Highlights From The Canadian Chronic Disease Surveillance System
Parkinsonism, including Parkinsons disease, can have significant impacts for those affected, their caregivers, and society. With a growing and aging population, it is estimated that the number of Canadians living with parkinsonism will double between 2011 and 2031 and that the incidence will increase by 50%.Footnote 1
The Public Health Agency of Canada , in collaboration with all Canadian provinces and territories, conducts national surveillance of parkinsonism to support the planning and evaluation of related policies, programs, and services. This fact sheet presents an overview of the data on diagnosed parkinsonism, including Parkinsons disease, from the Canadian Chronic Disease Surveillance System .
Surgery For People With Parkinsons Disease
Deep brain stimulation surgery is an option to treat Parkinsons disease symptoms, but it is not suitable for everyone. There are strict criteria and guidelines on who can be a candidate for surgery, and this is something that only your doctor and you can decide. Surgery may be considered early or late in the progression of Parkinsons. When performing deep-brain stimulation surgery, the surgeon places an electrode in the part of the brain most effected by Parkinsons disease. Electrical impulses are introduced to the brain, which has the effect of normalising the brains electrical activity reducing the symptoms of Parkinsons disease. The electrical impulse is introduced using a pacemaker-like device called a stimulator. Thalamotomy and pallidotomy are operations where the surgeon makes an incision on part of the brain. These surgeries aim to alleviate some forms of tremor or unusual movement, but they are rarely performed now.
What Is The Prognosis
The disease gets progressively worse, with people becoming severely disabled within three to five years of onset. Affected individuals are predisposed to serious complications such as pneumonia, choking, head injury, and fractures. The most common cause of death is pneumonia. With good attention to medical and nutritional needs, it is possible for individuals with PSP to live a decade or more after the first symptoms of the disease appear.
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How Is Psp Different From Parkinson’s Disease
PSP is often misdiagnosed as Parkinsons disease, especially early in the disorder, as they share many symptoms, including stiffness, movement difficulties, clumsiness, bradykinesia , and rigidity of muscles. The onset of both diseases is in late middle age. However, PSP progresses more rapidly than Parkinsons disease.
- People with PSP usually stand exceptionally straight or occasionally tilt their heads backward . This is termed axial rigidity. Those with Parkinson’s disease usually bend forward.
- Problems with speech and swallowing are much more common and severe in PSP than in Parkinson’s disease and tend to show up earlier in the disease.
- Eye movements are abnormal in PSP but close to normal in Parkinson’s disease.
- Tremor is rare in PSP but very common in individuals with Parkinsons disease.
Although individuals with Parkinson’s disease markedly benefit from the drug levodopa, people with PSP respond minimally and only briefly to this drug.
People with PSP show accumulation of the protein tau in affected brain cells, whereas people with Parkinsons disease show accumulation of a different protein called alpha-synuclein.
Causes Of Parkinsons Disease
At present, we do not know the cause of Parkinsons disease. In most people there is no family history of Parkinsons Researchers worldwide are investigating possible causes, including:
- environmental triggers, pesticides, toxins, chemicals
- genetic factors
- combinations of environment and genetic factors
- head trauma.
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How Is Parkinson’s Disease Treated
Parkinsons disease is a progressive disease, and patients are sometimes not treated with medication initially, Dr. Tinaz says.
Instead, patients are encouraged to participate in physical activity and it’s even better if it is done together with a group. “There has been a lot of evidence that exercise can help with symptom control and has potential to delay clinical progression of disease,” Dr. Tinaz says. Other lifestyle changes to try first include following a Mediterranean diet, getting enough sleep, and seeking intellectual stimulation.
Once symptoms start interfering with daily life, patients will be prescribed a medication that will help boost levels of dopamine that diminish as nerve cell damage progresses. While there is no cure for Parkinsons disease, these medications have been proven to reduce symptoms.
In some cases, such as for those with severe tremor or frequent off periods, the most effective treatment is a surgical procedure called deep brain stimulation. Here, surgeons implant small electrodes in specific sites in the brain, and a battery under the skin in the chest wall. The battery sends electrical signals to the electrodes, which then block targeted areas of brain activity without damaging healthy tissue.
“I don’t give patients false hope, but I do tell them they still have agency over this. There are so many things patients can do to improve their quality of life,” Dr. Tinaz says.
Living With Parkinson’s Disease
Coming to terms with a diagnosis of Parkinson’s and living with the disease is challenging and will take a lot of adjustment. There are still things you can do that can help you to feel more in control of your situation and to stay positive. Some things that might help could include:
- choosing to lead a healthy lifestyle
- making informed decisions related to your treatment
- keeping a diary of your symptoms in preparation for meetings with health and social care professionals
- attending a self-management course
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What Are The Symptoms
Each person is affected differently by Parkinsons disease and no two people will experience exactly the same symptoms. The impact of Parkinsons disease can be unpredictable and it is common for people to have good days and bad days.
