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5 / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x
6 / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x / x
Table(E)1. Brain sites involved in stages 1-6 of Parkinson disease (PD). From predisposed sites in stage 1 (dmo – dorsal motor vagal nucleus, irz – intermediate reticular zone, aon – anterior olfactory nucleus, ob/otr – olfactory bulb/olfactory tract), the disease process advances during stage 2 into additional portions of the brain stem, including the rmg – nucleus raphes magnus, rob – nucleus raphes obscurus, gig – gigantocellular reticular nucleus, and coe/sub – coeruleus/subcoeruleus complex. Patients with clinical (i.e., chiefly somatomotor) symptoms usually show lesions corresponding to stage 3 or higher. In stage 3, the essentially ascending process advances upon the cam – central nucleus of the amygdala, sn – pars compacta of the substantia nigra, tpp – tegmental pedunculopontine nucleus, magnocellular nuclei the basal forebrain (bnM – basal nucleus of Meynert, idb – interstitial nucleus of the diagonal band, ms – medial septal nucleus), vta – ventral tegmental area, ora – the oral raphe nuclei, and tub – hypothalamic tuberomamillary nucleus. In stage 4, it reaches the cbam – corticobasal nuclei of the amygdala, ist – interstitial nucleus of the stria terminalis, inthal – intralaminar thalamic nuclei, vc – ventral claustrum, and, for the first time, nonolfactory structures of the cerebral cortex (not shown), also initially affecting the antt – anteromedial temporal mesocortex, ins/sub – insular and subgenual mesocortex, acg – anterior cingulate gyrus, and CA2 – second sector of the Ammon’s horn. The disease process encroaches upon neocortical high order sensory association areas and prefrontal fields in stage 5, whereas first order sensory association areas, premotor fields, and eventually primary fields of the neocortex follow in the final stage 6.19,23