What is Parkinson’s Disease?
Parkinson’s disease is a progressive neurological disorder. The first signs are problems with movement.
Smooth and coordinated muscle movements of the body are made possible by a substance in the brain called dopamine. Dopamine is produced in a part of the brain called the “substantia nigra.”
In Parkinson’s, the cells of the substantia nigra start to die. When this happens, dopamine levels are reduced. When they have dropped 60 to 80 percent, symptoms of Parkinson’s start to appear.
There’s currently no cure for Parkinson’s, a disease which is chronic and worsens over time. More than 50,000 new cases are reported in the United States each year. But there may be even more, since Parkinson’s is often misdiagnosed.
It’s reported that Parkinson’s complications are the 14th major cause of death in the United States.
Symptoms of Parkinson’s Disease
Some of the early symptoms of Parkinson’s can come before motor problems by several years. These earliest signs include:
- decreased ability to smell (anosmia)
- small, cramped handwriting
- voice changes
- stooped posture
The four major motor problems seen are:
- tremor (shaking that occurs at rest)
- slow movements
- stiffness of arms, legs, and trunk
- problems with balance and tendency to fall
Secondary symptoms include:
- blank facial expression
- a tendency to get stuck when walking
- muffled, low-volume speech
- decreased blinking and swallowing
- tendency to fall backward
- reduced arm swinging when walking
Other, more severe, symptoms may include:
- flaky white or yellow scales on oily parts of the skin, known as seborrheic dermatitis
- increased risk of melanoma, a serious type of skin cancer
- sleep disturbances including vivid dreams, talking, and movement during sleep
- problems with attention and memory
- difficulty with visual-spatial relationships
Early signs of Parkinson’s disease may go unrecognized. Your body may try to alert you to the movement disorder many years before movement difficulties begin with these warning signs.
Causes of Parkinson’s Disease
The exact cause of Parkinson’s is unknown. It may have both genetic and environmental components. Some scientists think that viruses can trigger Parkinson’s as well.
Low levels of dopamine and norepinephrine, a substance that regulates dopamine, have been linked with Parkinson’s.
Abnormal proteins called Lewy bodies have also been found in the brains of people with Parkinson’s. Scientists don’t know what role, if any, Lewy bodies play in the development of Parkinson’s.
While there’s no known cause, research has identified groups of people who are more likely to develop the condition. These include:
- Sex: Men are one and a half times more likely to get Parkinson’s than women.
- Race: Whites are more likely to get Parkinson’s than African Americans or Asians.
- Age: Parkinson’s usually appears between the ages of 50 and 60. It only occurs before the age of 40 in 5-10 percent of cases.
- Family history: People who have close family members with Parkinson’s disease are more likely to develop Parkinson’s disease, too.
- Toxins: Exposure to certain toxins may increase the risk of Parkinson’s disease.
- Head injury: People who experience head injuries may be more likely to develop Parkinson’s disease.
Each year, researchers are trying to understand why people develop Parkinson’s.
Parkinson’s Disease Stages
Parkinson’s disease is a progressive disease. That means symptoms of the condition typically worsen over time.
Many doctors use the Hoehn and Yahr scale to classify its stages. This scale divides symptoms into five stages, and it helps healthcare providers know how advanced the disease signs and symptoms are.
Stage 1 Parkinson’s is the mildest form. It’s so mild, in fact, you may not experience symptoms that are noticeable. They may not yet interfere with your daily life and tasks.
If you do have symptoms, they may be isolated to one side of your body.
The progression from stage 1 to stage 2 can take months, or even years. Each person’s experience will be different.
At this moderate stage, you may experience symptoms such as:
- muscle stiffness
- changes in facial expressions
Muscle stiffness can complicate daily tasks, prolonging how long it takes you to complete them. However, at this stage, you’re unlikely to experience balance problems.
Symptoms may appear on both sides of the body. Changes in posture, gait, and facial expressions may be more noticeable.
At this middle stage, symptoms reach a turning point. While you’re unlikely to experience new symptoms, they may be more noticeable. They may also interfere with all of your daily tasks.
Movements are noticeably slower, which slows down activities. Balance issues become more significant, too, so falls are more common. But people with stage 3 Parkinson’s can usually maintain their independence and complete activities without much assistance.
The progression from stage 3 to stage 4 brings about significant changes. At this point, you will experience great difficulty standing without a walker or assistive device.
Reactions and muscle movements also slow significantly. Living alone can be unsafe, possibly dangerous.
In this most advanced stage, severe symptoms make around-the-clock assistance a necessity. It will be difficult to stand, if not impossible. A wheelchair will likely be required.
Also, at this stage, individuals with Parkinson’s may experience confusion, delusions, and hallucinations. These complications of the disease can begin in the later stages.
This is the most common Parkinson’s disease stage system, but alternative staging systems for Parkinson’s are sometimes used.
Diagnosing Parkinson’s Disease
There’s no specific test for diagnosing Parkinson’s. Diagnosis is made based on health history, a physical and neurological exam, as well as a review of signs and symptoms.
