Whats Different About Young
The age of diagnosis matters for a variety of reasons, from probable causes of early cases to symptoms and treatment:
- Genetics. As with any case of Parkinsons disease, the exact cause is usually unknown. That said, The young-onset cases of Parkinsons disease are, on average, a bit more likely to be familial or genetic, says Gregory Pontone, M.D., director of the Johns Hopkins Movement Disorders Psychiatry Clinic.
- Symptoms. In many patients with YOPD, dystonia is an early symptom. People with YOPD also report more dyskinesia . They also tend to exhibit cognitive problems, such as dementia and memory issues, less frequently.
- Progression. Patients with young-onset Parkinsons appear to have a slower progression of the disease over time, says Pontone. They tend to have a milder course, staying functional and cognitively intact for much longer.
- Treatment. Most patients with Parkinsons take the medication levodopa. However, other drugs, such as MAO-B inhibitors, anticholinergics, amantadine, and dopamine receptor agonists, may be used before levodopa.
How Do I Take Care Of Myself
If you have Parkinsons disease, the best thing you can do is follow the guidance of your healthcare provider on how to take care of yourself.
- Take your medication as prescribed. Taking your medications can make a huge difference in the symptoms of Parkinson’s disease. You should take your medications as prescribed and talk to your provider if you notice side effects or start to feel like your medications aren’t as effective.
- See your provider as recommended. Your healthcare provider will set up a schedule for you to see them. These visits are especially important to help with managing your conditions and finding the right medications and dosages.
- Dont ignore or avoid symptoms. Parkinsons disease can cause a wide range of symptoms, many of which are treatable by treating the condition or the symptoms themselves. Treatment can make a major difference in keeping symptoms from having worse effects.
What Sets Young Onset Parkinsons Apart From A Diagnosis At An Older Age
Because the majority of people who get Parkinsons disease are over the age of 60, the disease is often overlooked in younger people, leading many to go undiagnosed or misdiagnosed for extended periods of time.
However, once it has been diagnosed, the rate of the diseases progression is usually much slower in younger than older people, due in part to the fact that younger people have fewer general health problems and are more capable during physical therapy treatment.
Symptoms of young onset Parkinsons disease
While common symptoms of Parkinsons may be similar no matter what age you are, the progression is often different:
- Young people often have more involuntary movement problems due to the most commonly prescribed Parkinsons disease medication, levodopa. For this reason, young onset patients are usually initially treated with alternatives to levodopa.
- Other problems associated with Parkinsons such as memory loss, confusion, and balance difficulties tend to be less frequent in young people with the disease.
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Causes Of Early Onset Parkinsons Disease
Its unclear exactly what causes Parkinsons at any age. Genetic factors, environmental factors, or some combination of the two may play a role. This condition occurs when cells are lost in the part of the brain that produces dopamine. Dopamine is responsible for sending brain signals that control movement.
Certain genes are associated with early onset Parkinsons.
According to the National Parkinson Foundation, studies show that 65 percent of people with Parkinsons who experience onset before age 20 may do so because of a genetic mutation. This organization also suggests this mutation affects 32 percent of people who experience onset between age 20 and 30.
Environmental causes of the condition may include exposure to chemical toxins such as certain insecticides, fungicides, and herbicides.
The U.S. Department of Veterans Affairs recognizes Parkinsons as a disease caused by exposure to Agent Orange. Agent Orange is a synthetic chemical herbicide that was used to spray vegetation and trees during the Vietnam War.
You may have a higher risk of developing Parkinsons if you:
What Is The Treatment For Parkinsons Disease
There is currently no treatment to cure Parkinsons disease. Several therapies are available to delay the onset of motor symptoms and to ameliorate motor symptoms. All of these therapies are designed to increase the amount of dopamine in the brain either by replacing dopamine, mimicking dopamine, or prolonging the effect of dopamine by inhibiting its breakdown. Studies have shown that early therapy in the non-motor stage can delay the onset of motor symptoms, thereby extending quality of life.
