Parkinson’s disease is a movement disorder caused by a neurological problem. There are various symptoms such as tremors, slowness of movement, stiff muscles, unsteadiness of walking, and problems with balance and coordination. The disease does not have a cure. Many patients and their families can manage the disease with medication. Occasionally, patients may benefit from surgery to alleviate symptoms.

What is Parkinson’s disease?

You may be able to control your movement with Parkinson’s disease if your nervous system is damaged. Parkinson’s disease typically begins slowly and progresses over time. People with Parkinson’s disease may have difficulty walking, maintaining balance and coordination, and have muscle stiffness and shaking. The disease can cause you to experience behavioral changes and other symptoms as well as having trouble talking and sleeping.

Read: Stereotypic Movement Disorder

Who gets Parkinson’s disease?

Parkinson’s disease is more common in men than women. It typically affects people 60 years and older. It can sometimes be diagnosed in people younger than 50.

There are about 60,000 Parkinson’s cases diagnosed each year in the US.

Is Parkinson’s disease inherited?

The cause of Parkinson’s disease has been found to be a gene mutation. The cause of early-onset Parkinson’s disease – when it begins before age 50 – may come from genetic factors. It was found that Parkinson’s patients with Lewy bodies in their brains, which are clumps of the protein alpha-synuclein, carried a gene mutation.

The purpose of this study is to understand this protein’s function and its relation to genetic mutations that are seen sometimes in Parkinson’s disease and in individuals with Lewy body dementia, a type of dementia that can cause uncontrolled movement.

Parkinson’s disease is associated with several other genetic mutations. The mutation of these genes can affect a nerve cell’s ability to release dopamine, resulting in the death of the nerve cell. Researchers are still trying to understand how gene mutations lead to Parkinson’s disease by understanding what causes these genes to mutate.

The genetic mutation associated with Parkinson’s disease is thought to affect up to 10% to 15% of those who suffer from it. However, environmental factors also play a part, which isn’t fully understood.

Read: Frontotemporal Dementia

What causes Parkinson’s disease?

The central nervous system (substantia nigra) of the brain is affected by the disease when nerve cells (neurons) die. Dopamine (neurotransmitter) is normally produced by these cells for helping the brain communicate (to transmit signals between brain areas). They produce less dopamine when their function is impaired or they die. The basal ganglia in the brain is especially dependent on dopamine. This area organizes the brain’s commands that control the movement of the body. People suffering from Parkinson’s disease experience movement symptoms due to a loss of dopamine.

Norepinephrine is another neurotransmitter lost by Parkinson’s disease patients. A healthy sympathetic nervous system requires the presence of this chemical. A number of autonomic functions of the body are controlled by this system, including digestion, heart rate, blood pressure and breathing. One of the causes of some Parkinson’s disease symptoms other than movement is the loss of norepinephrine.

There is no clear explanation for why neurotransmitter chemicals that produce these chemicals die.

What are the symptoms of Parkinson’s disease?

People with Parkinson’s disease may experience different symptoms and experience varying degrees of decline. There are several symptoms that are common:

• Tremor: You will experience shaking at the start. This can also occur in the foot or jaw. Affected parts of your body usually begin to swell from the early stages of the disease. Tremors may become more widespread as the disease advances. During times of stress, it may be aggravated. If your arm or leg is being moved while sleeping or while you are sleeping, the tremor will often go away.
• Slowness of movement (bradykinesia): Basically, this is the slowdown in movement caused by your brain’s inability to transmit instructions quickly enough to the appropriate parts of your body. If left untreated, this can be disastrous. Suddenly, you may be able to move with ease and finish simple tasks like getting dressed, bathing, and hopping out of a chair without any assistance. You may also be able to walk with ease.
• Rigid muscles/stiff limbs: When your muscles are rigid, they cannot relax normally. Your muscles become rigid when you tense them without control and can no longer move freely. The affected muscles may hurt and you may have limited range of motion.
• Unsteady walk and balance and coordination problems: You may fall when you are bumped more easily due to your forward lean. If you don’t swing your arms naturally while walking, you may take short shuffling steps, struggle to start or stop walking, and take short shuffling steps. While trying to take a step, it may seem like your feet are stuck to the ground.
• Muscle twisting, spasms or cramps (dystonia): The toes might be curled and clenched as well as painful cramping in your foot. Dystonia can also affect other parts of the body.
• Stooped posture: The posture you assume is hunched over.

