The Neuropsychology of Degenerative Brain Diseases

By Robert G. Knight | Go to book overview
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Chapter 6

Louis is a 66 year old architect. Some 6 years ago he first noticed he had occasional difficulty with "tightness" in his arm muscles. Two years later he developed a tremor in his left hand when it was at rest. At this time he was told he had Parkinson's disease. The tremor has gradually become more pronounced and affects his right hand as well. He can still do most things he could do before, although he finds walking increasingly difficult. "It seems," he says, "as if the muscles just seize up if I go too far." The change has been gradual and it is only looking back on things he could do a year ago, but cannot do now, that makes him realise the disease is progressing.

Asked about changes in his mental abilities, Louis reports that his memory is not as good as it was, and he finds it hard sometimes to find a word that he needs. His reaction to the disease is stoical. He describes himself as less outgoing than he used to be, but he "is determined to keep busy and not to give up."


In his classic "An Essay on the Shaking Palsy" ( 1817), James Parkinson opened his account of the disease he labeled Paralysis Agitans with the following summary: "Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forward, and to pass from a walking to a running pace: the senses and intellects being uninjured" ( Parkinson, 1955, p. 153).

His description was based on six cases, one of whom was observed only casually ("the lamented subject of which was only seen at a distance") but he captured the essence of the disease and its manifestations. The progress of the disease, barely perceptible at first, proceeds until "the hand failing to answer with exactness to the dictates of the will. Walking becomes a task which cannot be performed without considerable attention ... care is necessary to prevent frequent falls." (p. 154)


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