Parkinson's Disease
A positive attitude can make a big difference
Parkinson's disease is an adult-onset, chronic, progressive disorder of the nervous system. It affects 1 in 250 individuals over age 40 (1 in 100 over 65). It is the fourth most common disease of older people and effects about 1% of those over 65. Parkinson's is a controllable disease and, as a result, life expectancy in many cases can be extended to equal normal longevity.
Parkinson's often begin with tremors or shaking when at rest, sluggish initiation of movements, muscular stiffness, and instability of walking and balance. The disease begins subtly and progresses gradually. In some cases symptoms may disappear when at rest and emotional distress or stress may increase tremors and shaking.
Although there is no cure for Parkinson's disease, it can be treated with a variety of drugs and some times surgery. Medication plus exercise is known to reduce the physical limitations of the disease, and as a result many individuals can live for years with minimal disability.
Synonyms & Abbreviations
- PD
- Paralysis agitans
- Shaking palsy
Detailed Description
In most cases of Parkinson's disease, evidence of the disease begins with a tremor in the hand when at rest. This decreases when the hand is moving purposefully and can stop completely when resting. Although shaking begins in one hand, this tremor can progress to the other hand, the arms and the legs. The jaw, tongue, forehead, or eyelids may be effected by a tremor. In about one third of all cases, however, the tremor isn't the first symptom, and in others it never develops.
Additional symptoms include difficulty initiating a movement; muscle rigidity; stooped posture and difficulty with balance; and a less-expressive face due to facial-muscle impairment. This lack of expression may be taken for depression; in some cases people with Parkinson's will, in fact, become depressed. Loss of mental sharpness may also occur and can be found in 30% of cases within seven to 10 years.
Parkinson's has five stages. In the first stage symptoms appear only on one side of the body, with minimal or no functional impairment. The second stage shows symptoms on both sides of the body without impairing balance. During the third, posture may be off-balance, restricting some activities. In the fourth stage, there is an inability to walk or stand unassisted. In the fifth stage, those with Parkinson's may be restricted to bed or a wheelchair unless aided.
Patients with mild Parkinson's may require little or no medication and death is not usually due to the disease itself, but to complications related to immobility.
Parkinson's disease may begin in childhood or in adolescence (juvenile Parkinsonism).
Characteristics of Parkinson's Disease
Parkinson's disease is a progressively debilitating disorder of certain brain centers that contribute to body-movement control. Initial features include slowness of movement, stiffness and rigidity of the arms and legs (sometimes referred to as feeling "wooden"), and head, arm, and leg tremors that are worse with anxiety and absent during sleep. The person may also have stooped posture and a sluggish, short-stepped, and unstable gait when walking. Speech may be slurred, low-volume, and monotonous. The face may become mask-like and expressionless, and muscles may feel achey and cramped.
Eventually the face can take on a blank stare with infrequent blinking. The muscle stiffness in the face and throat may make swallowing difficult, causing a drool or choking. Those experiencing Parkinson's may also speak softly or stutter and find it difficult to articulate their thoughts. As tremors become more pronounced, dopaminergics and anticholinergic drugs can be prescribed. These drugs are thought to reestablish a normal balance of brain chemicals and can significantly reduce the severity of symptoms.
How Common Is Parkinson's Disease?
Approximately 1.5 million Americans (or 1% of the population over age 50) have Parkinson's disease. There are about 50,000 new cases annually. Only 10% of Parkinson's cases are found in those younger than age 40, 20% of cases are found in those between ages 40 and 50, and 70% of the cases are found in those age 50 and older. The average age at onset is ages 58 to 62.
Some sources report that Parkinson's disease is more common in men than in women by a ratio of 3:2. However, other sources suggest that the disorder is found equally in both men and women.
What You Can Expect
There is no cure for Parkinson's disease; however, many of its symptoms may be treated with drugs. Continuous control may be difficult, therefore close monitoring and adjustments of medication are very effective.
Established Causes
In Parkinson's disease, nerve cells in the basal ganglia (the area of the brain responsible for smooth movement and posture coordination) degenerate, resulting in a lower production of dopamine (a neurotransmitter) and fewer connections with other nerve cells and muscles. This is the main cause of the disease. Why it happens is unknown. Although genetics does not seem to play a major role in the disease, it does seem to run in families.
