View Full Version : Parkinson's Disease

15-02-2012, 09:37 AM
Parkinson's Disease Overview

Symptoms of Parkinson's disease include muscle rigidity, tremors, and changes in speech and gait. Parkinson’s causes are unknown but genetics, aging, and toxins are being researched. After a Parkinson’s diagnosis, Parkinson’s disease treatments are given to help relieve symptoms. There is no cure for Parkinson's and herbal remedies are unproven. Studies on using stem cells to treat Parkinson's disease are under way. The prognosis depends on the patient's age and symptoms.

Topic Overview


What is Parkinson's disease?

Parkinson's disease affects the way you move. It happens when there is a problem with certain nerve cells in the brain.

Normally, these nerve cells make an important chemical called dopamine. Dopamine sends signals to the part of your brain that controls movement. It lets your muscles move smoothly and do what you want them to do. When you have Parkinson’s, these nerve cells break down. Then you no longer have enough dopamine, and you have trouble moving the way you want to.

Parkinson’s is progressive, which means it gets worse over time. But usually this happens slowly, over a period of many years. And there are good treatments that can help you live a full life.

What causes Parkinson's disease?

No one knows for sure what makes these nerve cells break down. But scientists are doing a lot of research to look for the answer. They are studying many possible causes, including aging and poisons in the environment.

Abnormal genes seem to lead to Parkinson's disease in some people. But so far, there is not enough proof to show that it is always inherited.
What are the symptoms?

The four main symptoms of Parkinson’s are:

Tremor, which means shaking or trembling. Tremor may affect your hands, arms, or legs.
Stiff muscles.
Slow movement.
Problems with balance or walking.

Tremor may be the first symptom you notice. It is one of the most common signs of the disease, although not everyone has it. More importantly, not everyone with a tremor has Parkinson's disease. Tremor often starts in just one arm or leg or only on one side of the body. It may be worse when you are awake but not moving the affected arm or leg. It may get better when you move the limb or you are asleep.

In time, Parkinson’s affects muscles all through your body, so it can lead to problems like trouble swallowing or constipation. In the later stages of the disease, a person with Parkinson’s may have a fixed or blank expression, trouble speaking, and other problems. Some people also have a decrease in mental skills (dementia).

People usually start to have symptoms between the ages of 50 and 60. But in some people symptoms start earlier.

How is Parkinson's disease diagnosed?

Your doctor will ask questions about your symptoms and your past health and will do a neurological exam. A neurological exam includes questions and tests that show how well your nerves are working. For example, your doctor will watch how you move, check your muscle strength and reflexes, and check your vision. In some cases, your doctor may have you try a medicine. How this medicine works may help your doctor know if you have Parkinson's disease. He or she will also ask questions about your mood.

There are no lab or blood tests that can help your doctor know whether you have Parkinson’s. But you may have tests to help your doctor rule out other diseases that could be causing your symptoms. For example, you might have an MRI to look for signs of a stroke or brain tumor.

How is it treated?

At this time, there is no cure for Parkinson's disease. But there are several types of medicines that can control the symptoms and make the disease easier to live with.

You may not even need treatment if your symptoms are mild. Your doctor may wait to prescribe medicines until your symptoms start to get in the way of your daily life. Your doctor will adjust your medicines as your symptoms get worse. You may need to take several medicines to get the best results.

Levodopa (also called L-dopa) is the best drug for controlling symptoms of Parkinson's disease. But it can cause problems if you use it for a long time or at a high dose. Sometimes doctors use other medicines to treat people in the early stages of the disease. This lets them delay the use of levodopa. But other medicines have more side effects and don't control symptoms as well as levodopa. And the long-term problems caused by medicine are the same, no matter what medicine is used first.1 The decision to start taking medicine, and which medicine to take, will be different for each person with Parkinson's disease. Your doctor will be able to help you make these choices.

In some cases, a treatment called deep brain stimulation may also be used. For this treatment, a surgeon places wires in your brain. The wires carry tiny electrical signals to the parts of the brain that control movement. These little signals can help those parts of the brain work better.

There are many things you can do at home that can help you stay as independent and healthy as possible. Eat healthy foods. Get the rest you need. Make wise use of your energy. Get some exercise every day. Physical therapy and occupational therapy can also help.

How will Parkinson's disease affect your life?

Finding out that you have a long-term, progressive disease changes your life. It is normal to have a wide range of feelings. You may feel angry, afraid, sad, or worried about what lies ahead. It may help to keep a few things in mind:

No one can know for sure how your disease will progress. But usually this disease progresses slowly. Some people live for many years with only minor symptoms, such as a tremor in one hand.
Many people who have Parkinson's disease can and do keep working for years. As the disease gets worse, you may need to change how you work. You can get support to learn ways to adapt.
It is important to take an active role in your health care. Learn all you can about the disease. Find a doctor you trust and can work with. Go to all your appointments, and get all the treatment your doctor suggests.
Depression is common in people who have Parkinson’s. If you feel very sad or hopeless, talk to your doctor or see a counselor. Antidepressant medicines can help.
It can make a big difference to know that you are not alone. Ask your doctor about Parkinson’s support groups, or look for online groups or message boards.
Parkinson’s affects more than just the person who has it. It also affects your loved ones. Be sure to include them in your decisions. Help them learn about the disease and get the support they need.


