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Imaging, cerebrospinal fluid, and autopsy studies indicate that depression in Parkinson disease is associated with dysfunction of basal ganglia dopaminergic circuits that project to the frontal lobes, as well as noradrenergic limbic and brainstem structures.

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However, balance impairment in Parkinson disease is a late phenomenon, and in fact, prominent balance impairment in the first few years suggests that Parkinson disease is not the correct diagnosis.

Stereotaxic surgery and deep brain stimulation for Parkinson disease and movement disorders.

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One of the most frustrating symptoms of advanced Parkinson's disease is longer periods of time spent when movement is poor, and is known as the "off state" or " off period.

DDCI and entacapone therapy translates into greater efficacy, providing significant benefits in terms of symptom control compared with conventional levodopa.

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Questions about other comorbid sleep disorders such as obstructive sleep apnea (OSA) or restless leg syndrome (RLS) are also relevant.

In a multinational, randomized, double-blind clinical study in advanced PD patients, LCIG resulted in a significant improvement in “off” time, “on” time without troublesome dyskinesia, and measures of quality of life and activities of daily living compared with immediate-release oral levodopa-carbidopa (IR-LC).

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Magnetic resonance diffusion-weighted imaging regional apparent diffusion coefficients (rADCs) may also be helpful.

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Unfortunately, the ultimate cause of Parkinson's disease, the reason that the cells in the brainstem become altered and die, is not known but researchers suggest that a combination of both genetic and environmental factors cause about 90% of all Parkinson's disease.

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Trazodone, a frequently prescribed antidepressant for insomnia in older persons, is very sedating, can cause orthostasis and has no published evidence of sustained efficacy.

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