Demographic And Geographical Variation In Pd Diagnosis
Although the cause of PD remains unknown, environmental factors are suspected.47 PD diagnoses cluster in the Midwest and Northeast United States, even after adjustment for population characteristics and physician density .8 PD risk also varies across demographic groups, suggesting differential susceptibility to PD-type neurodegeneration. Parkinson disease has been consistently diagnosed more often in men compared to women, and the neuroprotective effects of estrogen have been evidenced by increased risk of PD in women with early menopause.911 In a nationwide Medicare beneficiary study, Asian and African Americans had almost half the risk of PD as whites , and an excess of diagnoses among whites has been found in most mixed race populations worldwide.8 Proposed biological mechanisms for this include increased baseline neuromelanin, the antioxidant that protects from free radical damage in people of color, increased resilience to age-related degeneration and lower prevalence of common PD-causing genes.1215
Age-Adjusted Prevalence of Parkinson Disease Diagnoses among Medicare Beneficiaries 65 by Race/Ethnic Category, 2003.
How Is Parkinson Disease Treated
Parkinson disease can’t be cured. But there are different therapies that can help control symptoms. Many of the medicines used to treat Parkinson disease help to offset the loss of the chemical dopamine in the brain. Most of these medicines help manage symptoms quite successfully.
A procedure called deep brain stimulation may also be used to treat Parkinson disease. It sends electrical impulses into the brain to help control tremors and twitching movements. Some people may need surgery to manage Parkinson disease symptoms. Surgery may involve destroying small areas of brain tissue responsible for the symptoms. However, these surgeries are rarely done since deep brain stimulation is now available.
Where To Go For Help
Several national PD outreach groups exist and provide education, community support, research funding, patient and caregiver programs. Clinical trials of experimental therapies for PD are listed at www.clinicaltrials.gov. The organizations in Table 2 have many patient booklets available for download, educational DVDs, physician information, local support groups, dance and exercise classes, caregiver respite care, fundraising opportunities, and movement disorder specialist referral lists.
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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.
Risk Factors For Psychosis
Not everyone with Parkinsons will develop hallucinations or delusions, but there are several things can increase your risk:
- Dementia or impaired memory
- Depression: Individuals suffering from depression and PD are at a greater risk. In addition, severe depression alone can cause psychosis.
- Sleep disorders, such as vivid dreaming. Individuals commonly report vivid dreaming prior to the onset of psychosis. Other associated sleep disturbances include REM sleep disorder and general insomnia.
- Impaired vision
1Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
2German Center for Neurodegenerative Diseases , Munich, Germany.
3Metabolic Biochemistry, Biomedical Center , Faculty of Medicine, Ludwig Maximilians University, Munich, Germany.
4Munich Cluster for Systems Neurology , Munich, Germany.
5Department of Chemistry, Chemistry of Life Processes Institute, Center for Molecular Innovation and Drug Discovery, and Center for Developmental Therapeutics, Northwestern University, Evanston, Illinois, USA.
6Parkinsons Disease Center, Department of Neurodegenerative Science, Van Andel Institute, Grand Rapids, Michigan, USA.
Address correspondence to: Dimitri Krainc, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Ward 12-140, Chicago, Illinois 60611, USA. Phone: 312.503.3936 Email: .
LFB and JZ contributed equally to this work.
Find articles byBurbulla, L.in: |PubMed |
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What Causes The Condition
Although there are several recognized risk factors for Parkinsons disease, such as exposure to pesticides, for now, the only confirmed causes of Parkinsons disease are genetic. When Parkinsons disease isnt genetic, experts classify it as idiopathic . That means they dont know exactly why it happens.
Many conditions look like Parkinson’s disease but are instead parkinsonism from a specific cause like some psychiatric medications.
Familial Parkinsons disease
Parkinsons disease can have a familial cause, which means you can inherit it from one or both of your parents. However, this only makes up about 10% of all cases.
Experts have linked at least seven different genes to Parkinson’s disease. They’ve linked three of those to early-onset of the condition . Some genetic mutations also cause unique, distinguishing features.
Idiopathic Parkinsons disease
Experts believe idiopathic Parkinsons disease happens because of problems with how your body uses a protein called -synuclein . Proteins are chemical molecules that have a very specific shape. When some proteins dont have the correct shape a problem known as protein misfolding your body cant use them and can’t break them down.
With nowhere to go, the proteins build up in various places or in certain cells . The buildup of these Lewy bodies causes toxic effects and cell damage.
Induced Parkinsonism
The possible causes are:
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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.
