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Parkinson’ s Disease

What is Parkinson’ s Disease? 
Parkinson’s Disease (PD) is a chronic brain disorder that affects movement and bodily functions. Damaged cells in the brain do not produce a necessary chemical, dopamine, which usually controls these processes. Without dopamine, the body has trouble performing everyday movements. Parkinson’s is a progressive disease, which means that symptoms worsen over time, usually many years. Recent findings indicate that although dopamine may be the most important chemical that is missing in Parkinson’s’ disease, it may not be the only one.

Who is affected by Parkinson’ s Disease? 
Approximately 60,000 individuals in the US are diagnosed with Parkinson’s disease each year, with men being slightly more often affected. Most Parkinson’s patients are diagnosed after age 60, but 10-15% of Parkinson’s cases are found before age 40, which is considered “early-onset.” While we do not know what the cause of Parkinson’s is, there are studies that have found some genetic links to the disease. Family history of Parkinson’s is particularly important in early-onset forms of the disease.

What are the Symptoms of Parkinson’ s Disease? 
Symptoms that may indicate Parkinson’s:
  • Shaking (tremors) of the arms and legs initially on one side of the body while resting or walking
  • Slowness of movement (bradykinesia), especially in starting and attempting to continue rapid repetitive movements (finger taps, foot taps, etc.)
  • Muscle and limb stiffness
  • Poor balance, difficulty walking with shuffling of the feet
  • Fatigue
  • Emotional changes such as depression
  • Decline in mental function over time (dementia)
  • Sleep disturbances
  • Problems with swallowing, speech, bladder control and constipation
  • Seborrheic Dermatitis
  • Small, cramped handwriting (micrographia)
  • Impaired sense of smell
  • Visual hallucinations

How is Parkinson’ s Disease diagnosed? 
A physician diagnoses Parkinson’s by performing a physical exam and taking a detailed medical history. A diagnosis would depend on the presence of slowness of movement (bradykinesia) and at least one of the other major signs: tremor at rest, rigidity or poor balance. A gradual disease course in a patient with resting tremor and bradykinesia on one side is typical, however, 25% of PD patients may not have resting tremor. There are no specific tests for Parkinson’s disease but your doctor may order some brain scans such as an MRI or a CT scan to rule out other disorders. Many disorders have similar symptoms but different causes so it is important that those are ruled out before diagnosing Parkinson’s.
Often the best way to confirm a diagnosis is by how well a person responds to medication designed to treat Parkinson’s. It may take time to make the correct diagnosis in a patient.

What are treatment options for Parkinson’ s Disease? 
There is no single medication or surgery that cures PD and every individual has different needs and levels of disease progression. However, there are a number of different treatments available that may help improve quality of life and delay onset of the nerve damage caused by Parkinson’s. A neurologist would prescribe and try different treatments to determine the best choice for an individual.

Medication:  There are three different types of medications prescribed to alleviate the symptoms of Parkinson’s.
  • Drugs used to increase or mimic function of dopamine in the brain such as carbidopa/levodopa (Sinemet) and dopamine agonists—pramipexole (Mirapex), rotigotine (Neupro), and ropinirole (Requip).
  • Drugs used to balance the chemicals in the brain by lowering excessive chemicals such as acetylcholine.
  • Drugs to treat non-motor issues such as anti-depressants.

Surgery:  There is no surgery that can cure Parkinson’s, but some surgical options have been successful in improving quality of life for patients. These delicate procedures are typically reserved for individuals that have advanced disease.
  • Lesioning Surgeries- Small overactive areas of the brain are destroyed to prevent some of the symptoms. These techniques are rarely used in the US.
  • Deep Brain Stimulation (DBS)- An electrode is implanted into the brain and is used to stimulate the brain, thus reducing some of the motor symptoms of Parkinson’s. This also involves implanting a pacemaker under the skin to drive the stimulation and occasional adjustments to the stimulation settings.

Do the symptoms of Parkinson’ s Disease progress over time? 
Yes, Parkinson’s disease progresses over time, typically taking many years to pass through the different stages. The National Institute of Neurological Disorders and Strokes describes
5 Stages:
1. Symptoms on one side of the body only.
2. Symptoms on both sides of the body. No impairment of balance.
3. Balance impairment. Mild to moderate disease. Physically independent.
4. Severe disability, but still able to walk or stand unassisted.
5. Wheelchair-bound or bedridden unless assisted.

Is there a cure for Parkinson’ s Disease? 
No. There is currently no cure for Parkinson’s. However, medication, healthy lifestyle choices, and different treatments can greatly improve quality of life. There is ongoing research to determine if various drugs (creatine, coenzyme Q10) can slow Parkinson’s disease.

What psychological illnesses are associated with Parkinson’s? 
Individuals diagnosed with Parkinson’s are more likely to experience depression and dementia. Depression can also be caused by emotional changes that come with the progression of PD, such as feelings of powerlessness and dependence. Parkinson’s patients may develop dementia as the disease reaches more advanced stages.

Are there other things I can do if I am diagnosed with Parkinson’s? 
People can improve their quality of life through healthy eating and exercise. Each individual should set up an individualized nutrition plan to maintain weight and counteract reactions to medications. Some Parkinson’s patients have negative reactions to protein and others lose weight without trying to. Regular exercise and physical therapy can help alleviate some of the symptoms of Parkinson’s, decrease pain, and increase range of motion.



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