The main symptoms of Parkinsons disease are:
- tremor
- rigidity
- balance problems
- problems with posture
Other possible symptoms include difficulty initiating movement , a shuffling gait when walking, and freezing when trying to move . People might experience a loss of facial expression, speech problems , swallowing problems, bowel and bladder problems, difficulties at night and tiredness during the day. Skin can become greasy and people might experience excessive sweating. Sexual problems are common. People often experience depression and anxiety. Another common symptom is small handwriting .
Other less common symptoms can include pain and memory problems.
Foster A Good Relationship
Lastly, maintaining your relationship and communication with the person with Parkinsonâs can be the most challenging and rewarding aspect of caregiving. As Parkinsonâs disease progresses, the roles change and the person with Parkinsonâs may go from being an independent head of the household to a very dependent person requiring a significant level of care. However, research shows that despite high levels of strain, caregivers with good quality relationships have reduced depression and better physical health. Remember, as a caregiver your service to your loved one is beyond measure in terms of love, depth of care, and concern.
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How Is Parkinson’s Disease Managed
Your doctors will tailor your treatment based on your individual circumstances. You will manage your condition best if you have the support of a team, which may include a general practitioner, neurologist, physiotherapist, occupational therapist, psychologist, specialist nurse and dietitian.
While there is no cure for Parkinson’s disease, symptoms can be treated with a combination of the following.
Surgery And Deep Brain Stimulation
Deep brain stimulation is a treatment for Parkinsonâs disease that uses an implantable pacemaker-like device to deliver electrical pulses to parts of the brain involved in movement. The DBS system consists of leads precisely inserted into a specific brain target, the neurostimulator implanted in the chest, and extension wires that connect the leads to the neurostimulator. Though implantation of the system requires a neurosurgical procedure, the treatment itself consists of long-term electrical stimulation. Advantages of DBS include its ability to reduce the high doses of medications , its adjustability , and its reversibility DBS was approved by the Food and Drug Administration as a treatment for PD in 2002 and according to Medtronic , more than 80,000 patients have undergone DBS surgery worldwide.
Typical candidates are those who have motor fluctuations or periods of âoffâ time with troublesome symptoms alternating with periods of âonâ time with good symptom control, and also with possible periods of excessive movement .
Not all patients with Parkinsonâs disease are good candidates for treatment with DBS. Approximately 10â20% of patients considered for possible treatment with DBS include those:
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Drug Therapy And Research
If the disease progresses beyond minor symptoms, drug treatment may be indicated. Drug therapy for Parkinsonâs typically provides relief for 10â15 years or more. The most commonly prescribed medication is L-dopa , and this helps replenish some of the depleted dopamine in the brain. Sinemet, a combination of levodopa and carbidopa, is the drug most doctors use to treat Parkinsonâs disease. Recent clinical studies have suggested, in the younger person, the class of drugs called âdopamine agonistsâ should be used prior to levodopa-carpidopa except in patients with cognitive problems or hallucinations. In those older than 75, dopamine agonists should be used cautiously because of an added risk of hallucinations.
Other drugs are also used, and new drugs are continually being tested. It is common for multiple drugs to be prescribed because many of them work well together to control symptoms and reduce side effects. Contrary to past beliefs, starting Sinemet in newly diagnosed people does not lead to early symptoms of dyskinesia . Current knowledge is that the disease progression causes dyskinesias, not a âresistanceâ to the drug.
Quality of life studies show that early treatment with dopaminergic medications improves daily functioning, prevents falls, and improves a personâs sense of well-being.
What Are The Symptoms Of Parkinson’s Disease
The main symptoms of Parkinson’s disease are:
- tremor or shaking, often when resting or tired. It usually begins in one arm or hand
- muscle rigidity or stiffness, which can limit movement and may be painful
- slowing of movement, which may lead to periods of freezing and small shuffling steps
- stooped posture and balance problems
The symptoms of Parkinson’s disease vary from person to person as well as over time. Some people also experience:
- loss of unconscious movements, such as blinking and smiling
- difficulties with handwriting
- drop in blood pressure leading to dizziness
- difficulty swallowing
- sweating
Many of the symptoms of Parkinson’s disease could be caused by other conditions. For example, stooped posture could be caused by osteoporosis. But if you are worried by your symptoms, it is a good idea to see your doctor.
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What Is Parkinsons Disease
Parkinsons disease is a chronic neurological condition. It is progressive and symptoms worsen over time. It is named after Dr James Parkinson who first described the condition in 1817.
People with Parkinsons disease experience a loss of nerve cells in the part of their brains responsible for controlling voluntary movements. This part of the brain is called the substantia nigra . The nerve cells in the substantia nigra usually produce a chemical called dopamine which helps transmit messages from the brain to the rest of the body via the central nervous system . As these cells are lost, people with Parkinsons disease experience a loss of dopamine and the messages controlling movement stop being transmitted efficiently.
Parkinsons disease is more common as people get older but it can affect younger adults. Men tend to be affected in slightly higher numbers than women.
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Is There Any Treatment
There is currently no effective treatment for PSP and symptoms usually do not respond to medications.
