An estimated seven to 10 million people across the globe — and up to a million in the United States — suffer from Parkinson's disease, the second most common progressive neurological disease after Alzheimer's. The characteristic symptoms of tremor, slowness of movement and rigidity aren't the only ones patients live with as as dopamine-producing nerve cells are gradually lost. Because there is no cure for Parkinson's disease, treatment focuses on symptom management. It is, however, possible to live a productive and fulfilling life with Parkinson's for a very long time.
What should everyone — from people who have noticed symptoms that may point to Parkinson's and those who have recently been diagnosed to people who would simply like to learn more about the condition — know about Parkinson's disease?
Parkinson's disease: Basics everyone should be aware of
Parkinson's disease, classified as a movement disorder, describes the loss of dopamine-producing nerve cells in a part of the brain called the substantia nigra — which goes on to result in symptoms when between 50 and 80 percent of these cells have been destroyed. The presence of so-called Lewy bodies, clusters of abnormally folded proteins in the brain, is another characteristic feature of Parkinson's disease. It is notIt is not yet clear what causes the loss of nerve cells in Parkinson's disease, but a combination of environmental and genetic factors are thought to be implicated.
The symptoms of Parkinson's disease
Nearly everyone has heard of Parkinson's disease, which affects around one percent of people over 60 and five percent of those over 85 ― but unless you have a close relative with the condition or have come across people with Parkinson's in your professional life, you may not know that much about the possible symptoms. Tremor, rigidity, and slowness of movement are most characteristic and probably what most people think of when they hear the term "Parkinson's disease". Not every patient experiences the same symptoms, however, and the possible range of ways in which the condition does affect patients is also much broader.
The primary motor symptoms of Parkinson's are:
- Tremor. Tremors typically occur at rest and affect one side of the body in the beginning while gradually spreading to both sides. A hand, arm, leg, or foot may be affected, but tremors can also strike the jaw, chin, or tongue. It is important to note that not every Parkinson's patient experiences tremor, as well as that tremor can also be caused by other conditions such as Essential Tremor.
- Rigidity or stiffness may strike the arms, legs, and torso, and especially in the early stages, patients and doctors alike may simply attribute it to the normal aging process.
- Slowness of movement, medically called bradykinesia. This symptom can manifest in many different ways, from "mask-like" facial expressions to a shuffling gait, and from micrographia, a small and crowded handwriting, to trouble blinking or turning while in bed.
- Postural problems, especially trouble maintaining balance, means that people with Parkinson's are much likely to suffer falls. Many Parkinson's patients also slouch.
- Dyskinesia refers to involuntary, jerking or twitching, movements that aren't tremor. They often get worse with certain Parkinson's medications.
A combination of these features can result in difficulty getting dressed, eating, swallowing, speaking clearly (Parkinson's patients may speak with an ever-decreasing volume), and experiencing "freezing", where the patient can't seem to move.
The non-motor symptoms, meanwhile, can include:
- The loss of a patient's sense of smell, a somewhat surprising symptom that can actually manifest years before any other symptom announces itself. Because of this, anyone manifesting Parkinson's-like symptoms will be asked about their sense of smell during the diagnostic process.
- Depression and anxiety. While data on the frequency of these problems in Parkinson's patients varies, the general consensus is that at least 40 percent of patients experience depression or anxiety.
- Fatigue and sleeping difficulties are other frequent non-motor symptoms of Parkinson's. It is most typical for a patient to have no problem with the ability to fall asleep in the first place, but to have difficulty staying awake through the night. Vivid dreams that patients act out (REM behavioral disorder) is another possibility.
- Constipation is another possible early warning sign of Parkinson's that can appear years before motor symptoms.
- Urinary urgency or frequency are also possible.
- Parkinson's dementia — which can manifest through forgetfulness, irritability, trouble concentrating, impaired judgment, personality changes, and even hallucinations — may affect as many as 80 percent of patients over the course of their illness.
- Psychosis is also possible, and associated with certain medications prescribed to combat the symptoms of Parkinson's disease.
- Excessive sweating, especially in the upper body, also affects some Parkinson's patients.
