Talk:Parkinson's disease/Archive 7

Citation needed tag/TFA
I'd like to rerun this article as a main page TFA some time in August, but there is currently a "citation needed" tag. Would someone be able to address it? I've left a note at WT:MED too. Thanks. Mike Christie (talk - contribs - library) 21:15, 15 July 2017 (UTC)

Content
"with dopamine agonists being used once levodopa becomes less effective. As the disease progresses and neurons continue to be lost, these medications become less effective while at the same time they produce a complication marked by involuntary writhing movements. "

Is based on a 2016 review article? Ref says


 * "Levodopa, a prodrug to dopamine, is standard and the most common initial therapy for patients. Early on, response is usually good. With disease progression and less capacity of the system to store dopamine, the majority of patients experience shorter duration of response to individual doses (wearing-off symptoms), alternative phases with good and poor response to medication (on-off symptoms), involuntary movements of the head, trunk or limbs (dyskinesias) and other motor complications. Other dopaminergic medications are used to manage these fluctuations."

So not sure the issue?

Doc James (talk · contribs · email) 21:12, 1 August 2017 (UTC)


 * Well,, I can see some of the problems. But my view is that the passage is not so terribly wrong that it needs to be removed immediately -- better to remove it when something superior is available as a replacement. Looie496 (talk) 17:38, 2 August 2017 (UTC)
 * Happy to see the wording improved. Doc James  (talk · contribs · email) 04:35, 3 August 2017 (UTC)

Genetics
In fixing a recent "clarification", I decided to remove a sentence about PD traditionally not being thought of as genetic. The situation is actually more complex. Traditionally PD was classified as "idiopathic", a term that basically means "self-caused", which is a sort of one-word oxymoron. In practice the term was understood to mean something like "we don't know what causes it but it isn't some simple factor like a pathogen or brain insult". I feel that in an article like this we should try to avoid getting bogged down in that sort of stuff. Looie496 (talk) 14:14, 3 August 2017 (UTC)

Neuropsychiatric signs and symptoms
Coverage of this may be somewhat out of date. In the last few years, the term "Parkinson's disease psychosis" has come into use. (Should it have its own article?) Also within the last two years, a new drug has been released that seems to be very good at dealing with the neuropsychiatric symptoms. See HERE. Lou Sander (talk) 13:23, 4 August 2017 (UTC)
 * And https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5352252/ is a MEDRS-level review of the topic. Looie496 (talk) 14:18, 4 August 2017 (UTC)
 * Yep. I've noticed that. I'll get to it eventually, if no one does before me. (And yes, I think it deserves an article.) --Anthonyhcole (talk · contribs · email) 15:46, 4 August 2017 (UTC)

Diagnosis via medical dogs.
I have an lay interest in dementia research and observed a former colleague during his final years. I note Manchester university is developing a plausible scheme for early detection using dogs. I hesitate to add to a wp:FA from a non medical source without consensus. Could I have views re inclusion under diagnosis please? Of course, there may be a better source. Regards JRPG (talk) 10:58, 30 September 2017 (UTC)
 * Will need a high quality source. Doc James  (talk · contribs · email) 03:07, 4 October 2017 (UTC)

External links modified
Hello fellow Wikipedians,

I have just modified one external link on Parkinson's disease. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:
 * Added archive https://web.archive.org/web/20081220041909/http://www.pdgene.org/ to http://www.pdgene.org/

When you have finished reviewing my changes, you may follow the instructions on the template below to fix any issues with the URLs.

Cheers.— InternetArchiveBot  (Report bug) 20:44, 13 October 2017 (UTC)

Semi-protected edit request on 23 December 2017
Put under section treatment/or prevention that methylphenidate may provide protection from the disease reference can be found at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2701286/ Chris140890 (talk) 03:56, 23 December 2017 (UTC)

Sorry the correct link is that suggests methylphenidate may protect from the disease: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2701286/ Chris140890 (talk) 04:02, 23 December 2017 (UTC)


 * Red question icon with gradient background.svg Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format. dross [talk] 04:21, 23 December 2017 (UTC)

Popular press is not suitable
Moved here

"===Joy Milne===

It is claimed that Joy Milne from Perth, Scotland is able to detect the disease by smell, with 100% accuracy. Scientists at Glasgow and Manchester universities hope to identify the molecular signature which is likely to be associated with changes in skin structure, and thereby develop a diagnostic test. " Doc James  (talk · contribs · email) 23:44, 14 January 2018 (UTC)

Introduction
I was just trying to make some adjustments to the Parkinson's disease article.

1. Par. 1, line 2: “slowly over time”. How long? Isn’t “slowly” and “over time” the same thing?

2. Par. 2, line 5: “coffee or tea”. The point is caffeine, not limited to coffee or tea. It even says “caffeine” later in the article.

3. Par. 4, line 7: “Public awareness” should start a new paragraph.

Aryehmann (talk) 15:30, 5 February 2018 (UTC)

External links modified
Hello fellow Wikipedians,

I have just modified one external link on Parkinson's disease. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:
 * Added archive https://web.archive.org/web/20110515204903/http://www.pdf.org/en/about_pdf to http://www.pdf.org/en/about_pdf

When you have finished reviewing my changes, you may follow the instructions on the template below to fix any issues with the URLs.

Cheers.— InternetArchiveBot  (Report bug) 22:49, 7 November 2017 (UTC)

adding more information in rehabilitation section.
I wanted add some information on the "rehabilitation" section in the Parkinson's disease article, but the editing is locked.

In addition to the effect of the supervision of a physiotherapist, "mind-body intervention focusing on mind, body, social, spiritual, and behavior factors, such as Tai Chi, yoga and dance, improve motor symptoms, postural instability and functional mobility among individuals with mild to moderate Parkinson's disease. In terms of psychological benefits by practicing mind-body exercises, there is some evidence suggesting the benefits of cognitive interventions. However, the the beneficial effect on patients with PD remain inconclusive due to a lack of high level studies".

Kwok JYY, Chow CK, Yue Lai CH. Effects of mind-body exercises on the physiological and psychosocial well-being of individuals with parkinson's disease: A systematic review and meta-analysis. Complement Ther Med. 2016;29:121-131. https://search-proquest-com.lb-proxy8.touro.edu/docview/1846847890?accountid=14375. doi: http://dx.doi.org.lb-proxy8.touro.edu/10.1016/j.ctim.2016.09.016. — Preceding unsigned comment added by Ldonggue (talk • contribs) 15:39, 5 February 2018 (UTC)
 * Please look at the URL and the doi you are suggesting we use. Do you see how it says "touro.edu" in each of them? That means that nobody else outside of Touro can use either of those links.
 * About the proposed content (which i guess in the quotes? The quote is not from the source...) this is a difficult kind of source. It is a journal focused on this kind of thing and the authors conclusions ignore the issues they themselves note with the studies they are analyzing (e.g "The overall methodological rating indicated one study as strong, five studies as moderate, and four studies as weak....No study was double blind.")  This is the kind of ref I find sometimes and then leave behind to look for better ones.  If you take the last sentence of what you wrote seriously "the beneficial effect on patients with PD remain inconclusive due to a lack of high level studies" then you cannot make the definitive, un-nuanced statement that you made, where you said that the interventions "improve" the condition. (indicative mood, signifying that this is indeed a fact).  If it is indeed "inconclusive", then you cannot also say these interventions "improve" the condition. Jytdog (talk) 22:17, 5 February 2018 (UTC)

Management > Rehabilitation
The article is locked so I can't edit, but I think the first sentence in "Management > Rehabilitation" should be replaced with: “Despite medical therapies, surgical interventions and drugs for Parkinson's disease, patients tend to progressively lose their abilities. Accordingly, the role of physiotherapy is to maximize functional ability and minimize secondary complications through movement rehabilitation within a context of education and support for the whole person. The overall objective is to optimize safety, wellbeing, and independence, thus enhancing the patient’s quality of life.”

Citation

Clarke C, Deane K, Herd C, Ives N, Meek C, Patel S, Sackley C, Shah L, Stowe R, Tomlinson C, Wheatley K; Physiotherapy for Parkinson's disease: a comparison of techniques; Cochrane Movement Disorders Group; 14 June 2014; Par. 1

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002815.pub2/full

Aryehmann (talk) 15:06, 5 February 2018 (UTC)
 * Thanks for posting this suggestion and for helping to improve the Wikipedia article. Here are a few small comments:


 * Try to include a citation after every sentence for medical articles, even if that means you use the same citation a few times in a paragraph
 * We try to refer to "people" rather than "patient's" in Wikipedia articles
 * Insert the reference using the PMID citation tool e.g:
 * I am a fan of adding comma after surgical interventions, but that may be a personal thing ;)
 * If there is anything else that I can help with, please let me know.
 * user:JenOttawa 23:59, 5 February 2018 (UTC)

A few small problems with the article - potential for adjustments
In the introduction: 1. Par. 4, line 3: “Males affected more than females.” How much more?

2. Par. 3: “As the disease….writhing movements.” The L-DOPA causes the writhing movements. So it really worth taking them? In the long run, it seems to make things worse.

In rehabilitation: 1. Par. 1, line 2: Why is the evidence for which exercises are more effective so inconclusive? Why are the studies scarce and of low quality? Why don’t they do something about it to make the research more reliable?

2. What is the relationship between smoking and Parkinson’s disease in regard to smoking intensity and long-term smoking? Smoking how many pack-years helps protect against PD? Is the graph linear for both intense smoking (e.g. three packs a day for a year) and long-term smoking (e.g. one pack a day for three years)?

Aryehmann (talk) 15:52, 5 February 2018 (UTC)
 * The answer to question 1 was in the source and I have added it. About question 2, see the L-Dopa artile for more on the risk/benefit; in general this is more of a Help:reference desk question. Likewise the two questions about rehab are reference desk questions.Jytdog (talk) 18:34, 5 February 2018 (UTC)

Edit Request
Under the Rehab section of the wiki page, I would like to add this part in based on a systematic review: "In recent years, virtual reality (VR) technology has been used as a promising new rehabilitation tool, to treat people with Parkinson's disease. Virtual reality technology includes commercial items such as the X-box Kinect, Nintendo Wii, and customized VR tools specifically for this population. It has been shown to be a safe and effective way to improve motor control. Based on recent findings, VR has been shown to be as effective as more conventional physical therapy interventions. There is evidence suggesting that VR can lead to improvements in gait, balance, activities of daily living, quality of life, and cognitive function. Currently, the quality of evidence is limited due to only a handful of studies done on this topic. Therefore, further studies need to be done to strength the evidence for the use of VR in patients with Parkinson's disease."

Dockx K, Bekkers EMJ, Van den Bergh V, Ginis P, Rochester L, Hausdorff JM, Mirelman A, Nieuwboer A. Virtual reality for rehabilitation in Parkinson’s disease. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD010760. DOI: 10.1002/14651858.CD010760.pub2.

--Vpatel72395 (talk) 16:39, 5 February 2018 (UTC)
 * Nothing is "recent" in Wikipeda. See WP:RELTIME. Please always keep this in mind. Also since evidence is limited you are suggesting to give way too much WEIGHT, and claims that are too definitive, to this. Jytdog (talk) 18:28, 5 February 2018 (UTC)

Parkinsonism
I added a wikilink to the article's mention of Parkinsonism. There is a whole small article there, which seems to me to be better stated than the material in this article. Maybe some medical editor could make the two article work together better. Lou Sander (talk) 20:00, 5 February 2018 (UTC)

Differential
I have now worked in Parkinson's disease dementia; why is there no differential diagnosis section? An FA should not have things mentioned in the infobox that are not covered in the article. The overlap with Dementia with Lewy bodies is not covered in differential. Sandy Georgia (Talk)  21:41, 23 April 2018 (UTC)

Cocaine abuse and Parkinson's disease
Hardly new...and not mentioned in this article -- at all -- because...?

https://www.eurekalert.org/pub_releases/2005-12/sjcr-elc121205.php

https://lagunatreatment.com/co-occurring-disorder/parkinsons-syndrome/

https://www.sciencemag.org/news/2001/11/could-cocaine-cause-parkinsons-disease — Preceding unsigned comment added by 67.48.200.162 (talk) 16:54, 3 November 2018 (UTC)

New data and graphics for the Epidemiology section
The two yellow-orange global map graphics belong in the Epidemiology section, but one is in the Prognosis section, I guess to spread the graphics around the article. The data for these come from the WHO in 2004 and 2012 respectively.

