Parkinson's Disease (PD) is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms generally come on slowly over time. Early in the disease, the most obvious are shaking, rigidity, slowness of movement, and difficulty with walking. Doctors do not know what causes it and finds difficulty in early diagnosing the presence of Parkinson’s disease. An artificial neural network system with back propagation algorithm is presented in this paper for helping doctors in (...) identifying PD. Previous research with regards to predict the presence of the PD has shown accuracy rates up to 93% [1]; however, accuracy of prediction for small classes is reduced. The proposed design of the neural network system causes a significant increase of robustness. It is also has shown that networks recognition rates reached 100%. (shrink)

This article discusses contemporary social psychological approaches to (a) the social relations and appraisals associated with specific emotions; (b) other people’s impact on appraisal processes; (c) effects of emotion on other people; and (d) interpersonal emotion regulation. We argue that single-minded cognitive perspectives restrict our understanding of interpersonal and group-related emotional processes, and that new methodologies addressing real-time interpersonal and group processes present promising opportunities for future progress.

This paper is concerned with some limitations of the vignette methodology used in contemporary appraisal research and their implications for appraisal theory. We focus on two recent studies in which emotional manipulations were achieved using textual materials, and criticise the investigators' apparent implicit assumption that participation in everyday social reality is somehow comparable to reading a story. We take issue with three related aspects of this cognitive analogy between life and its narrative representation, by arguing that emotional reactions in real (...) life are not necessarily mediated by symbolic processes, that people are involved participants of real life rather than neutral observers, and that in real life people's evaluations and emotions are typically part of an ongoing dialogue rather than the expression of a soliloquy. Results from these studies of emotional vignettes therefore tend to overestimate the importance of constructive, abstract, and individualistic processes in the everyday causation of social emotions. In real life, people do not necessarily have to calculate, transform, or internally represent the meaning of the dynamic situation in order to make emotional sense of what is happening to them in the social world. (shrink)

BACKGROUND: Hallucinations and delusions that complicate Parkinson’s disease could lead to nursing home placement and are linked to increased mortality. Cognitive impairments are typically associated with the presence of hallucinations but there are no data regarding whether such a relationship exists with delusions. OBJECTIVE: We hypothesized that hallucinations would be associated with executive and visuospatial disturbance. An exploratory examination of cognitive correlates of delusions was also completed to address the question of whether they differ from hallucinations. METHODS: 144 PD subjects (...) completed a neuropsychological battery to assess cognition and the SAPS to examine psychosis. Correlational analyses assessed associations between hallucinations and delusions with cognitive domains. RESULTS: 48 subjects reported psychotic symptoms: 25 experienced hallucinations without delusions, 23 had symptoms dominated by delusions. Severity and/or number of hallucination subtypes were significantly correlated with lower scores in language, memory, attention, executive functioning, and visuospatial ability. Correlations with delusions were non-significant. Tests of differences in the size of the correlations between groups revealed a significant relationship between language and visuospatial performance with hallucinations. CONCLUSIONS: Cognitive correlates of hallucinations and delusions appear to be different in PD, suggesting distinct pathogenic mechanisms and possibly anatomical substrates. Hence, delusions may not share the same associations with dementia as hallucinations. Since this is a new finding, further studies will be needed to confirm our results. (shrink)

Professor Parkinson's book on Spinoza's theory of knowledge makes a serious attempt to consider this theme in isolation. The author argues that an understanding of this particular theory is a prerequisite to any understanding of Spinoza's theory of ethics or his metaphysical views. The text also discusses Spinoza's interests, especially the influence of science on the development of his thought, and ultimately provides a critical account of the philosopher's methodology, theory of truth, and theory of differing kinds of knowledge.

