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Attorney General Janet Reno Diagnosed With Parkinson's

By Pierre Thomas and David Brown
The Washington Post

Attorney General Janet Reno revealed Thursday that she has Parkinson's disease, an incurable degenerative illness that causes muscular stiffness and involuntary trembling. She said she feels fine and plans to continue her duties.

Parkinson's disease primarily impairs movement, although it can alter mood and thinking, as well. It affects about 1 percent of people over age 50. The average age of a person at the time of diagnosis is 57 -- Reno's age.

Reno, the nation's top law enforcement officer, made the disclosure in a low-key fashion at the beginning of her weekly news conference, "I first noticed my hand shaking ... over the summer and I thought it would go away," Reno told reporters, a number of whom had earlier inquired about her health after noticing her left hand sometimes trembled. "When it didn't, I went to see the doctor."

Three weeks ago, Reno learned of the diagnosis and, after researching the disease, last weekend began telling family members. Earlier this week, she informed key members of her staff, including Deputy Attorney General Jamie S. Gorelick, and Thursday morning telephoned White House Chief of Staff Leon E. Panetta. She emphasized her health is good and that she has begun medication which has been effective, removing the trembling.

However, she recognized that over time the disease can become more debilitating. "As I grow old ... and become an old lady, I may find some limitations in mobility," said Reno, who Thursday afternoon received a call of support from President Clinton. "But I feel fine now... . I don't feel I have any impairment."

Reno's neurologist, Jonathan Pincus of Georgetown University Medical Center, said the attorney general's "prognosis is excellent," adding "nothing about... the disorder she has should impair her capacity to do her job."

Reno is taking carbidopa and levodopa, a two-drug combination that is the usual first treatment for the disease. The medicine has eliminated the hand tremor, which is classically the first symptom of the disease, and to date Reno's only one.

Besides tremor, muscle rigidity and difficulty initiating movements (such as getting out of a chair) are the other common symptoms of the ailment. Pincus said it is likely "these other symptoms will develop later," but he believes Reno could experience no change or worsening of the disease for 5 to 10 years.

Although the disease has little effect on life expectancy, it almost always worsens with time. In its advanced stages, sufferers are often severely disabled, with problems feeding themselves, talking and walking.

Between 15 percent and 20 percent of Parkinson's patients develop obvious dementia, or mental impairment, though this symptom is less common among people who develop the disease before age 60. About 40 percent to 50 percent of people also experience depression during the illness. Unlike dementia, which tends to occur late, mood changes can appear at any time. The mood disorder seems to be a result of the disease process, and is not simply an emotional reaction to illness. It is as treatable with antidepressant drugs as non-Parkinsonian depression.

While the cause of Parkinson's disease is mysterious, the site of the brain damage has been known for decades. A region known as the substantia nigra, easily identified because it contains dark-pigmented cells, slowly degenerates. In particular, cells that employ a signaling chemical called dopamine are lost. The region is part of a complicated nerve circuit that helps create smooth, coordinated movement.

Reno's diagnosis comes after what has been a particularly acrimonious professional season. This summer she faced intense questioning and criticism from Republican congressional leaders about her leadership during the standoff with the Branch Davidian cult near Waco, Tex., a confrontation that left David Koresh and more than 80 followers dead.

Thursday, however, was one of some bipartisan support for Reno.

"Our prayers go out to her," said Sen. Orrin G. Hatch, R-Utah, chairman of the Senate Judiciary Committee.

Her peers in the Justice Department expressed confidence in her health and praised her for being direct about a matter that had begun to worry some.

"I certainly noticed the shaking hand," one senior official said. "It worried me until I learned what was causing it. Now I know she's fine."

Gorelick agreed, noting "I'm with her every day, much of the day. She's as strong as can be."