- Parkinsons disease medications, such as ropinirole, rarely provide additional benefit. In some individuals, other antiparkinsonian medications, such as levodopa, can treat the slowness, stiffness, and balance problems associated with PSP, but the effect is usually minimal and short-lasting.
- Botulinum toxin, which can be injected into muscles around the eyes, can treat excessive eye closing.
- Some antidepressant drugs may offer some benefits beyond treating depression, such as pain relief and decreasing drooling.
Non-drug treatment for PSP can take many forms.
- Weighted walking aids can help individuals avoid falling backward.
- Bifocals or special glasses called prisms are sometimes prescribed for people with PSP to remedy the difficulty of looking down.
- Exercise supervised by a healthcare professional can keep joints limber but formal physical therapy has no proven benefit in PSP.
A gastrostomy may be necessary when there are swallowing disturbances or the definite risk of severe choking.
Deep brain stimulationwhich uses surgically implanted electrodes and a pacemaker-like medical device to deliver electrical stimulation to specific areas in the brain to block signals that cause the motor symptoms of several neurological disordersand other surgical procedures commonly used in individuals with Parkinson’s disease have not been proven effective in PSP.
Causes Of Parkinson’s Disease
Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.
Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson’s disease.
Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.
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How Is Parkinson’s Disease Diagnosed
A doctor who suspects that a patient might have Parkinsons disease will ask for a medical history and perform a few movement tests to check for tremors and muscle stiffness. Since Parkinsons can also be confused with other parkinsonisms, which are conditions that look like Parkinson’s disease , it’s beneficial for patients to receive a diagnosis from a specialized clinic like the Yale Medicine Movement Disorders Program.
In cases where a diagnosis is difficulta test called DaTscan can be used to confirm a diagnosis. has been proven to diagnose parkinsonism. DaTscan is an injection composed of small amounts of radioactive dye to mark dopamine receptors in the brain. Once administered, doctors can use an imaging device called a single-photon emission computed tomography , to identify reduced dopamine levels in the braina clear sign of parkinsonism.
Support For People With Parkinsons Disease
Early access to a multidisciplinary support team is important. These teams may include doctors, physiotherapists, occupational therapists, speech therapists, dietitians, social workers and specialist nurses. Members of the team assess the person with Parkinsons disease and identify potential difficulties and possible solutions.There are a limited number of multidisciplinary teams in Victoria that specialise in Parkinsons disease management. But generalist teams are becoming more aware of how to help people with Parkinsons disease.
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Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Neuroscience Communications and EngagementNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.
Diagnosis And Management Of Parkinsons Disease
There are no diagnostic tests for Parkinsons. X-rays, scans and blood tests may be used to rule out other conditions. For this reason, getting a diagnosis of Parkinsons may take some time.
No two people with Parkinsons disease will have exactly the same symptoms or treatment. Your doctor or neurologist can help you decide which treatments to use.
People can manage their Parkinsons disease symptoms through:
- seeing a Doctor who specialises in Parkinsons
- medication
- multidisciplinary therapy provided for example, by nurses, allied health professionals and counsellors
- deep brain stimulation surgery .
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How Is Yale Medicine’s Approach To Treating Parkinson’s Unique
Patients at the Yale Medicine Movement Disorders Program have access to the most advanced treatments and clinical trials for Parkinsons disease. Patients’ symptoms are thoroughly assessed before doctors create a treatment plan that will give the patient a good quality of life for as long as possible.
Physicians at Yale Medicine can perform and manage surgical procedures like deep brain stimulation.
Clinicians also understand that effective care goes beyond medication and surgery. Each doctor at the practice devotes considerable time to educate patients and caregivers. The doctors understand the nuanced challenges facing patients and how seemingly small adjustmentsfrom a change to a medications dose, to a new approach to coping with tremorscan make a big difference in the life of a Parkinsons patient. “We have all the resources needed to take care of patients,” Dr. Tinaz says.
How Many Canadians Live With Parkinsonism And How Many Are Newly Diagnosed Each Year
Based on the latest estimates available , in 20132014, approximately 84,000 Canadians aged 40 years and older were living with diagnosed parkinsonism and 10,000 Canadians were newly diagnosed with this condition . The age-standardized prevalence was 1.5Footnote i times higher among males than among females , and similarly the age-standardized incidence was 1.7Footnote i times higher among males than females . The epidemiological burden of parkinsonism increases with age. In 20132014, when comparing estimates among Canadians aged 85 years and older vs. those aged 40-44 years, the prevalence of the condition was 169Footnote i times higher in the older age group , while the incidence was 48Footnote i times higher in the older age group .
Figure 1: Prevalence of diagnosed parkinsonism, including Parkinsons disease, by sex and age group, Canada, 20132014
| Age group |
|---|
| 44.7 | 55.1 |
Note: The 95% confidence interval shows an estimated range of values which is likely to include the true value 19 times out of 20. Data source: Public Health Agency of Canada, using Canadian Chronic Disease Surveillance System data files contributed by provinces and territories, July 2017.
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