have to be congratulated for their hypothesis on PD pathogenesis. They suggest that the sequence of the brain changes in PD follows specific and repeatable patterns in all cases, as well as that a prion-like process underlies neurodegeneration. These ideas could explain several features of PD, such as the high prevalence of olfactory, autonomic, or sleep abnormalities. However, any pathogenic hypothesis should also explain:1. The variable rate of progression. 2. The heterogeneous presentation. 3. The persistent asymmetry of motor symptoms and signs. 4. The progressive worsening and somatotopic spreading of the same symptom, meaning that neurons displaying similar gene expression profile, intracellular enzymatic machinery, and signaling pathways are differentially affected by the process. 5. The case of young-onset cases: whereas they must have severe disease to present so early, disability progresses slowly.None of them are covered in the article. 1 Certainly, PD is a multisystem disorder. The view of PD resulting from the sequential pathological involvement of brain nuclei is based on the work by Braak, 2 which has received strong criticisms. 3It relies on the presence of a-synuclein inclusions, Lewy bodies, and Lewy neurites in the brain of subjects' dead of different causes. However, clinical information was extremely limited, some of the subjects included did not develop neither motor nor cognitive symptoms during life, staging was independent of disease duration, and neuronal loss was not recorded. Despite these limitations, Braak's findings have been interpreted as an open door to presymptomatic diagnosis according to the presence of abnormalities resultant from this pattern of involvement (i.e., hyposmia, REM behavior disorder, constipation,. . .). Compelling evidence suggests that a-synuclein inclusions not closely correspond to the severity of neuronal loss, neuronal dysfunction, or clinical expression. There is a gap between pathology and clinical picture. Thus, even admitting that pathology could follow a predefined order, the view of PD as a disease that starts with hyposmia, sleep disturbances, and constipation, follows with motor symptoms and ends with dementia, is not always true. Thus, the predictive value of premotor symptoms is relative. The prevalence of a-synuclein inclusions in the brain of old individuals dead without any neurological dysfunction is around 30%, whereas the prevalence of PD in this group of age is 2%.Further arguments come from the development of nondopaminergic symptoms. A recent study showed that age and severity of PD but not duration of illness, act as independent risk factors for developing dementia. 4 Furthermore, the brain of the majority of parkinsonian patients displaying dementia presents abundant changes characteristic of Alzheimer's disease. The relationship between dementia, aging, PD, and associated pathologies needs clarification. Additionally, rate of progression is more determinant of PD outcome than its multisystemic nature. It is likely linked to compens...

Acute mental health care facilities have become the modern equivalent to the old asylum, designed to provide emergency and temporary care for the acutely mentally unwell. These facilities require a model of mental health care, whether very basic or highly advanced, and an appropriately designed building facility within which to operate. Drawing on interview data from our four-year research project to examine the architectural design and social milieu of adult acute mental health wards in Aotearoa New Zealand, official documents, philosophies and models of mental health care, this paper asks what is the purpose of the adult inpatient mental health ward in a bicultural country and how can we determine the degree to which they are fit for purpose. Although we found an important lack of clarity and agreement around the purpose of the acute mental health facility, the general underpinning philosophy of mental health care in Aotearoa New Zealand was that of recovery, and the CHIME principles of recovery, with some modifications, could be translated into design principles for an architectural brief. However, further work is required to align staff, service users and official health understandings of the purpose of the acute mental health facility and the means for achieving recovery goals in a bicultural context.

To recognize the significance of indigenous cultures and their landscapes as well as to appraise these places, identification and evaluation have to focus on indigenous worldviews rather than on the deeply embedded Western civilization ideals and values of the design. Australian Aboriginal and New Zealand’s Maori cultures are genuinely rooted in experiential interrelationships with land with a particular orientation toward relationship and time entrenched in cosmology, narrative, and place. This article explores a participatory design strategy that facilitates and benefits indigenous cultures in Australia and Aotearoa/New Zealand. Using a design-led research approach, this study endeavors to nurture capacity building within “traditional custodians” in order to contribute to the sustainability of rural communities as well as caring for landscape. The article also introduces a framework better suited to nurturing and managing cultural landscapes. This framework demonstrates the potential to simultaneously empower indigenous cultures to protect things that matter but also to enhance their economic, political, and social freedom as they understand it through the lens of their own cultural values.

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