Background: Treating medication-refractory freezing of gait in Parkinson’s disease remains challenging despite several trials reporting improvements in motor symptoms using subthalamic nucleus or globus pallidus internus deep brain stimulation. Pedunculopontine nucleus region DBS has been used for medication-refractory FoG, with mixed findings. FoG, as a paroxysmal phenomenon, provides an ideal framework for the possibility of closed-loop DBS.Methods: In this clinical trial, five subjects with medication-refractory FoG underwent bilateral GPi DBS implantation to address levodopa-responsive PD symptoms with open-loop stimulation. Additionally, PPN (...) DBS leads were implanted for CL-DBS to treat FoG. The primary outcome of the study was a 40% improvement in medication-refractory FoG in 60% of subjects at 6 months when “on” PPN CL-DBS. Secondary outcomes included device feasibility to gauge the recruitment potential of this four-lead DBS approach for a potentially larger clinical trial. Safety was judged based on adverse events and explantation rate.Findings: The feasibility of this approach was demonstrated as we recruited five subjects with both “on” and “off” medication freezing. The safety for this population of patients receiving four DBS leads was suboptimal and associated with a high explantation rate of 40%. The primary clinical outcome in three of the five subjects was achieved at 6 months. However, the group analysis of the primary clinical outcome did not reveal any benefit.Interpretation: This study of a human PPN CL-DBS trial in medication-refractory FoG showed feasibility in recruitment, suboptimal safety, and a heterogeneous clinical effect in FoG outcomes. (shrink)

Parkinson, Joseph Near death experiences and the wisdom they produce are the stuff of countless novels, but when the story ends in the author's death, where is wisdom to be found? American neurosurgeon Paul Kalanithi has left an astonishingly eloquent and lucid account of his own dying and his inner journey to find meaning and even peace in that experience. As inspiring as it is tragic, "When Breath Becomes Air" rightly sits on The New York Times list of best sellers, (...) and is a must-read for anyone working in bioethics or health care. (shrink)

Parkinson, Joseph Research shows that sexual orientation is neither well defined nor ultimately defining for adolescents seeking self-identity. Rather, the data on instability of sexual orientation among youth and young adults suggest that most of the time unquestioning affirmation of an adolescent's claimed same-sex attraction will do more long-term harm than good. This article explores this complexity and proposes more appropriate ways to provide excellent pastoral care in schools.

IntroductionCognitive impairment is a highly prevalent non-motor feature of Parkinson’s disease. A better understanding of the underlying pathophysiology may help in identifying therapeutic targets to prevent or treat dementia. This study sought to identify metabolic alterations in the prefrontal cortex, a key region for cognitive functioning that has been implicated in cognitive dysfunction in PD.MethodsProton Magnetic Resonance Spectroscopy was used to investigate metabolic changes in the PFC of a cohort of cognitively normal individuals without PD, as well as PD participants (...) with either normal cognition, mild cognitive impairment, or dementia. Ratios to Creatine resonance were obtained for glutamate, glutamine and glutamate combined, N-acetylaspartate, myoinositol, and total choline, and correlated with cognitive scores across multiple domains administered to the PD participants only.ResultsWhen individuals retain cognitive capabilities, the presence of Parkinson’s disease does not create metabolic disturbances in the PFC. However, when cognitive symptoms are present, PFC Glu/Cre ratios decrease with significant differences between the PD-NC and PPD groups. In addition, Glu/Cre ratios and memory scores were marginally associated, but not after Bonferroni correction.ConclusionThese preliminary findings indicate that fluctuations in prefrontal glutamate may constitute a biomarker for the progression of cognitive impairments in PD. We caution for larger MRS investigations of carefully defined PD groups. (shrink)

