CONDITIONS

Parkinson’s Disease

What Is Parkinson’s Disease

Parkinson’s disease is a medical condition that affects the brain and the nervous system. Parkinson’s disease kills brain cells that help your brain control movement. This can lead to stiffness, shaking, tremors, and other problems with the way your body moves. Over time, the disease can also affect other brain cells, leading to symptoms such as fainting, confusion, and dementia.

In the United States, 60,000 new cases of Parkinson’s disease are diagnosed each year, and many more go undetected. Parkinson’s disease affects about 1 million Americans and 7 to 10 million people around the world. 

There is no cure for Parkinson’s disease, but medical treatment can help you get your symptoms under control.

What Causes Parkinson’s Disease

The exact cause of Parkinson’s disease is unknown. The disease involves a substance called alpha-synuclein building up in the brain and damaging the cells your brain uses to produce the hormone dopamine. Your brain uses dopamine to send the signals that tell your muscles to move. When your body makes less dopamine, you may have trouble moving, or parts of your body may move when you don’t want them to.

Unfortunately, doctors don’t know what causes alpha-synuclein to build up in some people’s brains. Experts believe that Parkinson’s disease is caused by a mix of genetic factors and causes in your environment, such as exposure to certain pesticides. The causes in one person may be different from the causes in another.

Risk Factors For Parkinson’s Disease

Factors that can increase your risk for Parkinson’s disease include:

  • Your age. Your risk for Parkinson’s disease roughly doubles after age 50.
  • Your genes. Scientists have identified a few genes that cause Parkinson’s, but there may be others. One out of every 4 to 7 people with Parkinson’s disease have a relative with the condition.
  • Your sex. Parkinson’s disease is more common in men than in women.
  • Exposure to some chemicals, including specific weed killers and insecticides.

Other causes in your living environment include well water, manganese, or living in the country.

Diagnosing Parkinson’s Disease

There is no test for Parkinson’s disease. Diagnosis is usually based on a neurological exam and the answers to questions your doctor asks, mostly to rule out other conditions. During the initial doctor’s visit, your doctor may: 

  • Check your facial expression, and how well your face moves
  • Ask you to hold out your arms, to check for tremors
  • Check your balance and how well you move when pulled backwards
  • Ask about stiffness in your neck and whether you have trouble getting up from a chair

Symptoms of Parkinson’s Disease

Parkinson’s disease affects different people in different ways. For many, the main symptom is tremor or shaking, but about 3 out of 10 people with Parkinson’s disease don’t have any tremors at all. Parkinson’s disease often starts with only mild symptoms. Your symptoms may progress slowly, or they could worsen very quickly.

Symptoms of Parkinson’s disease can be divided into motor symptoms, which affect the way you move, and nonmotor symptoms, which affect your mind or body in different ways.


The main motor symptoms of Parkinson’s disease are:

  • Resting tremor, which may cause shaking in your hands or feet, or a facial tic, when your muscles are otherwise relaxed. Tremor affects about 7 out of 10 people with Parkinson’s disease.
  • Bradykinesia, which may make it hard for you to move normally. Bradykinesia can slow you down and make it harder to do day-to-day tasks such as buttoning a shirt. It may also affect your facial expressions or make it hard for you to speak.
  • Rigidity, or stiffness in your arms, legs, neck, or torso. Rigidity can affect your elbows or knees, making you swing your arms or walk with your legs straight.
  • Postural instability, which can make it hard for you to balance when standing upright.

Other motor symptoms may include:

  • Momentarily freezing in place while walking
  • Micrographia (small handwriting)
  • A masklike expression or frozen face
  • Sudden fast movements
  • Cramps
  • Trouble swallowing
  • Drooling
  • Other problems with movement or coordination

Early nonmotor symptoms of Parkinson’s disease include: 

  • Constipation
  • Changes in your sense of smell
  • Orthostatic hypertension, which is a sudden dizziness or low blood pressure when you stand up
  • Mood disorders, such as depression or anxiety
  • REM behavior disorder, which can make you act out your dreams when you sleep

As Parkinson’s disease worsens, new nonmotor symptoms may develop, such as: 

  • Bladder control trouble
  • Problems with your eyes or teeth
  • Low energy
  • Depression
  • Anxiety
  • Sexual problems
  • Unwanted changes to your weight
  • Skin problems
  • Trouble thinking clearly
  • Memory loss or dementia

The medicines you take to control Parkinson’s disease may also cause side effects, such as involuntary movements, or making you act impulsively.