There is no known way to prevent Parkinson's disease.

Research has shown that people who eat more fruits and vegetables, high-fiber foods, fish, and omega-3 rich oils (sometimes known as the Mediterranean diet) and who eat less red meat and dairy may have some protection against Parkinson's disease. But the reason for this is still being studied


The type and severity of symptoms experienced by a person with Parkinson's disease vary with each individual and the stage of Parkinson's disease. Symptoms that develop in the early stages of the disease in one person may not develop until later-or not at all-in another person.

Symptoms of Parkinson's disease typically begin appearing between the ages 50 and 60. They develop slowly and often go unnoticed by family, friends, and even the person who has them.
A small number of people have symptoms on only one side of the body that never progress to the other side.

The most common symptoms include:

Tremor, or shaking, often in a hand, arm, or leg. Tremor caused by Parkinson's disease occurs when the person is awake and sitting or standing still (resting tremor) and subsides when the person moves the affected body part.
Stiff muscles (rigidity) and aching muscles. One of the most common early signs of Parkinson's disease is a reduced arm swing on one side when the person is walking that is caused by rigid muscles. Rigidity can also affect the muscles of the legs, face, neck, or other parts of the body and may cause muscles to feel tired and achy.
Slow, limited movement (bradykinesia), especially when the person tries to move from a resting position. For instance, it may be difficult to get out of a chair or turn over in bed.
Weakness of face and throat muscles. Talking and swallowing may become more difficult, and the person may choke, cough, or drool. Speech becomes softer and monotonous. Loss of movement in the muscles in the face can cause a fixed, vacant facial expression, often called the "Parkinson's mask."
Difficulty with walking (gait disturbance) and balance (postural instability). A person with Parkinson's disease is likely to take small steps and shuffle with his or her feet close together, bend forward slightly at the waist (stooped posture), and have trouble turning around. Balance and posture problems may result in frequent falls. But these problems usually do not develop until later in the course of the disease.

Tremor is often the first symptom that people with Parkinson's disease or their family members notice. Initially, the tremor may appear in just one arm or leg or only on one side of the body. The tremor also may affect the chin, lips, and tongue. As the disease progresses, the tremor may spread to both sides of the body. But in some cases the tremor remains on just one side.

Emotional and physical stress tend to make the tremor more noticeable. Sleep, complete relaxation, and intentional movement or action usually reduce or stop the tremor.

Although tremor is one of the most common signs of Parkinson's disease, not everyone with tremor has Parkinson's disease. Unlike tremor caused by Parkinson's disease, tremor caused by other conditions gets better when your arm or hand is not moving and gets worse when you try to move it. The most common cause of non-Parkinson's tremor is essential tremor, a treatable condition that is often wrongly diagnosed as Parkinson's disease.

Other symptoms
Parkinson's disease can cause many other symptoms. These can be disabling and may include:

Decreased dexterity and coordination. Changes in handwriting are common, with writing becoming smaller. Athletic abilities decline, and daily activities such as dressing and eating become harder.
Cramps in the muscles and joints.
Oily skin or increased dandruff.
Digestive and urinary problems. Constipation is common. Controlling urination (incontinence) may be difficult, and urination may be frequent and at times urgent. Drugs used to treat Parkinson's disease may help or may sometimes make these symptoms worse.
Problems with involuntary or automatic body functions, such as increased sweating, low blood pressure when the person stands up (orthostatic hypotension), and problems with sexual function. These symptoms may also be caused by Parkinson's-plus conditions or drugs used to treat Parkinson's disease.
Freezing, a sudden, brief inability to move. It most often affects walking.

Problems with sleep, mood, and thought also are common in people who have Parkinson's disease.

Problems falling asleep or staying asleep (insomnia) can result from anxiety, depression, or physical restlessness. People with Parkinson's disease may not be able to sleep well because they cannot easily turn over or change position in bed.
A person with Parkinson's disease may slowly become more dependent, fearful, indecisive, and passive. The person may talk less often than he or she used to, withdraw from family and friends, and remain inactive unless encouraged to move about. Depression is very common in people with this disease and can be caused by chemical changes in the brain or can be a reaction to having a disabling disease. Depression often improves with proper treatment.
Up to one-third of people with Parkinson's disease may develop dementia and confusion, similar to Alzheimer's disease, late in the course of the disease. Depression can further contribute to memory loss and confusion. Memory loss, hallucinations (seeing or hearing things that aren't really there), and vivid dreams may sometimes be caused by drugs taken to treat Parkinson's disease.

