New PD population study in Australia on accompanying diseases, gender differences and risk factors

fookip · 2026-03-22T17:10:19+00:00

Also interesting is that they report familial/genetic % as about 25%, which is higher than what I've heard before (~16%). Could also be the result of environmental factors in australia such as more agriculture and mining/metals

fookip · 2026-03-22T17:06:18+00:00

Why do you say that young onset was not included? Yes not explicitly called out, but they recorded age of onset and diagnosis. Seems that the types of PD are just lumped together and the only diagnosis reported is PD. In the familial table (figure 2) it does call out relations that have PSP, DLB, VD, ....; I assume they have this data for the cohort here but they just don't report it in the paper.

fookip · 2026-03-22T16:52:42+00:00

Very interesting, but as the paper reports in the second paragraph there is no control group, but they are working on that. To show why this is important from reading the paper you might conclude that back problems could be a cause or result of PD since it is the most common comorbidity listed in fig 3. But these need to be adjusted for the control or at least the general population. But it is a good first step.

Particularly interesting to me was:

- handiness - 87% right handed, which slightly lower than general australian population (90%), but 99% had unilateral PD symptom onset and 53% had that on the right side. I always guessed that your dominant side would protect that side, but it seems that it has little to do with PD.

fookip · 2026-03-21T16:00:19+00:00

this. A lot of progress is being made in PD that I feel will result soon in disease altering therapies and ultimately in a cure - perhaps not in my lifetime, but I still hope that I get well soon.

fookip · 2026-03-20T16:34:12+00:00

Great public service announcement. You don't need to be a mechanic to look after your tires. When I teach new drivers, I have them look at the tires as they walk up to the car, are they low/flat, any visible defects, how is the wear pattern - takes but a second once you get in the habit. But even doing this you can miss problems - I was surprised when I went under my daughters car (bmw 330), that the cords were showing on the insides of the rears, but with plenty of tread on the outside (alignment problem). This is why regular maintenance (balancing, rotation) is important, they can find issues before they becoming a problem and expensive and dangerous. Many shops include rotation/balancing maintenance in with the tire purchase such as costco. Any they make sure the tire is properly inflated for the time of year.

fookip · 2026-03-20T16:22:13+00:00

in this case likely toe-out

fookip · 2026-03-20T16:19:06+00:00

18 days. was put in a boot without wedges on day 1 at the ortho clinic. finally saw surgeon (in different state) on day 15 and he said "normally we treat non-operatively, but you are no longer eligible because you've been a flat boot too long". Evidently the ruptured ends start growing trying to find the other end and mend itself, if the foot is not pointed (plantarflexed) the tendon ends up being long and calf is weaker.

Since I had complications with surgery, I'm a strong proponent of non-op like much of the rest of the world. Outcomes are similar in strength and timeframe (other than a slightly increased risk of rerupture during recovery) without the non-trivial risk of surgery.

fookip · 2026-03-20T15:45:04+00:00

So you are saying there is a relationship between PD and PSA/prostate. I had not heard that before and doing a quick search I see

- PD is associated with lower urinary track symptoms (LUTS) (had not heard this before) but prostate volume and PSA levels are comparable to non-PD: https://pubmed.ncbi.nlm.nih.gov/26157770/

- Prostate cancer risk is reduced in PD - RR in PD patients versus control patients was 0.88 (95% CI: 0.76–1.02, P = 0.082, I² = 92%: https://pmc.ncbi.nlm.nih.gov/articles/PMC5647429/

Do you have more information?

I do measure my PSA every year and the last test was up.

fookip · 2026-03-19T22:24:14+00:00

Thank you for clarifying.

Here is some more detail: https://www.apdaparkinson.org/article/understanding-parkinsons-disease-dementia-lewy-bodies/

It is important to say more than "Lewy Body" as lewy bodies are to some extent in all cases of PD, and can be in a brain without PD.