- Many Parkinson's patients suffer from postural hypotension, or low blood pressure upon changing positions. This can leave patients feeling faint and lightheaded when they stand up after sitting, or when then sit up after lying down.
- A small minority of patients will experience impulse control issues that can lead to hypersexuality, gambling, overeating, or shopping problems.
Parkinson's disease: What are the causes or risk factors?
While the underlying causes that set the loss of dopamine-producing nerve cells in motion are as of yet unknown, they are believed to be due to a combination of environmental and genetic factors. Known risk factors for Parkinson's disease include:
- Age — most Parkinson's patients do not exhibit symptoms until they are over 60, and the condition is much more common after 85. It is, however, possible for people to develop "early onset Parkinson's disease" before 60, though it is rare.
- Being male — Parkinson's disease is diagnosed in men around 1.5 times more often than in women, something that may be explained by Differing environmental exposures as well as underdiagnosis in women.
- Genetics — the majority of Parkinson's cases do not appear to run in families, but around 15 percent of patients do have someone in their immediate family who also has the condition. Several genetic mutations that increase a person's risk of Parkinson's have been identified.
- Ethnicity — Caucasian and Hispanic (white and non-white) people appear to have the highest risk of developing Parkinson's disease.
- Environmental exposures — exposure to certain pesticides, herbicides, fungicides, and insecticides seems to increase a person's risk of Parkinson's, alongside exposure to metals like mercury, lead, iron, copper, manganese, thallium, zinc, aluminum, and Bismuth. Taking antidepressants, hypnotics, or anti-anxiety medications has also been correlated with a higher risk of Parkinson's. The same holds true for MPTP, a synthetic heroin.
- Head trauma is another possible risk factor, which research finding that veterans with a history of even one traumatic head injury have a 50 percent increased risk of Parkinson's.
How is Parkinson's disease diagnosed?
Without a single easy test to rely on for diagnosis, the process of figuring out whether a person's could have the condition is complex, multifaceted, and prolonged. People often first see a family doctor after they notice changes they're worried about, and it's up to this primary care physician to consider multiple possible conditions. If Parkinson's has been ruled in as a possibility, they will then refer you to a neurologist, who will continue the diagnostic process.
The most commonly used rating scale for Parkinson's disease is the Unified Parkinson's Disease Rating Scale (UPDRS). Your neurologist will ask you about your symptoms — when they first started, what their nature is, when they are better or worse, and so on — and will need access to your personal and family medical history. They'll need to know what medications you may be taking as well. Over the course of the diagnostic process for Parkinson's disease, your doctor will:
- Quiz you and perhaps a support person about cognitive and motor symptoms. (See — Diagnosing Parkinson's disease: 50+ questions you can expect from your neurologist.)
- Ask you to engage in a series of tasks to assess your motor function.
- Imaging tests, such as MRI or CT scans, may be carried out to rule other possible conditions out.
- You may be offered carbidopa/levodopa, a combination medication used to treat Parkinson's disease, to see if your symptoms improve.
Understanding the stages of Parkinson's disease
Parkinson's disease, as a progressive neurological condition, is divided into five distinct stages. If you are diagnosed, your doctor will assess the stage you are currently in. The 5 stages of Parkinson's disease are:
- Stage 1 Parkinson's disease typically features tremors, rigidity, slowness of movement including gait changes, and changed facial expressions. These motor symptoms typically occur on one side of the body. Non-motor symptoms like fatigue will also be present. At this stage, the symptoms are mild enough that they're easily missed or simply attributed to aging.
- Stage 2 Parkinson's disease frequently means the symptoms experienced in stage 1 now start to affect both sides of the body as well as being more severe. In addition, your speech may change, becoming lower in volume as a conversation progresses, or becoming slurred. Facially, blinking may become increasingly difficult. Parkinson's is harder to miss at this stage, but balance is not yet an issue.
- Stage 3 Parkinson's disease patients will experience all these issues, as well as suffering from trouble maintaining balance, having more pronounced slowness of movement, and having slower reflexes. It is at this stage that independent living often first becomes a significant challenge.