This open-access article from 2018-10-01 has more detailed information and a colored global map:

Global, regional, and national burden of Parkinson's disease, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30295-3/fulltext

Perhaps the copyright of the Lancet article would enable its map and other charts to used in this WP article. The Lancet map shows prevalence, rather than disability-adjusted life years per 100,000 inhabitants or deaths per million. In order for this Lancet map to be used is a sidebar graphic, I think it would need to be edited to remove all the little sections at the bottom, and to provide a separate color scale which is as readable in the small initial size of the graphic as are those of the current maps.

Alternatively, someone might create a new map along the lines of the current ones, with the new data. But that would involve choosing a map to start with while negotiating the objections to the Robinson projection map mentioned at https://commons.wikimedia.org/wiki/File_talk:BlankMap-World6.svg#Notice. I think any map which is reasonably compact and viewable in a sidebar graphic is not going to meet all the criteria for suitability mentioned there.

Figure 4 of the Lancet article is perhaps more informative than the global maps, since it shows a strong positive correlation between PD prevalence and socio-demographic index. This is "age-standardised" so I think it does not reflect increased incidence with longer average lifespans. Other factors must be significant, since the USA and Canada especially have much higher levels than European countries.

I plan to cite this Lancet article in the Epidemiology section once I have read it and found a few sentences to quote or paraphrase.

The epidemiology of PD is a heavily researched field. Perhaps it would best be covered by its own WP article. Robin Whittle (talk) 00:20, 8 November 2018 (UTC)

Major, missing section on PD subtypes
Dear approved editors, I believe the Wikipedia page for Parkinson's disease (PD) is missing a critical section on PD subtypes. PD subtypes are now well-recognized and have important implications for diagnosis and prognosis. Due to the complex constellation of symptoms, PD is a highly heterogeneous disease. For instance, some patients do not even experience tremor. While the most established subtypes are tremor dominant (TD) and postural instability and gait disorder dominant (PIGD) (e.g., ref: https://www.ncbi.nlm.nih.gov/pubmed/28754232), there is an ongoing investigation into other subtypes that are not yet widely used (e.g., ref: https://jnnp.bmj.com/content/early/2018/07/25/jnnp-2018-318337). Wikibluejay (talk) 19:47, 12 November 2018 (UTC)
 * Those are primary sources; we build content from secondary sources (see WP:MEDDEF) Jytdog (talk) 00:25, 22 October 2018 (UTC)
 * There are numerous secondary sources. You can take your pick (e.g., https://www.ncbi.nlm.nih.gov/pubmed/24514863). Nonetheless, this is a critical section that is missing. Happy to help add it in if it's not going to be immediately deleted :) Wikibluejay (talk) 19:47, 12 November 2018 (UTC)
 * This is an interesting sort of thing. There is wide agreement in the field, that PD is heterogeneous.  We could definitely have discussion in the Research section, about efforts to identify and validate subtypes.  The question is what should go into the classification section (in other words, what are actual, clinically-used classifications?) that we should then follow down through the article (describing differing symptoms, diagnosis, and management of the differing sub-types)...  What classifications are "accepted knowledge" in clinical practice and the literature?  Really good sources for this would be clinical guidelines; if subtypes are not there, it will be hard to argue that they are actually "accepted knowledge" clinically.... Do you see what I am saying?  Jytdog (talk) 20:31, 12 November 2018 (UTC)

Semi-protected edit request on 29 November 2018
Mutations in the LRRK2 gene is the main factor in contributing to the genetic development of Parkinson's disease, and over 100 mutations in this gene have been shown to increase the chance of PD development. These mutations are most commonly seen in Jewish, North African Arab Berber, Chinese, and Japanese populations. 24.126.91.113 (talk) 03:53, 29 November 2018 (UTC)


 * ❌ Please provide a reliable medical source for this change. --Izno (talk) 18:53, 1 December 2018 (UTC)

prevention by undoing/replacing, not adding to
Prevention should focus on thoughtfully changing practices that initiate/inflame biological disturbances. Prevention should not focus on adding to thoughtless practices. The life force has produced a beautiful order on this planet. Let us support that process with 100% positivity in thought/action. Rtdrury (talk) 14:32, 1 December 2018 (UTC)
 * Please do not use Wikipedia as a forum. --Izno (talk) 00:36, 3 December 2018 (UTC)

Prevalence in History
For the History section, PD May have been far less prevalent in the past. https://content.iospress.com/download/journal-of-parkinsons-disease/jpd181474?id=journal-of-parkinsons-disease%2Fjpd181474 — Preceding unsigned comment added by FeasibleAlternative (talk • contribs) 01:11, 26 December 2018 (UTC)

Signs and Symptoms : Motor
Those with advanced progression are often bothered greatly by Dystonia and cramping, particularly of the feet. They can also have freezing episodes while lying down.FeasibleAlternative (talk) 13:03, 26 December 2018 (UTC)

After diagnosis, people often become aware had they had PD symptoms for many years prior to diagnosis. Those early symptoms can include, for example, reduced arm swing, facial masking, loss of the sense of thirst, sensitivity to heat, and impaired handwriting.FeasibleAlternative (talk) 13:43, 26 December 2018 (UTC)

Society and Culture : Notable Cases
Perhaps add the following names: Linda Ronstadt, Neil Diamond, Alan Alda, Janet Reno, and others.FeasibleAlternative (talk) 13:49, 26 December 2018 (UTC)

Incorrect Life Expectancy
The InfoBox says “Prognosis: Life expectancy - 10 years”. The introduction says “The average life expectancy following diagnosis is between 7 and 14 years”. This life expectancy information appears to be incorrect based on other sources and common knowledge. FeasibleAlternative (talk) 19:08, 25 December 2018 (UTC)
 * Please write a draft revision and cite it with a WP:MEDRS review for evaluation here by other editors. --Zefr (talk) 19:33, 25 December 2018 (UTC)
 * Also it should mention whether or not it is age ajusted, so the reader understands the real net reduction in LE (since people are diagnozed later in life).Limit-theorem (talk) 19:39, 25 December 2018 (UTC)

I prefer not to write the draft revision due to a lack of research and Wikipedia experience. Here are two possible sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095626/ http://n.neurology.org/content/early/2018/10/31/WNL.0000000000006560 FeasibleAlternative (talk) 22:27, 25 December 2018 (UTC)

Here’s another possible source: http://jamanetwork.com/journals/jamaneurology/fullarticle/2625134 FeasibleAlternative (talk) 15:13, 30 December 2018 (UTC)

Lewy Bodies not always present
The Pathophysiology section and other sections mention Lewy bodies as a characteristic of PD. Research indicates that Lewy Bodies are not present in all cases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3739929/ — Preceding unsigned comment added by FeasibleAlternative (talk • contribs) 01:00, 26 December 2018 (UTC)

Here are two more possible sources: https://www.hindawi.com/journals/crinm/2018/6838965/ http://n.neurology.org/content/early/2016/05/04/WNL.0000000000002744 FeasibleAlternative (talk) 15:31, 30 December 2018 (UTC)

Page Illustration
While the illustration in the InfoBox is historically significant, it is exaggerated and objectionable. Most PWP don’t have a stooped posture or one that pronounced. And most don’t have wrinkles that pronounced.FeasibleAlternative (talk) 16:00, 30 December 2018 (UTC)

Telemedicine in Parkinson's Disease
There is a growing evidence base for the use of telemedicine in the management of Parkinson's Disease. Studies have suggested that telemedicine can improve quality of life, cost-effectiveness, and access to care.

--Cancorbinhall (talk) 18:22, 17 January 2019 (UTC)

]] t • c 10:30, 27 August 2020 (UTC)

Addition to differential diagnosis section
Stiff Person Syndrome should be added as a condition that can have similar presentation to PD. The SPS Wikipedia page notes that Parkinson’s has similar symptoms to SPS (“A variety of conditions have similar symptoms to SPS, including myelopathies, dystonias, spinocerebellar degenerations, primary lateral sclerosis, neuromyotonia, and some psychogenic disorders.[2] Tetanus, neuroleptic malignant syndrome, malignant hyperpyrexia, chronic spinal interneuronitis, serotonin syndrome,[30] Multiple sclerosis, Parkinson's disease,[22] and Isaacs syndrome should also be excluded.[30]“)

Since GAD antibodies are found in 80% of SPS patients, it’s not likely that people with SPS would be misdiagnosed with Parkinson’s, but as SPS is a very rare disease, it would be more likely (“more likely” in the context of it being rare) that someone with SPS could be misdiagnosed as having Parkinson’s. It’s easy enough for someone to rule it out, but for the one in a million person looking on the Parkinson’s page because their symptoms “don’t quite fit” it could save a life. (I know someone with SPS who was originally diagnosed for several years with early onset Parkinson’s. This also seems like one of the common early misdiagnoses in the SPS circles.)

Thank you! — Preceding unsigned comment added by Nicollel (talk • contribs) 20:37, 27 August 2020 (UTC)

Animal models
I'm very new, so please explain if I'm making a mistake with this. Would it be possible for someone who can to link the orphaned article Animal models of Parkinson's disease? Ideally under section 12.1 "animal models". Thanks! Xurizuri (talk) 13:08, 18 December 2020 (UTC)

UCF WIKIPMEDS 2021 BLOCK 8
Hello, I am a fourth year medical student working on improvement of wikipedia articles for the next four weeks and I believe that I can help make this article better. My plan for the month is below:

Lead -Information already seems good, will just fix grammar and add clarity

Classification - Increase the section for subtypes of PD per the Update Needed. The classification section also has a lot of jargon that I believe can be cleaned up to be easier understood. - Classification includes many symptoms which is repeated in the section below. I would like to redo this in order to expand on different parkinsonisms.

Signs and Symptoms - Split the Neuropsychiatry section into neurologic (cognitive dysfunction, dementia) and psychiatric (associated depression, ocd) in order to give more room for explanation into both sections

Causes - Discuss genes found in familial parkinson's as well as differentiate which ones are AD and AR

Pathophysiology - Clean up jargon - Include images to better explain concepts

Diagnosis - Include exclusion criteria from queens brain bank and MDS

Management - Currently requested PUBMED article to update medications as necessary - Will do further research into most recent guidelines and change sections accordingly

--Jbobet830 (talk) 15:28, 5 January 2021 (UTC)
 * , awesome, it's always great to get subject matter experts. Welcome to Wikipedia! – Novem Linguae (talk) 00:55, 7 January 2021 (UTC)

Classification
This is my first edit. I worked on the classification section to make it allow it to differentiate idiopathic parkinsonism to secondary, vascular, parkinson's plus. If this is not up to WikiProject Medicine's standards than I am sorry and would love constructive criticism. — Preceding unsigned comment added by Jbobet830 (talk • contribs) 20:56, 5 January 2021 (UTC)

COMT Inhibitors
Added more sources and information. Please let me know if anything can be improved. — Preceding unsigned comment added by Jbobet830 (talk • contribs) 00:37, 7 January 2021 (UTC)

Patients
User:Jbobet830, thanks for your recent work on this article. While you're editing anyway, could you see about replacing the word "patients" with "people", at least most of the time? It's one of Wikipedia's stylistic quirks. WhatamIdoing (talk) 01:44, 9 January 2021 (UTC)

Sounds like a plan! Jbobet830 (talk) 01:51, 12 January 2021 (UTC)

LRP10
Hello everyone, for the genetics section, does anyone have any review articles that mention this gene. I have plenty of primary source material and added a fresh source to the citation but I wanted to reach out.
 * Thanks for all the high quality writing you are doing here. If possible, the primary sources should be replaced by secondary sources as per WP:MEDRS. I am not in this field, but I do see that the primary study on LRP10 is cited in this review article: https://link.springer.com/article/10.1007/s13760-020-01473-5 . I looked at the full text of this review and LRP10 is listed under a section called "Controversial genes linked to typical Parkinson’s disease" in a list that includes: TMEM230, LRP10, NUS1 and ARSA. I think that the primary study should be removed in the case. How do you feel? This review article cites the same primary sources that are presenting in the WP article. I see Wikipedia's article presently reads: An autosomal dominant form has been associated with mutations in the LRP10 gene.

