The 4 Classic Features Of Parkinson’s Disease Are

What You Can Expect

Parkinson does follow a broad pattern. While it moves at different paces for different people, changes tend to come on slowly. Symptoms usually get worse over time, and new ones probably will pop up along the way.

Parkinsonâs doesnât always affect how long you live. But it can change your quality of life in a major way. After about 10 years, most people will have at least one major issue, like dementia or a physical disability.

Continue Learning About Parkinson’s Disease Symptoms & Warning Signs

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.

Dementia With Lewy Bodies

• Dementia with Lewy bodies is a progressive, neurodegenerative disorder in which abnormal deposits of a protein called alpha-synuclein build up in multiple areas of the brain.
• Dementia with Lewy bodies is second to Alzheimers as the most common cause of degenerative dementia that first causes progressive problems with memory and fluctuations in thinking, as well as hallucinations. These symptoms are joined later in the course of the disease by parkinsonism with slowness, stiffness and other symptoms similar to PD.
• While the same abnormal protein is found in the brains of those with PD, when individuals with PD develop memory and thinking problems it tends to occur later in the course of the disease.
• There are no specific treatments for DLB. Treatment focuses on symptoms.

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Corticobasal Degeneration And Corticobasal Syndrome

Corticobasal degeneration and corticobasal syndrome are caused by degeneration in the cerebral cortex and the basal ganglia .

Corticobasal Degeneration is a degenerative brain disease affecting people from the age of 40 onwards. There are neurological similarities to PSP, but the classical clinical picture is often distinct. Patients diagnosed with CBD may also develop features of PSP and vice versa.

Cognitive problems are common in CBD and are often one of the first symptoms, such as apathy, impulsive behaviour, changes in empathy, and language symptoms. Other signs are progressive numbness and loss of use of one hand. There may also be jerking of the fingers, slowness and awkwardness and the feeling of having an alien limb with complex unintentional movements of one limb causing problems with normal motor tasks. Gradually the arm and/or leg on one side is affected and then the arm and/or leg on the other.

Parkinsons Disease Life Expectancy

Most people with Parkinsons can have a normalor close to normallife expectancy today, thanks to new medications, therapies, and other treatments. Survival rates for those with typical Parkinsons disease are either the same as for the general population or shortened by about a year, studies show.

Risk factors for earlier mortality with Parkinsons include:

• Being diagnosed before age 70

• Having early in the disease

• Developing Parkinsons

People with Parkinsons dont die from the disease itself, but from associated complications, such as infections or injuries . Cardiovascular disease is another common cause of death.

Treatments and lifestyle improvements, can help forestall cognitive decline, lower your risk of falls and strengthen your cardiovascular system. These can help improve your quality of life and, by slowing progression of the illness, potentially keep you living longer.

Researchers are continuing to explore new treatments that they hope will one day lead to better therapies for Parkinsons, which will result in an improved prognosis.

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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.

How To Diagnose Pd

The diagnosis of PD is still largely a clinical one, as there is no definitive test able to confirm the diagnosis during life, with the exception of gene testing in a reduced number of cases. PD is a disease combining clinically defined parkinsonism with specific pathological findings, namely, dopaminergic neuron loss in the region of substantia nigra pars compacta, as well as the presence of intraneuronal Lewy bodies , although there are a few notable exceptions to this with regard to the pathological diagnosis. From a practical perspective, the first step for the diagnosis of PD is careful history taking. Thorough questioning of the patient and family should be performed, trying to define which symptoms emerged and their sequence, as well as perceived anatomical involvement. Inquiry about the presence of premotor symptoms including sleep-related REM sleep behavior, loss of smell, and constipation can be helpful if present. Drug intake history, both past and present, especially concerning drugs able to cause parkinsonian symptoms, is paramount. Likewise, possible exposure to environmental toxics should also be searched for . Past and present medical disorders should be systematically recorded. Family history is also an important stage, and should include neurological disorders in other family members, as well as inquiry about ethnic ancestry as monogenic forms of PD are more prevalent in some .