Additional symptoms include:

• Decreased facial expressions. Your face lacks expression as the disease worsens; you may not smile or blink as often
• Speech/vocal changes. The speaker may speak quickly, become slurred, or speak softly. It may be difficult to speak at first. It is possible that your voice pitch does not change (monotone)
• Handwriting changes. You may have difficulty reading your handwriting
• Depression and anxiety
• Swallowing and chewing issues, drooling
• Urinary problems
• Memory and thinking problems
• Hallucinations / delusions
• Constipation
• Problems with the skin, such as dandruff
• Loss of smell
• Sleep disturbances, such as nightmares and restless legs syndrome
• Apathy, pain, fatigue, weight change, vision changes
• Low blood pressure

Read: Huntington’s Disease

What are the different stages of Parkinson’s disease?

Parkinson’s disease affects people differently, just as each individual experiences the disease differently. Not all Parkinson’s symptoms are experienced by all individuals. There is no universally accepted order in which symptoms occur. Mild symptoms may appear in some people but severe symptoms may appear in others. It is also challenging to predict at the beginning how quickly symptoms will worsen since they vary from individual to individual.

The disease progresses from its early stages to its mid-stages to its late stages to its advanced stages. The typical progression of the disease is as follows:

Early stage

Parkinson’s disease begins gradually, with mild symptoms that often do not affect daily activities. Early symptoms can be challenging to identify, or you could misinterpret them as simply normal signs of aging. Symptoms may include fatigue and a sense of apprehension. Some people experience tremors while standing.

Some subtle signs are noticed by a close family member or friend before you. A doctor may report symptoms such as body stiffness or a lack of normal movement (no swinging of your arms when walking), slow or small writing, lack of expression in your face, or problems getting up from a chair.

Mid stage

Symptoms begin to worsen. Now both sides of the body may experience tremors, stiffness and movement issues. People are experiencing balance issues and falling more often. Even though you are fully independent, everyday activities such as bathing and dressing require more effort and time.

Read: Mild Cognitive Impairment

Mid-late stage

It is increasingly difficult to stand or walk and may be necessary to use a walker. If you wish to remain at home, you may need full-time care.

Advanced stage

Your mobility has been impaired and you need help getting around. It is possible you may be experiencing hallucinations. It has become necessary for you to receive 24-hour nursing care.

Parkinson’s disease diagnosis

There are no specific blood or laboratory tests to diagnose Parkinson’s disease, and its symptoms can mimic those of other disorders in the early stages. It is possible to rule out other conditions that have similar symptoms through imaging tests such as computed tomography or magnetic resonance imaging.

Your symptoms, medications, and exposure to toxins may be asked for in order to diagnose Parkinson’s disease. You’ll also need to watch your walk, have your posture checked and your coordination checked, and look for signs of tremors and muscle stiffness.

Ideally, you should see a neurologist who specializes in movement disorders if you think you may have Parkinson’s disease. Early treatment decisions can affect treatment effectiveness in the long run.

What is the treatment for Parkinson’s disease?

No cure exists for Parkinson’s disease. You can relieve some symptoms with medications and other treatments, however. You can significantly reduce the symptoms of Parkinson’s disease with exercise. Additionally, physical therapy, occupational therapy, and speech-language therapy can help individuals with difficulty walking and balancing, eating and swallowing difficulties, and communicating effectively. Some patients may need surgery.

Read: Chronic Fatigue Syndrome

What medications are used to treat Parkinson’s disease?

Patients with Parkinson’s disease are primarily treated with medications. Depending on your disease severity, side effects of the drug class, and whether or not your symptoms are controlled by the medications, your doctor will work closely with you to develop a treatment plan.

Parkinson’s disease is treated with medications that:

• Improve brain function by making dopamine.
• Stimulate brain function by generating dopamine.
• Reduce dopamine breakdown in the brain by blocking an enzyme.
• Alleviates some Parkinson’s symptoms.