In some cases however, the cause of Parkinson's is known. It is sometimes the late complication of viral encephalitis, a rare, but severe flu-like infection that causes the brain to become inflamed. In other cases the cause can be other degenerative diseases and brain conditions, drugs or toxins that interfere with the production of dopamine in the brain.
Other causes may include:
- Blood-vessel disorders including atherosclerosis (hardening of the arteries), stroke
- Hypoparathyroidism
- Shy-Drager syndrome and other degenerative diseases of the brain
Theoretical Causes
The basis for Parkinson's disease may be injury to the brain by a toxin not yet recognized, or by oxidation, a chemical reaction that produces free radicals.
Drugs That Can Cause or Aggravate Parkinson's
Antipsychotic drugs used to treat severe paranoia and schizophrenia block the action of dopamine on nerve cells. Also a street-synthesized form of opium known as N-MPTP can cause severe Parkinson's.
Risk Factors
General risk factors for Parkinson's disease include the following:
- Family history of the disease (one third to one quarter of Parkinson's patients have a family history)
- Risk is higher if the father had this disease
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.
Symptoms
Some symptoms of Parkinson's may not appear until the disease is more established. They can include the following:
- Tremor in repose (relieved with activity or concentration; increases with sleep)
- Bradykinesia (slow movement)
- Hypokinesia (difficulty reaching the target of movement)
- Shaking of the head
- Rigidity
- Poorly enunciated speech; low volume
- Small, cramped handwriting
- Ocular abnormalities (decreased blinking, impaired upward gaze)
- Gait disturbances (e.g., no arm swing, freezing, uncontrollable acceleration)
- Reduced facial expression
- Dementia
- Depression
Conditions That May Be Mistaken for Parkinson's Disease
Conditions that may appear similar to Parkinson's disease include:
- Depression
- Old age
- Patients on antipsychotic drugs
- Other degenerative conditions of the brain
How Parkinson's Disease Is Diagnosed
Diagnosis is primarily clinical. The doctor starts with a careful review of medical history and medications. The doctor performs a careful neurological examination and looks for characteristic tremors and other signs associated with the disease. Tests are conducted on the individual's reflexes, coordination, muscle strength and mental function. Since there are no definitive tests for Parkinson's disease, all other conditions that could be associated with these symptoms must be ruled out.
Laboratory Work
- Blood tests
- Urinary test
Imaging
CT (computed tamography) or MRI (magnetic resonance imaging) tests to rule out disorders that mimic Parkinson's disease.
Goals of Treatment
At this time, there is no known curative treatment for Parkinson's disease, however it can be treated with drugs (levodopa, amantadine, bromocriptine, etc.). In some cases, a surgical procedure such as a pallidotomy can reduce tremors, rigidity and impaired movement.
Treatment is designed to:
- Improve overall function and mobility
- Reduce muscular rigidity
- Reduce tremor
- Reverse slowed movements
- Improve posture, gait, balance, writing skills, and speech
- Maintain mental clarity
Treatment Overview
Drug Therapy
Drugs most commonly prescribed
- Cogentin (benztropine)
- Parlodel (bromocriptine)
- Sinemet (carbidopa-levodopa)
- Permax (pergolide)
- Deprenyl (selegiline)
- Artane (trihexyphenidyl)
Second choices
- Requip (ropinirole)
- Symmetrel (amantadine)
- Akineton (biperiden)
- Mirapex (pramipexole)
New drugs in development
- Tasmar (tolcapone)
- Entacapone
Surgery
A pallidotomy may be performed. In some individuals improvement is sustained up to four years after surgery. High frequency stimulation of the brain is a treatment that is classified as "promising." Deep brain stimulation may effective for tremors. Transplanting of fetal dopamine neurons is currently under experimentation at several medical centers and study trials are under way. It is hoped that this transplantation may proof to reverse the chemical abnormality in the brain.
