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July 27, 2020

Time for a New Image of Parkinson Disease

Author Affiliations
  • 1McKnight Brain Institute, Department of Neurology, University of Florida College of Medicine, Gainesville
  • 2Norman Fixel Institute for Neurologic Diseases, University of Florida, Gainesville
JAMA Neurol. 2020;77(11):1345-1346. doi:10.1001/jamaneurol.2020.2412

Parkinson disease is now the fastest growing neurological disorder globally.1 An estimated 6.1 million individuals worldwide had a Parkinson disease diagnosis in 2016, 2.4-fold higher than in 1990.1 The most common representation of Parkinson disease continues to be the 1886 sketch by Sir William Richard Gowers, MD, published in his book A Manual of Diseases of the Nervous System (Figure, A).2 Other Parkinson disease images remain largely based on Gowers’ famous sketch: older white men who are frail, hunched forward, and shaking.

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2 Comments for this article
Thanks for the Image Update- I can see myself
David Blacker, MB BS, FRACP | Perron Institute for Neurological and Translational Science
Thanks to Armstrong and Okun for this compact, informative and timely article, co-inciding with the week of the World Federation of Neurology World Brain Day (July 22nd), which this year highlights Parkinson Disease. What we say as doctors to patients is highly impactful; words need to be chosen carefully and perceptions of illness count. I suspect that mental perception of PD may even influence progression; if a negative, nihilistic image is formed around the time of diagnosis, the self-fulfilling prophecy concept, combined with apathy, could contribute to lack of engagement in physical therapy and mobility, which I suspect accelerates progression. />
I have recently publicised my experience as a neurologist living and working with PD (1), and I immediately related to the image of the runner with the dystonic foot; I thank the authors for giving me a more positive picture than the 1886 version of PD.

The downside of the article is the statistics; even for my mild version, seeing the median time from diagnosis to first milestone as 14 years and death as 20 years is sobering. As a physician I know about the vagaries of clinical data and the meaning of standard deviations, but as a patient, there is a gnawing fear; does that mean I'm not going to live beyond 60? The long lead-in phase with subtle non-motor symptoms makes it difficult to know when "the clock starts".

My message is that whilst images and words are impactful and important, maybe numbers are even more frightening,


(1) A neurologist with Parkinson's disease. Practical Neurology 2020, Blacker D.
They are good but...
Jonny Acheson, MB Bch BaO FCEM MMed | University Hospitals of Leicester
The most commonly used image for Parkinson's online from 1886 needed to be replaced and these new images go someway to do that. However, we need an image that is gender neutral, race neutral, ageless and encompasses both motor and non-motor symptoms. A modern image that a person with Parkinson's can look at and relate to, something that says: yes this is me.