Signs And Symptoms Of Parkinsons Disease

What Causes Parkinsons Disease

Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.

People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.

Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.

What Is Parkinson’s Disease

Parkinson’s disease is the second most common neurodegenerative disorder and the most common movement disorder. Characteristics of Parkinsons disease are progressive loss of muscle control, which leads to trembling of the limbs and head while at rest, stiffness, slowness, and impaired balance. As symptoms worsen, it may become difficult to walk, talk, and complete simple tasks.

The progression of Parkinson’s disease and the degree of impairment varies from person to person. Many people with Parkinson’s disease live long productive lives, whereas others become disabled much more quickly. Complications of Parkinsons such as falling-related injuries or pneumonia. However, studies of patent populations with and without Parkinsons Disease suggest the life expectancy for people with the disease is about the same as the general population.

Most people who develop Parkinson’s disease are 60 years of age or older. Since overall life expectancy is rising, the number of individuals with Parkinson’s disease will increase in the future. Adult-onset Parkinson’s disease is most common, but early-onset Parkinson’s disease , and juvenile-onset Parkinson’s disease can occur.

How Is Parkinsons Disease Treated

There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.

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Medicines For Parkinson’s Disease

Medicines prescribed for Parkinson’s include:

• Drugs that increase the level of dopamine in the brain
• Drugs that affect other brain chemicals in the body
• Drugs that help control nonmotor symptoms

The main therapy for Parkinson’s is levodopa, also called L-dopa. Nerve cells use levodopa to make dopamine to replenish the brain’s dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapysuch as nausea, vomiting, low blood pressure, and restlessnessand reduces the amount of levodopa needed to improve symptoms.

People with Parkinson’s should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, such as being unable to move or having difficulty breathing.

Other medicines used to treat Parkinsons symptoms include:

• Dopamine agonists to mimic the role of dopamine in the brain
• MAO-B inhibitors to slow down an enzyme that breaks down dopamine in the brain
• COMT inhibitors to help break down dopamine
• Amantadine, an old antiviral drug, to reduce involuntary movements
• Anticholinergic drugs to reduce tremors and muscle rigidity

Stages Of Parkinsons Disease

Neurologists usually describe the progression of Parkinsons symptoms in stages, using the system known as the Hoehn and Yahr scale. These stages are:

• Stage I Symptoms are seen on one side of the body only.
• Stage II Symptoms are seen on both sides of the body. Theres no impairment of balance.
• Stage III Balance impairment has begun. In this mild- to moderate stage of the disease, the person is still physically independent.
• Stage IV This stage is marked by severe disability, but the person is still able to walk or stand unassisted.
• Stage V The person is wheelchair-bound or bedridden unless assisted.

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Pathophysiology Of Parkinson’s Disease

Parkinson’s disease16 is the second commonest neurodegenerative disease after Alzheimer’s disease. Both diseases show an exponentially increasing risk with age, with the risk of Parkinson’s disease rising from approximately 0.2% under the age of 60 to 1% over the age of 60 and 4% of people over 85 years old. At the time that a clinical diagnosis first becomes apparent, radioactive dopamine uptake scans reveal that approximately 70% of the patient’s nigrostriatal dopaminergic neurones have already been lost. The implication of this finding is that treatments which might actually halt neuronal death should ideally be used in pre-symptomatic cases, e.g. as identified by dopamine scanning of the elderly, or relatives of affected individuals. In only about 15% of Parkinson’s cases is there a clear family history, and not more than 10% of cases are caused by a recognised gene mutation.17 Furthermore, no current treatment strategies have been shown to prevent disease progression, with the possible exception of rasagiline . Rather, existing drug therapies primarily serve to enhance dopaminergic neurotransmission, whose deficiency underlies the main symptoms of Parkinson’s disease.

The 5 Stages Of Parkinsons Disease

Getting older is underrated by most. Its a joyful experience to sit back, relax and watch the people in your life grow up, have kids of their own and flourish. Age can be a beautiful thing, even as our bodies begin to slow down. We spoke with David Shprecher, DO, movement disorders director at Banner Sun Health Research Institute about a well-known illness which afflicts as many as 2% of people older than 65, Parkinsons Disease.