JenOttawa (talk) 02:25, 27 January 2021 (UTC)

UCF College of Medicine WikiProject Peer Review
Lead: Great lead! So much great information and it really hits on the most important aspects of the disease. My only suggestion is moving the last paragraph to the history section as what is written is interesting but extra information.

Classification: Also, a well written section that provides the highlights.

Signs and Symptoms: Great section, it is very thorough. I’m really glad that you included the mood manifestations of this disease as it plays a great part in the quality of life for these patients. Depression and other psychiatric and behavioral symptoms should be recognized. I thought this was a great section. My only other thought is to add the masked facial expression (hypomimia), speech impairment and dysphagia that these patients eventually suffer from as well as part of the motor difficulties they encounter. Also they have a decrease in their blinking rate which is something that can be assessed during physical exam.

Causes: Glad that environmental factors as well as drug-induced parkinsonism are included as the symptoms can be reversible by stopping these drugs and eliminating the exposure. Great job on including the genes associated with PD. This disease is multifactorial and an area of exciting research.

Pathophysiology: Very well-written section with great resources.

Diagnosis: The differential diagnosis for PD is extensive and it is important for the public to recognize that and be educated about this fact. In the differential diagnosis section there is a link for all of them except two. Maybe write a line or two about what these are (obsessional slowness and psychogenic parkinsonism).

Prevention: I like the section on prevention. It is very educational as it explains what theories have been proposed and also whether or not they have been supported by the research.

Management: Very detailed and well organized. It also explains the mechanism of how and why the medication has its effect.

Summary: I think this is a great article, it is well-written and informative. From a reader’s perspective, the article is easy to read and understand even though there is a lot of information. PD is a very important and pertinent topic so there is a lot of information to cover. Gonzalezmabit (talk) 16:38, 26 January 2021 (UTC)
 * New posts typically go at the bottom of talk pages, so I've moved yours. I hope you don't mind! Thanks for taking a look through this article! Best, Ajpolino (talk) 22:31, 26 January 2021 (UTC)

new user needs some help
Hey im new, im trying to add some details, can you give me some help — Preceding unsigned comment added by Sschrank (talk • contribs) 20:12, 9 March 2021 (UTC)
 * see User talk:Sschrank. Your professor should get in touch with wiki ed program staff. Sandy Georgia  (Talk)  20:45, 9 March 2021 (UTC)

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 4 January 2021 and 29 January 2021. Further details are available on the course page. Student editor(s): Jbobet830. Peer reviewers: Gonzalezmabit.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 06:09, 17 January 2022 (UTC)

Body scent
you have twice added this WP:UNDUE text; please discuss. Sandy Georgia (Talk)  23:58, 17 April 2021 (UTC)


 * Please explain how it fails WP:UNDUE. Research published in Nature Communications and ACS Central Science as noted in citations given. Anyway this information has been public knowledge for years. Facts707 (talk) 00:03, 18 April 2021 (UTC)


 * If it has been public knowledge for year, then a broad secondary review of Parkinson’s will cover it. The amount of detail you have been adding is UNDUE, and please locate a WP:MEDDATE compliant secondary review that addresses the matter. Sandy Georgia (Talk)  00:07, 18 April 2021 (UTC)

I agree with SandyGeorgia. WP:PRIMARY studies do not meet WP:MEDRS and should not be included in this article. We need secondary sources such as review articles for medical citations. My preliminary search is not finding review articles that cover this topic, although feel free to check yourself using different search terms. – Novem Linguae (talk) 03:59, 18 April 2021 (UTC)

RFC: Lots of old references here, contradicting MEDDATE
Many of the citations here are quite old (1988, 2000, 2005, etc.) articles, in apparent contradiction of WP:MEDDATE, particularly those on diagnosis and treatment. I tagged some of the worst sections after an editor pointed out the policy, but then another editor reverted. Am I misinterpreting something here? Cheers, Facts707 (talk) 04:03, 18 April 2021 (UTC)
 * Comment. Hello friend. I'm the one that reverted, sorry for any inconvenience that caused. From what I've seen in other medical articles, I'd say the review article requirement of MEDRS is pretty important, but the MEDDATE part is not applied as often and there is more flexibility there. If the MEDDATE issues really bother you, perhaps one tag for the entire article would be appropriate. One reason I reverted is that 7 MEDDATE cleanup tags were added. – Novem Linguae (talk) 04:34, 18 April 2021 (UTC)
 * Reply. Thanks for the info. I didn't want to tag the whole article because many sections appear well referenced with recent citations. Some are not though, particularly important ones such as Parkinson's disease, Parkinson's disease and Parkinson's disease. If I were a Parkinson's patient or loved one of same, I think I would like to have an idea if the info I'm seeing is 15-20 years old. A bit frustating because I like to leave each article a little better than when I read it, but that's not happening here. Cheers, Facts707 (talk) 05:13, 18 April 2021 (UTC)
 * By the way, I apologize for quoting WP:POINT in my edit summary. From your great attitude in your responses, I misjudged you, and I apologize. I of course have no problem with the 7 tags being added back assuming there is consensus for it in this RFC. Happy editing my friend. – Novem Linguae (talk) 05:35, 18 April 2021 (UTC)
 * Thanks for the kind words - no problem, I can seen how that could be mistaken. I edit a lot of pages and am occasionally reverted for one reason or other - here twice, which is most unusual. Cheers, Facts707 (talk) 19:06, 19 April 2021 (UTC)

Why are you starting an RFC when Featured article review/Parkinson's disease/archive1 was just done? Have you read it? And the “Update needed” section at the top of the page, which lists newer secondary reviews that have not been incorporated? RE your edits, tagbombing an article for MEDDATE is incorrect because in some cases a seminal finding or paper will be an old one. And it is unnecessary to tag every section when the entire article is outdated. Please be familiar with the article talk page and article milestones. Also, please read WP:OTHERSTUFFEXISTS; because the article is dated does not make it OK to add other faulty content and sources. If the tagbombing was not POINTY (as retracted by Novem Linguae) this RFC is; it asks no question that the community needs to resolve, and you could have asked the same question on talk without the RFC. Discussion is the first step in dispute resolution. Sandy Georgia (Talk)  13:18, 18 April 2021 (UTC)
 * Reply. You bring up several points here which I will address in a list:
 * I added an RFC because a third editor reverted my UPDATE tags based on MEDDATE, which you had pointed out to me in your reversion of an edit I made mentioning an article on the scent of Parkinson's published in ACS and Nature journals. When I encounter differing opinions of other editors on a narrow topic I like to get more opinions.
 * You say "Featured article review/Parkinson's disease/archive1 was just done? Have you read it?", but that was done in October 2020. I'm not a regular editor of this page and it is unlikely I would browse its archives to see if it is not being updated regularly.
 * You go on to say 'And the “Update needed” section at the top of the page, which lists newer secondary reviews that have not been incorporated?' But that edit was added by you after I had finished all my edits including the 'update' tags, so no, I didn't see it.
 * You say "RE your edits, tagbombing an article for MEDDATE is incorrect..." - Firstly "tagbombing" is a rather judgemental term in the circumstances.
 * You go on to say "...because in some cases a seminal finding or paper will be an old one.  And it is unnecessary to tag every section when the entire article is outdated.  Please be familiar with the article talk page and article milestones." - As I said to the editor above who reverted, which you might have seen when you posted below it: "Thanks for the info. I didn't want to tag the whole article because many sections appear well referenced with recent citations. Some are not though, particularly important ones such as Parkinson's disease, Parkinson's disease and Parkinson's disease. If I were a Parkinson's patient or loved one of same, I think I would like to have an idea if the info I'm seeing is 15-20 years old. A bit frustating because I like to leave each article a little better than when I read it, but that's not happening here..."
 * You then say "Also, please read WP:OTHERSTUFFEXISTS; because the article is dated does not make it OK to add other faulty content and sources." - I read WP:OTHERSTUFFEXISTS which summarizes itself as These "other stuff exists" arguments can be valid or invalid., essentially leaving it up to consensus.
 * You add "because the article is dated does not make it OK to add other faulty content and sources." - Again, I think that is rather judgemental in the circumstances, and you seem to imply that Nature and the American Chemical Society are faulty sources.
 * You then say "If the tagbombing was not POINTY (as retracted by Novem Linguae) this RFC is; it asks no question that the community needs to resolve, and you could have asked the same question on talk without the RFC." - As you note, the named editor had graciously and kindly retracted the WP:POINTY remark. However, you then applied it to the RFC, saying "you could have asked the same question on talk without the RFC". Yes, I could have, but as noted above when editors give apparently conflicting opinions on a topic, I like to ask for more input.
 * You finish with "Discussion is the first step in dispute resolution." - This implies that 1) there is a dispute; and 2) that an RFC on a talk page is not an appropriate for a discusion. Firstly I didn't know there was a dispute. You reverted an edit of mine trying to add a research topic of interest to the article, saying lay press (BBC) was inappropriate. I readded with Nature and ACS references, trimming the content substantially, and you reverted again mentioning MEDDATE and others. I hadn't heard of MEDDATE so I read it and realized it applied to a few Parkinson's disease sections. As I mentioned to the other editor, I make lots of edits and get reverted occasionlly so I'm used to it.
 * On browsing some of the edit history and talk, it appears you have been involved with the article for some time, e.g. with an editor asking you "SandyGeorgia Can I restore this reference I cited the underlying trial as well as review - but this review provides a more comprehensive discussion the of trials and got removed at the same time. The trial about AAV-GAD is the only one of interest in terms of efficacy to secondary sources. The Nature reviews disease primer was published before these and wasn't up to date with respect to that trial which reported long term results in Science Tran. Medicine, and JCI insight after the primer was published." - I don't have any history with the article so I don't know the clan editors or if there are certain protocols to be followed. I certainly understand if you feel your toes have been stepped on.
 * I'm hoping you just misinterpreted my intent and rushed a bit in reply. All good faith editors are valued by me. Facts707 (talk) 20:26, 19 April 2021 (UTC)

Robin Williams
There is a sentence saying "Another case is Robin Williams; he was diagnosed with Lewy body dementias after his death, and it most likely contributed to his suicide.", with a recent "citation needed" attached. Wikipedia's article on Robin Williams, has a well-referenced paragraph stating that the post-mortem indicated dementia with Lewy bodies, not Parkinson's. It seems therefore inappropriate to include him here. I will remove unless anybody has better information and can cite references. Jmchutchinson (talk) 17:07, 21 May 2021 (UTC)
 * SandyGeorgia has provided a full, well-referenced account now, so issue resolved: thanks! Jmchutchinson (talk) 19:54, 22 May 2021 (UTC)

Sex differences in mortality
I have reverted a series of primary sources for the second time. Sandy Georgia (Talk)  19:55, 22 May 2021 (UTC)

Alan Alda
Alan Alda went public with his diagnose a while back. https://www.youtube.com/watch?v=drGv9fKfjrY — Preceding unsigned comment added by 212.100.117.2 (talk) 22:49, 7 July 2021 (UTC)

Updating the medicine section
The medicine section had mentioned about upcoming drugs that were still in research but in recent times, new drugs have come out for the treatment of Parkinson's disease. I have updated the section with the changes. — Preceding unsigned comment added by Goldman09 (talk • contribs) 16:22, 29 March 2022 (UTC)

Updating research section
More recent research studies and clinical trials haven't been updated in the research section, especially in the usage of LRRK2 inhibitors for PD. — Preceding unsigned comment added by ChonkPD (talk • contribs) 15:22, 30 March 2022 (UTC)

Updating the cost section
The cost section had mentioned about needing to update the costs of PD but precise calculations are difficult due to methodological issues in research. I have updated the section with findings from a recent study that examined the current economic burdens of PD in the US and future projections. Yi Ni Toh (talk) 15:29, 30 March 2022 (UTC)

therapies
Needs to mention fava beans as a studied alternative medicine for mild Parkinson's. — Preceding unsigned comment added by 172.58.75.64 (talk) 23:32, 25 May 2022 (UTC)

Nightshade
Re this edit, I can find no mention in the source; perhaps I missed it. user:Lopkiol, could you explain? Sandy Georgia (Talk)  08:17, 9 July 2022 (UTC)


 * My bad, I forgot to add this source: Ann Neurol., 74: 472-477. Lopkiol (talk) 09:06, 9 July 2022 (UTC)
 * That's not enough info about the source to locate it. Sandy Georgia (Talk)  17:05, 9 July 2022 (UTC)
 * Found:  is a dated primary study; please familiarize yourself with WP:MEDRS. (I believe  has already raised this on your talk.) Sandy Georgia  (Talk)  17:08, 9 July 2022 (UTC)

Non-motor symptoms, including problems swallowing, must be mentioned in first paragraph
OK, I have no more time to figure out what sources you allow for this (my addition was reverted with a non-explanatory referral to WP:MEDRS; as far as I can tell by reading it, my sources seem consonant with MEDRS). So I'm not gonna deal with this. But I will point out: as it stands, with no list or explanation of what the common non-motor symptoms other than the cognitive ones and sleep-related ones in the first paragraph, this article is not good. If a high-school student were to submit a report on Parkinson's, without mentioning constipation and difficulty swallowing in the first paragraph of the report, the highest grade that student could hope to receive from me would be a C-minus; more likely the grade would be D or F. Constipation is one of the most common complaints Parkinson's patients have, and choking on food because of impaired swallowing-reflex is one of the most common causes of death.

