Parkinson's Movement
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PIGD real or unreal?

Here are contrasting opinions. I side with the "PIGD is real" concept, even if PIGD and tremor-dominant are nodes in a spectrum.

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pmc/articl...

Early after my dx in late 2011 I could walk for miles, do errands in morning and afternoon. All on 3 of 1/2 of 25\100 c\l. Yet even during that time I would lose balance while standing and conversing. I think I've had postural instability from my first awareness of having PD. Little tremor then, only slightly more now.

However, in recent weeks: more drooling, lower lip droops, postural instability has increased dramatically, and I've begun to experience FOG.

Cholinergic herbs help (Bacopa, Ashwagandha, Gingko), but their effect on PIGD/FOG only seems to last ~2 hours, then off time sets in rapidly.

See also:

mdsabstracts.org/abstract/l...

bebrainfit.com/acetylcholin...

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"The study showed that another type of intestinal bacteria ― Enterobacteriaceae ― was linked to the severity of postural instability and gait difficulty (PIGD). These bacteria were significantly more abundant in patients with a PIGD phenotype than in patients with tremor dominant (TD) phenotype."

medscape.com/viewarticle/84...

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Silvestrov,

Thanks for the link. The article also states:

The study showed that another type of intestinal bacteria ― Enterobacteriaceae ― was linked to the severity of postural instability and gait difficulty (PIGD). These bacteria were significantly more abundant in patients with a PIGD phenotype than in patients with tremor dominant (TD) phenotype.

There is a wide variation in clinical manifestations in PD patients ― with some having mostly tremor, and others, rigidity ― and the question is whether these phenotypes represent the same disease. Itis possible, said Dr Scheperjans, that different PD subtypes are linked to different bacteria.

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See also:

Cholinesterase inhibitors from botanicals.

Pharmacogn Rev 2013 Jul-Dec; 7(14): 121–130.

ncbi.nlm.nih.gov/pmc/articl...

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See also:

Clinical Markers for Identifying Cholinergic Deficits in Parkinson's Disease.

Mov Disord 2015 Feb; 30(2): 269–273.

ncbi.nlm.nih.gov/pmc/articl...

There were 49 (35.8%) hypocholinergic PD subjects. The combination of RBD symptoms and fall history showed highest diagnostic accuracy (81.1%) for predicting combined thalamic and cortical cholinergic deficits. A combined assessment of 8.5 meter walk time and lower score on the Montreal cognitive assessment scale provided diagnostic accuracy of 80.7 % for predicting isolated cortical cholinergic denervation.

Heterogeneity of cholinergic denervation in Parkinson's disease without dementia.

J Cereb Blood Flow Metab 2012 Aug; 32(8): 1609–1617.

ncbi.nlm.nih.gov/pmc/articl...

Cholinergic denervation is heterogeneous with reduced neocortical and/or thalamic acetylcholinesterase activity in 36% of nondemented PD subjects with corresponding clinical phenotypic variation. Results also show independent cognitive effects for both cholinergic and dopaminergic system changes in nondemented PD subjects.

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See:

Functional connectivity alterations in the motor and fronto-parietal network relate to behavioral heterogeneity in Parkinson's disease.

March 2016 Volume 24, Pages 48–55.

prd-journal.com/article/S13...

This multilevel analysis showed differential connectivity alterations in large scale neural networks and between motor and cognitive control areas that related to behavioral heterogeneity in PD, underscoring the classic TD-PIGD phenotypical classification.

[subtypes].

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