Healthcare Professionals Who May Be Involved in Treatment
The following individuals provide a variety of services that include diagnosing the disorder, prescribing medication, monitoring the patient, educating, and providing support and long-term care:
- Family physicians
- Neurologists
- Neuropsychiatrists
- Neurological nurse practitioners
- Psychiatrists
Activity & Diet Recommendations
Remaining active is very important for those with Parkinson's. In the early stages it is important to continue performing daily activities as mush as possible. As the disease progresses and motor functions become more impaired, adopt a regular exercise routine to maintain physical conditioning and learn new strategies for adapting to the decline in movement. Physical therapists will design exercise programs to meet your specific needs, which will help in retaining function and mobility for a longer period of time. You will be prone to falls. The use of a cane, walker or other assistive devices may be necessary in those with advanced disease.
Managing Parkinson's Disease Treatment
Care should be taken to monitor the effects of medication in order for correct dosages to be established. Serial comparisons of routine tasks such as rising from a chair or walking can help make this determination. It is also important to note that some medications may be responsible for elevating mood.
Possible Complications
Possible complications include:
- Depression
- Pneumonia
- Severe constipation
- Falls and resulting fractures
- Urine retention (caused by some medications)
Quality of Life
To keep yourself active and independent, you will probably need long-term drug therapy and supportive treatments that include proper diet and exercise. In addition, family support is important to establish an effective therapeutic plan. Remember, if you continue to perform as many normal daily activities as possible, you will help yourself maintain mobility despite Parkinson's. A positive mental attitude appears to play an important role in maintaining independence and improving quality of life.
Supplements
Vitamin E Some experts suggest that 800 IU to 1,200 IU a day of vitamin E can help. [1]
Relaxation
The tremors of Parkinson's disease are, to some extent, stress-related. To help control them, incorporate a stress-management program into your life, like meditation, biofeedback, visualizations, or self-hypnosis.
1 Lieberman, S. Real Vitamin & Mineral Book. Garden City, NY: Avery, 1997.
Preventing Parkinson's Disease
While there is no known prevention for Parkinson's disease, limiting your exposure to industrial toxins and monitoring your response to the drugs taken for your condition can perhaps help minimize progression of symptoms.
Self-Care Measures
- Eat a low-protein diet. Several studies show that a low-protein diet improves tremor and overall functioning. Cut out some if not all meat and dairy.
- Eat fava beans. They are a good natural source of L-dopa. The drug form of L-dopa is used to treat Parkinson's.
- Watch your step. Intentionally lifting your feet when you walk can help diminish shuffling and reduce the possibility of a fall. Avoid using shoes with rubber soles, which may stick to the floor and cause you to fall.
- Exercise regularly. This will help maintain muscle strength and mobility. Moderate exercise can also reduce the risk of falling, improve respiration and circulation, and promote bowel function. Active range-of-motion exercises can be very helpful. Consider exercising when you feel most rested and movement seems easiest, e.g., soon after taking your medication.
Websites & Organizations
The American Parkinson Disease Association Inc.
1250 Hylan Blvd., Suite 4B
Staten Island, NY 10305-1946
Phone: 800-223-2732
Email:apda@admin.con2.com
APDA Young Parkinson's I & R Center
1041 Foxenwood Drive
Santa Maria, CA 93455
Phone: 800-223-9776 or 805-934-2216
National Parkinson's Foundation
1501 NW Ninth Avenue
Miami, FL 33136
Phone: 305-547-6666
Phone: 800-327-4545 or 800-433-7022
Office of Communications
National Institute of Neurological Disorders and Stroke
Bethesda, MD 20892
Parkinson's Action Network
822 College Avenue, Ste. C
Santa Rosa, CA 95404
Phone: 707-544-1994 or 800-820-4716
Fax: 707-544-2363
Email: ParkActNet@AOL.com
Parkinson's Disease Foundation
William Black Medical Research Building
640 West 168th St.
New York, NY 10032
Phone: 212-923-4700 or 800-457-6676
Parkinson's Education Program
3900 Birch St., Room 105
Newport Beach, CA 92660
Phone: 714-250-2975 or 800-344-7872
The Parkinson's Institute
1170 Morse Avenue
Sunnyvale, CA 94089
Phone: 800-786-2958 or 408-734-2800
The Parkinson's Web page
The United Parkinson's Foundation and the International Tremor Foundation
833 West Washington Boulevard
Chicago, IL 60607
Phone: 312-733-1893
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