Someone who understands MEDRS, fix this, please. Either provide some explanation why my sources don't meet WP:MEDRS, or, adjust WP:MEDRS so that I can read it and easily see what the objection to my sources is, or, do a bit of work and find some sources which are acceptable your own self. I'm not gonna spend more time trying to second-guess what the authors of WP:MEDRS have in mind, and as it currently stands, without these symptoms in the first paragraph, this article is an embarrassment to Wikipedia. One way or another, get 'em in!!! HandsomeMrToad (talk) 22:58, 25 August 2022 (UTC)


 * There's an ideal sources template at the top of this talk page that you can use to locate a secondary literature review that you can use to source text, preferably one within the last five years (WP:MEDDATE). Then that text should be integrated in to the body first, in the appropriate section, rather than dropping new content in to the lead.  From the body, the WP:LEAD is a summary. If you are unable to locate a recent secondary review using the ideal sources template above, this Signpost article is a slight bit dated, but gives the basics on how to negotiate PubMed to locate WP:MEDRS sources. If you would like to understand how to better assign due weight to what gets included in a lead (which can't be every sign and symptom), you might familiarize yourself with a similar article, dementia with Lewy bodies, where we don't mention in the lead that problems swallowing are one of the main causes of death (via aspiration pneumonia), although that is well covered in the body.  The lead is an overall summary at a higher level. For comparison's sake, you might also notice that there is a very limited use of the advocacy organization, the Lewy Body Dementia Association, at the article, and it's not used to describe symptoms, not should a Parkinson's org be used for that. It is correct that this is not a decent article; that's why it's assessed C-class, and was de-featured from FA status. If you'd like to improve this article, the very similar condition of DLB is FA class, and gives you an idea of how a lead is constructed. Also, have a good look at the guidance at WP:LEAD.  The average length of a well-constructed medical lead is between 400 and 500 words; this one is already over that at 550, and already mentions non-motor symptoms in summary form.  Have a look also at how the top literature reviews on PD handle their summary abstracts, and how much weight they give to non-motor symptoms relative to every other area of WP:MEDORDER, which needs a place in our lead summary. In other words, please don't add text to the lead without first adding it to the body, based on secondary reviews, and from there, take into consideration what gets summarized to the lead. Sandy Georgia  (Talk)  23:53, 25 August 2022 (UTC)

Wiki Education assignment: Psychology Capstone
— Assignment last updated by Rahneli (talk) 14:19, 4 September 2022 (UTC)

Joy Milne
This article says nothing about Joy Milne being able to smell Parkinsons, and the mountain of biomarker detection work based on that. I just added a link to one paper, but there are a lot more. I can't think of this as a complete or NPOV article with such a huge omission. Google Scholar search for Joy Milne's name gets 27,800 results, a lot of which (at least on the first page) look perfectly usable. 2601:648:8201:5DD0:0:0:0:5265 (talk) 23:56, 24 September 2022 (UTC)


 * Please see WP:MEDRS (in conjunction with WP:NOTNEWS). There are rare circumstances where it is acceptable to use a primary source in medical articles; this is not one of them.  A secondary review of the primary study is needed. Sandy Georgia  (Talk)  00:08, 25 September 2022 (UTC)
 * , a very recent review, says that whether smell can be considered a biomarker is a matter of debate and more studies are needed.
 * , also a recent review, says similar in a longer way.
 * Sandy Georgia (Talk)  00:35, 25 September 2022 (UTC)

I wrote a response that seems to have gotten clobbered in an edit conflict. However, here is a more selective (651 results) Google scholar search about diagnosis through sebum (the method in the paper I cited involved mass spectrometry analysis, rather than smell, though it was motivated by the earlier smell studies). Anyway, I have trouble imagining an academic survey of the Parkinson's diagnostics literature ignoring this topic. So if Wikipedia ignores it, it is Wikipedia rather than the Parkinson's literature that is deficient. 2601:648:8201:5DD0:0:0:0:5265 (talk) 00:43, 25 September 2022 (UTC)
 * This is cited by 39 other works in Google Scholar, secondary citations being one of Wikipedia's traditional methods of establishing relevance. People are going berserk with MEDRS here.  I can understand not wanting to mislead people into self-treatment using kitty litter or whatever, but nobody is going to build a home mass spectrometry lab to mis-diagnose Parkinsons. 2601:648:8201:5DD0:0:0:0:5265 (talk) 00:46, 25 September 2022 (UTC)
 * And I've just spent a good deal of time in PubMed finding there is no secondary literature to back up this notion; if there is, I missed it. Sandy Georgia (Talk)  00:51, 25 September 2022 (UTC)
 * The template at the top of this talk page may be helpful in finding sources that meet Wikipedia's sourcing guidelines; perhaps you'll find something I didn't/couldn't. Sandy Georgia (Talk)  00:52, 25 September 2022 (UTC)
 * I really don't care that much. There is a ton of primary literature as I've already cited.  If there is no secondary literature criticising it, I have no reason to think anything is wrong with it.  There is no practical danger (with regard to this topic) of anyone harming their health by misinterpreting a primary study, the supposed motivation of MEDRS's insistence on secondary studies.  So I'd just cite the primary literature which I would consider NPOV requires.  If Wikipedia forbids that anyway, and thereby fails to keep its readers informed on the topic, well, that's a deficiency of Wikipedia that I'm not interested in battling against.  Regards, 2601:648:8201:5DD0:0:0:0:5265 (talk) 03:43, 25 September 2022 (UTC)
 * This is clearly secondary literature backing up the notion. It's not a meta-study but imho that requirement is ridiculous for a topic like this.  2601:648:8201:5DD0:0:0:0:5265 (talk) 04:01, 25 September 2022 (UTC)
 * On the other hand, I see potential for plenty of potential for harm in promoting unproven diagnostic tools for any condition; Wikipedia does not lead, it follows. We can't be encouraging readers towards anything medical that does not have secondary literature review. Sandy Georgia  (Talk)  12:29, 25 September 2022 (UTC)
 * It's also interesting that the only things in pubmed about Joy Milne are the three primary articles she has co-authored: . It seems that other Parkinson's researchers aren't particularly interested in her.  Again, I may have missed something. Sandy Georgia  (Talk)  12:32, 25 September 2022 (UTC)

One approach to your concern is to add a Biomarkers section to the Research section, where one sentence summarizing the two recent literature reviews I linked above would be appropriate due weight; more than that would not be warranted, and the sentence would state basically that smell as a biomarker is under investigation. In that section, other current research for other biomarkers would also be given a sentence or two as warranted. For example, based on overviews: By looking at those broader reviews, it can be more easily appreciated why devoting too much space in this article to smell as a biomarker would be WP:UNDUE. Sandy Georgia (Talk)  13:18, 25 September 2022 (UTC)


 * I came here looking to read about Joy Milne (it’s a redirect). Was surprised to read nothing about her - I saw a documentary about her a few years ago and she’s just been featured in another one on the BBC:
 * https://www.theguardian.com/tv-and-radio/2022/oct/04/paxman-putting-up-with-parkinsons-review-i-am-already-dreading-his-absence?CMP=Share_iOSApp_Other
 * If she doesn’t deserve a mention here (which I find very odd), then maybe she should have her own page?
 * Recent Guardian article about her: https://www.theguardian.com/society/2022/sep/07/woman-who-can-smell-parkinsons-helps-scientists-develop-test?CMP=Share_iOSApp_Other — Preceding unsigned comment added by 109.152.244.12 (talk) 05:28, 13 October 2022 (UTC)

Image
The cartoon depicted on this page does not reflect that Parkinson's can affect anyone at any stage. It would be fantastic if we could update this to make it more broadly representative of the Parkinson's community. We have some ideas from the community but further advice on how to go about this would be really appreciated and I know the Parkinson's community would be so supportive of this change.HelenM100 (talk) 15:01, 17 March 2022 (UTC)
 * Which image is the "cartoon depicted on this page" that you refer to ? Getting images that comply with the licensing requirements explained at Image use policy is difficult for most articles, not just medical.  There are tutorials on images listed at Images. Sandy Georgia  (Talk)  15:22, 17 March 2022 (UTC)
 * Hi, Thank you for your reply. I was referring to the main image of the page. We have some suggestions that we believe would comply with the Image Use policy but would like to open up a discussion about what the most appropriate and up-to-date image would be.
 * The image we had in mind can be seen at this link
 * https://mbi.ufl.edu/2020/07/27/uf-neurologists-create-a-new-image-of-parkinson-disease/
 * It would be great to hear thoughts on whether this was the image to use. HelenM100 (talk) 09:59, 24 March 2022 (UTC)
 * First, I'm having a hard time making any sense of that image. Maybe I'm dense, but the image is meaningless to me, and a lot for a reader to process in the lead of an article. Second, the journal article is not freely available and I cannot access its copyright information, but unless it is licensed in a way that we can use it, we can't.  Did you read the image use links above?   could be helpful here, as he may be able to access the article, he may understand the image, and he can tell you whether it can be uploaded. If it can be uploaded, perhaps it can be used elsewhere in the article. Finally, who are you referring to with "we"?  That is, have you read WP:COI?  Considering you've provided a 2020 source from the creators of the concept, it would be helpful to know there is no COI here, and that this concept has broad acceptance, eg, in secondary reviews and sources. Sandy Georgia  (Talk)  17:07, 24 March 2022 (UTC)
 * It is really hard to get good illustrations for Wikipedia as they need to be either in the public domain (as this old sketch probably is, though that appears to be somewhat uncertain) or freely licenced. Most images are copyright and all-rights-reserved. If we wanted to use this image (or elements of the image) then we'd need to get permission from the copyright holder, not only for it to be used on Wikipedia, but for them to give it a free licence so anyone can use it, even commercially. The copyright holder is probably Erica Rodriguez, though it depends on their contract with the two medical people who acted as consultants and commissioned it. Assuming the copyright holder agreed, we'd need to go through the permission-checking process on Commons, which can take a while.
 * I watched the video and they claimed searching for "Parkinson's disease image" produced universally the old sketch. They used Bing. I tried this on Bing and couldn't reproduce that. I got a wide variety of mostly modern illustrations. Same with Google. Perhaps in 2020, Bing's image search was worse? The problem with many images are that they contain lots of annotations which are unreadable unless the image is large on the screen. That's not appropriate for Wikipedia where we generally just have thumbnails (and imo a flaw with Wikipedia in 2022). It is really hard to illustrate a neurological condition. The images at epilepsy are just awful.
 * I think it would be difficult to use the modern image as one, with all the different subjects, because Wikipedia would make it too small and because it only really works well when accompanied by a good caption text, which would need to be long to cover all three. The JAMA paper describes the images, though in very medical language. I could see us potentially making use of this as three images, each with a caption describing the features on show, each showing a different degree of impairment and progression. I agree with the paper's comments that in 2022 we should move away from "elderly white man" as a stereotype image.
 * Perhaps the best step would be to ask at WT:MED if people think we could use (elements of) this image in the article. If it is felt to be useful, then it may be worth the next stage of asking about licensing. It may be that if the intention is to have a widely used image of Parkinson's then they are very happy to freely licence it, or even place it in the public domain. -- Colin°Talk 20:31, 24 March 2022 (UTC)
 * Thanks for the help, Colin. Before taking time from others at WT:MED, I'd prefer to first have the original poster indicate whether they can get copyright approval. Best, Sandy Georgia  (Talk)  21:02, 24 March 2022 (UTC)