Imaging tests, such as a CAT scan or MRI, may be used to rule out other conditions. A dopamine transporter (DAT) scan may also be used. While these tests don’t confirm Parkinson’s, they can help rule out other conditions and support the doctor’s diagnosis.
Treatments for Parkinson’s Disease
Treatment for Parkinson’s relies on a combination of lifestyle changes, medications, and therapies.
Adequate rest, exercise, and a balanced diet are important. Speech therapy, occupational therapy, and physical therapy can also help to improve communication and self-care.
In almost all cases, medication will be required to help control the various physical and mental health symptoms associated with the disease.
Drugs and medication used to treat Parkinson’s disease
A number of different drugs can be used to treat Parkinson’s.
Levodopa is the most common treatment for Parkinson’s. It helps to replenish dopamine.
About 75 percent of cases respond to levodopa, but not all symptoms are improved. Levodopa is generally given with carbidopa.
Carbidopa delays the breakdown of levodopa which in turn increases the availability of levodopa at the blood-brain barrier.
Dopamine agonists can imitate the action of dopamine in the brain. They’re less effective than levodopa, but they can be useful as bridge medications when levodopa is less effective.
Drugs in this class include bromocriptine, pramipexole, and ropinirole.
Anticholinergics are used to block the parasympathetic nervous system. They can help with rigidity.
Benztropine (Cogentin) and trihexyphenidyl are anticholinergics used to treat Parkinson’s.
Amantadine (Symmetrel) can be used along with carbidopa-levodopa. It’s a glutamate blocking drug (NMDA). It offers short-term relief for the involuntary movements (dyskinesia) that can be a side effect of levodopa.
Catechol O-methyltransferase (COMT) inhibitors prolong the effect of levodopa. Entacapone (Comtan) and tolcapone (Tasmar) are examples of COMT inhibitors.
Tolcapone can cause liver damage. It’s usually saved for people who don’t respond to other therapies.
Ectacapone doesn’t cause liver damage.
Stalevo is a drug that combines ectacapone and carbidopa-levodopa in one pill.
MAO B inhibitors
MAO B inhibitors inhibit the enzyme monoamine oxidase B. This enzyme breaks down dopamine in the brain. Selegiline (Eldepryl) and rasagiline (Azilect) are examples of MAO B inhibitors.
Talk with your doctor before taking any other medications with MAO B inhibitors. They can interact with many drugs, including:
- St. John’s wort
- some narcotics
Over time, the effectiveness of Parkinson’s medications can decrease. By late-stage Parkinson’s, the side effectsof some medicines may outweigh the benefits. However, they may still provide adequate control of symptoms.
Parkinson’s Disease Surgery
Surgical interventions are reserved for people who don’t respond to medication, therapy, and lifestyle changes.
Two primary types of surgery are used to treat Parkinson’s:
Deep brain stimulation
During deep brain stimulation (DBS), surgeons implant electrodes in specific parts of the brain. A generator connected to the electrodes sends out pulses to help reduce symptoms.
In January 2015, the U.S. Food and Drug Administration (FDA) approved a pump-delivered therapy called Duopa.
The pump delivers a combination of levodopa and carbidopa. In order to use the pump, your doctor will have to perform a surgical procedure to place the pump near the small intestine.
Parkinson’s Disease Prognosis
Complications from Parkinson’s can greatly reduce quality of life and prognosis. For example, individuals with Parkinson’s can experience dangerous falls, as well as blood clots in the lungs and legs. These complications can be fatal.
Proper treatment improves your prognosis, and it increases life expectancy.
It may not be possible to slow the progression of Parkinson’s, but you can work to overcome the obstacles and complications to have a better quality of life for as long as possible.
Prevention of Parkinson’s Disease
Doctors and researchers don’t understand what causes Parkinson’s. They’re also not sure why it progresses differently in each person. That’s why it’s unclear how you can prevent the disease.
Each year, researchers investigate why Parkinson’s occurs and what can be done to prevent it. Recent research suggests lifestyle factors — like physical exercise and a diet rich in antioxidants — may have a protective effect.
If you have a family history of Parkinson’s, you may consider genetic testing. Certain genes have been connected to Parkinson’s. But it’s important to know that having these gene mutations does not mean you’ll definitely develop the disease.
Talk to your doctor about the risks and benefits of genetic testing.
Parkinson’s Disease Heredity
Researchers believe both your genes and the environment may play a role in whether or not you get Parkinson’s. How great their impact can be, however, is unknown. Most cases occur in people with no apparent family history of the disease.
Hereditary cases of Parkinson’s are rare. It’s uncommon for parents to pass Parkinson’s to a child.
According to the National Institutes of Health, only 15 percent of people with Parkinson’s have a family history of the disease.
Parkinson’s Disease Dementia
Parkinson’s dementia is a complication of Parkinson’s disease. It causes people to develop difficulties with reasoning, thinking, and problem solving. It’s quite common — 50 to 80 percent of people with Parkinson’s will experience some degree of dementia.
