Bibliographic Essay

Parkinsons disease (PD) is a terrible neurodegenerative disease that affects approximately one
million people in the United States. With around fifty to sixty thousand people diagnosed each year,
complications of the disease is one of the leading causes of death in the country. It is a devastating and
crippling illness, and like with all illnesses, knowledge is the only weapon we have in our arsenal to fight
against it. This means that getting correct information into the hands of those on the front lines fighting
this disease is critically important to its treatment and, eventually, its cure. However, this is not as straight
forward as it sounds. Not all the people who deal with Parkinsons disease everyday have the same level
of education. A doctor will probably know more about medicine than a patient or family member with the
disease, and a researcher or specialist may know more about the disease than a general doctor. So, in
order to accurately disseminate information properly, one must take these differences into account and
then create a tiered system of information to accommodate all comers. While this is not easy or simple, it
is what is needed in the war against this terrible sickness.
The first stage in the system of information has to also be the most basic: what is Parkinsons
disease? While all doctors and researchers will understand the basic concept of PD, there are many
patients first diagnosed with the disease who have never even heard of it. These patients will have basic
questions such as what is a neurodegenerative disease or what is a movement disorder. All these questions
must be answered before any other steps are taken. Further, family members will need basic questions
answered as well. Many of these questions will be the same, however there will be other topics to cover
as well, such as is Parkinsons disease contagious, or how does someone properly care for a patient with
Parkinsons disease. These are also questions that would need to be answered in the first stage of any
information packet. Finally there are those people who are not directly affected by the disease, but would
still like to help and contribute to the cause. It is important not to forget about this population, because
without volunteers and donations from the outside, most research would not be able to go forward. Since
no one has ever raised money or spent time helping a cause they have never heard of, a section of basic
information for these people should also come in the first stage of the guide.
The sources for this kind of information are very different from any of the other sources normally
used in medical research. However, because of the basic nature of these questions, the best places to look
are foundation websites and other sources like it. Parkinsons Foundations play a massive role in the
research and treatment of the disease. Being both a hub for patient advocacy as well as laboratory and
medical functions, they are often a first stop for many who are just getting acquainted with Parkinsons.
Because of this, many if not all have adopted an About Parkinsons Disease section on the front of their
home page. These resources are top notch. They spell Parkinsons disease out in a simple enough way that
any untrained person could understand it, and are kept both up to date and accurate by a myriad of
experts. The two foundations listed below, the Michael J. Fox Foundation and the National Parkinsons
Foundation are two example of many great organizations that fill this much need role. They are the first
stop in anyones search for knowledge about Parkinsons disease.
After the basics of what Parkinsons disease entails are covered, it is important to get into specifies on the
disease. The worlds technology is improving every day at an exponential rate, and medicine is no

different. What is the limit of knowledge five or ten years ago may only scratch the surface today.
Therefore, it is important for everyone, not just patients and the general public, but doctors and
researchers to have a clear definition of the disease and what its different symptoms are.
However, one problem with any discussion of medicine that goes into great detail is that the detail is
inherently complex. This complexity may pose a problem to those in the general public who do not have
the educational background possessed by doctors and researchers. There is no easy solution to this
problem, any attempt to simplify information must discard the detail that experts the experts need. So it
should be assumed that from this point on in the discussion, there is a base level of understanding that is
necessary. This is not to say that someone without Dr. in front of their name cannot understand the articles
and sources listed, but it does mean that it will take some work and concentration to fully comprehend
what is being discussed.
Any detailed discussion starting at the beginning of Parkinsons must start at the cause of the disease. On
this topic, the list of sources is very short, there are none. The cause of Parkinsons remains unknown to
researchers. While there are several theories as to what the genesis of the condition is, none have been
proven and are best left in the experimental side of the topic.
Without the cause, the next step of uncovering the details of PD is the diagnosis. If the diagnosis is not
correct, the patient will not get the proper care they need, which will drastically reduce the quality of their
lives, and of any research they were participating in. While this may seem like an obvious and easy step,
in practice this is a difficult process. Parkinsons disease can only be diagnosed at autopsy. This is a
crucial problem, and because of this the only way to diagnose Parkinsons is with a clinical diagnosis. The
different steps in clinical diagnosing a patient are clearly laid out in many papers. The paper cited below
is what is called a scholarly review. A review is a paper that takes all the different current scholarly
literature on a subject and condenses it into one, cohesive work. These review papers are great places to
start learning in depth about a topic because of the broad scope that they reach and the amount of articles
they use as sources that can also be accessed by the reader.
There is no cure for Parkinsons. Therefore, when a patient walks into a doctors office, complete
remission of the disease it is never really the goal. Instead, it is the goal of the treatment team to manage
all the patients symptoms to improve their quality of life as much as is possible. However, as is true with
many complex ideas, simply properly diagnosing a patient is not truly enough to understand their
symptoms. Parkinsons disease has many different presentations, and just like no two patients are exactly
the same, no two patients have the exact same symptoms. This makes treating Parkinsons difficult, and to
do so properly requires a good understanding of all the possible symptoms.
The symptoms of Parkinsons can be classified into two main groups: motor symptoms and non-motor
symptoms. The motor symptoms of Parkinsons are what are classically thought of as the hallmark of the
disease. These definitions have been around for many years, and are well documented and described.
There is a review of the motor symptoms cited below, however there will also be a lot of information on
this subject in the clinical diagnosis section, as the motor symptoms are used to diagnosis the disease.
While this aspect of the disease is important, it is more recently being thought of as simply the final and
much more obvious stages of a deeper and larger disease.

