The Fascinating Field of Movement Disorders

Dr. Barry Goldlist
Editor in Chief
Geriatrics & Aging

As I write this editorial, I am looking forward to an important event in Canadian geriatrics. For the first time since its inception, the Canadian Geriatrics Society is meeting independently of the Royal College of Physicians and Surgeons. This is not by chance, and certainly not because the Royal College has asked us to leave. This is a deliberate attempt to make the activities of the society more accessible to family physicians with an interest in geriatrics. Now, physicians will no longer have to pay a registration fee to the Royal College when they are only interested in the section on geriatrics. This year's meeting is in Edmonton, and in addition to our usual scientific sessions and symposia, we are having a CME day that is specifically targeted to primary care physicians. We would certainly welcome as members any physicians who are interested in care of the elderly. The current membership fee is minimal ($50/year) and information can be obtained from our current secretary-treasurer, Dr. Chris MacKnight (e-mail: "" and mailing address: Camp Hill Veteran's Memorial Building, 5955 Jubilee Road, Halifax, NS, B3H 2E1). Next year's meeting is tentatively scheduled for mid-October in Toronto, in collaboration with a meeting on dementia that is being sponsored by the Tanz Centre for Research in Neurodegenerative Disease at the University of Toronto. I have seen the preliminary program and it is quite impressive.

I believe we have quite an interesting journal for you this month. Extensive research has clearly documented that impaired mobility is the most common cause of functional disability in the elderly. The causes of impaired mobility are numerous. Perhaps the most common is "simple" osteoarthritis but stroke, and fractures secondary to osteoporosis, are also important causes. This issue focuses on the fascinating field of movement disorders. Although it might seem relatively easy to recognize full-blown Parkinson's disease, diagnosis at an early stage can be quite challenging. Dr. Janis Miyasaki discusses the diagnosis of Parkinson's disease and how to differentiate it from other causes of tremor and the other Parkinsonian syndromes. As in other chronic conditions, the long-term management of patients suffering from Parkinson's disease can be extremely challenging. In her article, Sharon Yardley discusses some of the non-pharmacological treatments that are available. Dr. Robert Chen explores the burgeoning field of surgical treatment for Parkinson's disease. The pharmacological armament for treatment of Parkinson's disease has expanded dramatically in the past few years. While this is good news for the patient, as treatment can now be better tailored for the individual, it means physicians need to be provided with more information. In their article on the pharmacological treatment of Parkinson's disease, Doctors Sanjiv and Tsui address this potential information gap. Dr. Nadege Chery's article addresses drug induced Parkinsonism, which can represent a therapeutic challenge if the offending drug is considered essential for the patient. Parkinsonism is not always caused by a primary neurodegenerative disorder, and in his article Dr. D'Arcy Little describes the secondary causes of Parkinsonism, such as trauma or stroke.

As well as the focus on movement disorders, we also have our usual pot-pourri of articles on geriatric topics. Our column on ethics examines the ethical issues involved in transplanting foetal brain tissue in patients with Parkinson's disease. Another article discusses the utility of memory clinics for the diagnosis and management of Alzheimer's disease and other dementias. In the cardiology column, we look at the rational diagnosis of leg swelling and also review the application of the results of the HOPE study to clinical practice. There are also articles on the clinical aspects of Lou Gehrig's disease and the benefits of pancreatic transplants, an area in which Canadians are among the world leaders. I hope you enjoy this edition.