Observational studies on vitamin E are low-quality evidence
This revert was justified because a meta-analysis of observational studies is still an analysis of low-quality, primary evidence, as displayed in WP:MEDASSESS. The conclusions are only suggestive and insufficient to establish an effect by vitamin E intake on PD, as the authors admit in the article. Zefr (talk) 19:13, 6 December 2022 (UTC)

Update needed
This article is quite outdated. At minimum, current thinking on subtypes of PD should be incorporated, and issues raised on talk (above) have not been addressed.
 * do you know how to fix the vanc author error in the citation above? Best, Sandy Georgia  (Talk)  15:42, 22 August 2020 (UTC)
 * in this edit. vauthors of cite journal only allows the first two initial of the first/middle names. The original Vancouver style also is restricted to the first two letters but at some point, PubMed started to allow three characters. I now see that the citation filling tool is allowing three characters. I will change this to truncate to two characters to prevent this error in the future. Boghog (talk) 17:25, 22 August 2020 (UTC)
 * Thanks so much, -- I thought it was the space in his name! Sandy Georgia  (Talk)  17:38, 22 August 2020 (UTC)
 * in this edit. vauthors of cite journal only allows the first two initial of the first/middle names. The original Vancouver style also is restricted to the first two letters but at some point, PubMed started to allow three characters. I now see that the citation filling tool is allowing three characters. I will change this to truncate to two characters to prevent this error in the future. Boghog (talk) 17:25, 22 August 2020 (UTC)
 * Thanks so much, -- I thought it was the space in his name! Sandy Georgia  (Talk)  17:38, 22 August 2020 (UTC)


 * Advances in Parkinson's research continue, but this article is static. Sandy Georgia (Talk)  23:35, 28 June 2020 (UTC)
 * Can I restore this reference I cited the underlying trial as well as review - but this review provides a more comprehensive discussion the of trials and got removed at the same time. The trial about AAV-GAD is the only one of interest in terms of efficacy to secondary sources. The Nature reviews disease primer was published before these and wasn't up to date with respect to that trial which reported long term results in Science Tran. Medicine, and JCI insight after the primer was published. See https://doi.org/10.1016/j.parkreldis.2019.07.018 PainProf (talk) 18:54, 22 August 2020 (UTC)
 * , by all means, and my apologies ... cleaning up too fast, and I did not notice the review amid all the last first last first last first. One thing that would be very helpful is to use the Boghog citation filling tool for generating citations compatible with the article style. Just plug in a PMID, and you get a consistent citation so BogHog doesn't have to go through and repair. (I also add a parameter, type= Review to those I have checked to make sure they aren't primary sources. And I truncate at the same time six or more authors to three et al, so we don't have to edit around so much cruft inside ref tags.)  My apologies again ... I was too quickly trying to catch up with you ... I am also discouraged at realizing how much still needs updating :(  Best, Sandy Georgia  (Talk)  19:07, 22 August 2020 (UTC)
 * No worries at all. PainProf (talk) 20:02, 22 August 2020 (UTC)
 * Advances in Parkinson's research continue, but this article is static. Sandy Georgia (Talk)  23:35, 28 June 2020 (UTC)
 * Can I restore this reference I cited the underlying trial as well as review - but this review provides a more comprehensive discussion the of trials and got removed at the same time. The trial about AAV-GAD is the only one of interest in terms of efficacy to secondary sources. The Nature reviews disease primer was published before these and wasn't up to date with respect to that trial which reported long term results in Science Tran. Medicine, and JCI insight after the primer was published. See https://doi.org/10.1016/j.parkreldis.2019.07.018 PainProf (talk) 18:54, 22 August 2020 (UTC)
 * , by all means, and my apologies ... cleaning up too fast, and I did not notice the review amid all the last first last first last first. One thing that would be very helpful is to use the Boghog citation filling tool for generating citations compatible with the article style. Just plug in a PMID, and you get a consistent citation so BogHog doesn't have to go through and repair. (I also add a parameter, type= Review to those I have checked to make sure they aren't primary sources. And I truncate at the same time six or more authors to three et al, so we don't have to edit around so much cruft inside ref tags.)  My apologies again ... I was too quickly trying to catch up with you ... I am also discouraged at realizing how much still needs updating :(  Best, Sandy Georgia  (Talk)  19:07, 22 August 2020 (UTC)
 * No worries at all. PainProf (talk) 20:02, 22 August 2020 (UTC)
 * Advances in Parkinson's research continue, but this article is static. Sandy Georgia (Talk)  23:35, 28 June 2020 (UTC)
 * Can I restore this reference I cited the underlying trial as well as review - but this review provides a more comprehensive discussion the of trials and got removed at the same time. The trial about AAV-GAD is the only one of interest in terms of efficacy to secondary sources. The Nature reviews disease primer was published before these and wasn't up to date with respect to that trial which reported long term results in Science Tran. Medicine, and JCI insight after the primer was published. See https://doi.org/10.1016/j.parkreldis.2019.07.018 PainProf (talk) 18:54, 22 August 2020 (UTC)
 * , by all means, and my apologies ... cleaning up too fast, and I did not notice the review amid all the last first last first last first. One thing that would be very helpful is to use the Boghog citation filling tool for generating citations compatible with the article style. Just plug in a PMID, and you get a consistent citation so BogHog doesn't have to go through and repair. (I also add a parameter, type= Review to those I have checked to make sure they aren't primary sources. And I truncate at the same time six or more authors to three et al, so we don't have to edit around so much cruft inside ref tags.)  My apologies again ... I was too quickly trying to catch up with you ... I am also discouraged at realizing how much still needs updating :(  Best, Sandy Georgia  (Talk)  19:07, 22 August 2020 (UTC)
 * No worries at all. PainProf (talk) 20:02, 22 August 2020 (UTC)
 * No worries at all. PainProf (talk) 20:02, 22 August 2020 (UTC)

Additional high quality sources
 * I think the most helpful review for the subtypes appears to be the JAMA one which takes a very balanced approach and discusses the controversy well. Stem cell review doesn't include the first in human trial (as that was published in May), though that is described in secondary sources already, its a weird case in that the original study is so notable being the second iPSC to make it to humans (done in a safe and responsible environment), we could cite this in Cell Stem Cell though I quite like citing the original paper in the NEJM too? PainProf (talk) 20:02, 22 August 2020 (UTC)
 * I think the most helpful review for the subtypes appears to be the JAMA one which takes a very balanced approach and discusses the controversy well. Stem cell review doesn't include the first in human trial (as that was published in May), though that is described in secondary sources already, its a weird case in that the original study is so notable being the second iPSC to make it to humans (done in a safe and responsible environment), we could cite this in Cell Stem Cell though I quite like citing the original paper in the NEJM too? PainProf (talk) 20:02, 22 August 2020 (UTC)
 * I think the most helpful review for the subtypes appears to be the JAMA one which takes a very balanced approach and discusses the controversy well. Stem cell review doesn't include the first in human trial (as that was published in May), though that is described in secondary sources already, its a weird case in that the original study is so notable being the second iPSC to make it to humans (done in a safe and responsible environment), we could cite this in Cell Stem Cell though I quite like citing the original paper in the NEJM too? PainProf (talk) 20:02, 22 August 2020 (UTC)
 * I think the most helpful review for the subtypes appears to be the JAMA one which takes a very balanced approach and discusses the controversy well. Stem cell review doesn't include the first in human trial (as that was published in May), though that is described in secondary sources already, its a weird case in that the original study is so notable being the second iPSC to make it to humans (done in a safe and responsible environment), we could cite this in Cell Stem Cell though I quite like citing the original paper in the NEJM too? PainProf (talk) 20:02, 22 August 2020 (UTC)
 * I think the most helpful review for the subtypes appears to be the JAMA one which takes a very balanced approach and discusses the controversy well. Stem cell review doesn't include the first in human trial (as that was published in May), though that is described in secondary sources already, its a weird case in that the original study is so notable being the second iPSC to make it to humans (done in a safe and responsible environment), we could cite this in Cell Stem Cell though I quite like citing the original paper in the NEJM too? PainProf (talk) 20:02, 22 August 2020 (UTC)

Initiating treatment
Lancet Neurol 10.1016/S1474-4422(20)30036-3
 * L-Dopa can be started even with mild symptoms
 * MAO-B inhibitors and dopamine agonists may be useful later

JFW &#124; T@lk  10:46, 23 April 2020 (UTC)
 * Listed in section above. Sandy Georgia  (Talk)  15:36, 22 August 2020 (UTC)

Smoking sources
Examples only, of just a few recent sources that meet WP:MEDRS: Sandy Georgia (Talk)  15:13, 21 October 2021 (UTC)
 * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6981000/
 * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311367/
 * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494127/


 * The article needs to mention that even if smoking protects from PD nobody should smoke to prevent PD as smoking has it massively increase risk for multiple cancers ,cardiovascular diseases, etc. The takeaway of this article shouldn't be that people start smoking to prevent PD hence it is important to mention that any minor benefits smoking may have is heavily/overwhelmingly outweighed by the dangers.2409:4042:4D46:AD2:14BA:93B0:D5AD:D7F0 (talk) 08:28, 22 October 2021 (UTC)
 * See WP:SYNTH, WP:NOTADVICE and WP:RIGHTGREATWRONGS; if you can find a WP:MEDRS-compliant source that says what you want to say, then we can talk about a policy-compliant edit. Sandy Georgia  (Talk)  01:01, 23 October 2021 (UTC)
 * An "although" statement might be fine.. As a smoker myself (planning to quit next month). Ceoil (talk) 13:52, 29 April 2023 (UTC)

WP:CITEVAR
Citations for the WP:CITEVAR style used in this article can be generated by plugging a PMID in to the Diberri tool. Sandy Georgia (Talk)  16:16, 28 March 2023 (UTC)

Melanoma and Parkinson's Disease
Per the sources here, can we add something about the increased risk of development of melanomas in patients with PD? Andy Mabbett ( Pigsonthewing ); Talk to Andy; Andy's edits 12:11, 29 April 2023 (UTC)
 * The sources listed there are: Sandy Georgia (Talk)  13:34, 29 April 2023 (UTC)

Numbers 4, 5, and 6, don't appear to be useful. No. 4 is not a review, and Nos. 5 and 6 are red-flagged by Headbomb's script and/or not even PubMed-indexed. Number 3 is a dated review (WP:MEDDATE) but might be useful for historical context. Numbers 1 (Dean2021) and 2 (Lang2018) might be useful, and are WP:MEDRS-compliant (although Lang is borderline dated). Next two steps are a) to read them (fortunately both are freely available), and b) to do a search to see if there are other mentions and to see what other more recent and broad reviews have to say. Still working, Sandy Georgia (Talk)  13:41, 29 April 2023 (UTC)
 * Found another red-flagged by HeadBomb:

But it does appear that something can be said based on these (what to say, though, requires time and a careful read-- I have come across no recent broad overview that mentions this, so how much weight to give this must be considered). Sandy Georgia (Talk)  13:57, 29 April 2023 (UTC)


 * I am thinking of something along the lines of ...
 * While overall cancer rates are lower than expected in individuals with PD, studies since 1972 have identified higher rates of some types of cancer including melanoma; how alpha-synuclein deposits might interact with some kinds of cancer cells needs further study.
 * Considering no major reviews mention this best I can tell, I suggest placing the information in the Research section. I haven't yet read Hang. Sandy Georgia (Talk)  14:11, 29 April 2023 (UTC)

The role of desulfovibrio bacteria
I'm not a contributor on Wikipedia's medical side, but I thought you might find this recent article interesting: "Desulfovibrio bacteria enhance alpha-synuclein aggregation in a Caenorhabditis elegans model of Parkinson’s disease. Brittletheories (talk) 10:56, 5 May 2023 (UTC)
 * That is a primary study in a weak journal. Not clinical evidence. There is not enough evidence on Desulfovibrio bacteria currently and Parkinson's disease but there have been some interesting studies. I found a review that does mention some of the studies so it is worth citing on the Desulfovibrio article in brief but not on this one. Psychologist Guy (talk) 17:40, 6 May 2023 (UTC)
 * Agree with Psychologist Guy. Sandy Georgia (Talk)  18:02, 6 May 2023 (UTC)

Wiki Education assignment: Psychology Capstone
— Assignment last updated by Rahneli (talk) 19:34, 29 May 2023 (UTC)

Science magazine
Good recent overview in Science magazine, which explains how drugs like MPP and rotenone inhibit mitochondrial complex I, which causes Parkinson's in animals and probably in humans. The scientist they profile is Parkinson's researcher Tim Greenamyre, who developed Parkinson's himself, after (and plausibly because) he was using rotenone on mice in a laboratory model of Parkinson's.