Prognosis

Sadly, there is no known cure for Parkinson’s disease. The condition worsens over time, though it may develop quickly or very slowly.

Parkinson’s disease is not fatal, although it can put you at risk for fatal diseases or injuries. For some people, Parkinson’s disease can lead to an early death. However, the average life expectancy for people with Parkinson’s disease is only slightly lower than for the general population.

Living With Parkinson’s Disease

Life with Parkinson’s disease can be a challenge, but there are things you can do to make it easier on yourself.

Eating a healthy, balanced diet is important. Omega-3 fatty acids, found in nuts and fatty fish, may help. You should also drink plenty of fluids and eat high-fiber foods such as fruits and vegetables to prevent constipation, which may be a problem for people with Parkinson’s disease.

Keep your body active. Parkinson’s disease may make it hard to exercise, but staying active can help you keep your body working well. Exercise helps keep you strong and flexible and may improve your balance and help fight nonmotor symptoms such as depression and anxiety. If your symptoms make it hard to exercise, a physical therapist can help you develop a program that works for you.

Occupational therapy. An occupational therapist can help you find new ways to manage day-to-day activities such as eating, bathing, and getting dressed.

Take care of your emotional health as well. Having a chronic disease is stressful, and the effects of Parkinson’s disease on your brain chemistry can make it worse. Don’t be afraid to reach out to family and friends for help–but it’s also a good idea to find a support group where you can talk to people who are going through the same things you are.

Screening

At present, there are no guidelines recommending screening for Parkinson’s disease, but screening may be a good idea for people who are at high risk. This includes:

  • People with a family history of Parkinson’s disease
  • People who have been regularly exposed to chemicals that can increase disease risk

Tests that may help screen for Parkinson’s disease risk include: 

  • Imaging tests such as positron emission tomography (PET) scan or single photon emission computed tomography (SPECT) to check dopamine levels in the brain
  • Genetic tests for people at risk of familial Parkinson’s disease
  • Testing your sense of smell

Of these tests, imaging tests are the most accurate but also the most expensive. Smell testing is easy and inexpensive, but not as precise. A smell test may be an effective way to assess whether you need a more detailed imaging test.

Prevention

For most people, there isn’t a lot you can do to prevent Parkinson’s disease, but there are risk factors you can avoid. Stay away from the pesticides and herbicides that can increase your risk, such as:

  • Permethrin (Nix)
  • Beta-hexachloocyclohexane (β-HCH)
  • Methyl viologen dichloride (Paraquat)
  • 2,4-dichlorophenoxyacetic acid (Hedonal, Trinoxal, Crossbow)
  • Manganese ethylene (Maneb)
  • Agent Orange

If you must handle any of these chemicals, take proper precautions.

There are also factors that can lower your risk. These include:

  • Coffee
  • Tea
  • Anti-inflammatory drugs such as ibuprofen (Motrin)
  • Exercise
  • Sunlight or vitamin D
  • Smoking–although the harmful effects of smoking outweigh the benefit for most people

Common Treatment

At present, there is no cure for Parkinson’s disease. The goal of treatment is to keep symptoms under control for as long as possible.

The most powerful medicine to control Parkinson’s disease is levodopa, which converts into dopamine in your brain. Because levodopa causes unpleasant side effects, such as nausea and vomiting, it is almost always given in combination with carbidopa, which helps levodopa get to your brain, so that patients can get the same effect with a smaller dose. Carbidopa/levodopa can be taken as a pill (Sinemet), as a tablet that dissolves in the mouth (Parcopa), or in other formulations.

Long-term levodopa use can cause new problems, such as dyskinesia (muscles moving on their own), or the medicine may stop working, without warning, from time to time. However, waiting too long to start treatment may put you at risk for other problems, such as injuries from falling. Talk to your doctor about the risks and benefits, and when you should start treatment.

Some treatments are taken with levodopa to help it work. These include: 

  • MAO-B inhibitors, such as rasagline (Azilect), to slow the breakdown of levodopa and reduce symptoms
  • COMT inhibitors, such as entacapone (Comtar) to keep levodopa from wearing off too quickly
  • Amantadine (Symmetrel) to prevent dyskinesia caused by levodopa. Amantadine can also be used in early treatment to reduce tremors.

