Glossary

TERM	DEFINITION
Akinesia	Akinesia is a main motor symptom of PD characterised by complete, or almost complete, absence of movement which is often associated with rigidity.
Anhedonia	The absence of pleasure or the ability to experience it.
Assessment of Potential ImPact of Mirapexin^®/Sifrol^® (pramipexole) On Underlying Disease (PROUD)	The international study PROUD, sponsored by Boehringer Ingelheim, will examine whether there is an advantage in treating PD with Mirapexin^®/Sifrol^® (pramipexole) early after onset of symptoms in order to slow or postpone future disability, for an enhanced understanding of how best to help patients who present with symptoms of early PD.
Beck Depression Inventory (BDI)	The BDI is a 21-item, self-report instrument for measuring the severity of depression in adults and adolescents aged 13 years or older.
Bradykinesia	Bradykinesia is a main motor symptom of PD characterised by slowness of movement that can often result in a shuffling gait.
Central nervous system (CNS)	The CNS is a network of nerve cells present in the brain and spinal cord. Information is passed from the CNS to the different parts of the body via the peripheral and autonomous nervous systems.
Cognitive impairment	Cognitive impairment is a brain disorder where the ability to think or remember is impaired beyond the level expected for the age and education of the affected individual.
Comparison of the Agonist Mirapexin^®/Sifrol^® (pramipexole) with Levodopa on Motor complications of Parkinson's Disease (CALM-PD)	CALM-PD was a 4 year study comparing initial treatment with Mirapexin^®/Sifrol^® (pramipexole) to initial treatment with levodopa in early, symptomatic PD with regard to the development of dopaminergic motor complications. Results reported that fewer patients receiving initial treatment for PD with Mirapexin^®/Sifrol^® developed dopaminergic motor complications than with levodopa. The study enrolled approximately 300 patients and was first reported in the year 2000.
Catechol-O-methyl transferase (COMT) inhibitors	COMT inhibitors are a group of drugs used for treatment of PD. COMT inhibitors block the breakdown of the neurotransmitter dopamine and thereby prolong the action of levodopa.
Deep brain stimulation (DBS)	DBS is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain. There are a few sites in the brain that can be targeted to achieve differing results, so each patient must be assessed individually, and based on their needs a site will be chosen. Traditionally, the two most common sites to stimulate are the subthalamic nucleus (STN) and the globus pallidus interna (GPi). DBS is especially useful in patients with severe symptoms of tremor, involuntary movements (dyskinesia), and problems with gait.
Dopa-decarboxylase inhibitors (DDIs)	DDIs inhibit the peripheral metabolism of levodopa before it reaches the dopaminergic neurons of the brain and are usually given as combination preparations of carbidopa/levodopa or benserazide/levodopa. [N.B. this is not to be confused with drug-drug interactions also abbreviated as DDIs].
Dopamine	Dopamine is a naturally occurring chemical in the body and is described as a neurotransmitter. A neurotransmitter transfers nerve impulses across spaces between nerve cells (synapses) and in this way allows cells to communicate with each other. Dopamine is essential to the functioning of the central nervous system.
Dopamine agonist (DA)	A dopamine agonist mimics the effect of natural dopamine in the body and produces dopamine-like effects. Mirapexin^®/Sifrol^® (pramipexole) is a non-ergot dopamine agonist.
Dopamine receptors	There are five identified subtypes of dopamine receptors which are located in the central nervous system and are responsible for control of motor movement, motivation, learning, and others. Mirapexin^®/Sifrol^® (pramipexole) is selective for the D2-type receptor family.
Dopamine transporter (DAT)	The dopamine transporter (DAT) is a membrane-spanning protein that binds the neurotransmitter dopamine. DAT provides the primary mechanism through which dopamine is cleared from synapses, transporting dopamine from the synapse into a neuron.
Diagnostic and Statistical Manual of Mental Disorders (DSM-1V)	The DSM-IV is the fourth edition of a comprehensive classification of diagnostic criteria of mental disorders published by the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders; APA, 1994).
Dyskinesia	Dyskinesias are characterised by involuntary jerking movements which can affect any part of the body. Dyskinesias are often the result of chronic levodopa therapy; they can be very disabling and can have a very negative impact on patients' quality of life.