The most effective therapy for Parkinsons disease is levodopa , which is converted to dopamine in the brain. However, because long-term treatment with levodopa can lead to unpleasant side effects , its use is often delayed until motor impairment is more severe. Levodopa is frequently prescribed together with carbidopa , which prevents levodopa from being broken down before it reaches the brain. Co-treatment with carbidopa allows for a lower levodopa dose, thereby reducing side effects.
In earlier stages of Parkinsons disease, substances that mimic the action of dopamine , and substances that reduce the breakdown of dopamine inhibitors) can be very efficacious in relieving motor symptoms. Unpleasant side effects of these preparations are quite common, including swelling caused by fluid accumulation in body tissues, drowsiness, constipation, dizziness, hallucinations, and nausea.
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Medicines For Parkinsons Disease
Medicines can help treat the symptoms of Parkinsons by:
- Increasing the level of dopamine in the brain
- Having an effect on other brain chemicals, such as neurotransmitters, which transfer information between brain cells
- Helping control non-movement symptoms
The main therapy for Parkinsons is levodopa. Nerve cells use levodopa to make dopamine to replenish the brains dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapy such as nausea, vomiting, low blood pressure, and restlessness and reduces the amount of levodopa needed to improve symptoms.
People living with Parkinsons disease should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, like being unable to move or having difficulty breathing.
The doctor may prescribe other medicines to treat Parkinsons symptoms, including:
- Dopamine agonists to stimulate the production of dopamine in the brain
- Enzyme inhibitors to increase the amount of dopamine by slowing down the enzymes that break down dopamine in the brain
- Amantadine to help reduce involuntary movements
- Anticholinergic drugs to reduce tremors and muscle rigidity
Diagnosis In Young Onset Parkinsons
Many young onset patients experience delay in diagnosis given the uncommon age and often different symptoms as outlined below. Similar to late onset patients, the diagnosis is made based on history and clinical examination. There are still no proven diagnostic tests that can definitively diagnose PD. In some cases, other mimics of Parkinsons need to be evaluated for given their increased likelihood in younger patients. Given the complexities, it is important to seek evaluation by a neurologist and in many cases a movement disorder specialist.
In addition, young onset patients are more likely to have a genetic risk factor or cause to their symptoms, especially if there is a family history. Genetic testing can be considered, but should always be done after consulting a physician and in many cases a genetic counselor.
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Is Parkinsons Disease Fatal
Most doctors agree that Parkinsons disease is not fatal. In fact, the majority of Parkinsons patients live as long as others in their age group. According to the Michael J. Fox Foundation for Parkinsons Research, people with Parkinsons die WITH the condition, not from it. This means that, as the disease progresses, your risk factor for fatal injuries increases, but Parkinsons itself does not cause death.
Advantages Of Comt Inhibitors
When used with levodopa, COMT inhibitors can reduce the daily off time and increase the on time.
In many cases, the dose and frequency of levodopa can also be reduced.
The terms on/off or motor fluctuations refer to the period when people can no longer rely on the smooth and even symptom control that their drugs once gave them.
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Diagnosis Of Parkinsons Disease
There are currently no blood or laboratory tests to diagnose non-genetic cases of Parkinsons. Doctors usually diagnose the disease by taking a persons medical history and performing a neurological examination. If symptoms improve after starting to take medication, its another indicator that the person has Parkinsons.
A number of disorders can cause symptoms similar to those of Parkinsons disease. People with Parkinsons-like symptoms that result from other causes, such as multiple system atrophy and dementia with Lewy bodies, are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinsons, certain medical tests, as well as response to drug treatment, may help to better evaluate the cause. Many other diseases have similar features but require different treatments, so it is important to get an accurate diagnosis as soon as possible.
