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1. Two years of growth and developmentThe Parkinson’s Disease Society (PDS) is delighted with the progress that has been made in developing the PDS Tissue Bank at Imperial College in the 2 years since the PDS Tissue Bank opened its doors. It is clear that firm foundations have been laid to run an extremely efficient Tissue Bank, to provide tissue for research to laboratories in the UK and around the world and to support Parkinson's research programmes undertaken at Imperial College itself. The PDS provides support for the Tissue Bank as a major investment in the research infrastructure in the UK. Donated tissue both from people with Parkinson's and from those without a neurological condition (known as "control" tissue) is a vital resource to researchers seeking solutions to Parkinson’s disease. In looking at the progress being made, some highlights are set out below.
Donors – making the vital gift
Reaching out widely to prospective donors
Supporting Parkinson’s Research
The Management Board
External Links
The Team at Imperial
Robert Meadowcroft
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2. Review of PDS Tissue Bank Donor Profiles to June 2004When a brain donation is made to the Tissue Bank, viewing brain cells stained using special methods down the microscope allows a pathological diagnosis to be made. An essential task in achieving the fullest possible understanding of the changes seen in the nervous system is to review all available clinical information, mainly by studying GP notes and copies of specialist letters. This dual process permits the optimum characterisation of the brain in the so-called "clinicopathological correlation". Analysis of the medical notes of fifty-one tissue donations to the newly established PDS Tissue Bank has revealed a clinical diagnosis of Parkinson’s disease (PD) in 92% (47/51) of donations, a "Parkinson's Plus" syndrome, Multiple System Atrophy (MSA), in 6% (3/51) and Dementia with features of PD in one individual (2%). The average age at disease onset was 65 (range: 32-78) with the average age at death 77 (range: 42-87), thus yielding an average duration of illness of 12 years (range: 2-34 years). This confirms that with modern treatment regimens there is no significant shortening of the lifespan with PD. Approximately one third of the donors were female and the remaining two thirds male, which agrees well with the known gender ratio for PD. A predominantly tremulous presentation was found in 47% of donors with an akinetic-rigid syndrome (stiffness and slowness of movement without tremor) in 29%. Falls or ataxia (impaired walking) were dominant presenting features in 10% followed by autonomic nervous system dysfunction (mainly drooling) in 6% and dementia in one individual. In 6% (3/51) the mode of presentation remains unknown at this time. Most donors were either reformed smokers or had never smoked (90%) and in the 3 individuals who were active smokers atypical clinical features were present suggestive of possible vascular Parkinsonism (related to blood vessel damage). A positive family history of Parkinsonism was present in 14% of donors. Neuroleptic (dopamine-blocking) drug intake was present at some point in the history of 12% of donors with two further donors disclosing a history of other possible toxin exposure. Dyskinesia induced by L-DOPA was present in 43% of cases. Neuropsychiatric features were prominent, including hallucinations and delusions (59%), cognitive decline and dementia (61%), confusion and agitation (53%), depression (37%) and anxiety (27%). Autonomic nervous system dysfunction was also common, including bowel symptoms (mainly constipation) in 73%, bladder dysfunction (51%), speech and swallowing difficulties (53%), blood pressure abnormalities (37%), drooling (33%), sleep disorders (14%), sexual dysfunction (14%) and a seborrheoic skin rash and sweating (12%). These features relate both to PD itself as well as to the side effects of drug treatment. Atypical or unusual features were found in several individuals, including abnormal eye movements in three, focal dystonia (abnormal limb posturing) on presentation in two, prominent drooling on presentation in five, myoclonus (jerky limb movements) in two and hand/wrist contractures (fixed abnormal posturing) in one case. As further donations accumulate it will be possible to analyse these clinical features in more detail, with comparisons of the clinical course for disease onset at varying ages, assessments of the effects of differing drug treatment regimens, the influence of family history and other factors. A standardised collection of clinical data is planned with a prospective questionnaire to be sent out to all registered donors. This will increase the reliability and detail of the clinical histories, all of which will eventually be joined with detailed neuropathological diagnostic assessments. Combining examination of the clinical history with tissue analysis will produce clues regarding potential protective and aggravating environmental, treatment and familial factors as well and will help to indicate the brain regions responsible for specific signs and symptoms.
Dr Ronald K B Pearce
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3. Tissue Bank UpdateUp until the end of August 2004, the Tissue Bank has had just under 900 requests for information, of which 581 had then gone on to register with us as prospective donors. Of those that have registered in the past couple of years, 36% are actually people that do not have Parkinson's or a related disorder, which is vitally important for research and allows identification of differences between changes in the normal ageing and the Parkinson's brain. To the end of August there have been 71 tissue donations, of which 3 have been from people without Parkinson’s. Dr Kirstin Goldring 4. The Tissue Bank's second anniversaryThe UK PDS Tissue Bank at Imperial has recently, in mid-August, celebrated its second anniversary of full operation. The first two years have been an exciting and challenging time for the staff at the Tissue Bank. The progress over the past two years has been extremely encouraging and the Tissue Bank continues to play an important role in research into Parkinson's. We have continued to work hard at increasing the numbers of potential donors registered with the Tissue Bank. In 2003 we had an average of 11 registrations of prospective donors per month. In 2004, our average registration is up to 20 per month. The number of potential donors registered with the Tissue Bank currently stands at 581. Of the donors that have registered with us we have had 71 tissue donations. These donations are vital to further research into Parkinson's and related disorders. However, for every 20 Parkinson’s brains we collect we only receive 1 brain donation from a healthy person. These healthy brains are also vital for research since scientists need to understand how the healthy brain functions and compare it to research results from Parkinson’s brain tissue. Since brain tissue is vital for Parkinson’s research and that we have more requests from researchers than we can supply, we are still encouraging people, particularly healthy individuals to register with the Tissue Bank. The work of the Tissue Bank and research on the tissue collected has been presented in talks to a large number of PDS branches and in a number of articles on Parkinson’s. In addition we have published and distributed our first two newsletters to registered potential donors, their next-of-kin, GP’s, and mortuary staff who have helped us collect tissue etc. The newsletters have been a great success, with many people writing to say that they welcome the contact with the Tissue Bank and that the articles contained in the newsletter are interesting and informative. Please let us know if there are any issues you would like to be addressed in our newsletter. We have also held annual open days with talks about the workings of the Tissue Bank and research projects using the donated tissue, along with a guided tour of the Tissue Bank. These have proved to be highly successful. Dr David Dexter and Dr Kirstin Goldring 5. Notices
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6. Future Branch Talks
Please contact us if you require further details. 7. Contact Information
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