The idea of non-motor symptoms of Parkinsons disease is relatively new. Having not been fully
described until recently, this is the part of the disease that most people, doctors included, seem to
overlook. This makes it all the more important that information on the condition be readily available to
researchers and the general public alike. There is a review cited, which is always a good place to start a
search into the topic. Another good resource to use when looking into this particular topic is something
called the DSM-V. This text is what has been nicknamed by the experts in the field as psychiatrys
bible. It contains all the official definitions of every mental disorder currently recognized by the field. It
is especially useful when considering the non-motor symptoms of Parkinsons. Many of the non-motor
symptoms are psychiatric in nature; however, the research papers that are written for experts in the field
will only name the disorder itself without any explanation as to what that particular disorder entails.
Having this guide by your side while sifting through the scientific articles will greatly enhance your
understanding of the subject and the speed at which you gain that understanding.
Once the different symptoms are understood, it is time to introduce the currently accept
treatments. Unfortunately, this is the point where all the information being contained in a single, well
written review comes to an end. Because of the variety of symptoms, the variety of different methods for
treating each individual symptom, and the variety of how each individual patient responds to a particular
treatment, a review of all possible treatments would not so much be a review article as a review
encyclopedia. However, there are a few places to start when researching the treatments of a particle
symptom. First, most of the research of already well-established symptoms from above will also naturally
contain the standard treatment protocols. This all but ensures that any researcher who has studied a
symptom will have already at least been exposed to the treatment. After this, the best resource to go to is
probably the American Academy of Neurologys database of its Scholarly Journal Neurology (cited
below). In this contains articles labeled as Practice Parameter which are reviews of different scholarly
articles on the current accept treatment practices of a specific stage or symptom of the disease. These
articles are a good jumping off point for any foray into research on specific accepted treatments on the
disease.
After learning and research all the already currently accepted practices and knowledge of the
diseases comes the dreaded experimental treatment and theories. This section is by far the most difficult
to compile research about. This ever-changing landscape contains so many different theories going in so
many differing directions it is impossible to put together a cohesive review of any kind. Instead, the most
effective method for showing the current research would be to shed light on some of the most common
topics currently being investigated in the field. By doing this, hopefully the aspiring researcher will
understand what the experts on the bleeding edge of the field are doing and what the newest research
actually looks like. Unfortunately, just due to the nature of this type of subject, this section will not stay
current for very long, and should not be trusted more than a few year down the road.
The first and most obvious topic of new research is also the most studied: What causes Parkinsons
disease. The review cited is a good starting point for understanding where the research in this important
field as already been and where it may be headed in the future. As an example of research taking a path
that might not be immediately obvious to the new learner is the paper on worldwide occurrences of
Parkinsons disease. Since most researchers currently believe there is a environmental component to the
disease, knowing which environments produce the most cases is good information to have when
researching the cause (this paper could also be used in the very beginning of research when trying to