Symptoms Of Parkinson’s Disease
You can attribute the symptoms of Parkinson’s to a deficiency of a chemical in your brain called dopamine. The four classic motor symptoms of Parkinson’s include:
Shaking and tremors while you are resting is typically the first sign of Parkinson’s disease, but about one-third of patients won’t experience those symptoms. These symptoms tend to be worsened by emotional and physical stress. Sleep or moving can help reduce these issues.
Parkinson’s disease is both chronic and progressive with symptoms generally getting worse as time goes on. As it progresses, other disabilities can develop, including:
- Difficulty talking and swallowing
- A sudden inability to move,
Some sufferers also have symptoms that don’t affect their motor skills, including:
- Mental health issues such as anxiety, depression and memory loss
- Trouble sleeping, including thrashing and other sudden movements
- Change in blood pressure
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Surgical Therapies With Transplantation And Gene Therapy
Cell transplantation is regarded as a potential future PD treatment. There have been trials using autologous and non-autologous cells. Human embryonic stem cells and induced pluripotent stem cells are few of the cells that have been included in these transplantation studies. One of the concerns with cell transplantation using stem cells is the ethical bounds that must be considered.
Since the first clinical trial in 1987 involving the transplantation of dopaminergic- neuron-rich human fetal mesencephalic tissue into PD patients striatums, more research has aimed to explore whether the grafted dopaminergic neurons will live and form connections in the brain, if the patients brain can harmonize and make use of the grafted neurons, and if the grafts can generate significant clinical improvement. Clinical trials with cell therapy intend to discover if there are long-lasting improvements following restoration of striatal DA transmission by grafted dopaminergic neurons. Experimental data from rodents and nonhuman primates show that fetal ventral mesencephalon intrastriatal grafted DA neurons demonstrate many morphological and functional characteristics of normal DA neurons. Significant improvements of PD-like symptoms in animal models have been demonstrated after successful reinnervation by the grafts. Dopaminergic grafts can reinnervate the striatum in the brain, restore regulated release of DA in the striatum, and can become functionally integrated into neural circuitries.
What Would Happen If I Try To Manage Without Medication For Some Time
Any change to your medication regime must be discussed with your doctor so that you understand how this might affect you.
Parkinsons medication should never be stopped abruptly as this can be dangerous. If both you and your doctor agree to stop any medication, it will be necessary to do so by very gradually reducing the medication dose.
If you agree to do so, it would be useful if you kept a diary to monitor how this was affecting your symptoms. This can help to highlight any changes in symptom pattern, or in your emotions or behaviour that may be related to medication.
Writing down your own individual experiences on a day-to-day basis can also help you to talk about any changes in your symptoms and your feelings with your doctor. This can be very useful, particularly as appointments are often too short for doctors to ask lots of questions, and your visit may be on a day when your symptoms do not follow their general pattern.
See also Keeping a diary.
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Who Gets Parkinson Disease
The exact cause of Parkinson disease is unknown, but it is assumed to be the result of a combination of environmental influences superimposed on genetic predisposition or susceptibility .1416 There is increasing evidence that the genetic and environmental insults leading to Parkinson disease commonly lead to abnormal forms of a normal protein, -synuclein, which seems to contribute to cell death.16,23 The onset of Parkinson disease can be categorized as juvenile , early onset and late onset .24,25 The juvenile form is rare, is often familial , is most frequently associated with a parkin gene mutation and has an atypical presentation.25,26 Of patients with Parkinson disease, 10%16% have an affected first- or second-degree relative first-degree relatives may have double the risk of Parkinson disease compared with the general population.2629 In early- and late-onset Parkinson disease, the frequency of a positive family history is not statistically different.24
How Is It Diagnosed
Diagnosing Parkinsons disease is mostly a clinical process, meaning it relies heavily on a healthcare provider examining your symptoms, asking you questions and reviewing your medical history. Some diagnostic and lab tests are possible, but these are usually needed to rule out other conditions or certain causes. However, most lab tests arent necessary unless you dont respond to treatment for Parkinsons disease, which can indicate you have another condition.
