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- What is Parkinson's Disease?
- Diagnosing Parkinson's Disease
- What Causes Parkinson's Disease?
- Help for Parkinson's Disease
- More Information on Parkinson's Disease
What is Parkinson's Disease?
Parkinson's disease is a degenerative disorder of the central nervous system. It belongs to a scientific group of disorders referred to as movement disorders.
Parkinson's is associated with tremors of the arms and legs, rigidity of the muscles, poor balance, slow movement (bradykinesia) and difficulty walking, the most well known characteristic. It occurs as a result of the degeneration of nerve cells producing a chemical called dopamine in certain areas of the brain, the substantia nigra and locus coeruleus.
Dopamine is a neurotransmitter that stimulates motor neurons, (nerve cells which control the muscles) and strongly influences the thinking areas of the brain. When dopamine production decreases, the motor system nerves are unable to control movement and coordination, and progressively more motor and gross-movement problems are experienced.
It is also believed that Parkinson's may be caused by a combination of genetic and environmental factors. Symptoms of Parkinson's disease start very slowly and gradually becomes progressively worse over time.
Parkinson's disease affects over 1.5 million people in the United States. It is more common in men than in women. It occurs in all races, but Caucasians tend to be more prone to developing the disease. Most people develop symptoms of Parkinson's disease around the age of 60 years old, but it can affect a small minority below this age.
Diagnosing Parkinson's Disease
The diagnosis of Parkinson's is based on the analysis of symptoms as well as a full physical and neurological examination to rule out any other conditions that could produce similar symptoms.
There are no specific diagnostic tests that can be performed to diagnose Parkinson's disease. Often, in older patients, the doctor may dismiss symptoms of Parkinson's disease as signs of aging. In younger patients, these symptoms may also be overlooked because they are not normally expected. A neurologist may perform the following tests to meet other criterion for a diagnosis of Parkinson's:
- CT scan (computerized tomography)
- MRI (magnetic resonance imaging)
- Mild tremor in the fingers of one hand
- Mumbling speech that is inaudible
- An arm that does not swing when you walk
- Feeling depressed
- Trouble sleeping
- Lack of energy
- Routine tasks such as eating, showering or shaving may take unusually longer than normal
- Tremors or shaking in hands, fingers or legs
- Slowed motion (bradykinesia) – slow, shuffling walk with an unsteady gait and stooped posture, and legs freezing up
- Rigid stiff muscles
- Poor balance – posture becomes unstable
- Loss of automatic movements – blinking, the swinging of arms while walking, an inability to gesture and even smiling can be diminished
- Impaired speech – voice becomes monotonous and soft, and there may be trouble speaking
- Difficulty swallowing (dysphagia)
- Urinary problems
- Excessive saliva (hypersalivation)
- Excessive sweating (hyperhidrosis)
- Dementia – affects the ability to think, reason and remember. Dementia only occurs in the later stage of this disease, although there may be memory and concentration problems earlier on
Symptoms of Parkinson's Disease
Early signs of Parkinson's disease
Later signs of Parkinson's disease
Other Conditions Resembling Parkinson's Disease
There are a number of diseases or conditions that may appear similar to Parkinson's and they include the following:
- Vascular pseudo-parkinsonism
- Progressive supranuclear palsy
- Corticobasal degeneration
- Multiple systems atrophy
- Essential tremor (ET)
- Side effects of certain drugs
What Causes Parkinson's Disease?
Parkinson's disease is caused by the progressive loss of brain cells (neurons) which release the chemical known as dopamine to a part of the brain (substantia nigra). The dopamine cells are essential for movement, and ensure that your muscles perform smooth, controlled movements. When the neurons become damaged or destroyed, the dopamine-producing cells drop, and signs of Parkinson's disease develop.
Environmental and Genetic Factors
Exposure to herbicides and pesticides increases the likelihood of developing Parkinson's Disease.
A number of drugs taken excessively or for long periods of time can cause the same symptoms as Parkinson's disease. Medications prescribed for certain psychiatric disorders (haloperidol and chlorpromazine), nausea (metoclopramide) or epilepsy (valproate) can also have side effects similar to those of Parkinson's Disease. These drugs do not cause Parkinson's disease itself but can, over time, produce the same symptoms.
Risk Factors for Parkinson's Disease
- A genetic predisposition to Parkinson's (strong inheritance pattern)
- Increases with age, especially in the middle or later years of life
- Men are more likely to develop this disease than women
- Exposure to herbicides and pesticides
- Living in a rural area or drinking well water
- Reduced estrogen levels
- Obsessive personality
- Severe emotional trauma or stress
- Previous head injury
Help for Parkinson's Disease
While there is no cure for Parkinson's disease, there are various treatment options available which can control the symptoms and improve quality of life.