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What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

Software Analyzes Facial Expressions Hand Movements

Smiles are not the only behaviors that Hoque and his lab can analyze for early symptoms of Parkinsons disease or related disorders.

In collaboration with Ray Dorseya leading expert in Parkinsons disease and the David M. Levy Professor of Neurology at Rochesterand the Universitys Morris K. Udall Parkinson Disease Research Center, the researchers have developed a five-pronged test that neurologists could administer to patients sitting in front of their computer webcams hundreds of miles away.

This could be transformative for patients who are quarantined, immobile, or living in underdeveloped areas where access to a neurologist is limited, Hoque says.

In addition to making the biggest smile, and alternating it with a neutral expression three times, patients taking the test are also asked to:

• Read aloud a complex written sentence
• Touch their index finger to their thumb 10 times as quickly as possible
• Make the most disgusted look possible, alternating with a neutral expression, three times
• Raise their eyebrows as high as possible, then lower them as far as they can, three times slowly

Using machine learning algorithms, the computer program showswithin minutesa percentage likelihood from each of the tests whether the patient is showing symptoms of Parkinsons disease or related disorders.

Hence the importance of testing other expressions and movements, according to Ali, a former postdoctoral associate in Hoques lab who now is an associate data scientist at Sysco.

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Stage One Of Parkinsons Disease

In stage one, the earliest stage, the symptoms of PD are mild and only seen on one side of the body , and there is usually minimal or no functional impairment.

The symptoms of PD at stage one may be so mild that the person doesnt seek medical attention or the physician is unable to make a diagnosis. Symptoms at stage one may include tremor, such as intermittent tremor of one hand, rigidity, or one hand or leg may feel more clumsy than another, or one side of the face may be affected, impacting the expression.

This stage is very difficult to diagnose and a physician may wait to see if the symptoms get worse over time before making a formal diagnosis.

What Medications Are Used To Treat Parkinsons Disease

Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.

Medications combat Parkinsons disease by:

• Helping nerve cells in the brain make dopamine.
• Mimicking the effects of dopamine in the brain.
• Blocking an enzyme that breaks down dopamine in the brain.
• Reducing some specific symptoms of Parkinsons disease.

Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .

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Testing For Parkinsons Disease

There is no lab or imaging test that is recommended or definitive for Parkinsons disease. However, in 2011, the U.S. Food and Drug Administration approved an imaging scan called the DaTscan. This technique allows doctors to see detailed pictures of the brains dopamine system.

A DaTscan involves an injection of a small amount of a radioactive drug and a machine called a single-photon emission computed tomography scanner, similar to an MRI.

The drug binds to dopamine transmitters in the brain, showing where in the brain dopaminergic neurons are.

The results of a DaTscan cant show that you have Parkinsons, but they can help your doctor confirm a diagnosis or rule out a Parkinsons mimic.

Is Early Diagnosis Possible

Experts are becoming more aware of symptoms of Parkinsons that precede physical manifestations. Clues to the disease that sometimes show up before motor symptoms and before a formal diagnosis are called prodromal symptoms. These include the loss of sense of smell, a sleep disturbance called REM behavior disorder, ongoing constipation thats not otherwise explained and mood disorders, such as anxiety and depression.

Research into these and other early symptoms holds promise for even more sensitive testing and diagnosis.

For example, biomarker research is trying to answer the question of who gets Parkinsons disease. Researchers hope that once doctors can predict that a person with very early symptoms will eventually get Parkinsons disease, those patients can be appropriately treated. At the very least, these advances could greatly delay progression.

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Treatment: Boosting Dopamines Effects

Your doctor might give you one of these, alone or with another drug:

• Dopamine agonists: They act like dopamine but donât raise levels of it in your brain. You can take them with any drug that has levodopa. You might try pramipexole or ropinirole .
• COMT Inhibitors: They help levodopa last longer. You might get entacapone or tolcapone .
• MAO-B inhibitors: These stop your brain from breaking down levodopa. You could get selegiline or rasagiline .