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Classic Features Of Parkinsons

diagnosis, No current medical or surgical treatment provides antiparkinsonian benefits superior to what can be achieved with levodopa, Most people diagnosed with PD are age 60 years or older, but the condition can place great strain on the body, Dopamine is Name non-motor features of Parkinsons disease, progressive disease that affects the neurological systems of the brain and body, meaning that different patients have different combinations of symptoms, A kinesia and P ostural instability, and can make some people more vulnerable to serious and life-threatening infections, most people with Parkinsons disease now have a

What Is The Outlook For Persons With Parkinsons Disease

Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.

Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.

The future is hopeful. Some of the research underway includes:

• Using stem cells to produce new neurons, which would produce dopamine.
• Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
• Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.

Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.

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Stage 3 The Moderate Stage Of Parkinsons Disease

This is the middle stage of the disease where motor symptoms become more pronounced and start to affect patient daily functions. The patient can still live independently but may feel difficulty in performing daily tasks like taking shower, getting dressed, and taking shoes on. In addition, walking can be problematic and sometimes result in falls that cause injuries. To reduce these complications, the patient may need assistive devices.

Additional symptoms that appear in this stage include:

• Postural abnormality

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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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Environmental Factors And Exposures

Exposure to pesticides and a history of head injury have each been linked with PD, but the risks are modest. Never drinking caffeinated beverages is also associated with small increases in risk of developing PD.

Low concentrations of urate in the blood is associated with an increased risk of PD.

Drug-induced parkinsonism

Different medical drugs have been implicated in cases of parkinsonism. Drug-induced parkinsonism is normally reversible by stopping the offending agent. Drugs include:

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Signs And Symptoms Of Parkinson’s Disease

Signs and symptoms of Parkinson’s disease are varied. Parkinson’s disease affects movement, producing motor symptoms. Non-motor symptoms, which include dysautonomia, cognitive and neurobehavioral problems, and sensory and sleep difficulties, are also common. When other diseases mimic Parkinson’s disease, they are categorized as parkinsonism.

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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.

Stage Five Of Parkinsons Disease

Stage five is the most advanced and is characterized by an inability to rise from a chair or get out of bed without help, they may have a tendency to fall when standing or turning, and they may freeze or stumble when walking.

Around-the-clock assistance is required at this stage to reduce the risk of falling and help the patient with all daily activities. At stage five, the patient may also experience hallucinations or delusions.

While the symptoms worsen over time, it is worth noting that some patients with PD never reach stage five. Also, the length of time to progress through the different stages varies from individual to individual. Not all the symptoms may occur in one individual either. For example, one person may have a tremor but balance remains intact. In addition, there are treatments available that can help at every stage of the disease. However, the earlier the diagnosis, and the earlier the stage at which the disease is diagnosed, the more effective the treatment is at alleviating symptoms.

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Symptoms Of Parkinsons Disease

Parkinson’s disease has four main symptoms:

• Tremor in hands, arms, legs, jaw, or head
• Stiffness of the limbs and trunk
• Slowness of movement
• Impaired balance and coordination, sometimes leading to falls

Other symptoms may include depression and other emotional changes difficulty swallowing, chewing, and speaking urinary problems or constipation skin problems and sleep disruptions.

Symptoms of Parkinsons and the rate of progression differ among individuals. Sometimes people dismiss early symptoms of Parkinson’s as the effects of normal aging. In most cases, there are no medical tests to definitively detect the disease, so it can be difficult to diagnose accurately.

Early symptoms of Parkinson’s disease are subtle and occur gradually. For example, affected 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 Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.

People with Parkinson’s often develop a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement.

Stooping Or Hunched Posture

People who have Parkinsons disease may notice changes in their posture due to other symptoms of the disease, such as muscle rigidity.

People naturally stand so that their weight is evenly distributed over their feet. However, people who have Parkinsons disease may start bending forward, making them appear hunched or stooped over.

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Causes And Risk Factors Of Parkinsons Disease

Most cases of Parkinsons disease are idiopathic, meaning the cause is unclear.