Treatment Options for Parkinson's Disease
The medication administered to a Parkinson's patient is tailored to his or her specific needs. Finding the most effective combination of medications with the least side effects often involves a period of trial and error. Some patients build up a resistance to their medication, making changes necessary from time to time. Be sure to communicate with your doctor if you have any questions, are experiencing unpleasant side effects or find that your medication becomes less effective.
The following are some of the drugs most commonly used for Parkinson's – depending on the needs of the individual.
- Dopamine-enhancing drugs such as levodopa and carbidopa help with walking, movement and tremors. Levodopa and carbidopa are also effective in treating bradykinesia and rigidity.
- Dopamine Agonists (adjuncts to levodopa) which enhance the action of the dopamine present
- Amantadine (antiviral drug with dopamine properties)
- MAO-B Inhibitors (Dopamine is oxidized by the enzyme monoamine oxidase B and MAO-B inhibitors boost the effects of levodopa as they help to slow the breakdown of dopamine)
- Anticholinergics (adjuncts to levodopa) can help with symptoms such as excessive salivation and can enhance autonomic activity
- COMT (catechol-O-methyl transferase) Inhibitors
Surgery is another treatment option to consider when medical treatment becomes ineffective. There are risks involved and it is not guaranteed that the symptoms will improve. Surgical procedures include:
A heated electrode is inserted into the targeted area
Thalamotomy involves the destruction of small amounts of tissue in the thalamus
Deep Brain Stimulation (DBS)
In DBS, the targeted area is inactivated, but not destroyed, by an implanted electrode.
Transplantation or Restorative Surgery
In transplantation, or restorative, surgery dopamine-producing cells are implanted into the striatum of the brain.
An electric current is used to destroy a small amount of tissue in the pallidum (globus pallidus), a part of the brain responsible for many of the symptoms of Parkinson's disease. Pallidotomy may improve tremor, rigidity and slowed movement, and can be helpful in countering the involuntary movements caused by drug therapy.
Complementary Treatment Modalities for Parkinson's Disease
- Physical therapy
- Occupational therapy
- Music therapy
- Alexander technique
- Tai Chi
- Support Groups
- Herbal and Homeopathic remedies
More Information on Parkinson's Disease
Prognosis for Parkinson's Disease Suffers
Parkinson's Disease is related to other disorders such as depression, substance abuse, other phobias and anxiety disorders (particularly Panic Disorder).
It is therefore recommended that a professional evaluation be sought, so that you can receive a proper diagnosis and treatment for any other co-existing problems.
Some Tips for Parkinson's Patients
- Educate yourself about the disease so that you understand the symptoms, treatment options and various medications involved. A good relationship with your neurologist will also help you to be aware of new developments and treatments for the disease.
- Eat a well balanced diet that is high in fiber as constipation is a common symptom of the disease as well as a side effect of many of the medications.
- Exercise is important but it has to be gentle, as this increases the patient's general mobility, balance, flexibility and wellbeing. Many people find yoga very beneficial – especially with an experienced teacher who takes their condition into account.
- A support group can be very helpful, helping to share feelings with others who understand and are having the same experience.
- A strong family and support network of friends and relatives can have a positive effect on emotional health.
- Modifying the home helps to accommodate physical difficulties and improve quality of life.
- Invest in a walker or quad crane for balance and to improve walking. Use a
portable tub, shower chair, multi-level hand grips and safety rails to avoid falls
- Wear clothes that are comfortable and easy to slip into like sweat pants, dresses or pants with elastic waistbands. Replace buttons or zips with Velcro fasteners.
- Communicate openly with your partner about your feelings, how the disease has affected you and the rest of the family and the impact it has on your sex life
- Simple physical activities such as walking, gardening, and swimming can greatly improve one's sense of well-being.
- The slow flowing movements of Tai Chi help to maintain flexibility, balance and can provide valuable relaxation.
- Avoid driving because reflexes and perception are usually impaired during this disease.
Some Tips for Care-Givers and Family
Caring for someone suffering from Parkinson's disease is challenging, and at times it can take its toll on you. Use these helpful tips to help you cope:
- It is important that a person with Parkinson's feels useful. Allow him or her to handle tasks that will not cause strain or be too exhausting. Offer to help if necessary – but encourage independence as much as possible.
- Stay positive and be patient. People with Parkinson's often become very depressed or grumpy about their condition. Try to be as encouraging, upbeat and optimistic as possible.
- Join a support group where you will be able to relate to others who are in a similar situation
- Keep the channels of communication open. Speak about everyday occurrences, changes in symptoms or difficulties experienced
- Noise, crowds and bright lights can often be bothersome – be aware of this when planning an outing or activity
- Stay informed. Maintain contact with the neurologist about new treatment or medication. Read about new developments in medical journals or on the internet. Research on Parkinson's is active and ongoing so it helps to keep up to date.