understand how prevalent this disease is, but due to the scientific nature of the paper, it was left out of the
basic, stage one aspect of research.)
The second path of research is understanding the different underlying mechanisms behind the symptoms
exhibited by patients. Though it is well known that Parkinsons underlying cause lies somewhere in the
dopamine system of the brain, the exact mechanisms have not been fully described. The paper on the
Freezing gait does a good job of showing how researchers are attempting to discover these mechanisms.
While this very specific example is not the only one contained in the subject, it is a good way to show
what type of experiments are being done, and more importantly, what type of experiments to look for if a
researcher would like to learn more on this subject.
The final path of research is also the biggest from an economic stand point. This is the subject of
experimental treatments for Parkinsons disease. Much like the last paths, this subject is far too broad and
far too fluid to attempt to name every study. So instead, there are several highlighted papers that will
hopefully illuminate the type of material that is out there for this particle topic. The first is the paper on
Deep Brain Stimulation. This paper highlights the fact that not all treatments come in the form of pills but
can also take the shape of surgeries. The field of Deep Brain Stimulation is maybe the fastest growing of
the new Parkinsons treatments, as it currently has the best outcomes for patients with difficult cases. The
second, serotonin and dopamine paper highlights the more conventional side of pharmaceutical treatment.
It was chosen not simply to name off another experimental drug being tested, but to show the driving
thought behind the creation of new pharmaceuticals. The paper details the different aspects of the brains
chemical pathways, which are the main systems that most pills act on. By understanding these concepts,
the researcher will be able to easily evaluate all new pharmaceutical research quickly and efficiently,
because they have command of the underlying patterns.
There are volumes of information on Parkinsons disease available, and learning it all takes a lifetime.
Hopefully, using the above process, a reader who is relatively uninformed about the disease can walk
themselves though the most important points and, when they discover the subject that they wish to purse,
can use the cited works to begin the never ending process of research. After all, only with constant
learning and determination can we as a species come closer to curing this dreadful disease and helping
those who are at the root of all the papers and databases, the patients themselves.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Arlington, VA: American Psychiatric Publishing.
This is the official guide of psychological disorders published by the APA. It is a manual designed
for experts to use in the field, however is not so complicated that non-experts cannot understand
it. It is a useful reference for anyone attempting to learn the different disorders. It is both up to
date and very reliable.
Benabid, A. L., Chabardes, S., & Mitrofanis, J. (2009). Deep brain stimulation
of the subthalamic nucleus for the treatment of Parkinson's disease.
Neurology, 8(1), 67-81. http://dx.doi.org/10.1016/
S1474-4422(08)70291-6
This paper goes over the procedure known as Deep Brain Stimulation and
its implications in Parkinson's Disease. It is a paper mainly for doctors
and experts about the surgical procedure. It goes over outcomes of

patients as well as risk of complications and other pertinent data.

The paper is from 2009, so its data may be a little off. Even
though it was published only 6 years ago, the procedure was very new when
the paper is written, so there may be more data available now. However,
it is still a good resource to start for people wanting to learn what DBS
is and how it is used.
Bezard, E., & Carta, M. (2015). Could the serotonin theory give rise to a
treatment for levodopa-induced dyskinesia in Parkinsons disease? Brain.
http://dx.doi.org/10.1093/brain/awu407
This is an article detailing a new, experimental theory on how to deal
with one of the main side effects of Parkinson's treatments. It is a
paper designed mainly for experts and researchers. It details a phase 1
trail of a new drug that may help Parkinson's dyskinisea.
This paper does not yet have much practical use. The theory
that this paper details is very new and does not yet have the data to
prove its effectiveness. It is, however, a good source to learn about
where Parkinson's research is going in the future.
Chaudhuri, R. K., & Schapira, A. H. (2009). Non-motor symptoms of Parkinson's
disease: dopaminergic pathophysiology and treatment. FMedSci, 8(5),
464-474. http://dx.doi.org/10.1016/S1474-4422(09)70068-7
This is a paper written for doctors and other experts, but could be read
by a non-professional or patient who are dedicated to learning about the
disease. It catalogs the different types of non motor symptoms that occur
in Parkinson's disease. This paper is also a review so it encompasses
many different aspects of the non motor symptoms and articles relating to
the subject.
This is a incredibly important resourceful for all doctors and
experts looking to learn about this disease. The non-motor sympotms are
not aloways known by even practicing M.Ds who are not specialized to
treat the disease This causes many of these patients to have untreated
symptoms and therefore a lower quality of life. So anyone who is learning
about this disease in a expert capacity should make sure to read this
paper and learn about this aspect of this disease.
Fox, M. J. (n.d.). Understanding Parkinson's. Retrieved February 15, 2015, from
The Michael J Fox Foundation website: https://www.michaeljfox.org/
The Michael J Fox foundation is one of the largest charity foundations
dedicated to furthering medicines understanding of Parkinson's Disease.
On their website, they have a section called Understanding Parkinson's
which is a good resource for a beginners to learn about the disease. A
patient or family member can learn anything from what the diagnosis means
to what the prognosis is for the disease.
The Michael J Fox foundation is one of the most reliable sources