Levodopa

Parkinson’s disease is characterized by sluggish movements, tremors, and stiffness caused by levodopa. People with Parkinson’s disease have low levels of dopamine in their brains, which are replenished by levodopa. Carbidopa (Sinemet) is typically taken alongside levodopa to increase the amount of levodopa reaching the brain and to reduce or prevent the side effects of levodopa, like nausea and vomiting and low blood pressure.

Synemet comes in a long-acting, controlled release formula and an immediate release formula. Rytary is a long-acting capsule version of the cancer drug levodopa/carbidopa. Inbrija is a new treatment that offers inhaled levodopa. Carbidopa/Levodopa users who experience off episodes should take this medication for when they have them (see below).

The effects of levodopa do not last as long for people with Parkinson’s disease since their levodopa doses are given over a longer period of time, which makes their symptoms (tremor, muscle rigidity, slowness) worse prior to taking their next dose. The effects of the drug wear off over time. They may also notice uncontrollable, floating movements of their bodies called dyskinesias. If these movements occur, it may be due to an excessive dose of levodopa. A neurologist can often improve these levels of levodopa effects by adjusting the medication. These fluctuations are called motor fluctuations.

Read: Short-Term Memory Loss

Dopamine agonists

The effects of these drugs are similar to those of dopamine. Levodopa is most effective for controlling muscle rigidity and slow muscle movement. It may be necessary to add levodopa if these medications cannot effectively control your symptoms, depending on your age and the severity of your symptoms.

Ropinirole (Requip) and pramipexole (Mirapex) are the two newest dopamine medications. The Neupro patch contains rotigotine (Neupro). Apomorphine (Apokyn) is an injectable medicine with a short half-life.

Dopamine agonists come with side effects like nausea, vomiting, dizziness, lightheadedness, insomnia, leg swelling, confusion, hallucinations, and compulsive behavior (like excessive gambling, buying, eating, or sex). People who are older than 70 are more likely to experience some of these side effects.

Catechol O-methyltransferase (COMT) inhibitors

They interfere with an enzyme that is responsible for the breakdown of dopamine. They prolong and improve the effectiveness of levodopa by slowing your body’s ability to eliminate it. COMT inhibitors include entacapone (Comtan) and tolcapone (Tasmar). In April 2020, the FDA approved Opicapone (Ongentys). Levodopa may be more effective with this condition as well as involuntary movements (dyskinesia). A lot of liver damage can result in the prescription of tolcapone, and close monitoring is required to avoid liver failure.

Read: Generalized Dystonia

MAO B inhibitors

Monoamine oxidase B (MAO B) is the brain enzyme responsible for breaking down dopamine in the brain. When this happens, dopamine will remain active longer in the brain. These include selegiline (Eldepryl, Zelapar), rasagiline (Azilect) and safinamide (Xadago). Both nausea and insomnia can occur as side effects. Hallucinations and dyskinesia are more likely to occur when taking carbidopa-levodopa with an MAO B inhibitor. When you are taking antidepressants or narcotics, MAO B inhibitors are not recommended. The best course of treatment for you will be determined by reviewing all your current medications.

Anticholinergics

These drugs decrease muscle stiffness and tremors. Trihexyphenidyl (Artane) and benztropine (Cogentin) are examples. These drugs were once the only treatments available for Parkinson’s disease. It can cause blurred vision, constipation, dry mouth, and urine retention as side effects. Anticholinergics should not be taken by people over the age of 70 who have memory impairment, confusion, or hallucinations. These medications are less commonly prescribed because of the potential side effects.

What are the surgical treatments for Parkinson’s disease?

Medications are often effective in maintaining a good quality of life for patients with Parkinson’s disease. Patients may experience reduced effectiveness of medications if their disease worsens. Those with this condition experience unpredictable medication effects – reducing symptoms during periods of medication peaking and symptoms not being controlled during periods of medication waning, which usually occur before the next dose is taken.

It is sometimes possible to manage these variations by changing medications. Other times, this is not possible. If your doctor sees that you are experiencing symptoms that are severe, failing to improve with medication adjustments and that your quality of life has declined, it may be time to discuss some surgical options.

