (which rule out PD), red flags (which must be counterbalanced by additional supportive criteria to allow diagnosis of PD), and supportive criteria (positive features that increase confidence of PD diagnosis). Two levels of certainty are delineated: Clinically-established PD (maximizing specificity at the expense of reduced sensitivity), and Probable PD (which balances sensitivity and specificity).
Conclusion
The MDS criteria retain elements proven valuable in previous criteria and omit aspects that are no longer justified, thereby encapsulating diagnosis according to current knowledge. As understanding of PD expands, criteria will need continuous revision to accommodate these advances. Disclosure: Dr. Postuma has received personal compensation for activities with Roche Diagnostics Corporation and Biotie Therapies. Dr. Berg has received research support from Michael J. Fox Foundation, the Bundesministerium fur Bildung und Forschung (BMBF), the German Parkinson Association and Novartis GmbH.

MDS Clinical Diagnostic Criteria for Parkinson's Disease (S19.001)

Unified Parkinson's Disease Rating Scale

This handbook presents guidelines for synthesizing findings of qualitative research.After discussing the importance of such synthesis for building knowledge, in the second chapter the authors introduce definitions of and types of qualitative research synthesis.They view the synthesis as a study comprising a series of steps, starting with the formulation of a problem and a statement of purpose. In chapter 3 the authors focus on the steps of retrieving all research reports and determining their relevance to the study domain. In chapter 4 they describe strategies for appraising individual study reports and for conducting a comparative appraisal. Comparative appraisal consists of displaying key elements of the studies included in the synthesis and comparing them in order to determine whether they confirm, extend, refute, or complement each other. In chapter 5 Sandelowski and Barroso discuss issues encountered in appraising the quality of qualitative studies and present a typology of findings that can be used to classify results. In chapters 6 and 7 they describe the process of implementing the two types of qualitative research synthesis, metasummary and metasynthesis. In chapter 8 the authors review strategies for maintaining validity of qualitative research synthesis and in chapter 9 they review content and format for presenting the results of the synthesis. Sandelowski and Barroso are to be commended for addressing a controversial topic, and for refining the types of qualitative research findings and procedures for conducting a synthesis of these findings.They clarify the arguments advanced by proponents and opponents of the qualitative research synthesis, thereby facilitating our understanding of the rationale underlying the two types of synthesis. Conceiving the synthesis as a study that is conducted in steps, similar to those entailed in a metaanalysis, helps us to view the process as a systematic one with a welldefined sequence of steps.The book is structured accordingly, starting with the formulation of a researchable problem, moving on to the conduct of an extensive search of the relevant literature, then to an appraisal and synthesis of findings across studies, and ending with CJNR 2008,Vol. 40 No 3, 179 –180

https://cjnr.archive.mcgill.ca/article/download/2146/2140

Handbook for Synthesizing Qualitative Research

Meaning reconstruction and the experience of loss. Edited by R.A. Neimeyer. American Psychological Association, Washington, DC, 2001. 368pp, ISBN: 1557987424.

Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.

Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System

Family caregiving in the context of advanced disease in particular, can be physically and emotionally taxing. Caregivers can subsequently face bereavement exhausted with few supports, limited resources and a significant proportion will develop negative psychological and social outcomes. Although some research has attended to the bereavement experiences of family caregivers who had cared for a person requiring palliative care, a comprehensive qualitative understanding of the impact of caregiving on bereavement has not been articulated. The purpose of this study was to conduct a qualitative metasummary to explore the experiences of bereaved family caregivers of people who received palliative care services, regardless of their underlying disease. Sandelowski and Barroso’s qualitative metasummary method was utilized: 1287 articles were identified through extensive database searches (i.e. – MEDLINE, PsychINFO, and CINAHL) and reviewed to determine if they fit the criteria. Those included in the review were assessed for study quality. Findings from each study were then thematically coded and a frequency of themes was calculated. The sample consisted of 47 qualitative studies. A total of 15 themes emerged. In descending order of frequency, the 15 themes were: the individual emotions of serenity, sadness, guilt, uncertainty, trauma, escape, and anger; post-loss experiences that helped the caregiver in bereavement; post-loss experiences that hindered; practical life changes; caregiver role identity; pre-loss experiences that helped; pre-loss experiences that hindered; caregiver context; and a need for different kinds of supports. Three key findings emerged from the themes: (1) many different aspects of the caregiving experience impact the bereavement experience, (2) every bereavement experience is unique, and (3) a variety of supports must be developed and made available to caregivers to meet these unique needs. Based on the metasummary findings, changes are needed in practice and policy to ensure the health and well-being of the family caregiver is maintained by offering support both during caregiving and bereavement.

/pdf/honoring-the-voices-of-bereaved-caregivers-a-metasummary-of-exgymfi83m.pdf

Honoring the voices of bereaved caregivers: a Metasummary of qualitative research.