Symptoms of Parkinson’s disease dementia include:
- sleep disturbances
- mood swings
- slurred speech
- changes in appetite
- changes in energy level
Parkinson’s disease destroys chemical-receiving cells in the brain. Over time, this can lead to dramatic changes, symptoms, and complications.
Certain people are more likely to develop Parkinson’s disease dementia. Risk factors for the condition include:
- Sex: Men are more likely to develop it.
- Age: The risk increases as you get older.
- Existing cognitive impairment: If you had memory and mood issues before a Parkinson’s diagnosis, your risk may be higher for dementia.
- Severe Parkinson’s symptoms: You may be more at risk for Parkinson’s disease dementia if you have severe motor impairment, such as rigid muscles and difficulty walking.
Currently, there’s no treatment for Parkinson’s disease dementia. Instead, a doctor will focus on treating other symptoms.
Sometimes medications used for other types of dementia can be helpful.
Life Expectancy of Patient with Parkinson’s Disease
Parkinson’s disease is not fatal. However, Parkinson’s-related complications can shorten the lifespan of people diagnosed with the disease.
Having Parkinson’s increases a person’s risk for potentially life-threatening complications, like a fall, blood clots, lung infections, and blockages in the lungs. These complications can cause severe health issues. They can even be fatal.
It’s unclear how much Parkinson’s reduces a person’s life expectancy. One study looked at the 6-year survival rates of nearly 140,000 people who had been diagnosed with Parkinson’s. In that six-year span 64 percent of people with Parkinson’s died.
What’s more, the study found that 70 percent of people in the study had been diagnosed with Parkinson’s disease dementia during the span of the study. Those who were diagnosed with the memory disorder had lower survival rates.
Exercises for Patient with Parkinson’s Disease
Parkinson’s often causes problems with daily activities. But very simple exercises and stretches may help you move around and walk more safely.
To improve walking
- Walk carefully.
- Pace yourself — try not to move too quickly.
- Let your heel hit the floor first.
- Check your posture and stand up straight. This will help you to shuffle less.
To avoid falling
- Don’t walk backwards.
- Try to not carry things while walking.
- Try to avoid leaning and reaching.
- To turn around, make a U-turn. Don’t pivot on your feet.
- Remove all tripping hazards in your house such as loose rugs.
When getting dressed
- Allow yourself plenty of time to get ready. Avoid rushing.
- Select clothes that are easy to put on and take off.
- Try using items with Velcro instead of buttons.
- Try wearing pants and skirts with elastic waist bands. These may be easier than buttons and zippers.
Yoga uses targeted muscle movement to build muscle, increase mobility, and improve flexibility. People with Parkinson’s may notice yoga even helps control tremors in some affected limbs.
Diet for Patient with Parkinson’s Disease
For people diagnosed with Parkinson’s, diet can play an important role in daily life. While it will not treat or prevent progression, a healthy diet may have some significant impacts.
Parkinson’s is the result of decreased dopamine levels in the brain. You may be able to increase levels of the hormone naturally with food.
Likewise, a healthy diet that focuses on specific nutrients may be able to reduce some symptoms and prevent progression of the disease. These foods include:
Foods high in these substances may help prevent oxidative stress and damage to the brain. Antioxidant-rich foods include nuts, berries, and nightshade vegetables.
These lime green beans contain levodopa, the same ingredient used in some Parkinson’s medications.
These heart- and brain-healthy fats in salmon, oyster, flax seed, and some beans may help protect your brain from damage.
In addition to eating more of these beneficial foods, you may want to avoid dairy and saturated fat. These food groups may increase your risk for Parkinson’s or speed up progression.
Parkinson’s Disease and Dopamine
Parkinson’s disease is a neurodegenerative disorder. It affects the dopamine-producing neurons (dopaminergic) in the brain. Dopamine is a brain chemical and neurotransmitter. It helps send electric signals around the brain and through the body.
The disease prevents these cells from making dopamine, and it may impair how well the brain can use dopamine. Over time, the cells will die entirely. The drop in dopamine is often gradual. That’s why symptoms progress, or slowly get worse.
Many of the Parkinson’s medications are dopaminergic drugs. They aim to increase the level of dopamine or make it more effective on the brain.
Parkinson’s Disease vs Multiple Sclerosis (MS)
At first glance, Parkinson’s disease and multiple sclerosis (MS) may seem very similar. They both affect the central nervous system, and they can produce many similar symptoms.
- slurred speech
- poor balance and instability
- changes in movement and gait
- muscle weakness or loss of muscle coordination
The two conditions are very different, however. The key differences include:
MS is an autoimmune disorder. Parkinson’s is the result of decreased dopamine levels in the brain.
MS primarily affects younger individuals. Average age of diagnosis is between 20 and 50. Parkinson’s is more common in people over 60.
People with MS experience issues like headaches, hearing loss, pain, and double vision. Parkinson’s can ultimately cause muscle rigidity and difficulty walking, poor posture, loss of muscle control, hallucinations, and dementia.
If you’re showing unusual symptoms, your doctor may consider both of these conditions when making a diagnosis. Imaging tests and blood tests may be able to help distinguish between the two conditions.