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What is Parkinson’s disease (PD)?
Parkinson’s disease (PD) is a progressive degenerative nervous system disease that kills certain brain cells, affecting the ability to move. One of the first symptoms people notice is a tremor in their hands.
Other symptoms include decreased facial expressions, problems with dexterity that affect things like dressing and playing sports, and a shuffling walk.
PD gets worse over time, and other symptoms may develop. There is no cure, but some treatments help with symptoms. Research suggests that some medications may slow the progression of the disease.
At least one million people in the U.S. suffer from PD, according to the Parkinson’s Foundation. It is second only to Alzheimer’s disease as the most common neurodegenerative disease.
Spotting the signs of Parkinson’s disease
The first signs of PD usually start small and then gradually get worse, such as tremors in one or both hands. People may start to appear slow as movement becomes more difficult. They often take short, shuffling steps, and they are more likely to fall.
A person’s arms, legs, and face do not move easily. It can appear as though they are wearing a mask because their facial muscles are still. Their muscles become rigid, resisting movement, even when someone tries to move their body.
It is often hard for people with Parkinson's to dress themselves or do activities they used to, like playing golf, dancing, and swimming. Other common symptoms include sleep problems, depression, and a soft voice.
- Tremors, especially in one or more hands.
- Decrease in facial expressions.
- Loss of dexterity, such as problems with dressing or sports.
- Slow movements (bradykinesia).
- Change in walking, such as shuffling feet or less arm swinging.
Other accompanying symptoms
- Loss of sense of smell
- Feeling weak, tired
- Urinary urgency
- Excessive saliva
- Writing changes
- Stiff muscles
The following symptoms usually develop gradually. A sudden worsening of symptoms can be a sign of a different underlying problem that may need immediate medical attention.
- Many people develop a hunched over walk. They are more likely to lose their balance since they cannot make their muscles move quickly to adjust or correct their position.
- Speech can lose its tone and pitch and gradually becomes a soft monotone. This is caused by rigidity of the chest muscles, which can no longer force the breath.
- Dementia and other memory problems occur in some people.
- Swallowing may be deliberate and slow, creating a buildup of saliva, which causes drooling, and increasing the danger of choking when eating.
- Hemorrhoids and constipation may occur because of slower movement of the intestinal muscles.
- Some people experience sensations of unpleasant cold or heat in certain areas of their body.
- Sleep problems
An important question to ask your doctor: How can I best prepare for the future? Approximately two-thirds of people with PD will develop memory loss. It is important to consider advance-care planning early, before cognitive changes occur. —Dr. Leenu Palickal
PD occurs when specific neurons that produce dopamine in the brain die. Dopamine neurons help start movement and influence mood, sleep, and other functions. As dopamine decreases in the brain, symptoms of PD start to appear. The symptoms continue to get worse as more and more of the neurons die.
It’s unclear exactly why dopamine decreases but genes and exposure to toxins sometimes plays a role.
- Genes seem to play a role in about 10% to 15% of all Parkinson’s cases. Familial cases of PD can be caused by certain gene mutations. Those with a genetic cause tend to be younger when their symptoms begin.
- Exposure to certain toxins or environmental factors, such as industrial bug- or weed-killers, may increase risk. Most of these chemicals are no longer used. Living near industrial areas, consuming well water, and using pesticides are linked with increased risk.
- The risk of PD increases with age. The average age at diagnosis is 60 years old. It is rare to get PD under 40 years old.
- Men are 1.5 times more likely to get PD than women.
- People with diabetes and melanoma have an increased risk of PD.
If you or a loved one have any symptoms of PD, call your doctor. A physician will do an examination and may refer you to a neurologist for further testing.
Parkinson’s symptoms are often subtle at first and progress over weeks to months. If symptoms, like unexplained falls, arise quickly or other serious symptoms are present, get emergency care.
If you are taking carbidopa/levodopa, take it at the same time every day and keep a consistent amount of protein in your meals. Protein can affect absorption of the medication. —Dr. Palickal
Can Parkinson’s disease be cured?
There is no cure for Parkinson’s disease, but treatments can greatly increase quality of life and may slow the progression of the disease.
The first treatment for PD is usually medication that increases the body’s dopamine levels. These typically work for many years but they eventually lose their effectiveness as the disease becomes more advanced. They include:
- Levodopa/Carbidopa increases dopamine.
- Monoamine oxidase inhibitors like selegiline (Zelapar), rasagiline (Azilect), and safinamide (Xadago) prevent the breakdown of dopamine.
- Ropinirole and pramipexole used alone or with the above treatments mimics dopamine.
Other medications affect different chemicals in the body to help movement.
- Anticholinergic drugs, such as trihexyphenidyl or benztropine, increase the activity of neurons responsible for movement.
Deep brain stimulation
Deep brain stimulation (DBS) may help people who do not benefit from medication. With DBS, electrodes are surgically put into the brain and a small device is implanted in your chest. These devices decrease the unwanted movement you get with PD.
Daily living activities—such as dressing, speaking, eating, bathing and writing—can be difficult for people with PD. Different types of therapy, like physical therapy, occupational therapy, and speech therapy, can help you improve these activities and quality of life.
Therapies like massage, yoga, tai chi, and meditation can reduce pain, fatigue, and depression.
There is growing attention to physical activity for people with PD, with special PD- centered programs for boxing, dance, Feldenkrais, and yoga. —Dr. Palickal
People with Parkinson's disease must have regular follow-up care with their neurologist to monitor and try to treat any new motor and behavioral changes. Follow-up care should be provided every 3 to 6 months once people are stable on their medication.
While no specific activities prevent Parkinson’s disease, some risk can be decreased.
- Healthy diet and exercise can slow the progression of the disease.
- Some studies have shown an association between exercise earlier in life and a reduced chance of developing Parkinson's later.
Dr. Rooney is a Physician Scientist with deep interest and knowledge of axon degeneration, rare diseases, and neurodegeneration. Experienced in developing in vivo and in vitro assays to rigorously assess disease biomarkers and therapeutics. Successfully leads and works within crossfunctional teams to perform collaborative studies supporting research, development, and clinical testing efforts. Clinical experience working with patients and families, especially in Neurology. Excellent communicator with an enthusiasm for mentoring.