Background Essential tremor and Parkinson's syndrome are two common movement disorders that may co-occur in some individuals. There is no diagnostic neuropathology for essential tremor, but in PD and other Parkinson's syndrome variants, the neuropathology is well known. The spectrum of Parkinson's syndrome variants associated with essential tremor, their clinical features, and course have not been determined in autopsy-confirmed cases. Objectives To identify: diagnostic features of essential tremor/Parkinson's syndrome, different Parkinson's syndrome variants, and long-term clinical profile in such cases. Methods Patients that had an essential tremor diagnosis and a subsequent clinical or pathological diagnosis of Parkinson's syndrome seen in our clinic during 50 years were included. The diagnosis of parkinsonism was made when bradykinesia, rigidity, and resting tremor were all clinically evident. Results Twenty-one cases were included. All the common variants of parkinsonism co-occurred with essential tremor. The most common was PD (67%) followed by PSP. The pathological findings were not predicted clinically in 2 cases that had essential tremor/PD and in all 5 essential tremor/PSP cases. Conclusion In most essential tremor/Parkinson's syndrome patients, the main motor features of parkinsonism-bradykinesia, rigidity, and resting tremor-were identifiable. All known degenerative Parkinson's syndrome variants co-occurred in essential tremor patients. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/mds.27729

Parkinsonism in essential tremor cases: A clinicopathological study.

While a significant number of individuals in Canada and globally are affected by prenatal fetal alcohol exposure, scant research exists that focuses specifically on the subjective experiences of this population. Based on a single case study exploring through Photovoice methodology the life experiences of a young adult with Fetal Alcohol Spectrum Disorder (FASD), this research paper utilises Schwab’s curriculum commonplaces as a framework to present results pertinent to the field of Education. Four themes emerged that illuminate the participants’ resilience and self-awareness of issues related to independence versus support, strengths and challenges, attitude and adaptation strategies, and advice for others. Curriculum suggestions based on the findings are offered for educators working with young people with FASD in general education settings. Further implications for Education and suggestions for additional research are included.

A School Curriculum for Fetal Alcohol Spectrum Disorder: Advice from a Young Adult with FASD.

We initiated an individual case study with one young adult in Canada about everyday life with Fetal Alcohol Spectrum Disorder (FASD). Using Photovoice, we explored his experiences through photography and interviews. Findings highlight his multi-faceted identity based around ability and challenge negative stereotypes. The study supports Photovoice as a strategy to explore FASD experiences.

Strengths and Challenges: A Young Adult Pictures FASD Through Photovoice

We appreciate the interest of Mulroy et al in our article. They claim that more than half of our patients did not meet the essential tremor (ET) diagnostic criteria recommended by Bhatia et al. When our article is read in conjunction with that statement, their major questions have already been addressed. Their criticism: “Onset was monomelic in 8 patients. Additionally, 3 patients were diagnosed with ET on the basis of an isolated head tremor—an exclusion criterion for diagnosing ET.” Both those are incorrect. They are confusing the ET onset site(s) with the findings used for ET diagnosis. The consensus notes, “It was discussed to include onset of tremor in the upper limbs as a further criterion, but there are no convincing data that support this criterion.” That report notes, “Isolated segmental postural or kinetic tremor syndromes commonly involve... but may also involve the head...,” and further notes, “Many patients with the syndrome ultimately fulfill criteria for ET.” Head tremor is part of the ET spectrum. It was present in 36% of cross-sectional and 73% of longitudinally followed autopsied ET cases. If tremor onset in ET is not always in the upper limbs, could it not start as head tremor? They incorrectly state that we made a diagnosis of ET based on “isolated” head tremor. Head tremor was followed by bilateral upper limb tremor when the diagnosis of ET was made (see Methods and Table 1). Mulroy et al argue against ET diagnosis when a patient has 1 upper limb tremor onset. The consensus statement does not address unilateral versus bilateral onset. ET onset is insidious, and diagnosis is made subsequently when the findings are consistent with the clinical diagnosis. The information on time and site of onset is part of standard neurological history. Most ET patients first notice tremor in the dominant or both upper limbs, and tremor asymmetry may persist through the course. All our patients met the ET diagnostic criteria. They claim that Video Segment 1 shows “dystonic” finger posturing on the left side. Such posture is well known in parkinsonism. The Video Segment 3 man is in a wheelchair because of injuries to lower limbs. Video Segment 2 must not be interpreted retrospectively after the pathology report. Clinical diagnosis made after autopsy information artificially inflates diagnostic accuracy, compared with premortem diagnosis by the same criteria. Table 1 in our article shows findings at baseline, final clinical diagnosis in our clinic, and the clinicopathological diagnosis considering all the information. We cannot comment on the role of beta-blockers in parkinsonism as most of our patients received those drugs.

Sarah Bocking

Papers

Honoring the voices of bereaved caregivers: a Metasummary of qualitative research.

Parkinsonism in essential tremor cases: A clinicopathological study.

A School Curriculum for Fetal Alcohol Spectrum Disorder: Advice from a Young Adult with FASD.

Strengths and Challenges: A Young Adult Pictures FASD Through Photovoice

Reply to: Parkinsonism in essential tremor cases: A clinicopathological study-were they really essential tremor?