Andrew John Lees

A.J. Lees explores how Gabriel García Márquez’s Love in the Time of Cholera challenges political and social perceptions of older people as frail and lacking in vitality, while also critiquing profit-driven medicine and the tendency to view ageing, including benign forgetfulness, as a pathological state.

Language often incorporates mechanistic assumptions. Terms used to describe protein behavior and properties, such as “accumulation,” “replication,” “propagation,” and “strains,” largely borrowed fr...

Corticobasal degeneration (CBD) is a late onset progressive neurodegenerative condition of the 4-repeat-tauopathy-type, classically presenting with asymmetrical rigidity, dystonia and myoclonus. In the most recent diagnostic criteria, Armstrong and colleagues (2013) described four clinical phenotypes associated with this pathology, including corticobasal syndrome (CBS), through a large retrospective analysis of published cases and confirmed brain bank cases of CBD. However, predicting CBD pathology remains challenging. With the advent of disease-modifying therapies, it has become particularly important to distinguish Alzheimer’s disease pathology from other underlying pathologies. We therefore combined two prospectively recruited cohorts of patients with CBS and analysed their key demographic, clinical and biomarker features. We included a separate cohort from UK brain banks who were diagnosed with CBS in life. We divided patients into three groups: CBS-Alzheimer’s (CBS-AD), CBS-non-Alzheimer’s (CBS-non-AD) and CBS-indeterminate (CBS-IDT) based on biomarkers and pathology, comparing clinical features, regional volumetric MRI measures and Nucleic Acid-Linked Immuno-Sandwich Assay with detection by next generation sequencing (NULISAseq) blood protein levels between groups. We performed additional analyses of pathologically verified cases. We included 397 participants, of which 57.7% were female. The mean age at symptom onset was 65.9 years. AD biomarkers and pathology permitted classifying 47 (11.8%) of the cases as CBS-AD, 134 (33.8%) as CBS-non-AD and 216 (54.4%) as CBS-IDT. Patients with CBS-AD had a younger age at onset (61.8 years vs 66.1 years, P < 0.01 and less severe motor deficits (non-significantly lower scores on MDS-UPDRS and PSPRS) and more severe cognitive impairment (non-significantly lower scores on MoCA). Patients with CBS-AD had higher rates of cortical sensory impairment (P = 0.087) and lower rates of limb dystonia (P < 0.01) and falls (P < 0.01) compared to the CBS-non-AD group. Volumetric MRI analysis revealed smaller parietal lobe volumes in CBS-AD (P = 0.01). The most common pathological diagnoses were PSP, CBD and AD. Limb dystonia was more common in people with CBD and PSP pathology (P = 0.077). Falls, impaired verbal fluency and impaired vertical saccades were confirmed as more common in PSP (P = 0.046, P = 0.040, P = 0.012, respectively). In summary, younger onset, less parkinsonism and more cognitive and cortical sensory impairment, along with reduced MRI parietal volumes point to CBS-AD, while limb dystonia, falls and worse verbal fluency relate to CBS-non-AD. Clinical, imaging and blood-biomarkers in can augment the Armstrong criteria in predicting the underlying pathology of corticobasal syndromes.

Importance: The real-world prevalence and the clinical determinants associated with cognitive impairment in diverse patients with Parkinson disease (PD) have been understudied. Objective: To determine the prevalence of cognitive impairment in a diverse PD cohort and explore associations with vascular, motor, and nonmotor factors. Design, setting and participants: Case-only analysis of diverse patients with PD recruited to the East London Parkinson disease project (July 2022 to July 2025) at the Royal London Hospital, a tertiary referral center. Of 237 patients with cognitive status defined by expert, multi-disciplinary, clinical consensus, 223 remained after excluding atypical or secondary parkinsonism, other dementias, and study withdrawal. Exposures: Observational study (no experimental intervention); exposures included vascular risk factors, motor and nonmotor clinical features. Main Outcome(s) and Measure(s): The main outcome was cognitive impairment (PDCI), defined as mild cognitive impairment (PDMCI) or dementia (PDD) by expert clinical consensus based on clinical, imaging, and cognitive screening. Results: Among 223 participants with a median disease duration of 4.0 (1.0-9.0) years, 112 (50.2%) had PDCI, including 62 (27.8%) with PDD and 50 (22.4%) with PDMCI. South Asian ethnicity was associated with PDCI in univariate analysis (OR, 2.30; 95% CI, 1.32-4.00, P = .003) and the association strengthened after adjusting for age, gender, years of education, disease duration and depression scores (OR, 3.60; 95% CI, 1.68-7.69, P < .001). PDCI was associated with increased odds of smoking (OR, 3.62; 95% CI, 1.56-8.41, P = .003) in the adjusted model. Increased odds were also associated with motor severity (Movement Disorders Society Unified Parkinson Disease Rating Scale Part III; OR per point increase 1.07; 95% CI, 1.04-1.10; P < .001), and daytime somnolence score (Epworth Sleepiness Scale; OR per point increase, 1.08; 95% CI, 1.01-1.16; P = .03). Conclusions and Relevance: In this multi-ethnic study of PD using gold-standard expert multidisciplinary consensus, cognitive impairment was common and more prevalent among South Asian individuals. Smoking, greater motor severity, and higher daytime somnolence were associated with increased odds of cognitive impairment.

Background: Soon after the advent of cinematography in 1895, neurologists began exploring its use as a permanent record of physical signs and as a teaching aid. We present the first known Spanish film on movement disorders, recorded in 1915. Methods: We describe and analyze the patients shown in the film within its historical context. Results: The first section of the film is a teaching session in which a fixed camera records the patients and the professor, surrounded by students. It presents 10 patients, including parkinsonian and catatonic patients. In the second section, a mobile camera follows two cases in more detail: a patient with probable Huntington's disease (HD), and an impressive case of paradoxical kinesia in Parkinson's disease (PD). Conclusions: The didactic value of the film is exceptional. It presents the first reported Spanish case of HD, and the first documented case of paradoxical kinesia in PD, 6 years before its written description in 1921. © 2026 International Parkinson and Movement Disorder Society.