Other medicines your doctor may prescribe include:

  • Dopamine agonists, such as pramipexole (Mirapex) and ropinirole (Requip) to stimulate your brain as if it were receiving dopamine
  • Anticholinergic medicines such as benztropine mesylate (Cogentin) to reduce tremors
  • Rivastigmine (Exelon) to treat dementia 

Parkinson’s disease can also be treated with a technique called deep brain stimulation, in which a surgeon implants a device like a pacemaker, called an impulse generator, under your collarbone. You can use a controller to send an electric impulse from the impulse generator to the part of your brain that controls motion. This electric impulse can help: 

  • Tremors
  • Dyskinesia
  • Problems with medication wearing off

Another type of surgery may attempt to remove or destroy the brain tissue that causes Parkinson’s disease. Scientists are also studying newer techniques involving stem cell transplants for Parkinson’s disease.

Complementary and Alternative Treatment

Complementary and alternative treatments are not as well studied or as well regulated as modern medicine, but scientists are researching some alternative and complementary treatments that may help people with Parkinson’s disease. So far, large studies with vitamins C and E, and an antioxidant known as Coenzyme Q10 have been disappointing.

Early studies with creatine and glutathione have shown promise, but more research is needed to find out the proper dose and the long-term risks and benefits.

Always talk to your doctor before taking any supplement. Supplements may have unexpected side effects, or they may interfere with other medicines you take.

Other alternative treatments may be helpful with few or no side effects. These include: 

  • Massage
  • Acupuncture
  • Yoga
  • Tai chi
  • The Alexander Technique
  • Meditation
  • Companion animals
  • Art or music therapy

Care Guide

Proper care includes many aspects of your life. In addition to your neurologist, you may want to speak with

  • A physical therapist to help keep your body functional
  • An occupational therapist to help you deal with day-to-day functions such as eating and getting dressed
  • A speech therapist to help you communicate
  • A counselor or social worker to help you cope with your condition.

It’s also important to take care of your overall health. Eat a healthy, balanced diet, including fruits, vegetables, nuts, and fatty fish, may help. Drink plenty of fluids. Keep your body active. If your symptoms get in the way, a physical therapist can help you develop a program that works for you.

It also helps to make sure you get rest when you need it and don’t overextend yourself.

A local support group can help you cope, with the help of people who are going through the same things you are.

Another concern with Parkinson’s disease is the risk of falling. To help you keep your balance: 

  • Install handrails in your house in bathrooms and stairways
  • Avoid walking backwards or turning all the way around. If you need to turn around, try making a U-turn like a car instead of trying to turn in place
  • Don’t carry more than you have to
  • Don’t lean over or reach too far; keep your weight centered over your feet

If you are caring for a loved one with Parkinson’s disease, do not neglect yourself. Caregiver burnout is a real and very serious problem. Make sure to: 

  • Take care of your own health
  • Take a break at least once a day
  • Ask for help when you need it, from family, friends, or professional caregivers
  • Consider joining a caregiver support group

Remember that taking good care of yourself helps you give better support to your loved one.

When To Contact A Doctor

Symptoms of Parkinson’s disease are often mild at first, and many of these symptoms may be caused by other conditions. If you have problems moving, you should not assume that it is caused by Parkinson’s disease. All the same, you should call your doctor if you have symptoms such as tremor, trouble balancing, or other symptoms that affect your movement.

Questions For Your Doctor

Choosing the right doctor is an essential step. The Parkinson’s Disease Foundation and the Michael J. Fox Foundation for Parkinson’s Research recommend finding a neurologist who specializes in movement disorders. You should also make sure to choose a doctor with whom you feel comfortable, who answers your questions clearly and thoroughly.

Your primary care doctor may be able to recommend a good movement disorders specialist, or you may need to ask around at a support group or at Parkinson’s disease organizations. If you can’t find a suitable movement disorders specialist near you, you can go to a general neurologist, but you may have to ask more questions and take a more active role in your own treatment.

Questions For A Doctor

When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:

  • What treatment do you recommend?
  • What are my other options?
  • Is there anything I should or shouldn’t do in my day-to-day life
  • How quickly is my condition likely to progress?
  • Is there anything else I should know about Parkinson’s disease?

Resources

Other useful resources to help you learn about Parkinson’s disease and take charge of your treatment can be found at:

Parkinson’s Disease Foundation

The Michael J. Fox Foundation for Parkinson’s Research

Parkinson’s Action Network

Parkinson’s Resource Organization

 

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