- Stage 4 Parkinson's disease makes independent living hard — patients find it difficult to complete everyday tasks like eating and getting dressed, and will require quite a lot of help. They will need home adaptations to improve their quality of life, also.
- Stage 5 Parkinson's disease patients will find that the medications they were prescribed are no longer as effective. Every day tasks become nearly impossible to carry out alone, and cognitive symptoms like hallucinations, confusion, and delusions affect a significant portion of patients.
How is Parkinson's disease treated?
While there is no cure for Parkinson's disease nor a way to slow its progression, a set of pharmacological, surgical, and lifestyle interventions can help you maintain a good quality of life for a very long time. What are your options in the treatment of Parkinson's disease?
Medications for Parkinson's disease
- Carbidopa/levodopa is widely prescribed combination medication that is effective as well as well-tolerated. While levodopa is converted into dopamine in the brain, carbidopa helps levodopa do a better job. Their efficacy dwindles over time, as patients notice they have "on periods" during which the drugs work well and "off periods" during which they don't. Brand names include Sinemet and Rytary, taken orally, and Duopa, which is admistered through a feeding tube.
- Dopamine agonists such as Rotigotine and Apomorphine act like dopamine and are less likely to produce side effects.
- Catechol-O-methyltransferase (COMT) inhibitors like Comtan need to be taken alongside levodopa, and are designed to make it more effective.
- MAO-B inhibitors like Azilect and Eldepryl have the goal of reducing the loss of dopamine.
- Anticholinergic drugs reduce tremors and are effective even in the later stages of Parkinson's. Because they are associated with side effects like hallucinations, memory loss, and loss of bladder control, they are now not used as often.
- Amantadine was originally a flu drug. It also helps Parkinson's patients improve motor symptoms.
The non-motor symptoms of Parkinson's — like depression, psychosis, and dementia — may be treated with antidepressants (especially SSRIs), antispychotics, and Cholinesterase inhibitors.
All medications have the potential of side effects, and Parkinson's drugs are no exception. The side effects you may experience while taking drugs for Parkinson's disease include:
- Dyskinesia — involuntary movements
- Nausea and vomiting
- A dry mouth
- Blurred vision
- Low blood pressure
- Constipation or diarrhea
- Confusion, hallucinations, delusions, or psychosis
- Loss of impulse control
- Fatigue and disordered sleep
Both patients and caregivers who notice these side effects can "sound the alarm" with the treating doctor when such side effects become apparent — tweaking your medication may make all the difference, and your doctor can also tell you about ways to cope with the side effects of Parkinson's disease drugs.
Deep Brain Stimulation
Deep brain stimulation (DBS) is a surgery in which electrodes are inserted into your brain. These electrodes are connected to a generator or "brain pacemaker", which can in turn be controlled with a remote. This surgery can make a big difference for certain patients, as it helps fight motor symptoms like tremor, rigidity, and slowness of movement, especially in people whose medications no longer work as well. It is not considered an option for those suffering from dementia. Ask your doctor how deep brain stimulation for Parkinson's disease works, and whether you may be a candidate, if you are interested in exploring this further.
How can lifestyle changes help people with Parkinson's?
Not all "treatments" involve medication or surgery — certain lifestyle changes and non-pharmacological treatments can also make a tremendous difference. These include:
- Regular physical exercise can help Parkinson's disease patients improve their strength, flexibility, and stamina as well as improve emotional wellbeing.
- Physical and occupational therapy include exercises as well as "work-arounds" that make daily activities easier with your current physical limitations.
- Home adaptations and specialized equipment — anything from railings to hold onto to walkers, special cups, and special straws, can help make life easier.
- Alternative treatments for Parkinson's disease that may improve your quality of life include acupuncture, massage, water therapy, and dance therapy.
- Some patients additionally turn to nutritional supplements for Parkinson's disease. Things like Coenzyme Q10, B vitamins, and vitamin E may help reduce your symptoms. However, they can also interact with medications you are taking, so it is important to discuss any supplements you are interested in exploring with your doctor.