Frontal Assessment Battery (FAB)	FAB is a short neuropsychological tool aimed at assessing executive functions at the bedside.
Gait	Gait is the posture/positioning of the body during walking.
Hospital Anxiety and Depression Scale (HADS)	HADS is a brief self-report measure of anxiety and depression. The scale is composed of 14 items and has two subscales: a depression subscale (HADS-D) and an anxiety subscale (HADS-A) each consisting of seven items.
Hamilton Depression Rating Scale (HAM-D-17)	HAM-D-17 is one of the most widely used scales for rating the severity of depression in patients and comprises 17 items in the shorter version.
Hoehn & Yahr Scale	The Hoehn & Yahr scale rates PD as one of five stages. Stage 0 = no symptoms and stage 5 = most severe disease stage.
Idiopathic	Idiopathic is the term used for a disorder/disease for which the cause remains unidentified.
INvestigating effects of Short-term treatment with Mirapexin^®/Sifrol^® (pramipexole) or levodopa on B-CIT and SPECT imaging in early Parkinson's disease (INSPECT)	INSPECT investigated the potential short-term effect of levodopa or Mirapexin^®/Sifrol^® (pramipexole) through pharmacologic interactions on dopamine transporters (DAT). The INSPECT results reported no significant short-term effect of levodopa or pramipexole on DAT imaging therefore disproving any pharmacologic interaction and thus strengthening the interpretation of CALM-PD ß-CIT SPECT data results. The study involved 80 patients from the US and is sponsored by Boehringer Ingelheim.
Levodopa (L-dopa)	Levodopa is a dopamine precursor, which, once it crosses the blood-brain barrier, is converted to dopamine. It is used to treat PD and Restless Legs Syndrome.
MAO-B Inhibitors	MAO-B inhibitors is a class of drugs that are used to treat the symptoms of early PD, as well as to reduce levodopa-induced motor fluctuations in more advanced disease. They work by stopping dopamine being broken down in the brain.
Mini-Mental State Examination (MMSE)	The MMSE is a brief, quantitative measure of cognitive status in adults.
Motor Symptoms	The motor symptoms of PD are those experienced by patients with PD which affect muscular movement. In PD, the three main motor symptoms are bradykinesia/akinesia, tremor and rigidity.
Neurology / neurological	Neurology is the branch of medicine that deals with the nervous system and its diseases; neurological means of the nervous system.
Neuroprotection	Neuroprotection is the protection of nerve cells. This is a strategy for future PD treatment, with research into drugs that can prevent nerve cell loss and damage in the brain.
Neurotransmitter	Neurotransmitter is a chemical present in the nervous system which carries messages between different nerve cells. Examples of neurotransmitters include dopamine, acetylcholine, noradrenalin and serotonin.
Non-ergot dopamine agonists	Non-ergot dopamine agonists are a subclass of dopamine agonists targeting dopamine receptors. The ergoline (ergot) dopamine agonists include bromocriptine, pergolide, lisuride, and cabergoline, whereas ropinirole and Mirapexin^®/Sifrol^® (pramipexole) are non-ergoline (non-ergot) dopamine agonists. Non-ergot dopamine agonists, such as pramipexole, do not contain an ergoline-structure and do not cause the specific side effects of ergots.
Non-motor symptoms	The non-motor symptoms of PD are those experienced by patients with PD which are not related to muscular movement such as depressive symptoms, fatigue, anxiety and autonomous dysregulation.
Off Time	Off time is a period of dramatically reduced motor functioning, at the end of the dosing interval, which in extreme cases can lead to total immobility.
On Time	On time is a period of improved motor functioning during the day.
On-Off Time	On-Off fluctuations describe the unpredictable changes between good and bad periods of motor functioning.