TWIST OF FATE: A physician-scientist has probed Parkinson’s disease for more than 30 years. Now, he has it

BY MEREDITH WADMAN

Science

4 MAY 2023

380(6644):448

https://www.science.org/content/article/twist-fate-what-happens-when-top-parkinson-s-researcher-gets-disease https://www.science.org/doi/epdf/10.1126/science.adi5207 --Nbauman (talk) 18:26, 11 July 2023 (UTC)


 * Maybe as an interest piece for external links, but it is not an article-worthy reference. Zefr (talk) 18:48, 11 July 2023 (UTC)
 * I'm not seeing a place for it in this article; maybe if his bio can be created, it belongs at List of people diagnosed with Parkinson's disease. Sandy Georgia (Talk)  18:58, 11 July 2023 (UTC)

Gut health research 2023
I would like to add a new sub section to the Research section called Gut health but I do not have permission

Gut health research 2023
A study reported in the medical journal Gut found that patients with a history of gut problems were more likely to develop Parkinson's disease than those without.

Researchers analysed US medical records of people with Parkinson's and people without:


 * 24,624 people with Parkinson's
 * 19,046 people with Alzheimer's disease
 * 23,942 people with brain bleeds or clots (Cerebrovascular disease)
 * 24,624 people with healthy brains

The study results concluded:


 * 1) Patients with Parkinson's were more likely to have had gut problems in the six years before their brain disorder was diagnosed.
 * 2) People with gut problems have a higher chance of developing Parkinson's.

Significance of study results
The study results are exciting because they correlate closely with the views of those health professionals who have long warned about the cytotoxic nature of proteins commonly found in grains passing through the intestines.

Predictors for PD correlate with gluten related complaints
The British physician Dr Rangan Chatterjee has reported treating patients who do not have celiac disease but do have problems with gluten and who often make a full and complete recovery when treated with a gluten-free diet.

Dr Chatterjee has reported successfully treating patients with gluten related conditions – that might be relevant to the recent study:
 * Dysphagia
 * ..."recurrent sinus or tonsil infections.
 * Gastroparesis
 * ..."severe heartburn and a dry cough.
 * IBS without diarrhoea and constipation
 * ..."Irritable bowel syndrome...

Dr Chatterjee warns that routine blood tests are "notoriously unreliable". The neurologist David Perlmutter recommends only using the Cyrex array 3 test.

Conclusion
If a patient presents any of the above predictors for PD then they should immediately be prescribed a gluten-free diet regardless of blood tests.

Comparison with other study results
A study found that viral exposures can significantly elevate risks of neurodegenerative disease.

Our immune system protects us from the cytotoxic nature of gliadin, however if the integrity of our immune system is impaired, for example by viral exposures and or steroid medication, then we might become more susceptible to gluten related neurodegenerative disease.

Conclusion
If a patient is prescribed steroid medication for any reason then they should immediately be prescribed a GFD regardless of blood tests.

The irony is that steroid medication is often prescribed to manage the symptoms of gluten related inflammation:
 * 1) Joint pain
 * 2) Respiratory system

Old Shaky Dude Picture
User:ClueBot III/ArchiveNow Is it possible to change the Old Shaky Dude picture in the sidebar with something that is more inclusive and less menacing. Look at people that have posted under the hastag #Parkinsonslookslikeme https://upload.wikimedia.org/wikipedia/commons/thumb/5/5d/Paralysis_agitans_%281907%2C_after_St._Leger%29.png/300px-Paralysis_agitans_%281907%2C_after_St._Leger%29.png Maptishous (talk) 14:56, 16 October 2023 (UTC)


 * See archived discussion. Sandy Georgia (Talk)  15:11, 16 October 2023 (UTC)
 * @SandyGeorgia Is your argument that we can't find another? Because I find the image personally offensive. User:Maptishous we should continue this discussion. Doug Weller  talk 19:22, 18 October 2023 (UTC)
 * The problem is finding something/anything else freely available that accurately represents Parkinson's. My personal view is that the current image is an accurate portrayal of the most typical Parkinson's scenario-- although I won't oppose should someone find something freely available that's better. There's a long explanation from  at the archived link-- I have never uploaded an image, and Colin speaks to images better than I can. The statement from the OP, "Look at people that have posted under the hastag #Parkinsonslookslikeme" gives me nothing to go on, and "looks like me" isn't necessarily representative of most people with PD, who may be underrepresented on the internet. TLDR: if someone proposes a useful image, we can have a more meaningful discussion of alternates.  Sandy Georgia  (Talk)  21:56, 18 October 2023 (UTC)
 * I am an elderly man with PD. The drawing being complained of is pretty much what I look like. I can't see anything "offensive" about it. Alarics (talk) 23:10, 18 October 2023 (UTC)
 * I see someone has uploaded File:New Parkinson disease representation.jpg to Commons. But I can't see anything to verify their claim it is licenced CC 2.5 and the uploader did that as their only contribution. We could try contacting the authors of the paper to see what the copyright/licence status of the image is. Or whether they or the illustrator will release it. But this is a lengthy process for everyone and not really worth it if there is no enthusiasm for the image (which can be broken up in to three images if needed). -- Colin°Talk 07:51, 19 October 2023 (UTC)
 * @Alarics I am also an elderly man with PD. I find it offensive. Please watch the video here and on that page it says "“Improving the image to include a broad diversity of people with Parkinson can help enhance Parkinson disease recognition and enforce the reality that the modern people with Parkinson can have meaningful lives that are not universally limited by disease-related disability,”
 * On the site of the article there are two comments by physicians
 * "Thanks to Armstrong and Okun for this compact, informative and timely article, co-inciding with the week of the World Federation of Neurology World Brain Day (July 22nd), which this year highlights Parkinson Disease. What we say as doctors to patients is highly impactful; words need to be chosen carefully and perceptions of illness count. I suspect that mental perception of PD may even influence progression; if a negative, nihilistic image is formed around the time of diagnosis, the self-fulfilling prophecy concept, combined with apathy, could contribute to lack of engagement in physical therapy and mobility, which I suspect accelerates progression. />
 * I have recently publicised my experience as a neurologist living and working with PD (1), and I immediately related to the image of the runner with the dystonic foot; I thank the authors for giving me a more positive picture than the 1886 version of PD.'
 * "The most commonly used image for Parkinson's online from 1886 needed to be replaced and these new images go someway to do that. However, we need an image that is gender neutral, race neutral, ageless and encompasses both motor and non-motor symptoms. A modern image that a person with Parkinson's can look at and relate to, something that says: yes this is me."
 * The article itself, available in the Wikipedia Library, says "The frailness and disability shown in Gowers’ 1886 picture is also not an accurate rendering of the modern experience of people with Parkinson disease. Recent subtyping identified the disabling diffusemalignant form of Parkinson disease in only 16% of cases." Sadly the images are copyright by the AMA.
 * Given that are you still happy with the image?@SandyGeorgia ? Doug Weller  talk 13:46, 20 October 2023 (UTC)
 * As I said, if we had something better, I wouldn't oppose it. I am concerned that we respect the epidemiology of the condition in whatever we choose; for example, if the image Colin mentions was found to be freely available, that would be grand. Sandy Georgia  (Talk)  13:50, 20 October 2023 (UTC)
 * @SandyGeorgia I've asked if they can create new images that we can use.
 * In the interim, I think the current image should be removed. Doug Weller  talk 14:12, 20 October 2023 (UTC)
 * @SandyGeorgia It looks as though JAMA might have given permission to the authors, but I've linked them to our policy page as that wouldn't be enough. Doug Weller  talk 16:18, 20 October 2023 (UTC)
 * I don't speak images and never have (image policy terrifies me), so have to rely on Colin and others re whether image policy is met. Sandy Georgia (Talk)  13:41, 21 October 2023 (UTC)
 * This is largely something that Commons will deal with. VP Copyright, FAQ and VRT are all the places to go for help on this. But I repeat that you might want to get some feedback on whether these images (or cropped versions) are likely to be accepted by editors here or at WT:MED. The Commons process isn't trivial and could be a fair bit of work for someone, and if in the end their images get rejected, that isn't really fair. -- Colin°Talk 14:12, 21 October 2023 (UTC)
 * I'm at a loss here as I don't know to what or whom Doug Weller refers with "I've asked if they" ... who is "they"? Re "linked them to our policy page", who is "them"? If it is File:New Parkinson disease representation.jpg that we are trying to get permission to use, and we are trying to replicate or split that into three images usable, b would not be a good lead image as it misrepresents the epidemiology (but would be useful elsewhere in the article), c is too detailed for a lead image but could be useful elsewhere in the article, and d would be a good lead image, as it does reflect the epidemiology.  I wouldn't support a lead image that misrepresents the epidemiology, as the current one and d at the proposed one do. It's also possible to use more than one image in the lead with a composite, but we do need something that reflects the epidemiological facts. Sandy Georgia  (Talk)  14:20, 21 October 2023 (UTC)
 * Sorry, I thought it was obvious I was talking about the authors. Doug Weller  talk 18:06, 21 October 2023 (UTC)
 * I was unclear if you meant you had contacted the uploader of the image (but then I glaze over when trying to sort image issues anyway :) Did you contact the authors or the uploader? If you're in contact with the authors, we may be on the road somewhere, subject to Colin's concerns ... Sandy Georgia  (Talk)  18:54, 21 October 2023 (UTC)
 * @SandyGeorgia The authors. Doug Weller  talk 19:10, 21 October 2023 (UTC)
 * Awesome, thanks for doing that, Sandy Georgia (Talk)  19:46, 21 October 2023 (UTC)
 * PS, I don't know if the medicine infobox allows a composite as in, for example, Minneapolis, wherby we could chop up the inmage as it is now to three different images. Sandy Georgia (Talk)  19:48, 21 October 2023 (UTC)
 * Yes, that infobox (and, I believe, almost all infoboxes) supports multiple image. You can see a quick and dirty test in this diff.  Anyone who's interested in this is welcome to play in my sandbox for testing. WhatamIdoing (talk) 00:57, 22 October 2023 (UTC)
 * I've posted a query at WT:MED. Sandy Georgia (Talk)  14:22, 21 October 2023 (UTC)
 * New_Parkinson_disease_representation.jpg
 * About the new image:
 * The original article ("Time for a New Image of Parkinson Disease") is available through The Wikipedia Library. I didn't see anything special about licensing.  I've corrected the image description on Commons, but I have no special insight into its copyright situation.
 * About the overall question:
 * I wonder how much of the gut reaction is due to the fact that it's showing advanced Parkinson's, and we'd like to cling to false hopes instead of facing reality. People who start off as the woman with the dystonic foot, or who get diagnosed at the stage shown by the businessman whose hand tremors return when the drugs wear off, are still on a path towards advanced disease.  I think it a bit ironic that the authors complain that "Other Parkinson disease images remain largely based on Gowers’ famous sketch: older white men who are frail, hunched forward, and shaking", and yet their recommended drawing for advanced PD is an older white man who is frail, hunched forward, shaking, and using a walker.  But if the copyright situation can be cleared up, I find the modern color drawing of the frail old man more visually appealing than the 19th century sketch.  Would you be just as satisfied with that one?  Or is the goal to make people think that jogging is a common and realistic activity for PD patients? WhatamIdoing (talk) 23:30, 21 October 2023 (UTC)
 * The current image isn't representative of people who have Parkinson's, only of the ones in whom it's far advanced. Similarly, all humanity is on a path to old age, if nothing intervenes, but an image of extreme old age wouldn't be a realistic representation of humans in general. NebY (talk) 00:24, 22 October 2023 (UTC)
 * Do we know what the ratios are? For example, at the time of initial diagnosis, is mild, intermediate, or advanced PD more typical? WhatamIdoing (talk) 01:12, 22 October 2023 (UTC)
 * I might ask, but as I note above, " Recent subtyping identified the disabling diffusemalignant form of Parkinson disease in only 16% of cases". I"m 81 this week. Diagnosed 3 years ago and was told had probably had it for 5 years given earlier symptoms. And despite being weakened by horrible cancer operations (last one failed), I can do 6k on my treadmill (2k sessions) easily. I am nowhere near decrepit. I go out shopping, do almost all the cooking, etc. That image in no way represents me.  thanks very much for your comment.  Doug Weller  talk 08:23, 22 October 2023 (UTC)
 * 🎂 Happy birthday! WhatamIdoing (talk) 19:23, 22 October 2023 (UTC)
 * I don't have those figures to hand, but delaying diagnosis until it was advanced would suggest very poor access to health facilities. Diagnosis may follow symptoms such as slow voluntary movement, poverty of movement (facial, manual, gait, etc), unilateral rigidity, rest tremor and balance disorders (not all these symptoms will present in early stages). Those signs are sufficiently concerning to the individual that in a health system such as the UK's, diagnosis will usually precede the advanced debilitation of end-stage Parkinson's by years and be followed by a prolonged period of (somewhat limited) management and reviews at intervals of 6-12 months, during which time it may, for example, still be legal, feasible and safe to drive a normal motor vehicle. NebY (talk) 10:39, 22 October 2023 (UTC)
 * From the JAMA article that offered the three-phases image: A mild motor-predominant Parkinson disease phenotype was the most common presentation (49%), followed by the intermediate form (35%). While all phenotypes are progressive, the mean (SD) time from diagnosis to first milestone (regular falls, wheelchair dependence, dementia, or residential/nursing home placement) was 14.3 (5.7) years for the mild motor-predominant form, 8.2 (5.3) years for the intermediate form, and 3.5 (3.2) years for the diffuse malignant form. Mean (SD) survival after diagnosis was 20.2 (7.8) years for the mild motor-predominant form, 13.2 (6.7) years for the intermediate form, and 8.1 (5.4) years for the diffuse malignant form. This suggests that people with Parkinson disease are living for many years without the profound disability implied by Gowers’ sketch. NebY (talk) 13:38, 22 October 2023 (UTC)
 * I'm not sure how the "first milestone" relates to disease progression. So:
 * mild: 9–20 years until first milestone
 * intermediate: 3 to 13 years until first milestone
 * diffuse malignant: 0 to 6 years until first milestone
 * Does that mean that mild usually progresses to intermediate in ~6 years, and from then to diffuse malignant in another ~5 years?
 * I also wonder whether these are worldwide numbers or US/wealthy country numbers. WhatamIdoing (talk) 03:15, 23 October 2023 (UTC)
 * We can't process standard deviations in quite that way (for example, we don't know if we're looking at a normal distribution; if we are, then 1 SD encompasses only 68% of the population so nearly a third lie outside it; figures such as 3.5 (3.2) suggest extraordinarily flat distributions; we can't assume the distribution's symmetrical above and below the mean - eg for 3.5 (3.2) there's a lower limit of -3.5 but there may be much higher instances) but that's not really the point when we're discussing whether the "Old Shaky Dude" (aka doddery old fool) image is appropriate. What those figures show (the authors' suggest is the cautious language of a journal) is that people with Parkinson disease are living for many years without the profound disability implied by Gowers’ sketch. If they have poor access to health facilities then formal diagnosis may be delayed (and self-diagnosis may be impaired by images such as Gowers') but the disease progresses whether or not you know you have it. NebY (talk) 09:39, 23 October 2023 (UTC)
 * @WhatamIdoing As it is atypical of Parkinson's absolutely not. PD progresses slowly and for most people is well controlled by levodopo for years. Another point is that not all of the symptoms are visible, read the article on PD for information on that. At the time of initial diagnosis it's usually mild, rare to be intermediate or advanced unless of course the individual has never had medical card, unlikely at least in developed countries. Doug Weller  talk 08:52, 22 October 2023 (UTC)
 * The caption quoted above says that 35% are in intermediate stage when they are first diagnosed. That makes me lean a little towards the image showing the businessman with visible hand tremors (when the medicine has worn off). WhatamIdoing (talk) 03:17, 23 October 2023 (UTC)