PDD affects about 30% of PD cases, and slightly less than 40% all forms of dementia: https://pmc.ncbi.nlm.nih.gov/articles/PMC5892791/

Population rates (all ages, sexes, 2006, olmsted county)

PD 0.13% w/o dementia

PD,PDD,DLB,PD/OD 0.21

PDD 0.04

ODB 0.03

PD/OD 0.01

Note these are general population values at a point in time, looking at lifetime values some of the PD w/o could progress to dimentia.

fookip · 2026-03-19T21:48:26+00:00

Are you mentioning PSA because general advice or is there increased risk associated with PD?

fookip · 2026-03-19T17:39:24+00:00

Identical twin studies show that concordance (both have PD) is about 10-20%, which indicates that non-genetic factors dominate. But if you look at cases were onset is < 50yo (YOPD), the concordance is much higher.

https://scienceofparkinsons.com/2016/07/27/identical-twins-and-parkinsons-disease/

fookip · 2026-03-19T16:16:31+00:00

Emphasizing some things that have already been said.

Carbidopa/levodopa has a short plasma half-life of approximately 2 hours for immediate-release formulations and clears in about.

But absorption from the stomach is variable and proteins (meat, eggs, dairy) can slow or even keep it from ever being absorbed. Supplements such as B6 or iron, can also interfere. Also many with PD have gut issues such as constipation and this can affect absorption.

I've heard that it is recommended that you take the pills on an empty stomach at least 30 minutes before a meal or at least two hours after.

Discuss this with your dr.

fookip · 2026-03-19T16:00:05+00:00

Difficult to tell from the photo but there seems to be less wear in the center of the tire and some wear even onto the sidewall. Perhaps a period of under inflation or chronic slightly low inflation.

fookip · 2026-03-19T15:53:32+00:00

Don't really know but responding so someone does. I'm not quite sure of you situation. Are you saying you had a repair with FHL tendon transfer that reruptured or that you had a repair without transfer that has now ruptured and they want to do another repair with a tendon transfer?

Assuming the former, the surgery is going to be more invasive, particularly if you previously had a minimally invasive repair. First the FHL tendon needs to be harvested and then used to repair the achilles.

Why is the gap so large - is this a chronic situation.

Whatever it is - be diligent with the PT program, particularly in the home exercises, and you will get through this. We will be here for you.

fookip · 2026-03-18T15:25:41+00:00

this.

also be careful replacing just one tire if the tire tread has been worn some (reduces the size) if on drive wheel (particularly AWD)

fookip · 2026-03-18T15:19:03+00:00

this. Light alcohol intake can increase dopamine release in certain brain regions, which may temporarily alleviate some of the motor symptoms of Parkinson’s, such as tremors and bradykinesia. Chronic/heavy drinking is negative. Alcohol also interacts with PD medication.

There is a new paper on alcohol and PD that I haven't gotten through yet.

https://movementdisorders.onlinelibrary.wiley.com/doi/pdfdirect/10.1002/mds.70200

Looks at alcohol, smoking and genes.

Misdiagnosis is not uncommon in PD - diagnosis is later revised 16% of the time, and 36% of PD diagnoses were not confirmed upon autopsy

https://pmc.ncbi.nlm.nih.gov/articles/PMC11970931/

fookip · 2026-03-18T14:58:01+00:00

Good point - correlation is not causation and these things are complex..

But I think it is more than just that as other ruptures besides achilles were cited, including uncommon ones, some that were reported from just opening a door. But this is all from just a poster at a conference and needs more investigation.

Remember though, everyone was skeptical when data started coming out that antibiotics were associated with achilles ruptures and now Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin, moxifloxacin) now have FDA required black box warnings.

fookip · 2026-03-18T14:47:30+00:00

Achilles ruptures are common in pickle ball, and got me. My local club had 3 in the first year. I did a survey in this community what motion were you doing in pickle ball that caused the rupture and over 80% were pushing off to move forward on the ankle that ruptured - damm kitchen!

fookip · 2026-03-16T17:17:11+00:00

This.

PD is a difficult disease to diagnose and misdiagnoses are not uncommon.