Using delay differential equations to study mathematical models of Parkinson's disease and Huntington's disease is important to show how important it is for synchronization between basal ganglia loops to work together. We used the delay circuit RLC (resistor, inductor, capacitor) model to show how the direct pathway and the indirect pathway in the basal ganglia excite and inhibit the motor cortex, respectively. A term has been added to the mathematical model without time delay in the case of the hyperdirect (...) pathway. It is proposed to add a non-linear term to adjust the synchronization. We studied Hopf bifurcation conditions for the proposed models. The desynchronization of response times between the direct pathway and the indirect pathway leads to different symptoms of Parkinson's disease. Tremor appears when the response time in the indirect pathway increases at rest. The simulation confirmed that tremor occurs and the motor cortex is in an inhibited state. The direct pathway can increase the time delay in the dopaminergic pathway, which significantly increases the activity of the motor cortex. The hyperdirect pathway regulates the activity of the motor cortex. The simulation showed bradykinesia occurs when we switch from one movement to another that is less exciting for the motor cortex. A decrease of GABA in the striatum or delayed excitation of the substantia nigra from the subthalamus may be a major cause of Parkinson's disease. An increase in the response time delay in one of the pathways results in the chaotic movement characteristic of Huntington's disease. (shrink)

IntroductionDeep brain stimulation has become a standard treatment option for select patients with Parkinson’s disease. The selection process and surgical procedures employed have, to date, not been standardized.MethodsA comprehensive 58-question web-based survey was developed with a focus on DBS referral practices and peri-operative management. The survey was distributed to the Parkinson’s Foundation Centers of Excellence, members of the International Parkinson’s Disease and Movement Disorders Society, and the Parkinson Study Group between December 2015 and May 2016.ResultsThere were 207 individual respondents drawn (...) from 59 countries and 6 continents, of whom 64% received formal training in DBS. Thirteen percent of centers reported that DBS could proceed despite a confidence level of < 50% for PD diagnosis. A case-based approach to DBS candidacy was applied in 51.3% of centers without a cut-off for levodopa-responsiveness. Surprisingly, 33% of centers regularly used imaging for diagnostic confirmation of idiopathic PD. Thirty-one percent of centers reported that neuropsychological evaluation did not affect DBS target selection. Approximately half of the respondents reported determination of DBS candidacy based on a multidisciplinary committee evaluation and 1/3rd reported that a committee was used for target selection. Eight percent of respondents felt that psychosocial factors should not impact DBS candidacy nor site selection. Involvement of allied health professionals in the preoperative process was sparse. There was high variability in preoperative education about DBS outcome expectations. Approximately half of the respondents did not utilize a “default brain target,” though STN was used more commonly than GPi. Specific DBS procedure techniques applied, as well as follow-up timelines, were highly variable.ConclusionResults revealed high variability on the best approaches for DBS candidate selection, brain target selection, procedure type, and postoperative practices. Cognitive and mood assessments were underutilized. There was low reliance on multidisciplinary teams or psychosocial factors to impact the decision-making process. There were small but significant differences in practice across global regions, especially regarding multidisciplinary teams. The wide variability of responses across multiple facets of DBS care highlights the need for prospective studies to inform evidence-based guidelines. (shrink)

The concept of freedom is one which Hegel thought of very great importance; indeed, he believed that it is the central concept in human history. ‘Mind is free’, he wrote, ‘and to actualise this, its essence – to achieve this excellence – is the endeavour of the worldmind in world-history’. Those who already have an interest in Hegel will doubtless be interested in his views on a topic which he thought so important; on the other hand, the many philosophers who (...) are either indifferent to or hostile to Hegel may point out that it does not follow that, because the subject of freedom interested Hegel, his views about this subject are of general interest. It will be the aim of this paper to show that they are of general interest; in the meantime, it may be recalled that Isaiah Berlin has argued that Hegel's concept of freedom is one of a type, called by him the concept of positive freedom, which is ‘at the heart of many of the nationalist, communist, authoritarian and totalitarian creeds of our day’. It will surely be worth while to see to what extent this is true of Hegel, and to what extent Hegel's views about freedom are true. (shrink)