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How Soon After Treatment Will I Feel Better And How Long Will It Take To Recover
The time it takes to recover and see the effects of Parkinson’s disease treatments depends strongly on the type of treatments, the severity of the condition and other factors. Your healthcare provider is the best person to offer more information about what you can expect from treatment. The information they give you can consider any unique factors that might affect what you experience.
Full List Of Medications Approved For The Treatment Of Parkinsons Disease In The Usa
Below is a full list of Parkinsons medications that have been approved to treat Parkinsons in the United States. This material is intended to provide you with information. It should not be used for treatment purposes, but rather as a source for discussion with the patients own physician. Work with your physician to determine which medications are best for you, and know the risks and benefits of each.
| Generic Name |
|---|
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What Are The Implications
According to this research, levodopa is unlikely to affect the progression of Parkinsons disease in the first year and a half following diagnosis.
Symptoms had improved to the same extent by 80 weeks and side effects were similar, suggesting people can start treatment as early as they need to for symptomatic relief.
This supports current practice in giving levodopa when clinically needed. There is no cure for Parkinsons disease, and further research is in progress to develop disease-modifying agents.
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Side Effects And Problems With Dopamine Agonists
Common side effects of dopamine agonists include:
- Nausea and vomiting
- Hallucinations or delusions and confusion
- Existing dyskinesias becoming more troublesome initially
If you are taking Cabergoline , Pergolide or Bromocriptine your neurologist or GP will have to arrange a chest CT scan or ultrasound of your heart yearly as over time these medications may effect heart or lung tissue.
This precaution does not apply to the other dopamine agonists available in Australia.
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How Does Exercise Change The Brain
Exercise affects how efficiently dopamine is used in the brain it does not produce more of the hormone dopamine. According to the Parkinsons Foundation, exercise improves this efficiency by modifying the areas of the brain where dopamine signals are received.
When dopamine travels through the brain, it connects to two brain cells through a space called the synapse. For one cell to close off the signal of dopamine to send it to the next cell, a protein complex known as the dopamine transporter has to pick it up. Studies have shown that people who exercise more have less of the dopamine transporter, allowing the dopamine to stay in the synapse longer and send a longer signal.
Dr. Joseph Jankovic, neurologist at Baylor St. Lukes Medical Center, has been a principal investigator in over 100 clinical trials for treatments of Parkinsons disease. He is also the founder and director of the Parkinson’s Disease Center and Movement Disorders Clinic, which has been recognized as a Center of Excellence by the National Parkinsons Foundation.
People who exercise also have increased connectivity within the brain, and they have less age-related degeneration of the brain. All of these factors support a notion that the brain benefits from long-term exercise, and this has been specifically shown in patients with Parkinsons disease.
Managing Motor And Nonmotor Symptoms In Advanced Disease
Most patients respond well to levodopa however, in 40%50% of patients, motor fluctuations and dyskinesias will develop within five years of chronic levodopa treatment and in 70%80%, after 10 years of treatment.34,82,83 Motor fluctuations are unexpected variations in the motor response, which may be erratic, to dopaminergic therapy, whereas dyskinesias are unwanted and intrusive, predominantly choreiform, movements resulting from levodopa .84 Dyskinesias are less likely to develop in patients receiving less than 400500 mg per day of levodopa.85 A higher cumulative incidence of dyskinesias, wearing off and onoff fluctuations in symptoms occurs in patients with early-onset disease and perhaps in women .24,61,82,86,87 Dyskinesias may indicate better response to medication, and most patients prefer to be on with dyskinesia than off.87
In advanced Parkinson disease, many disabling nonmotor symptoms emerge that are not improved by levodopa.42 Nonmotor symptoms and their management are reviewed in Appendix 3.
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