Parkinson’s Disease

It happens when nerve cells in the brain don’t produce enough of a brain chemical called dopamine. Sometimes it is genetic, but most cases do not seem to run in families. Exposure to chemicals in the environment might play a role.

Symptoms begin gradually, often on one side of the body. Later they affect both sides. They include

Trembling of hands, arms, legs, jaw and face
Stiffness of the arms, legs and trunk
Slowness of movement
Poor balance and coordination

As symptoms get worse, people with the disease may have trouble walking, talking, or doing simple tasks. They may also have problems such as depression, sleep problems, or trouble chewing, swallowing, or speaking.

There is no lab test for PD, so it can be difficult to diagnose. Doctors use a medical history and a neurological examination to diagnose it.

PD usually begins around age 60, but it can start earlier. It is more common in men than in women. There is no cure for PD. A variety of medicines sometimes help symptoms dramatically. Surgery and deep brain stimulation (DBS) can help severe cases. With DBS, electrodes are surgically implanted in the brain. They send electrical pulses to stimulate the parts of the brain that control movement.

Causes

Nerve cells use a brain chemical called dopamine to help control muscle movement. With Parkinson disease, the brain cells that make dopamine slowly die. Without dopamine, the cells that control movement cannot send messages to the muscles. This makes it hard to control the muscles. Slowly, over time, this damage gets worse. No one knows what causes these brain cells to waste away.

Parkinson disease most often develops after age 50. It is one of the most common nervous system problems in older adults.

• The disease tends to affect men more than women, although women also develop the disease. Parkinson disease sometimes runs in families.
• The disease can occur in younger adults. In such cases, it is often due to the person’s genes.
• Parkinson disease is rare in children.

Symptoms

Symptoms may be mild at first. For instance, you may have a mild tremor or a slight feeling that one leg is stiff and dragging. Symptoms may affect one or both sides of the body.

General symptoms may include:

• Problems with balance and walking
• Rigid or stiff muscles
• Muscle aches and pains
• Low blood pressure when you stand up
• Stooped posture
• Constipation
• Sweating and not being able to control your body temperature
• Slow blinking
• Difficulty swallowing
• Drooling
• Slowed, quieter speech and monotone voice
• No expression in your face (like you are wearing a mask)

Movement problems may include:

• Difficulty starting movement, such as starting to walk or getting out of a chair
• Difficulty continuing to move
• Slowed movements
• Loss of small hand movements (writing may become small and difficult to read)
• Difficulty eating

Symptoms of shaking (tremors):

• Usually occur when your limbs are not moving; this is called resting tremor
• Occur when your arm or leg is held out
• Go away when you move
• May be worse when you are tired, excited, or stressed
• Can cause you to rub your finger and thumb together without meaning to (called pill-rolling tremor)
• Eventually may occur in your head, lips, tongue, and feet

Diagnosis

Your health care provider may be able to diagnose Parkinson disease based on your symptoms and a physical exam. But the symptoms can be hard to pin down, particularly in older adults. Symptoms are easier to recognize as the illness gets worse.

The examination may show:

• Difficulty starting or finishing a movement
• Jerky, stiff movements
• Muscle loss
• Shaking (tremors)
• Changes in your heart rate
• Normal muscle reflexes

Your doctor may do some tests to rule out other conditions that can cause similar symptoms.

Treatment

There is no cure for Parkinson disease, but treatment can help control your symptoms.

MEDICINE

Your provider will prescribe medicines to help control your shaking and movement symptoms.

At certain times during the day, the medicine may wear off and symptoms can return.

If this happens, your provider may need to change any of the following:

• Type of medicine
• Dose
• Amount of time between doses
• The way you take the medicine

Tell your provider right away if you have these side effects. Never change or stop taking any medicines without talking with your provider. Stopping some medicines for Parkinson disease may lead to a severe reaction. Work with your provider to find a treatment plan that works for you.

SURGERY

Surgery may be an option for some people. Surgery does not cure Parkinson disease, but it may help ease symptoms.

Types of surgery include:

• Deep brain stimulation. This involves placing electric stimulators in areas of the brain that control movement.
• Surgery to destroy brain tissue that causes Parkinson symptoms.
• Stem cell transplant and other procedures are being studied.

LIFESTYLE

Certain lifestyle changes may help you cope with Parkinson disease.

The following are possible lifestyle changes one could make to cope with the disease:

• Stay healthy by eating nutritious foods and not smoking.
• Make changes in what you eat or drink if you have swallowing problems.
• Use speech therapy to help you adjust to changes in your swallowing and speech.
• Stay active as much as possible when you feel good. Do not overdo it when your energy is low.
• Rest as needed during the day and avoid stress.
• Use physical therapy and occupational therapy to help you stay independent and reduce the risk of falls.
• Place handrails throughout your house to help prevent falls. Place them in bathrooms and along stairways.
• Use assistive devices, when needed, to make movement easier. These devices may include special eating utensils, wheelchairs, bed lifts, shower chairs, and walkers.
• Talk to a social worker or other counseling service to help you and your family cope with the disorder. These services can also help you get outside help, such as Meals on Wheels.

Recovery

Medicines can help most people with Parkinson disease. How well medicines relieve symptoms and for how long, can be different in each person.

If not treated, the disorder gets worse until a person is totally disabled. Parkinson disease may lead to a decline in brain function and early death.