Deep brain stimulation is a well-established therapy for the motor symptoms of Parkinson’s disease, but there remains an opportunity to improve symptom relief. The temporal pattern of stimulation is a new parameter to consider in DBS therapy, and we compared the effectiveness of Temporally Optimized Patterned Stimulation to standard DBS at reducing the motor symptoms of PD. Twenty-six subjects with DBS for PD received three different patterns of stimulation while on medication and using stimulation parameters optimized for standard DBS. Side (...) effects and motor symptoms were assessed after 30 min of stimulation with each pattern. Subjects experienced similar types of side effects with TOPS and standard DBS, and TOPS were well-tolerated by a majority of the subjects. On average, the most effective TOPS was as effective as standard DBS at reducing the motor symptoms of PD. In some subjects a TOPS pattern was the most effective pattern. Finally, the TOPS pattern with low average frequency was found to be as effective or more effective in about half the subjects while substantially reducing estimated stimulation energy use. TOPS DBS may provide a new programing option to improve DBS therapy for PD by improving symptom reduction and/or increasing energy efficiency. Optimizing stimulation parameters specifically for TOPS DBS may demonstrate further clinical benefit of TOPS DBS in treating the motor symptoms of Parkinson’s disease. (shrink)

This article integrates arguments and evidence from my 2019 monograph Heart to Heart: How Your Emotions Affect Other People. The central claim is that emotions operate as processes of relation alignment that produce convergence, complementarity, or conflict between two or more people’s orientations to objects. In some cases, relation alignment involves strategic presentation of emotional information for the purpose of regulating other people’s behaviour. In other cases, emotions consolidate from socially distributed reciprocal adjustments of cues, signals, and emerging actions without (...) any explicit registration or communication of emotional meaning by parties to the exchange. The relation-alignment approach provides a fresh perspective on issues relating to emotion’s interpersonal, intragroup, and organizational functions and clarifies how emotions are regulated for social purposes. (shrink)

Dieser Aufsatz betrifft Leibniz' Gedanken über Metaphysik in der Zeit von Dezember 1675 bis Dezember 1676, d. h. von den letzten Monaten seines Parisaufenthaltcs bis zum Beginn seines Aufenthaltes in Hannover. In dieser Zeit entwarf Leibniz Pläne für eine Abhandlung über Gott und die Welt und erwog die Möglichkeit, dieser Abhandlung eine deduktive Form zu geben. Der vorliegende Aufsatz entwickit und erläutert eine vermutete deduktive Version ¿ es metaphysischen Systems, die in den verstreuten Schriften dieser Periode entdeckt werden kann. Es (...) zeigt sieht, daß viel von Leibniz' reifer Philosophie bereits in diesem System enthalten ist. Jedoch findet sich kein Hinweis auf den dynamischen Charakter der Substanz und keine klare Formulierung der These, daß jeder Substanz ein vollständiger Begriff zukommt. Man findet vielleicht einige Andeutungen der späteren These, aber diese sind eher als Vorausdeutungen auf Leibniz' spätere Philosophie zu verstehen denn als konstitutive Teile des Systems von 1675/76. (shrink)

Neurodegenerative Parkinson's Disease (PD) is one of the common incurable diseases among the elderly. Clinical assessments are characterized as standardized means for PD diagnosis. However, relying on medical evaluation of a patient's status can be subjective to physicians' experience, making the assessment process susceptible to human errors. The use of ICT-based tools for capturing the status of patients with PD can provide more objective and quantitative metrics. In this vein, the Personalized Serious Game Suite (PGS) and intelligent Motor Assessment (...) Tests (iMAT), produced within the i-PROGNOSIS European project (www.i-prognosis.eu), are explored in the current study. More specifically, data from 27 patients with PD at Stage 1 (9) and Stage 3 (18) produced from their interaction with PGS/iMAT are analyzed. Five feature vector (FV) scenarios are set, including features from PGS or iMAT scores or their combination, after also taking into consideration the age of patients with PD. These FVs are fed into three machine learning classifiers, i.e., K-Nearest Neighbor (KNN), Support Vector Machines (SVM), and Random Forest (RF), to infer the stage of each patient with PD. A Leave-One-Out Cross-Validation (LOOCV) method is adopted for testing the classification performance. The experimental results show that a high (>90%) classification accuracy is achieved from both data sources (PGS/iMAT), justifying the effectiveness of PGS/iMAT to efficiently reflect the motor skill status of patients with PD and further potentiating PGS/iMAT enhancement with a machine learning a part to infer for the stage of patients with PD. Clearly, this integrated approach provides new opportunities for remote monitoring of the stage of patients with PD, contributing to a more efficient organization and set up of personalized interventions. (shrink)

