Parkinson’s Disease

Overview

Parkinson’s Disease (PD) is a condition that affects the body’s motor system, causing symptoms such as tremor, rigidity (stiffness), and impaired balance and coordination. Symptoms of PD are the result of a loss of dopamine-producing brain cells.

Parkinson’s disease most often affects people over the age of 50, though it can also develop in younger individuals.

Causes

The symptoms of PD appear when the brain does not produce enough of a chemical called dopamine. Dopamine carries messages between the part of the brain where it’s produced (called the substantia negra) and the parts of the brain that control movement. This communication helps people have smooth and coordinated muscle movements. In PD, the cells that produce dopamine are damaged, and eventually—when 60 to 80 percent of these cells are damaged—they do not produce enough dopamine to enable smooth movement; when this occurs the motor symptoms of PD (such as shaking and tremor) begin to develop.

Symptoms

Many of the symptoms of PD are motor symptoms, affecting a person’s movement, strength, balance, and coordination. Other symptoms may be emotional or psychological.

Main Motor Symptoms:
·   Shaking or tremor at rest
·   Slowness of movement
·   Stiffness or rigidity of arms, legs, or trunk
·   Trouble with balance, causing falls

Secondary Symptoms:
·   Small cramped handwriting
·   Reduced arm swing on the affected side
·   Slight foot drag on the affected side; creates a shuffled walk
·   “Freezing”—being stuck in place when attempting to walk
·   Loss of facial expression due to rigidity of facial muscles
·   Low voice or muffled speech
·   Tendency to fall backwards
·   Decreased ability in automatic reflexes, such as blinking and swallowing

Other Symptoms:
·   Depression
·   Anxiety beyond the normal response to stress
·   Hallucinations, psychosis
·   Sleep disturbances (vivid dreams, talking and moving during sleep)
·   Constipation
·   Pain
·   Increase in dandruff or oily skin

Diagnosis

There is no definitive test to diagnosis PD. To make a diagnosis, doctors instead use the patient’s medical history and a neurologic exam. And, in order to rule out other diseases, doctors may use brain scans or laboratory tests.

Talking to Your Doctor

Your primary care physician, or family doctor, is likely to be the first healthcare provider you’ll see for diagnosis and treatment planning for PD. Due to the complex nature of PD, your healthcare team will probably expand to include specialists and other types of professionals. (A list of possible members of a healthcare team is included below in “Treating Parkinson’s Disease.”) You may want to ask your primary care physician for referrals as you build your healthcare team.

When you visit you primary care physician and other members of your team, you may find it helpful to bring a caregiver or loved one. Someone who knows you well and understands how PD is affecting you can be a valuable advocate for your care, help you communicate with your healthcare team, and take notes during doctors’ visits so that you have a good record of your treatment plan and current condition.

Treating Parkinson’s Disease

There is currently no cure for PD. Several medications, however, can help relieve symptoms—dramatically, in some cases. As well, a surgery called deep brain stimulation (DBS) can also help relieve symptoms in people whose disease doesn’t respond to medication.

Medication

Many of the drugs used to treat PD are targeted at the lack of dopamine in the brain. They work by temporarily replenishing dopamine or by imitating the action of dopamine. These medications, call dopaminergics, can help reduce motor symptoms such as rigidity and tremor and improve speed and coordination.

Deep Brain Stimulation

Deep brain stimulation is usually recommended only for patients whose symptoms are not adequately controlled with medication. The procedure involves implantation of a battery-operated neurotransmitter, a device that is similar to a pacemaker. The neurotransmitter delivers electrical stimulation to areas of the brain that control movement and blocks the abnormal nerve signals that cause motor symptoms of PD such as tremor. Healthy brain tissue is not harmed during DBS.

Parkinson’s disease affects a person in many ways—physically, mentally, and emotionally. As a result, PD is best treated by a team of healthcare professionals. Specialists that may make up this team include:

·   Neurologists
·   Primary care providers
·   Physicians assistants
·   Nurses
·   Mental health professionals (social workers, psychiatrists, psychologists)
·   Physical therapists or occupational therapists
·   Speech-language pathologists
·   Nutritionists or dieticians
·   Pharmacists
·   Neuropsychologists

How Fast Does It Progress?

The course of PD varies from person to person, progressing more quickly in some than in others. Parkinson’s disease may begin with subtle, gradually occurring symptoms.

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