What is Parkinson’s Disease?
Parkinson’s disease (PD) is a degenerative disorder of the central nervous system. Other names include primary parkinsonism, idiopathic parkinsonism, paralysis agitans or hypokinetic rigid syndrome (HRS). The average age of diagnosis is 62, but those exposed to certain solvents can develop symptoms decades earlier.
The progressive impairment and deterioration of neurons in a part of the brain known as the substantia nigra lead to Parkinson's. These neurons no longer produce dopamine, a vital brain chemical, that blocks messages from the substantia nigra to the corpus striatum, an area of the brain that helps coordinate intentional body movement. In the absence of this disease, this line of communication is smooth and muscle movement remains balanced. The lack of dopamine impairs the ability for the affected person to control his or her body movements.
A common way Parkinson’s is defined is idiopathic parkinsonism because there is no known cause to the disease. Some research links genetics to the disease, but it isn’t definitive in all cases. Recent research suggests pesticides and solvents play a critical role in causing Parkinson’s. Certain occupations, including welders, painters and steamfitters, have cases causally linked to the disease.
In 1990, Parkinson’s caused 44,000 deaths. By 2013, that number jumped to 103,000.
Parkinson’s disease vs. Parkinsonism
Parkinsonism is defined as a clinical syndrome with symptoms including bradykinesia, tremor, instability with posture and rigidity. It shares similar symptoms to Parkinson’s disease, but it isn’t a progressive neurodegenerative disease and is categorized as a symptom complex, meaning the various symptoms occur together to characterize the illness.
Lewy bodies are protein aggregates called alphasynuclein in the brain’s neurons and are found in patients with Parkinson’s disease. They allow the dopamine replacement treatments to alleviate the various symptoms. Parkinsonism, however, doesn’t respond to the treatments found to work with PD.
Symptoms of Parkinson's
Symptoms of Parkinson’s disease may present themselves differently in each individual, with the early signs so mild they go unnoticed. When symptoms begin to appear, they typically occur on one side of the body. Even after the symptoms move to both sides, the original side will remain worse.
Early Warning Signs
- Twitching of the limbs, including slight shaking in thumb, chin, lip, hands or legs.
- Loss of smell with foods like pickles, licorice and bananas.
- Constipation and strained bowel movements without other common factors, such as lack of water or fiber in diet or medication that may cause constipation.
- Hunching, stooping or slouching instead of being able to hold your body upright.
- Changes in handwriting, including smaller letters, is a common sign of Parkinson’s disease.
- Changes in voice, especially speaking lower, softer or more hoarse.
- Sudden movements while sleeping, including thrashing, kicking, punching and falling out of bed.
- A masked face making it appear like you’re mad or depressed with a blank stare and lack of blinking.
- A stiff body that causes trouble when moving or walking is an early sign. Look for arms not swinging when walking or a stiffness and or pain in the shoulder or hips.
- Dizziness or fainting when standing up.
The seemingly common nature and gradual progression of these signs make it challenging to see there is a bigger issue. As the disease progresses, these early warning signs turn into the common symptoms associated with Parkinson’s disease.
- One of the most common characteristics of Parkinson’s disease is a shaking hand while it is at rest. The rubbing of the forefinger and thumb in a back and forth manner is called a pill-rolling tremor.
- Rigidity in the muscles
- Stiff muscles may be felt in any part of the body, making it challenging to move and limiting range of motion.
- Impaired balance and posture
- A stooped standing position and lack of balance may occur with Parkinson’s disease.
- Challenges in writing
- Writing may look small and become more difficult.
- Bradykinesia, or slowed movement
- PD can slow movement as it reduces the overall ability to move, turning simple tasks into time-consuming and difficult challenges. Short steps, difficulty getting out of a chair and dragging feet are caused by bradykinesia.
- Changes in speech
- As with the early warning sign, speech may become softer and come out in a monotone without inflection. Other issues can involve speaking faster, slurring the words or hesitating before starting a sentence.
- Loss of automatic movements
- Unconscious movements, such as smiling, gesturing while talking, swinging your arms and blinking may be lost with Parkinson’s disease.
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Parkinson’s disease is incurable, but several methods exist to alleviate symptoms. Medications can dramatically assist in the control of the symptoms with surgery advised in more progressed cases. Lifestyle changes, including physical therapy focusing on balance, stretching and aerobic classes may aid the body.
Early treatment includes levopoda and dopamine agonists, meant to increase the levels of dopamine in the brain. The dopamine agonist activates dopamine receptors, allowing the pathways to send messages. The longer the disease is present, the less effective these methods become and cause dyskinesia, a movement disorder where muscles move involuntarily.
- A natural chemical, levodopa enters the brain and is converted into dopamine. Combining it with carbidopa, a peripheral metabolism inhibitor, protects it from becoming dopamine before it reaches the brain and can lessen or prevent certain side effects, including nausea. As the disease progresses, the chemical becomes less stable and it may wear off or cause dyskinesia.
- Dopamine agonist
- A dopamine agonist will mimic the effects of dopamine on the brain and last longer than levodopa. Because they aren’t as effective as other treatments, agonists may be combined with levodopa to reduced the on-again-off-again effect.
- Due to the side effects, including impaired memory and hallucinations, these medications aren’t used in the same capacity. Anticholinergics can help control the tremor.
- MAO-B Inhibitors
- These inhibitors, including selegiline and rasagiline prevent the breakdown of dopamine in the brain by inhibiting the enzyme monoamine oxidase, or MAO-B.
- Amantadine is typically prescribed during early-stage Parkinson’s to temporarily relieve mild symptoms. Later it may be given with carbidopa-levodopa to control dyskinesia.
- Catechol O-methyltrasferase (COMT) inhibitors
- By blocking the enzyme that breaks down the dopamine, COMT inhibitors can prolong the levodopa effects for a brief time.
- Deep brain stimulation (DBS)
- As levodopa becomes less effective, doctors may suggest DBS to stabilize the fluctuations with the medications, reduce dyskenisia, tremor and rigidity while slowing movements. The procedure involves planting electrodes into the brain that are connected to a generator implanted in the chest near the collarbone. This sends pulses to the brain to reduce Parkinson’s disease symtpoms.