This paper presents a new approach to the demarcation of social emotions, based on their dependence on social appraisals that are designed to assess events bearing on social concerns. Previous theoretical attempts to characterize social emotions are compared, and their inconsistencies highlighted. Evidence for the present formulation is derived from theory and research into links between appraisals and emotions. Emotions identified as social using our criteria are also shown to bring more consistent consequences for social behavior than nonsocial emotions. We (...) conclude by considering ways of validating and refining our classification. (shrink)

In April 1999, Dr. Curt Freed of the University of Colorado in Denver and Dr. Stanley Fahn of Columbia Presbyterian Center in New York presented the results of a four-year, $5.7 million government-financed study using tissue from aborted fetuses to treat Parkinson’s disease at a conference of the American Academy of Neurology. The results of the first government-financed, placebo-controlled clinical study using fetal tissue showed that the symptoms of some Parkinson’s patients had been relieved. This research study involved forty subjects, (...) nineteen women and twenty-one men; all suffered from Parkinson’s disease for an average of 13.5 years. In the study, each subject underwent neurosurgery: “four tiny burr holes, drilled through the wrinkle lines above the eyebrows into the skull, to clear a pathway to the brain. But only half received injections of fetal cells into the putamen, the region of the brain that controls movement; the other half received nothing. One year later, three members of the placebo group said their symptoms had improved.” In two-thirds of the transplant recipients, the fetal tissue took hold and seemed to establish a new network to produce the missing neurochemical dopamine. (shrink)

Schooling fish, swarms of starlings, plodding wildebeest, and musicians all display impressive synchronization. To what extent do they use acoustic cues to achieve these feats? Could the acoustic cues used in movement synchronization be relevant to the treatment of movement disorders such as Parkinson's disease in humans? In this article, we build on the emerging view in evolutionary biology that the ability to synchronize movement evolved long before language, in part due to acoustic advantages. We use this insight to (...) explore potential mechanisms that explain why music therapy has beneficial effects for PD patients. We hypothesize that rhythmic auditory cues, particularly music, can stimulate neuronal and behavioral processes that ease the symptoms and potentially the causes of PD because the neural circuits used in auditory entrainment at individual and group levels are associated with dopamine production. We summarize current treatment of PD and outline how new insights from an evolutionary perspective could improve understanding and eventual treatment of movement disorders in humans. (shrink)

Everyday ethics refers to those issues which have a sometimes unrecognized moral dimension and that arise regularly within healthcare and research. These issues are often contrasted to dramatic ethics issues (i.e. issues that have seemingly higher stakes such as those arising in acute care situations or with invasive or life-threatening interventions). Claims have been made that scholarly bioethics tends to focus on dramatic ethics to the detriment of everyday ethics discussions. However, empirical evidence showing this has been lacking. Our own (...) research investigating bioethics discussions in the Parkinson’s disease literature suggested this trend. Consequently, we decided to characterize the context and content of the Parkinson’s disease bioethics literature to empirically test the hypothesis that everyday ethics is under discussed. We conducted a broad literature search using the keywords “Parkinson’s disease” AND (“ethics” OR “bioethics”) and classified results inductively based on the context in which the bioethics discussion occurred. In line with our hypothesis and initial observations, we found that there is indeed a greater focus on dramatic ethics where topics such as deep brain stimulation and neuronal cell transplantations, dominated bioethics discussions. Given the potential utility of everyday ethics in improving healthcare and research, this mismatch in focus ought to be addressed. There is a clear need for further understanding and discussion of everyday ethical issues in scholarly bioethics. (shrink)

Parkinson, Joseph In September 2010, Western Australia's Legislative Council, the Upper House of that State's Parliament, voted down a Private Member's Bill to introduce voluntary euthanasia by a margin of 24 votes to 11. This article reviews the general context and content of the Bill and the public debate on euthanasia before offering more focused analysis.