Parkinson's disease (PD)	Parkinson's disease is the second most common chronic neurological disorder following Alzheimer's disease. It is caused by degeneration (dysfunction and death) of neurons within the brain, in particular those involved with movement. PD causes motor and non-motor symptoms. PD was first described in 1817 by James Parkinson in "An Essay on the Shaking Palsy." (see pramipexole)
Parkinsonism	Parkinsonism, also known as Parkinson's syndrome, atypical Parkinson's, or secondary Parkinson's, is a syndrome characterised by tremor, hypokinesia, rigidity, and postural instability. While the neurodegenerative condition PD is the most common cause of parkinsonism, a number of other etiologies can lead to similar symptoms.
Placebo	A placebo is a medication that does not contain a pharmacologically active ingredient but has medical effects due to purely psychological reasons. Sometimes a placebo is called a "dummy" or "sugar" pill.
Positron emission tomography (PET scan)	PET is a nuclear medicine medical imaging technique which produces a three-dimensional image or map of functional processes of the brain.
Postural instability	Postural instability is the loss of balance and/or difficulty with keeping steady body positions such as standing, sitting upright or walking.
Pramipexole	Pramipexole (known under the trade names Mirapexin^®, Sifrol^®, Mirapex^® and Pexola^®) is a compound from Boehringer Ingelheim research first approved in 1997 for the treatment of the signs and symptoms of idiopathic Parkinson's disease. In October 2009, Mirapexin^®/Sifrol^® received approval by the European Commission for its new prolonged-release, once daily tablet for the treatment of early and advanced Parkinson’s disease.* Pramipexole (immediate release formulation) is also indicated since 2006 for the symptomatic treatment of moderate to severe idiopathic Restless Legs Syndrome (RLS). * in all 27 Member States of the European Union plus Norway and Iceland
PROfile of DEpressive SympToms in Parkinson's Disease (PRODEST-PD)	PRODEST is a multi-national, multicentre, prospective observational study in which 24 centres in eight European countries participated with 1016 patients with idiopathic PD and a score on the Mini Mental State Examination (MMSE) of > 24. Results suggest that many depressive symptoms are an expression of Parkinson's disease, rather than of a depressive syndrome. This consideration, if supported by further analysis of the PRODEST study results, might suggest different treatment approaches for depression in PD (see Press Release issued by Boehringer Ingelheim on 28 Aug 2007).
Rigidity	Rigidity is a motor symptom of PD characterised by stiffness or inflexibility of the muscles.
Selective Serotonin Reuptake Inhibitor (SSRI) / Serotonin-norepinephrine reuptake inhibitor (SNRI)	SSRI/SNRIs is a class of antidepressants used in the treatment of depression, anxiety disorders and some personality disorders.
Snaith-Hamilton Pleasure Scale (SHAPS-D)	The SHAPS-D scale rates self-reported anhedonia in psychiatric patients.
Short Parkinson's Evaluation Scale (SPES)	The SPES scale rates motor impairments and disabilities in PD.
Single photon emission computed tomography (SPECT)	SPECT is a nuclear medicine tomographic imaging technique using gamma rays. It is very similar to conventional nuclear medicine planar imaging using a gamma camera. However, it is able to provide true 3D information of the brain.
Thalamic stimulation	Thalamic stimulation is a surgical technique where an electrode wire is inserted into the thalamus. The other end of the wire is connected to a pulse generator which delivers low-voltage pulses of electricity to the thalamus. This device can produce the benefit of thalamotomy without causing wound or scars on the skin.
Thalamotomy	First introduced in the 1950s, thalamotomy is an invasive procedure, primarily effective for tremors such as those associated with PD, where a selected portion of the thalamus is surgically destroyed (ablated).
Thalamus	The thalamus is an important part of the brain, it constitutes the main part of the diencephalon. The thalamus is known to have multiple functions. It is generally believed to act as a translator for which various "prethalamic" inputs are processed into a form readable by the cortex. Many different functions are linked to the system to which thalamic parts belong. This is at first the case for sensory systems, nevertheless a major role of the thalamus is devoted to "motor" systems e.g. tremor in PD.
Tremor	Tremor is a main motor symptom of PD characterised by mild shaking or trembling. This symptom is particularly debilitating in terms of its impact on patients' quality of life. There are different types of tremor including; intention (occurring in an outstretched body part), kinetic (occurring during voluntary movement), postural (occurring in a body part maintained against the force of gravity) and resting (occurring in a relaxed and fully supported body part).