There are many other conditions with similar symptoms. Some of these may be reversible.

Treatment Overview

No known treatment can stop or reverse the breakdown of nerve cells that causes Parkinson's disease. But drugs can relieve many symptoms of the disease. Surgery also can be effective in a small number of people to treat symptoms of Parkinson's disease.

Treatment is different for every person, and the type of treatment you will need may change as the disease progresses. Your age, work status, family, and living situation can all affect decisions about when to begin treatment, what types of treatment to use, and when to make changes in treatment. As your medical condition changes, you may need regular adjustments in your treatment to balance quality-of-life issues, side effects of treatment, and treatment costs.

Parkinson's disease causes a wide range of symptoms and complications. This topic covers the overall management of the disease. This topic does not discuss managing specific symptoms.

Initial and ongoing treatment

If your symptoms are mild, you may not need treatment for Parkinson's disease. Your doctor may wait to prescribe treatment with drugs until your symptoms begin to interfere with your daily activities. Other treatment methods (such as exercise, physical therapy, and occupational therapy) can be helpful at all stages of Parkinson's disease to help you maintain your strength, mobility, and independence.

There are many measures you can take at home to make dealing with the symptoms of Parkinson's disease easier. Simplify your daily activities so that you have the energy for those that are most necessary. And arrange your furniture and other commonly used items so that it is easier for you to move around and get to things in your home. This can help keep you functioning independently.

Getting regular exercise and eating a healthy, balanced diet are important parts of treating Parkinson's disease. Exercise can help you keep your strength, coordination, and endurance as well as control your weight and reduce the likelihood that you will become constipated. And although a balanced diet is important, people who take levodopa should talk to their doctor about when to eat protein, because levodopa may not work as well if you take it at the same time that you eat protein.

Depression is common in people with Parkinson's disease. Recognizing and dealing with depression is an important part of home treatment. There are medicines that can help the symptoms of depression in people with Parkinson's disease. Your doctor, other health professionals, or Parkinson's disease support groups can help you get emotional support and education about the illness. This is important both early and throughout the course of the disease.

As Parkinson's disease progresses, the symptoms usually become more disabling. Most people develop mild to moderate tremor. Movement is often slow and limited due to muscular rigidity and the slowing down and loss of automatic and spontaneous movement (bradykinesia). Treatment in this stage is determined by weighing the severity of the symptoms against the side effects of drugs.

The symptoms of Parkinson's disease change as the disease progresses. Because of this, your doctor will adjust your drugs to deal with the symptoms as they appear. Levodopa is the most commonly used drug for Parkinson's disease. It works better than any other drug used to treat Parkinson's disease symptoms and has fewer side effects. But after using levodopa for over 5 years, many people start to have problems with motor complications (times when the medicine suddenly stops working or when you have uncontrollable jerking movements). Because of this, your doctor may prescribe dopamine agonists such as pramipexole or ropinirole to delay the point at which you need to begin taking levodopa. Studies have suggested that this may delay the onset of levodopa's side effects.3 But in the longest study done, people who started treatment with a dopamine agonist had just as many problems with motor fluctuations at 14 years as people who started treatment with levodopa.1 Your doctor may also prescribe levodopa along with a dopamine agonist.

Treatment when the condition gets worse

A person in the advanced stages of Parkinson's disease is significantly limited in movement and activity. Symptoms can change daily, and the side effects of drugs can limit their effectiveness. Your doctor may change your drug in order to deal with the symptoms as they arise.

A speech therapist can suggest breathing and speech exercises that can help you overcome the soft, imprecise speech and monotone voice that develop in advanced Parkinson's disease. Changing how and what you eat can help you overcome problems with eating. For example, sitting upright, taking small bites and sips, and eating moist, soft foods can help you avoid nutrition problems and lessen your chance of choking. Keeping your chin up, swallowing often, and not eating sugary foods can help reduce drooling.

Freezing, or motor blocks, can be dealt with through purposeful movement. Stepping toward a specific target on the ground and making your first step a precise, long, marching-style stride can help you overcome freezing episodes. A physical therapist or occupational therapist may be able to offer some helpful advice to improve your walking and reduce your risk of falling.

Other common symptoms that appear during Parkinson's disease include depression and sexual dysfunction. Talk to your doctor about ways to overcome these problems. There are medicines that can help these symptoms in people with Parkinson's disease.

You or your family members may notice that you begin to have problems with memory, problem solving, learning, and other mental functions. When these problems keep you from doing daily activities, it is called dementia. There are medicines that can help treat dementia in people with Parkinson's disease.

Surgeries such as deep brain stimulation may be done during this stage of the disease.