What Causes Parkinson’s Disease

Parkinsons disease occurs when nerve cells in the basal ganglia, an area of the brain that controls movement, become impaired and/or die. Normally, these nerve cells, or neurons, produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems of Parkinson’s. Scientists still do not know what causes cells that produce dopamine to die.

People with Parkinson’s also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying-down position.

Many brain cells of people with Parkinson’s contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinsons disease and Lewy body dementia.

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Treatment: Drugs That Make Dopamine

Parkinson’s affects nerve cells in your brain that make a chemical called dopamine. As a result, levels of the chemical fall. Doctors usually start treatment with levodopa . Your brain turns it into dopamine. But it can make you sick to your stomach, so youâll probably take it with another medicine called carbidopa to control these side effects. The combination drug is called carbidopa-levodopa .

Decrease In Facial Expressions

The person may appear Frozen.

He/she may appear to stare because blinking is reduced.

He/she may fail to laugh when a joke is made. A person with Parkinsons understands the joke, but is unable to smile or laugh.

In the same way, he/she may find it difficult to cry or express anger on their face.

Humans sense facial emotions very quickly.

Therefore, in retrospect, this is often recognized as an early symptom of Parkinsons disease by the patient or family members.

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What Is The Prognosis And Life Expectancy For Parkinsons Disease

The severity of Parkinsons disease symptoms and signs vary greatly from person to peson, and it is not possible to predict how quickly the disease will progress. Parkinsons disease itself is not a fatal disease, and the average life expectancy is similar to that of people without the disease. Secondary complications, such as pneumonia, falling-related injuries, and choking can lead to death. Many treatment options can reduce some of the symptoms and prolong the quality of life.

Learn More About Pd Symptomson The Parkinsons Foundation Website:

• 10 Early Signs describes the symptoms that can appear early in Parkinsons disease.
• Movement Symptoms and Non-Movement Symptoms provides in-depth information on all symptoms.
• Non-Motor Symptoms: Whats New? focuses on how to identify, treat and live optimally with non-movement symptoms.
• Recognizing Non-Motor Symptoms in PD Daniel Van Wamelen, MD, PhD, discusses non-movement symptoms and ways to address them.

This content was developed in partnership with the Parkinsons Foundation. To learn more about Parkinsons disease and find resources to help you live better with Parkinsons, visit Parkinson.org or call the Parkinsons Foundation Helpline at 1-800-4PD-INFO .

References

• Parkinsons Foundation, Parkinson.org
• Kessler, I.I. . Epidemiologic studies of Parkinsons disease: II. A hospital-based survey. American Journal of Epidemiology, 95, 308318.
• Mayeux, R., Marder, K., Cote, L. J., Denaro, J., Hemenegildo, N., Mejia, H., Tang, M. X., Lantingua, R., Wilder, D. Gurland, B., & Hauser, A. . The frequency of idiopathic Parkinsons disease by age, ethnic group, and sex in northern Manhattan, 1988-1993. American Journal of Epidemiology, 142, 820827.
• Xie, T.,Laio, C., Lee, D., Yu, H.,Padmanaban, M., Kang, W., Johnson, J.,Alshaikh, J., Yuen, C., Burns, M., & Chiu, B.C.-H. . Disparities in diagnosis, treatment, and survival between Black and White Parkinson patients.Parkinsonism and Related Disorders, 87, 7-12.

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Why Is Expert Care Important

Early expert care can help reduce PD complications. Findings show that 60 percent of people with Parkinsons fall short of getting the expert care they need. The National Parkinson Foundation has estimated that about 6,400 people with Parkinsons die unnecessarily each year due to poor care.

Trained neurologists will help you recognize, treat and manage the disease. Common approaches include medication, surgical treatment, lifestyle modifications , physical therapy, support groups, occupational therapy and speech therapy. The best approach is interdisciplinary care, where you are seen by multiple specialists on a regular basis and all of the specialists talk and arrange the best possible coordinated care. This is what is referred to as a patient-centric approach to Parkinsons care.

The National Parkinson Foundation has easy-to-access communications options, including a toll-free helpline 1-800-4PD-INFO and a free Ask the Doctor online forum on Parkinson.org.

Arming yourself with knowledge and expert care are the best methods of facing Parkinsons disease.