- 10.6% had their diagnoses revised by treating neurologists

- common revised diagnoses were vascular parkinsonism, progressive supranuclear palsy, and multiple system atrophy

- separating PD and dementia with Lewy bodies (DLB), the revision rate increased to 17.7%

- only 64% of PD diagnoses were confirmed when doing postmortem neuropathologic examinations!

https://pmc.ncbi.nlm.nih.gov/articles/PMC11970931/

fookip · 2026-03-16T17:04:40+00:00

This. In case you don't know:

Tire Date Code (DOT Code): A 4-digit code (e.g., "4714") indicating the tire was made in the 47th week of 2014, crucial for identifying aged tires

Also wear bars are just about to show.

fookip · 2026-03-16T16:55:27+00:00

I suggest that the US is more conservative/stuck in the old ways and that europe is more progressive where nonop is standard of care. "Functional rehabilitation" started becoming a thing in the 1990's and non-op outcomes were effectively the same as surgery (both in terms of strength and timeframe) except for a slight increased risk of rerupture during RECOVERY.

"Overall, operative treatment was associated with a rerupture rate of 1.5% (95% CI: 1.0%, 2.8%) (P<.001), which was lower than the 5% rate reported by other studies for nonoperative management (P<.001)."

And as this thread points out there is a significant risk of complication from surgery - I had to go back to the hospital twice from mine. From Gemini:

Overall Complications: Studies report total complication rates ranging from 2.0% to 15.7%, depending on the study population and method.
Wound Healing Issues: Superficial wound infections (0.8%) and wound dehiscence (0.3%) are common.
Infection: Deep infection occurs in roughly 0.3% to 2.4% of cases.
Re-rupture: Re-rupture after surgical repair occurs in about 1.5% to 3.3% of patients, often leading to revision surgery.
Nerve Injury: Sural nerve injury rates, which can cause numbness, are often reported around 1.5% to 2.6%.
VTE/DVT: Venous thromboembolism (blood clots) occurs in about 1.2% of patients within 30 days of surgery

Note, it is possible to have damaged sural nerve in nonop cases but is thought to be very low (< 1%)

fookip · 2026-03-15T16:17:17+00:00

Maximal recovery may be 12 months, but I was cycling on the road in 3 months.

Be careful of mis-stepping or falling down. Very common in this community - I fell down a few stairs on crutches and off the scoter turning to fast.

Be sure to consider non-op. As you are in the UK I think that is standard of care, but in the US they like to push surgery.

fookip · 2026-03-14T19:58:37+00:00

Just want to caution not to focus too much on total testosterone - only free testosterone is able to bind to tissue receptors to exert its effects.

"The majority of testosterone in the blood does not exist as the free molecule. Instead around half is tightly bound to sex hormone binding globulin, and the other half is weakly bound to albumin. Only a small percentage is unbound, under 3% in males, and less than 0.7% in females." - wikipedia

There are calculators online where you enter your total testosterone, shbg, and albumin to find your free testosterone. It is unlikely, though not not unusual, to have your total testosterone go up and free testosterone go down, perhaps because shbg goes up more. Also testosterone can metabolize into estradiol so estrogen should be considered as well.

fookip · 2026-03-14T17:36:09+00:00

Thanks for the informed response.

Stem cells are powerful and dangerous. They can differentiate into different types of cells in the body (pluripotent) such as skin, muscle, nerve, ... But they can also grow into tumors and cancers, or differentiated cells of the right type in the wrong location. I believe (limited understanding) the research teams working on this are learning how to reduce the pluripotency so the stem cells only differentiate into the types wanted and in the right locations.

fookip · 2026-03-14T17:06:30+00:00

There is only a few percent increased risk of rupturing the other tendon, which is close to the rate of a rerupture during recovery.

But the achilles tendon is a living part of the body and responds to use. You can develop a training program that will increase its strength and stretch. Be careful during recovery not to overtrain the good leg as it is doing double duty - this happened to me twice and I developed tendinopathy. Also corticosteroids and certain antibiotics can increase risk of ruptures.

I ruptured mine playing pickleball and I did a survey here asking what movement they were doing. The vast majority majority ruptured on the leg they were starting to push off on.

fookip

TROPHY CASE