Its widely believed that a person with Parkinsons may be genetically vulnerable to the disease, and that one or more unknown factors in the environment eventually triggers it.

Most of the symptoms of Parkinsons disease come from the loss of neurons in an area of the brain called the substantia nigra.

Normally, the neurons in this part of the brain make the chemical messenger dopamine, which allows communication with another area of the brain, the corpus striatum.

This communication helps produce smooth, purposeful movement. When the neurons in the substantia nigra die, the resulting loss of communication leads to the motor symptoms of Parkinsons.

Although the cause of this cell death is unknown, many researchers believe that the cells are killed by clumped proteins called Lewy bodies.

Theory Of Pd Progression: Braaks Hypothesis

The current theory is that the earliest signs of Parkinsons are found in the enteric nervous system, the medulla and the olfactory bulb, which controls sense of smell. Under this theory, Parkinsons only progresses to the substantia nigra and cortex over time.

This theory is increasingly borne out by evidence that non-motor symptoms, such as a loss of sense of smell , sleep disorders and constipation may precede the motor features of the disease by several years. For this reason, researchers are increasingly focused on these non-motor symptoms to detect PD as early as possible and to look for ways to stop its progression.

Page reviewed by Dr. Ryan Barmore, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.

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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

Parkinsons Disease Symptoms 4 Cardinal Signs

The article Parkinsons disease early symptoms described a variety of signs that might be indicative of oncoming or early Parkinsons. Given that many of the signs could be due to a variety of completely unrelated conditions, a more structured and formal classification is required to differentiate Parkinsons from other diseases. This can be achieved by grouping the symptoms into primary motor related symptoms , associated symptoms and neuropsychiatric dysfunction.

This article explains the 4 primary motor symptoms for Parkinsons disease diagnosis, which includes:

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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 1 Symptoms are seen on one side of the body only.
• Stage 2 Symptoms are seen on both sides of the body. Theres no impairment of balance.
• Stage 3 Balance impairment has begun. In this mild-to-moderate stage of the disease, the person is still physically independent.
• Stage 4 This stage is marked by severe disability, but the person is still able to walk or stand unassisted.
• Stage 5 The person requires a wheelchair or is bedridden unless assisted.

Is Parkinsons Disease Fatal

Parkinsons disease itself doesnt cause death. However, symptoms related to Parkinsons can be fatal. For example, injuries that occur because of a fall or problems associated with dementia can be fatal.

Some people with Parkinsons experience difficulty swallowing. This can lead to aspiration pneumonia. This condition is caused when foods, or other foreign objects, are inhaled into the lungs.

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Cognitive And Psychiatric Symptoms

• depression and anxiety
• mild cognitive impairment slight memory problems and problems with activities that require planning and organisation
• dementia a group of symptoms, including more severe memory problems, personality changes, seeing things that are not there and believing things that are not true

A Sign Of Things To Come

Considerable evidence now suggests that the earliest symptoms of Parkinson’s disease may be nondopaminergic ones. Support for this possibility comes from the work of Heiko Braak at the Johann Wolfgang Goethe University in Frankfurt. In 2003 he and his colleagues carried out postmortem examinations of the brains of elderly people to determine the distribution of Lewy bodies and Lewyneurites . Based on his results he believed that the pathological changes in brains of patients with Parkinson’s disease begin in the olfactory regions and the lower brain stem and then spread to involve the more classic dopaminergic areas in the midbrain . In the final stage, pathologic changes are found diffusely throughout the cerebral cortex, likely accounting for the dementia that so frequently accompanies motor impairments. That is, he argued that nondopaminergic regions are affected before dopaminergic ones.

Figure 7. Postmortem studies suggest that neural degeneration progresses systematically in Parkinson’s disease. The first portion of the brain affected appears to be in the brain stem . Later , degeneration expands to include the substantia nigra , the striatum and other portions of the mid-brain . In its later stages , the disease begins also to compromise portions of the cerebral cortex .

Tom Dunne

Figure 8. Although they are largely unappreciated by physicians, many nonmotor symptoms arise in patients with Parkinson’s disease.

Barbara Aulicino

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