Medications Used For Treating Psychosis
Antipsychotic agents are designed to balance abnormal chemical levels in the brain. Up until the 1990s, the use of antipsychotics in PD was controversial because the drugs used until that time work by reducing excess dopamine. This alleviated psychosis but caused dramatic worsening of PD motor symptoms.
Fortunately, medications that are better tolerated by people with PD are now available. Today, there are three antipsychotic medications considered relatively safe for people with PD: quetiapine , clozapine and the newest agent, pimavanserin . They cause limited worsening of PD while treating hallucinations and delusions.
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Treatment For Parkinsons Disease
There is currently no treatment available for Parkinsons disease, but there are a number of therapies that may work to delay the onset of the diseases major symptoms. All therapies are focused on increasing dopamine in the brain or prolonging the effect of dopamine. It is through early therapies that many patients can delay the onset of motor symptoms.
Although controversial, some patients undergo deep brain stimulation, which involves stimulating areas of the brain that affect movement through implanted electrodes. Other alternative approaches are being developed, as well, including producing dopamine derived through stem cells.
It is important to note, however, that many Parkinsons patients find that rest, physical, occupational and speech therapies, and exercise are quite beneficial for moderating or controlling symptoms.
Symptoms Of Parkinsons Disease
Parkinsons has four main symptoms:
- Tremor in hands, arms, legs, jaw, or head
- Muscle stiffness, where muscle remains contracted for a long time
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms may include:
The symptoms of Parkinsons and the rate of progression differ among individuals. Early symptoms of this disease are subtle and occur gradually. For example, people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinsons. They may see that the persons face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s disease often develop a parkinsonian gait that includes a tendency to lean forward take small, quick steps and reduce swinging their arms. They also may have trouble initiating or continuing movement.
Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other.
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How To Identify Symptoms Of Parkinson’s In Older People
At first, the symptoms of Parkinsonâs may be subtle. They usually begin on one side of your body and are more present on that side even when they progress to your whole body.
These symptoms could be:
The onset of symptoms differs with different people. It can look like normal signs of aging because the symptoms appear so gradually. You might feel some mild shaking in your hand or have mobility issues at first, or you might start speaking slower or more softly.
However, you will eventually start to walk and stand leaning forward and do specific things with your arms. You will also start to experience symptoms on one side of the body. Many people first feel stiff, have a tremor, experience sleep difficulties, have constipation, experience loss of smell, or have restless legs before any other symptom.
What Is The Cause
Researchers are working hard to understand why some people develop PD. Some studies suggest that the risk of PD may be increased by environmental factors, specifically exposure to certain chemicals. They also believe there may be a genetic risk factors for PD. Distinct environmental and genetic risks factors may play different roles in different people with PD.1
PD affects the brain. There is an area of the brain called the substantia nigra. It holds brain cells that create a messenger chemical called dopamine. This dopamine is used to send messages to the basal ganglia, an area of the brain that helps fine-tune movement.1
The basal ganglia sends messages to other areas of the brain that control movement by sending signals to the rest of the body, telling it how and when to move. The basal ganglia is important in helping regulate the movement control centers of the brain.1
In PD, the neurons in the substantia nigra are damaged or die. They are not able to produce as much dopamine as they should. Without dopamine, the substantia nigra cannot send messages to the basal ganglia. In turn, the basal ganglia cannot send messages to the movement centers of the brain. This is why people living with PD move slowly and experience tremors.1
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What Are The Early Warning Signs Of Parkinson’s Disease
Parkinsons warning signs can be motor symptoms like slow movements, tremors or stiffness. However, they can also be non-motor symptoms. Many of the possible non-motor symptoms can appear years or even decades ahead of motor symptoms. However, non-motor symptoms can also be vague, making it difficult to connect them to Parkinson’s disease.
Non-motor symptoms that might be early warning signs include:
- Sleep problems such as periodic limb movement disorder , rapid eye movement behavior disorder and restless legs syndrome.
How Is It Treated
There is currently no cure for PD. However, there are many treatments that can help manage both motor and non-motor symptoms.
Most treatments focus on increasing the amount of dopamine in the body. The most common and effective treatment for motor symptoms is carbidopa/levodopa. Levodopa is a chemical the body can directly turn into dopamine. Carbidopa is added so more levodopa can get into the brain.3
In some people, carbidopa/levodopa does not effectively control PD symptoms. Some other treatments for PD symptoms include:3
- Dopamine agonists
- COMT inhibitors
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Common Complications And Side
As Parkinsons disease progresses , symptoms have a knock-on effect. Deterioration and impairments in the body can lead to a variety of other health concerns that cause a person great difficulty.
As much as these potential concerns cause discomfort for a person, all are treatable with appropriate medication or therapies.
