Parkinson’s disease is a neurodegenerative disorder caused by the malfunctioning and death of neuron cells in the brain’s substantia nigra region. The neurons produce the chemical messenger dopamine, responsible for relaying messages from the brain to control body movements. As dopamine-producing cells die, the messages are delivered ever-more slowly, interfering with the person’s ability to initiate and control body movements.

Resulting symptoms typically include a progressive slowing of body movements like walking and speaking, stiffness in the limbs, problems with balance and coordination, and development of tremors in the arms, hands, legs, face and jaw.

Parkinson’s disease (PD) is an insidious disorder, chronic and progressive over a span of years. Early symptoms are subtle as neurons begin to be damaged, but as it slowly progresses, the motor function symptoms become apparent.

Although there is no cure for Parkinson’s disease, there are a range of medical, surgical and physical therapies that can often help patients manage the symptoms and maintain their quality of life. The symptoms experienced by PD patients can vary significantly, both in nature and severity. Some patients may have only minor motor problems, others significant deficits. Courses of therapy need to be individualized, and patients need to work closely with their clinicians to ensure they remain appropriate.

Parkinson's Disease Overview:

• Prevalence
• Symptoms
• Diagnosis
• Treatments
• For More Information

Prevalence

Although people as young as 18 years of age have been diagnosed with Parkinson's disease, the average age of patients at diagnosis is 60. Advancing age is considered to be the single biggest risk factor, with men somewhat more at risk for the disorder than women. Overall, it’s estimated that Parkinson’s affects one percent of the population. The disease derives its name from James Parkinson, a British doctor who first described it in 1817.

Symptoms

The most obvious symptoms are the major motor symptoms, sometimes called “cardinal symptoms.” Typically, they begin on one side of the body and gradually migrate to the other side.

• Tremor – uncontrollable shaking in the hands, arms, legs, face and jaw.
• Bradykinesia – slowness of movement.
• Rigid or stiff muscles in the limbs and trunk.
• Impaired posture and balance and difficulty with coordination.

Other, less common symptoms may include:

• Loss of automatic movements, such as smiling or blinking and facial animation when speaking.
• Speech and swallowing difficulties.
• Decreased lung capacity, low volume of voice.
• Depression and anxiety.
• Sleep problems.
• Loss of sense of smell.

Diagnosis

There are no tests for diagnosing Parkinson’s Disease, and it is difficult to identify definitively. Many PD symptoms are also associated with other disorders and excluding all other possible causes may be an important part of the diagnosis.

An effective diagnosis begins with a thorough medical history and a neurological examination, watching for one or more of the four cardinal symptoms – resting tremor, bradykinesia, rigidity and postural instability. Sometimes, the diagnosis may come only after the physician places the patient on a medication that increases the brain’s supply of dopamine and confirms that the symptoms are reduced.

Treatments

There is no cure for PD at present but there are medical, surgical and therapeutic measures that can be taken to manage symptoms and enhance patients’ conditions, sometimes significantly restoring functions. Since the disorder progresses in severity over time, medication levels, for example, may need to be adjusted periodically.

Medical Treatments

• Dopamine Replacement Therapies involve doses of the drug Levodopa, which is converted by enzymes in the brain into dopamine. It’s often combined with the drug Carbidopa to slow the progression of symptoms. Unfortunately, Levodopa/Carbidopa use doesn’t slow the progression of the disease and the duration of good response between doses decreases over time. It’s not effective on all symptoms.
• Dopamine Agonists aren’t converted into dopamine but they mimic dopamine’s effect. They’re not effective on all symptoms and they don’t slow the disease’s progression.
• Other drugs are used in conjunction with Levodopa/Carbidopa to enhance their effectiveness. MAO-Inhibitors, for example, act against an enzyme that interferes with Levodopa.

Surgical Treatments

• The most common surgical treatment used today is Deep Brain Stimulation, which involves the implantation of an electrode the thickness of a strand of spaghetti in areas of the brain that are not functioning properly. A device similar to a cardiac pacemaker can be tuned to block nerve activity that causes PD symptoms. It’s only appropriate for some patients and is generally used only for patients with severe cases or severe side effects from medications.
• For a time, before the development of Deep Brain Stimulation, neurosurgeons utilized surgical procedures that involved destruction of targeted brain cells associated with symptoms like tremor. These are rarely done today.

Rehabilitation

Physical, occupational and speech therapy treatment throughout the course of the disease assists PD patients in improving their overall physical functioning, strategies and compensations to address cognitive decline, swallowing difficulties and physical impairments. Rehabilitation also aides in prevention of secondary impairments due to lack of exercise.

• Physical Therapy helps patients maximize their function, mobility, balance and motor coordination skills to maintain the highest quality of life.
• Occupational Therapy helps patients learn to deal with the many tasks involved in daily living and quality of life, from physical movement skills to handwriting to the use of kitchen utensils and other household items.
• Speech Pathology and Language Therapy helps patients deal with speech, swallowing, voice, language and memory issues. Many clients with PD experience difficulty being heard because of the low volume of their vocal quality. PRH offers treatment using the Silverman approach, an intensive treatment to aide client’s with their vocal quality and communication.

Portsmouth Regional Hospital maintains a strong outpatient rehabilitation service in the Day Rehabilitation Program.

For More Information:

National Institute of Neurological Disorders and Stroke National Institutes of Health
www.ninds.nih.gov

National Parkinson Foundation
www.parkinson.org

Parkinson’s Disease Foundation
www.pdf.org

Michael J. Fox Foundation for Parkinson’s Research
www.michaeljfox.org