Update ?
I see we now have no image at all; where do things stand on the new image? Sandy Georgia (Talk)  04:29, 15 November 2023 (UTC)


 * @SandyGeorgia waiting for it to be uploaded. Doug Weller  talk 07:46, 15 November 2023 (UTC)
 * Encyclopaedic illustration issues seem to pop up from time to time, it would be nice if we could target a Wiki Education Foundation-supported course assignment at a medical cohort. CV9933 (talk) 11:25, 15 November 2023 (UTC)
 * Someone didn't like the removal, but I can't decipher the meaning of the edit summary. Sandy Georgia (Talk)  06:58, 18 November 2023 (UTC)
 * @SandyGeorgia The edit summary doesn't make sense. The IP made two other edits, both very minor changes in AP articles. I'm removing the image once again. I think we are only days away from a new image, I've suggested a couple of possible changes. As an aside, I mentioned this to my consultant yesterday on a videocall and he said "righting great wrongs". Doug Weller  talk 08:04, 18 November 2023 (UTC)

Update
Hi there, I just discovered this:

https://movementdisorders.onlinelibrary.wiley.com/doi/full/10.1002/mds.27965

It showed the original drawings of Gowers, and the photos that his drawings were based on. It leads me to think that the “old shaky dude” impression maybe coming from the bad image quality of the etching. Gowers’ original drawings look much better. They were held in the archives of the Queen Square Library. “The original drawing by Gowers reveals a level of detail sadly lost in the etching and characteristic of an individual who had artistic work exhibited at the Royal Academy of Arts.”

And in fact, the drawings were based on the photos of Pierre D., who was only around 50 when the photos were taken. Not old at all.

While the etching has it’s flaws, it’s still widely used a hundred and thirty years or so after it’s creation, and there must be some good reasons. It’s clear about the symptoms/postures, shows the facial expressions, straightforward, have both side view and front view, and is easily understood at first sight. While we may have some other images that show the advance in science (e.g., people in mild stage with today’s better medication) as supplement, I still think Gowers’ work has its place in the article, especially that we now have his original drawings instead of the bad-looking etching. I have updated the article to include a gallery of four images. More images can be added to it when available. Please take a look. -- Dustfreeworld (talk) 19:27, 25 November 2023 (UTC)


 * @Dustfreeworld Then that’s an example of early onset Parkinson’s so not typical. I appreciate what you are trying to do but I have been working with Michael S. Okun to develop new images. He and a colleague are doing a lot of work to provide new images and I hope they aren’t wasting their time. See the article and particularly the video. Doug Weller  talk 20:04, 25 November 2023 (UTC)
 * Early onset may not be typical, but the signs and symptoms, the Parkinsonian gait, are typical. No I don’t think their time will be wasted. As I’ve said, more images can be added to the article when available.
 * This article has a very high page view and it’s not OK for it not having an image showing the symptoms of the disease for so long. This would be unfair for the readers who are desperately seeking for the info. It’s obviously more important for the advanced cases to be able to self-diagnose (or be alert) as soon as possible than for the mild cases. And it would be difficult without an image. -- Dustfreeworld (talk) 20:37, 25 November 2023 (UTC); edited 18:38, 12 December 2023 (UTC)
 * For quality reasons, I wonder if we could upload the photos from that paper. That brings home the reality that it's a real individual, and not just some composite sketch or artist's interpretation. WhatamIdoing (talk) 06:06, 1 December 2023 (UTC)
 * Just to make sure I get you right. Do you mean image like File:Parkinsonian gait outdoor.jpg is not preferred due to privacy concern? -- Dustfreeworld (talk) 08:31, 1 December 2023 (UTC)
 * @WhatamIdoing If it's the paper with the video, I'm getting, I hope, a non copyvio version of the images. If it's the image above, we can use it " You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use."  Doug Weller  talk 08:35, 1 December 2023 (UTC)
 * The photo of Pierre D., as taken in the 1880s (=150 years ago) and regardless of anything non-creative work done since then (e.g., scanning it) is in the public domain. (I assume it wasn't published under Crown copyright.)
 * It's likely the oldest extant photograph showing symptoms of PD, and therefore would have historical value merely for existing. WhatamIdoing (talk) 17:20, 1 December 2023 (UTC)
 * Do you mean we can add back:
 * Photographs of a Parkinson patient Pierre D.jpg
 * to the article/infobox? Sounds good to me. -- Dustfreeworld (talk) 01:15, 2 December 2023 (UTC)
 * Not to the infobox as it doesn't show a typical Parkinson's patient. History, ok. Doug Weller  talk 08:29, 2 December 2023 (UTC)
 * Yes, it's sad we have no image with this many pageviews. Is there a reason we can't at least add back the old image to the History section, where I had added it a week ago?  And maybe someone can locate a video of the Parkison's gait/shuffle, which would be more helpful than any image. Sandy Georgia  (Talk)  22:18, 25 November 2023 (UTC)
 * @SandyGeorgia yes, return it there. I’ll look into a video. Doug Weller  talk 09:06, 26 November 2023 (UTC)
 * There are loads.
 * These cover the gait, freezing, and an interesting talk by someone with Parkinson's. The external links section should include some of these, particularly the talk. Doug Weller  talk 09:51, 26 November 2023 (UTC)
 * Some of these are extremely long! See Tourette syndrome for what I had in mind. Sandy Georgia  (Talk)  17:43, 28 November 2023 (UTC)
 * @SandyGeorgia To be honest I didn’t watch them through and there seem to be a lot more, these were just some of the first I saw searching videos on Parkinson’s. And I only thought of them as possible external links.
 * what symptoms do you think would profit from video? The gait, obviously. Doug Weller  talk 20:16, 28 November 2023 (UTC)
 * It’s a great idea to have videos in the article, but good videos are difficult to find. And most of them are not under a free license. If there’s a good video with free license, length won’t be the main problem as it can be cut short before upload. -- Dustfreeworld (talk) 08:34, 29 November 2023 (UTC)
 * @Dustfreeworld How do you feel about having one or two as external links?  Doug Weller  talk 11:44, 29 November 2023 (UTC)
 * I'm not Dustfreeworld, but I think it would be a good idea.
 * As an alternative, if there is a web page somewhere that links many high-quality/well-curated pages, we could link to that. It does not have to be an "official" page or from a formal organization, and it can be user-generated (like DMOZ was).  What matters for web directories is that they are reasonably comprehensive, so that we can replace lots of links here with one good link to someone else's list. WhatamIdoing (talk) 06:04, 1 December 2023 (UTC)
 * Agree. Maybe this? Not all links on that page related to PD though. -- Dustfreeworld (talk) 08:28, 1 December 2023 (UTC)
 * That might work, with a suitable label ("Neurology-related videos, including several showing people with Parkinson's"?). WhatamIdoing (talk) 21:33, 12 December 2023 (UTC)
 * Done. Thanks WAID :) -- Dustfreeworld (talk) 10:43, 27 December 2023 (UTC)

