Another Parkinson's Disease Quiz! (Originally Appeared as a Post For the Northwest Parkinson's Foundation.)

I just ran across this forerunner of the PD Trivia quiz. I wrote it some time ago for the NWPF, and decided it is worth republishing here. Beware: it has a bit of attitude. But at least it's short.

QUIZ: How well do you know your Parkinson’s Disease?

To complete the quiz, you’ll need a pen, a pencil, or a stick to mark your answers; an encyclopedic knowledge of Parkinson’s disease, or access to a reliable search engine; a dogged perseverance; a sense of humor. Choose as many of the answers as seem true to you.

1.) Among the earliest signs of Parkinson’s Disease are:

A.) A shaking of an extremity that lessens when moving
B.) The sudden appearance of strange new vocabulary, with foreign-sounding words like “Dystonia” and “Festination”
C.) Constipation

(Answer:  C. Constipation. People can have this as a PD symptom a decade before other signs emerge.)

By the time a diagnosis of Parkinson’s Disease is made, a typical Parkinson’s patient:

A.) Has been misdiagnosed with so many other diseases that denial seems not only reasonable, but downright sensible.
B.) Has lost the use of as much as 80% of the cells that make dopamine in the substantia nigra
C.) Is ready to slug their doctor

(Answer: B. Cell loss. This is a tough one, but as only some patients suffer frequent misdiagnoses (as many as 30% of those who don’t see a movement disorders neurologist) and only a few feel like slugging their doctor, I’m sticking with B.

3.) Parkinson’s researchers divide symptoms of the disease into the following categories:

A.) motor and non-motor
B.) serious and frivolous
C.) sinister and hilarious

(Answer: A. Motor and non-motor. Motor symptoms are those like tremor or stiffness that affect movement. Non-motor symptoms involve other aspects such as emotion, with the onset of depression, or cognition, with the loss of ability to cope with complexity. And if you answered B or C, shame on you, cynic.)

4.) The number of people diagnosed with Parkinson’s in the United States is:

A.) Around a million
B.) Way, way too many
C.) Not getting any smaller, that’s for sure.

(Answer A, B, or C. Any of these is a defensible answer. The problem is that with the slipperiness of a PD diagnosis, and the consequent number of misdiagnoses, we really don’t know the exact number. A million seems to be the most common number tossed around in articles on PD. Answer B. way too many, goes without saying. C, not getting any smaller, is unfortunate but true as the baby boom generation is now entering its prime years for diagnosis.

5.) The most effective underutilized measure to cope with Parkinson’s Disease is:

A.) Exercise
B.) Exercise
C.) Exercise

(Answer: You can’t go wrong with exercise. Nutshell version: regular exercise can help with balance, mood, cognition,  and can very likely moderate the progression of the disease. Studies have found that the earlier regular exercise is implemented, the more gradual the patient will decline, compared with those that cannot or will not exercise. Also it is inexpensive, has no side-effects when properly done, and can actually be fun.

BONUS QUESTION: Which of these dictators suffered from Parkinson’s Disease?

A.) Adolph Hitler
B.) Ferdinand Franco
C.) Mao Tse-Tung

(Answer: All three! Maybe the urge to conquer the world should be considered a non-motor symptom of PD.)

Interpreting your score: 4-5 correct: PD Maven, put yourself in charge of your support group. 2-3 correct: PD Journeyman, put yourself in charge of snacks for your support group.  0-1 correct: PD Pre-K, Congratulations, you know as much about PD as the average American! Disagree with an answer or the scoring of questions? Comments are welcome below.

Pete's Parkinson's Portraits: Adolph Hitler

Is it true we share our affliction with arguably the worst person ever? While nobody searched for or found conclusive proof in an autopsy, there is convincing evidence that the Nazi leader did have Parkinson's. Further, there is interesting speculation that the disease may have cost Germany the war.

In an article from Pub.med, maintained by the National Institutes of Health, the authors write:

"It has been proved that Adolf Hitler suffered from idiopathic Parkinson's disease. No indication for postencephalitic parkinsonism was found in the clinical symptoms or the case history. Professor Max de Crinis established his diagnosis of Parkinson's disease in Hitler early in 1945 and informed the SS leadership, who decided to initiate treatment with a specially prepared 'antiparkinsonian mixture' to be administered by a physician."

As to how the disease affected Hitler, and hence the outcome of the war, the argument is outlined by the BBC as follows:

"The dictator suffered the disease, and the mental inflexibility associated with it could have been what led to his slow response to the D-Day landings in Normandy in 1944, researchers said at the International Congress on Parkinson's Disease in Vancouver.

Dr Tom Hutton, a neurologist who co-authored the study, said Hitler was suffering physical and mental symptoms of the disease, but his aides kept it secret.

He said that by the time of the Normandy landings, Hitler had suffered the disease for 10 years and would have had problems processing conflicting information - hence his initial refusal to allow Panzer divisions to move to the site of the invasion.

Hitler is said to have been convinced that the Allies would launch their attack at Calais."

Again we are forced to confront the ironies of Parkinson's Disease. Consider this, the stricken Fuhrer would not have survived the process of selection in which the weak and sick were culled from the death camps. With his symptoms aggravated by stress he would have advertised his own weakness and perished for it.

And this: For once, the illness does something good, helping to bring down a mass murderer and changing the course of history for the better. Yet one of the more acceptable traits of the disease, its slowness, left him in place long enough to ensure the massacre of millions of innocent Jews, Gypsies, homosexuals and others deemed subhuman or troublesome. Parkinson's Disease crept bit by bit through his system idly allowing Hitler to cause the deaths of millions of soldiers and civilians from all sides, and to leave Europe in ruins. Even when it does right, Parkinson's does it wrong.