of information for basic Parkinson's Disease information. Because of

there strong connection to research, the website has many reliable
articles that are checked by leading experts. The website is also updated
frequently, making it reliable as a resource for information.
Hoehn, M. M., & Yahr, M. D. (1967). Parkinsonism : onset, progression, and
mortality. Neurology, 17(5), 427-442. http://dx.doi.org/0028-3878
This is a paper describing the basics of Parkinson's disease and its
prognosis. It starts by describing how the disease starts off and what
patients look like when they originally present to the clinic. It then
goes to how the patients progress though the disease and how the
mortality rates progress over the different cohorts studied.
This is a great paper for anyone looking to learn the basic
motor symptoms of the disease. It is an older paper, written in 1998, so
there are some major aspects that are missing from this article. However,
the data that was collected is still valid and is a good first start to
learning about the progression of symptoms.
Jankovic, J. (2007). Parkinsons disease: clinical features and diagnosis. J
Neurol Neurosurg Psychiatry, 79, 368-376. http://dx.doi.org/10.1136/
jnnp.2007.131045
This is a review paper over the different aspects of attempting the
diagnosis of Parkinson's in a clinical setting. After a Medline search on
the topic, the author complied all the different results into one paper.
The paper is a good resource for experts in the field who are trying to
catch up on the cutting edge of the field.
The paper is a good, reliable resource for experts and doctors to
use. The articles sources are all valid peer reviewed journal entries and
the author is himself an expert in the field. Further the paper was
published in 2007, so while not being as up to date as is possible, is
still a relatively reliable and recent source.
Neurology. (n.d). The American Academy of Neurology. Retrieved at http://www.neurology.org/.
This is the official publication from the American Academy of Neurology. It is a gold standard
periodical for neurological research. It contains, among other things, reviews on current standards
of care for different research topics.
This is a very broad citation; however, it is very reliable and up to date. The articles it contains
are some of the best in term of being able to describe changing protocols and practices in a up to
date fashion.
Parkinsons's Disease. (2001, January 1). Retrieved February 15, 2015, from
National Parkinson Foundation website: http://www.parkinson.org/
parkinson-s-disease.aspx
The National Parkinson Foundation is a not for profit organization
dedicated to helping further awareness and research regarding

Parkinson's. Their website has numerous links to different resources from

basic information on Parkinson's to different research topics. It is a
good place to learn the basics of what Parkinson's is.
The source in this case is a very reliable foundation that has many
different sources of good information. Because they are directly involved
in funding and promoting research, they have experts regularly able to
add new, accurate information. There website is also updated regularly to
ensure the most current information possible.
Plotnik, M., Giladi, N., & Hausdorff, J. M. (2012). Is Freezing of Gait in
Parkinson's Disease a Result of Multiple Gait Impairments? Implications for
Treatment. Parkinson's Disease. http://dx.doi.org/10.1155/2012/459321
This paper details the different aspects of gait impairments of
Parkinson's Disease. It is a paper that talks about the different new
theories about how the gait impairment works in the later stages of the
disease. It ends with giving several testable hypothesis to test their
theories in the future.
This is an article without many practical uses just yet. It is a
theory about how to view the movement disorders differently than any
researchers have previously. This is a example of a good experimental
hypothesis in the field of Parkinson's research.
Wirdefeldt, K., Adami, H.-O., & Cole, P. (2011). Epidemiology and etiology of
Parkinsons disease: a review of the evidence. European Journal of
Epidemiology, 26(1), 1-58. http://dx.doi.org/10.1007/s10654-011-9581-6
This is a paper that takes all of the current articles and condenses it
into one large review. It goes over all the different possible factors
that could cause the disease of Parkinson's. It also shows all the
different disease's that can occur with Parkinson's and the likelihood of
each one occurring.
This is a good article for either experts and doctors, or a
well educated non-professional. It details the leading theories of the
cause of Parkinson's in one, concise paper. It was published within five
years, so it can be considered up to date, and the authors all are
experts in the field, making this the ideal starting point for research
into the subject.
Zhang, Z., & Roman, G. C. (1993). Worldwide Occurrence of Parkinson's Disease:
An Updated Review. Neuroepidemiology, 195-208. http://dx.doi.org/10.1159/
000110318
This paper is a overall review of how prevalent the disease is across
the planet. It takes information from different papers to try and compare
different all the regions of the world with respect to Parkinson's. It
then talks about possible environmental risk factors possibly associated
with the findings.

This paper is a good place to start if you are trying to get a

good idea of the distribution of Parkinson's throughout the world. The
information may be a little out of date, as the paper was written in
1993. However, the author uses different sources to make the different
conclusions very reliable.