About Parkinson Disease

Intro to Parkinson's Disease

Often times, the diagnosis of Parkinson's disease is accompanied with little or no information about its cause, prognosis or management. Here you will find some helpful information that will help you better understand PD. For additional information on the disease, health care referrals and community resources contact the Parkinson Foundation Western Pennsylvania at 412-837-2542.



What is Parkinson Disease?

Parkinson's disease (PD) is a progressive neurodegenerative disorder first described by Dr. James Parkinson in "An Essay on the Shaking Palsy" in 1817.

Some physicians use the term "parkinsonism" in the initial evaluation and diagnosis. Parkinsonism is an umbrella term applied to the clinical syndromes that share the cardinal movement disorders of resting tremor, bradykinesia, rigidity and postural instability.

Idiopathic Parkinson's disease or what is commonly referred to as Parkinson's disease (PD) makes up about 85% of all the parkinsonism syndromes. Idiopathic means unknown cause or origin.

Young Onset Parkinson's disease (YOPD) is a subgroup of idiopathic PD made up of those diagnosed before the age of 50. Although the disease is essentially the same as it is when diagnosed later in life, the issues surrounding the disease are different.

A clinical diagnosis of PD is made by assessing motor function or movement.
The diagnosis is made by the presence of at least two of the four cardinal motor or movement symptoms associated with PD. When the symptoms are present, medications which are known to reduce the symptoms are then often used to increase the likelihood of making a correct clinical diagnosis.

What causes PD?

No one is sure, but many risk factors have been discovered which likely contribute to developing Parkinson's disease. The extent to which each risk factor is involved though is still not understood from person to person.

Aging

  • Is considered one of the primary risk factors because it is very uncommon before the age of 30, and incidence rates increases with age.
  • It has been established that there is a decline in dopamine concentrations of 5-8% per decade after the age of 30.

Family link or genetic predisposition

  • Research studies show a genetic link or predisposition associated with developing Parkinson's disease. White males are more likely to be diagnosed with Parkinson's disease than African American males and Asian males are at lower risk than both white and African American males.
  • There are mutations on 11 genes found in three different regions of the brain currently being investigated in association with PD.

Environmental triggers
There have been a number of chemicals, injuries and infections associated with an increased risk of developing PD including:

  • Head injuries
  • Exposure to certain environmental toxins
  • Pesticides
  • Heavy metals
  • Welding exhaust
  • Viral infections
  • Increased oxidative stress
  • Mitochondrial dysfunction

Who Does PD Effect?

Parkinson's disease affects about 1 in 300 people in the general population. The prevalence increases with age to about 1.6% (1,560 per 100,000) in people over the age of 65. There are currently between one million and 1.5 million in the United States with Parkinson's disease. Most people are diagnosed with the disease between the ages of 55 and 65 and about 85 percent of people with Parkinson's are over the age of 65. There are an estimated 60,000 new cases of PD diagnosed each year and this number is increasing yearly as the population of the United States shifts. Men are almost 1.55 times more likely to be diagnosed than women.

What are the symptoms associated with Parkinson disease?

There are four cardinal symptoms. At least two of these symptoms must be present in order for a physician to suspect a diagnosis of Parkinson's disease.

Resting Tremor

  • Most recognized symptom
  • Seen initially in about 75% of persons with PD
  • Typically begins on one side
  • More noticeable at rest
  • Often presents as "pill rolling"
  • Increases with stress
  • Tremor can involve hands, arms, foot, leg, chin, jaw, or tongue

Rigidity

  • Involuntary increase in muscle tone resulting in continuous resistance
  • Tremor superimposed on the rigidity presents as a ratchet-like sensation known as "cog wheeling"
  • Rigidity underlies the stooped posture, forward flexed head, flexed knees and elbows

Bradykinesia

  • (Slowness of movement ) is the central, most significant movement disorder in PD
  • Inhibits all aspects of activities of daily living (ADL)
  • Secondary effects include decreased arm swing while walking & eye blink, facial masking, slowed chewing & swallowing

Postural Instability

  • Typically the last of the "cardinal" symptoms to appear
  • Not usually responsive to dopaminergic treatment
  • Appears to be a problem with the "righting reflex"

There are a number of secondary motor symptoms and non-motor features that are associated with Parkinson's disease also.

Some of the secondary motor symptoms include:

  • Dystonia
  • Fatigue
  • Impaired fine and gross motor coordination
  • Speech impairment
  • Swallowing difficulties
  • Micrographia

Some of the non-motor features include

  • Olfactory Dysfunction
  • Visual Dysfunction
  • Pain
  • Behavioral Dysfunction
  • Depression
  • Anxiety
  • Dementia
  • Sleep Disturbances
  • Respiratory Dysfunction
  • Autonomic Dysfunction

How does it progress?

Initially the symptoms are mild, usually on one side of the body, and may not require medical treatment. Resting tremor is a major characteristic of PD, and the most common presenting symptom, but some patients never develop it. Tremor may be the least disabling symptom, but is often the most embarrassing to the patient. Patients may keep their affected hand in their pocket, behind their back, or hold something to control the tremor, which may be more psychologically distressing than any physical limitation that it imposes.

Over time, initial symptoms become worse. A mild tremor becomes more bothersome and more noticeable. Difficulties may develop with cutting food or handling utensils with the affected limb. Bradykinesia (slowness in movement) becomes a significant problem and the most disabling symptom. Slowness may interfere with daily routines; getting dressed, shaving or showering may take much of the day. Mobility is impaired and difficulty develops in getting into or out of a chair or a car, or turning over in bed. Walking is slower and there is a stooped posture, with the head and shoulders hanging forward. The voice becomes soft and monotone. A disturbance of balance may lead to falls. Handwriting becomes small ("micrographia") and illegible. Automatic movements, such as arm swing when walking, are reduced.

Symptoms may originally be restricted to one limb, but will typically spread over time to the other limb. Generally this progression is gradual, but the rate of progression varies in different patients.

It is not possible to predict with any confidence the likely course of the disease in an individual patient. The rate of progression and resulting level of disability vary from patient to patient. Some indication of the likely outcome in individual patients is provided by its progression since first being diagnosed, but this is only suggestive of the future course.

How are symptoms treated?

Physicians can use different combinations of management strategies based on the needs of each patient and treatment philosophy.

Common treatments for PD include:

Pharmacologic

Carbidopa/Levodopa products increase the amount of Dopamine in the affect area of the brain

Dopamine agonists make the existing Dopamine more effective by binding to receptor sites on the neurons

Inhibitors that block the breakdown of levodopa and/or dopamine

MAO-B inhibitors

COMT Inhibitors

Surgical

Deep Brain Stimulation (DBS)

In certain patients, DBS can treat the same symptoms as levodopa, but can minimize dyskinesia, wearing off and tremor. This procedure makes use of electrodes placed in the midbrain and hooked up to pacemaker type devices to improve or manage symptoms. DBS may also decrease the need for medication.

Complimentary and Adjunctiveself-care strategies are essential for optimal management and should include:

  • Nutrition and dietary considerations
  • Exercise
  • Stress management

What's in the future?

There is much research being done that scientists hope will lead to identifying the cause and, eventually, discovering a cure. Cell transplantation, gene therapy, and the injection or stimulation of nerve growth factors may offer a potential cure in the future.

Is there a cure?

To date there is no cure for Parkinson's disease. In addition, because there is no definitive cause for the disease, it is not preventable. The management of Parkinson's disease is based on relieving the symptoms as much as possible.



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