Associated complications which can arise include:
How to manage some of the more common side-effects of Parkinsons disease
The nature of Parkinsons disease progression means that the condition manifests in a variety of ways, not just in areas of mobility. Non-motor symptoms can sometimes be of more distress to a sufferer, troubling their day-to-day lives even more so than their physical ailments.
Once certain non-motor symptoms are recognised, it is easier to understand why and how they are adversely affecting quality of life, as well as gain control through appropriate treatment.
Other problems which can also be effectively managed include:
What Can I Expect If I Have This Condition
Parkinsons disease is a degenerative condition, meaning the effects on your brain get worse over time. However, this condition usually takes time to get worse. Most people have a normal life span with this condition.
You’ll need little to no help in the earlier stages and can keep living independently. As the effects worsen, youll need medication to limit how the symptoms affect you. Most medications, especially levodopa, are moderately or even very effective once your provider finds the minimum dose you need to treat your symptoms.
Most of the effects and symptoms are manageable with treatment, but the treatments become less effective and more complicated over time. Living independently will also become more and more difficult as the disease worsens.
How long does Parkinsons disease last?
Parkinsons disease isnt curable, which means its a permanent, life-long condition.
Whats the outlook for Parkinsons disease?
Parkinson’s disease isn’t fatal, but the symptoms and effects are often contributing factors to death. The average life expectancy for Parkinson’s disease in 1967 was a little under 10 years. Since then, the average life expectancy has increased by about 55%, rising to more than 14.5 years. That, combined with the fact that Parkinson’s diagnosis is much more likely after age 60, means this condition doesn’t often affect your life expectancy by more than a few years .
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Complications Of Parkinsons And Covid
It has been found that motor and non-motor symptoms of Parkinsons disease may become worse due to COVID-19 infection.
Other studies showed an increase in symptoms from Parkinsons disease during the pandemic, even without COVID-19 infection, due to a lack of physical activity and the need for people with Parkinsons to isolate themselves from others to reduce the risk of infection. Worsening symptoms included:
- Psychologic distress
Long COVID-19 symptoms may continue well after the initial infection has resolved. COVID-19 infection has been associated with long-term effects on the following body systems:
- Heart: Heart muscle damage has been found in patients with COVID-19. This could lead to a weakened heart muscle or heart failure.
- Lungs: Damage to the air sacs in the lungs by pneumonia from the virus can cause difficulty breathing after the infection has resolved.
- Brain: Some people who had COVID-19 developed strokes, and many report difficulty thinking or concentrating.
One article estimated that at least 10% of people diagnosed with COVID-19 will be considered a long-hauler currently it is unknown which patients are at a higher risk for developing long COVID-19 symptoms.
Many long-haulers initially had mild symptoms, did not require hospitalization, and did not have other comorbidities.
At this time, it is not known if having Parkinsons disease increases the risk of being a long-hauler. Research is ongoing to help answer these questions.
Use Of Anticholinergic Medication In Pd
Anticholinergic medication was prescribed to 2597 of 8620 patients with PD trihexyphenidyl was prescribed more than benztropine . Anticholinergic use was observed to be higher in PD+D than in PD-D . The number of PD patients concurrently prescribed anticholinergic and anti-dementia medications was 1006 (25.9% of PD+D patients.
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What Are The Symptoms Of Parkinson Disease
Parkinson disease symptoms usually start out mild, and then progressively get much worse. The first signs are often so subtle that many people don’t seek medical attention at first. These are common symptoms of Parkinson disease:
- Tremors that affect the face and jaw, legs, arms, and hands
- Slow, stiff walking
How Is Parkinsons Disease Diagnosed
Parkinsons disease in the elderly is not easily diagnosed, as no screening or tests readily reveal the condition. However, some screenings and tests may rule out other conditions and help your loved ones physician proceed in their evaluation.
Because theres so much variability among patients in how the disease progresses, doctors cant accurately predict how quickly symptoms will worsen or even which specific symptoms will develop for each patient. This makes it difficult to say which symptoms of onset of Parkinsons disease will actually result in a diagnosis.
How one person displays symptoms may be quite different from another patient, explained Ruth Hagestuen, former director of field studies at the National Parkinson Foundation. However, the sooner a patient visits a neurologist, the better. That way, a treatment regimen can be implemented, because this is a chronic illness and will require many modes of treatment over time to maintain life quality.
To further complicate diagnosis, the onset of Parkinsons symptoms doesnt necessarily mean a patient has the disease. Parkinsonism, the term for displaying symptoms without actually having Parkinsons disease, was found in 35% of those patients monitored in a 2002 study. Parkinsonism can be caused by medication complications, blocked blood vessels in the brain, or other chronic conditions like dementia.
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