• Deep brain stimulation (DBS): Electrical impulses are delivered to the brain through electrodes that block or change abnormal activity. Most of the main Parkinson’s disease symptoms can be treated with DBS, including tremor, slowness of movement, and rigidity. Parkinson’s Disease symptoms that do not involve movement are not improved by it, such as memory loss, hallucinations and depression. If medication trials do not help control your symptoms, and you meet other strict criteria, you may be eligible for DBS. It will be determined by your doctor whether you should pursue this treatment.
• Carbidopa-levodopa infusion: Feeding tubes are surgically inserted into the small intestine. The tube in this picture delivers either carbidopa-levodopa gel (Duopa) or liquid medication. The continuous infusion method maintains a constant dosage within the body. These drugs help patients who respond differently to oral carbidopa-levodopa but continue to benefit from the combination therapy.
• Pallidotomy: During surgery, a small portion of the globus pallidus, which controls movement, is destroyed. This procedure reduces involuntary movements (dyskinesia), stiffness in the muscles and tremor.
• Thalamotomy: This is the process of destroying part of the thalamus. A few patients may benefit from this treatment if they suffer severe tremors of their arms or hands.

Read: Focal Dystonia

Can Parkinson’s disease be prevented?

Sadly, no. The disease worsens over time and results in long-term disability. The current state of the disease cannot be prevented or cured, but medications may significantly ease your symptoms. Surgical treatment may be an option for some patients – especially those at the later stage of the disease.

What is the outlook for persons with Parkinson’s disease?

Parkinson’s disease has neither a cure nor a specific method for preventing it, but scientists are striving hard to discover new ways to manage it, prevent its progression and ultimately eradicate it.

Your healthcare team is currently focusing on managing your symptoms medically along with making recommendations for general health and lifestyle improvement (exercise, healthy eating, sleep improvement). Most people with Parkinson’s disease can lead satisfying lives by identifying their individual symptoms and adapting their treatment according to changes in their symptoms.

The future looks bright. Researchers are working on:

• To generate neurons (using either bone marrow or embryonic stem cells) that produce dopamine
• An enzyme that produces dopamine is delivered to a gene that controls movement in the brain
• Dopamine-releasing nerve cells are protected by a natural occurring human protein, GDNF, derived from glial cell lines

Additional research is being conducted. We have learned many things, made many advances and can expect to learn even more.

Read: Subconscious Mind

What lifestyle changes can I make to ease Parkinson’s symptoms?

Exercise: Exercising improves strength, balance, coordination, flexibility, and reduces tremors. Exercising can also reduce anxiety and depression, as well as improve memory and cognition. Study results found people with Parkinson’s disease who exercised 2.5 hours per week had improved mobility as well as a slower decline in quality of life than those who ate the same diet or began exercising later in the disease process. In addition to strength training, stretching exercises, dancing and aerobic exercises, there are several exercises to consider. All of them are beneficial.

Eat a healthy, balanced diet: This can also be used to reduce Parkinson’s symptoms that don’t relate to movement, such as constipation. Fiber-rich foods can be used to treat constipation. The Mediterranean diet is one such diet.

What are some tips for maintaining balance?

• Whenever possible, keep one hand free. Try carrying things in a fanny pack or backpack rather than in your hands. If you walk with an object in both hands, you risk losing your balance.
• Try moving your arms back and forth while walking. Those with Parkinson’s disease may have to make a conscious effort to do this. Although it will improve your posture and balance, it will also reduce your risk of falling.
• Take your feet up off the ground whenever you walk. Losing balance is a common result of shuffling and dragging of the feet.
• If you need to make a turning maneuver, make a wide turn instead of pivoting sharply.
• Make sure your feet are shoulder-width apart. Your balance is more likely to be affected if your feet are close together for a long time.
• Focus on one thing at a time. Do not walk while reading, looking around, or doing another task. You can complicate your motor function by decreasing your automatic reflexes. Therefore, the less you are distracted, the better.
• Shoes with rubber or gripping soles should not be worn here, as they may cause tripping on the floor.
• Change positions slowly. Consider using grab bars and walking aids if you need them. Let each step take 15 seconds. Standing up after standing for 15 seconds is a good time to begin walking after a seated position.
• If you get “frozen,” think of stepping over something imaginary or have someone put their foot in front of yours. Caretakers or family members should not pull you — this may make you unbalanced and prolong the episode.
• Balance problems might warrant the use of a walking aid such as a stick, cane, or walker. You may feel ready to try walking on your own after you have mastered walking with help.