New image
Who is user:Msokun and where is it established that they own the rights to the new image ? shouldn't there be an OTRS ticket or something equivalent ? Sandy Georgia (Talk)  14:31, 12 December 2023 (UTC)


 * Also, we now have the 1880s image in both the lead and the history section. Sandy Georgia (Talk)  14:36, 12 December 2023 (UTC)
 * Yes, my bad ... I forgot. Will fix, thx :) -- Dustfreeworld (talk) 14:41, 12 December 2023 (UTC)
 * I'll deal with the rights problem. Doug Weller  talk 16:09, 12 December 2023 (UTC)
 * I think it should be enough if they comply with our COI policy and identify themselves. Doug Weller  talk 16:14, 12 December 2023 (UTC)
 * I see the version of the image we talked about before got deleted due to lack of permission. Did Msokun actually draw those images? To release them under CC0, as declared, they need to actually entirely own the copyright so they can let it go. It isn't enough that the artist gave them permission to use. If the artist has released them into PD then we declare that instead. And generally we do need OTRS (or its modern variant) for images already published. This is more a matter for Commons to deal with and there are people more expert than me who can help. -- Colin°Talk 16:34, 12 December 2023 (UTC)
 * Is it “already published”? It’s a new image IMHO. -- Dustfreeworld (talk) 17:06, 12 December 2023 (UTC)
 * No, it's not ... they need to get this sorted correctly on Commons, and with OTRS/VRT ... and we can't keep adding copyright issues to a highly viewed article. I will remove the image, please do not re-add it until we have clear clearance. Sandy Georgia (Talk)  16:40, 12 December 2023 (UTC)
 * I've been discussing this with Oksun. I'm an OTRS volunteer. I've had emails confirming it's him, are you disputing that? Doug Weller  talk 16:46, 12 December 2023 (UTC)
 * Ah, did not know you were VRT; then could you please get the proper documentation added on the image file ? Sandy Georgia  (Talk)  16:48, 12 December 2023 (UTC)
 * Please see Colin's response above; there is an administrator's noticeboard on Commons where this might be sorted, but it needs to be sorted before people keep adding the image here. Sandy Georgia (Talk)  16:51, 12 December 2023 (UTC)
 * Thanks Doug. I like the new image more than the old one, and we now have a handsome young man ;) Big thanks to Michael and his colleagues!! :) -- Dustfreeworld (talk) 16:32, 12 December 2023 (UTC)
 * Who is Michael ? He needs to deal with WP:VRT to get this done correctly. Sandy Georgia  (Talk)  16:44, 12 December 2023 (UTC)
 * Michael S. Okun. Doug Weller  talk 16:48, 12 December 2023 (UTC)
 * That's a start; I don't deal with Commons, and Colin has grown weary of answering my Commons queries. Could you please go to Commons and get the proper documentation added there ? Sandy Georgia  (Talk)  16:49, 12 December 2023 (UTC)
 * Does he *entirely own* the copyright, as indicated by Colin ?? Sandy Georgia (Talk)  16:49, 12 December 2023 (UTC)
 * I'm trying to deal with that issue. I'm not clear exactly needs to be done, ie what documentation needs to be provided. I think it was a collaboration though. Doug Weller  talk 16:53, 12 December 2023 (UTC)
 * Neither do I know exactly how one makes the right things happen on Commons, which is why I have to keep asking Colin; I can certainly see it hasn't (yet) happened. But what MUST be understood on this page is that we can't just keep adding potential copyright problems to this page. Someone needs to deal with the issues raised by Colin.  I am planning two funerals and am ready to unwatch this page in frustration, as I can't be doing image stuff now; please, people, stop adding images until copyright is sorted. Sandy Georgia  (Talk)  17:00, 12 December 2023 (UTC)
 * I’d like to know who’s “keep adding ...” as you keep saying.
 * Before I added the images. no one ever raised any “potential copyright problem”, and I’m not aware of it at all. You have your reasons. But please note that I only added the images ONCE, and I’d never edit war red with you, and I never will. Thanks. -- Dustfreeworld (talk) 17:12, 12 December 2023 (UTC)
 * BTW, pls WP:AGF. Thanks again. -- Dustfreeworld (talk) 17:13, 12 December 2023 (UTC)
 * And about “am ready to unwatch this page in frustration,”
 * Same here. -- Dustfreeworld (talk) 17:21, 12 December 2023 (UTC)
 * DFW, we've been dealing with this image situation for about a year-and-a-half (see archives); in this thread, the issues have been coming up since October. I understand and respect the desire to get the Florida group's work and views on Wikipedia, but it does seem that enthusiasm in this case has gotten ahead of knowledge of image copyright policy on Wikipedia. Colin is the only medical editor I know who speaks images, so my frustration is to remind people to please check before uploading.  This is not a straightforward copyright situation; I wish I knew how to fix it, but I don't.  And I'd be so excited if we had the same enthusiasm for improving content as we do for uploading an image! I did not say you edit warred or imply that you did; my apologies for anything I wrote that came across that way. Sandy Georgia  (Talk)  22:20, 12 December 2023 (UTC)
 * Okay I almost missed this post of yours. Sandy, FYI, I don’t have any “desire” to “get any group’s work and views on Wikipedia”. The images were added because I believe they are good and suitable for our readers, showcasing the symptoms that they need to know.
 * As for my enthusiasm for improving content on this page, it has long gone and I think you know why. -- Dustfreeworld (talk) 23:55, 12 December 2023 (UTC)
 * Just to clarify, as I’ve mentioned, I can’t agree that “enthusiasm in this case has gotten ahead of knowledge of image copyright policy on Wikipedia”. Feel free to discuss about that on my talk page.
 * Also, I don’t think spending time choosing the right image for use in the lead and solving any potential issues involved would be a waste of time. The problem should have been solved a year-and-a-half ago. It wasn’t. So we are solving it now.
 * Further, the lead image has a very high page views. I believe it’s very meaningful if people can get diagnosed early after viewing the image. Thanks and regards, -- Dustfreeworld (talk) 08:57, 14 December 2023 (UTC)
 * Hi everyone, I am Michael Okun. I am author on the article in JAMA Neurology a new image of Parkinson's and I am responsible for the JAMA picture, however Erica Rodriguez and I (she is our artist) redrew a picture just for Wiki and there is no copyright and it is freely available.  Hope you enjoy.  Msokun is Michael Okun Thanks and love this discussion. Msokun (talk) 16:59, 12 December 2023 (UTC)
 * Thanks for that information, and for the work, but this page is not the place to state those facts; the image issues are dealt with on Commons. Do we also have, for example, the release provided to our Volunteer Response Team from Erica ?  Those things are documented on Commons-- not on this page. Sandy Georgia  (Talk)  17:02, 12 December 2023 (UTC)
 * I'm in contact with Erica. I've told her I'll give her the OTRS address, but I'm not sure what she has to do to comply. Sandy, you know this stuff much better than I do. If you could please post here exactly what needs to be done I'll let her know if she doesn't read it here. It looks like the current one needs to be removed from Commons, is that right?  Doug Weller  talk 17:18, 12 December 2023 (UTC)
 * I'm not weary of Sandy's questions. It's just that this is a subject I know a little but also know that other people (mostly on Commons) know a lot and deal with this day in day out. The copyright issues really shouldn't be filling up a Wikipedia article talk page, as Sandy notes, we should be focused on choosing good images and improving text. But nor should Wikipedians post images onto an article if the copyright issue is uncertain. We are all responsible for our edits and sometimes people let their enthusiasm get ahead of their permission.
 * I didn't spot the images were "new". Thanks to Michael and Erica for doing this. But three points.
 * Firstly I doubt a copyright lawyer would regard them as "new" rather than "derivative works". If I open them in an image viewer, and flip them, and place them side-by-side, they appear to be traced or reworked versions of the original. They have the same creases in the clothes and skin. The runner is now black and the old man is now a woman but still derivative of the original work in nearly every other way. (I'm not using the word "derivative" in a derogatory sense, just a copyright sense). This doesn't matter one bit if the author is the same person, as we now know is the case, but would matter if some random Wikipedian claimed these "new works" were free of copyright issues that concerned the originals.
 * The second point is please could you upload a much larger resolution version of the file. The new ones are just a few hundred pixels across and only good for a standard-def thumbnail. For a high-DPI thumb or a larger image or for other publications a full size image (megapixels) would be far more useful. Really just upload as large as you can, and Commons software does an excellent job of scaling to whatever size someone wants.
 * Thirdly can you change the template on Commons to be "PD-author" (with the artist name as parameter) rather than "Cc-zero". The later is for copyright-owners to use and would only be valid if Erica had uploaded the image to Commons. Since it was Michael he should use the PD template. Also can you change the Author field on the page description to name the artist. By all means add your own name as someone who advised on the image or whatever, but it needs to be the artist named.
 * Btw, I think the old image already got removed (the red links in our talk page). Thanks again to those who are drawing and working on the images. Colin°Talk 17:37, 12 December 2023 (UTC)
 * Thanks for the reply Colin.
 * Agree with most of what you said. Just to clarify, as I said above, I never noticed any “potential copyright problem” before adding the images (I truly believed that the uploader is the creator of the image, and the image can be used on a Wikipedia article, just like other images that can be found on Commons; and it’s been on the article for a day without anyone raising any concern). Sorry for my potential ignorance, but there’s certainly no such thing as “let their enthusiasm get ahead of their permission” for me ... Thanks. -- Dustfreeworld (talk) 18:07, 12 December 2023 (UTC)
 * ,, If I understand it correctly, changing a line in the Commons’ file page will solve most problems (except image quality, which can be handled later by uploadding a new version to the page when available). So, must changing the template to PD-author be done by the one who uploaded the image? If not, perhaps Doug or I can do that. I suppose adding something like  to this page will do? -- Dustfreeworld  (talk) 09:51, 13 December 2023 (UTC)
 * The template is a formal document and so should mention only the copyright owner (Erica Rodriguez):
 * The Commons "Author" field at Commons:File:Modern Parkinson's Disease Image.png needs edited to change the line |author=Msokun to say |author=Erica Rodriguez I don't have a problem if Michael wants to also mention their contribution/guidance/whatever additionally to that in that place (but not in the copyright template) for example |author=Erica Rodriguez with medical guidance from Michael Okun or whatever is appropriate. Similarly, Dustfreeworld, you need to do the same to your derivative crops Author field, as you are derivative of Erica's work, not Michaels. And if your derivative crops are merely crops, which they appear to be, they don't actually create a new "work of copyright", so you must change the template on your crops to be the same as the original with the "PD-author". There is nothing stopping any of us here doing that change on Commons, it doesn't have to be Michael, but clearly it is neater if we all agree with Michael  and learn what the correct templates/values are. -- Colin°Talk 11:05, 13 December 2023 (UTC)
 * I tried to add all of the changes as I agree with all of them. I am not experienced so if I muffed anything feel free to change. Thank you Colin, Doug and Dustfreeworld! Msokun (talk) 12:29, 13 December 2023 (UTC)
 * I edited the pages according to Colin’s advice. I replaced the “CC-zero” templates with “PD-author”. Please take a look and feel free to change if needed. For those who want to know more about Commons public domain licenses here is a good start. Thanks all for the help to ensure that we are using the right license :) -- Dustfreeworld  (talk) 18:39, 13 December 2023 (UTC)
 * So can we use the images now? Doug Weller  talk 09:49, 15 December 2023 (UTC)
 * I’ve added them back to the article. -- Dustfreeworld (talk) 15:16, 15 December 2023 (UTC)
 * and, is it possible that a version with much larger resolution be uploaded (click the link after logged-in and scroll down to the bottom of the page), as suggested by Colin and also here? -- Dustfreeworld (talk) 17:22, 16 December 2023 (UTC)