Postural instability in Parkinson’s disease (PD) is characterized by impaired postural responses to transient perturbations, increased postural sway in stance and difficulty transitioning between tasks. In addition, some studies suggest that loss of dopamine in the basal ganglia due to PD results in difficulty using proprioceptive information for motor control. Here, we quantify the ability of subjects with PD and age-matched control subjects to use and re-weight sensory information for postural control during steady-state conditions of continuous rotations of the stance (...) surface or visual surround. We measure the postural sway of subjects in response to a pseudorandom, surface-tilt stimulus with eyes closed, and in response to a pseudorandom, visual-tilt stimulus. We use a feedback control model of the postural control system to interpret our results, focusing on sensory weighting as a function of stimulus amplitude. We find that subjects with PD can re-weight their dependence upon sensory information in response to changes in surface- or visual-stimulus amplitude. Specifically, subjects with PD behaved like age-matched control subjects by decreasing proprioceptive contribution to stance control with increasing surface-tilt amplitude, and decreasing visual contribution with increasing visual-tilt amplitude. However, subjects with PD do not decrease their reliance on proprioception as much as age-matched controls for small increases in surface-stimulus amplitudes. Levodopa medication did not affect sensory re-weighting behaviors for postural control. The impairment in PD subject’s ability to respond differently to small changes in surface rotation amplitudes is consistent with an increased threshold for perceiving proprioceptive signals, which may result from decreased signal-to-noise in the dopaminergic pathways associated with sensory processing and/or sensory integration. (shrink)

Implanted medical devices—for example, cardiac defibrillators, deep brain stimulators, and insulin pumps—offer users the possibility of regaining some control over an increasingly unruly body, the opportunity to become part “cyborg” in service of addressing pressing health needs. We recognize the value and effectiveness of such devices, but call attention to what may be less clear to potential users—that their vulnerabilities may not entirely disappear but instead shift. We explore the kinds of shifting vulnerabilities experienced by people with Parkinson’s disease (PD) (...) who receive therapeutic deep brain stimulators to help control their tremors and other symptoms of PD. (shrink)

Spinoza's Ethics is a classic philosophy text but it is also one of the most difficult to understand. This latest text in the Oxford Philosophical Texts series includes a new, lucid translation of Ethics in which Parkinson provides a comprehensive guide to the understanding of Spinoza's work. An extensive introduction includes a short biography of Spinoza himself; the form of his writing including his own particular uses of definitions; an introductory guide through the philosophy of Ethics; and a summary of (...) the contents of Ethics itself. Further aids include a glossary of terms, notes to the text, and notes to the translation. (shrink)

Why are some patients with Parkinson's disease unhappy about the outcome of deep brain stimulation (DBS)? Meccaci and Haselager (2014) attempt to answer this question by analyzing the seminal case...

Parkinson, Joseph Long after its publication in 1968, Pope Paul VI's encyclical letter on birth control Humanae Vitae continues to provoke great interest among Catholic bishops, clergy and faithful alike. At the time of its promulgation and in the years since, many Catholic couples struggled with the teaching contained in the document. Some couples apparently managed to adapt seamlessly to the continuing prohibition on contraception, but others encountered and continue to encounter major difficulties in receiving and living the teaching. Birth (...) control may no longer be an issue for that first generation of couples, yet many of them still view Humanae Vitae as a watershed in their journey in Catholic faith. (shrink)

Parkinson, Joseph Can a dead person conceive a child? Even if it is technically possible, should it be permitted? The legal system seems to have reached a position on this matter without obvious ethical reflection. Noting that a child should be able to know and relate to his or her parents, this article argues that a person's capacity to contribute to the conception of new life should cease with that person's death.