Parkinson’s Disease

What is Parkinson’s Disease?

Parkinson’s disease is named after James Parkinson, a British doctor who published his works on Parkinson’s disease in 1817. In his essay he described the disease in great detail which was referred to as the “shaking palsy”. Parkinson’s disease is the most common movement disorder and the second most common neurodegenerative disorder which is portrayed by the progressive loss of control of muscles. Thus, Parkinson’s disease concurrently leads to resting tremors, rigidity or stiffness,  slowness and diminished muscle strength and balance. As the disease progresses one may find it difficult to perform simple activities like walking, talking and completing simple day to day tasks.

The degree of progression and impairment of Parkinson’s disease differ from one person to another. Some have the tendency to live a long fruitful life whereas some others are prone to disability at its early stages. Premature death in Parkinson’s disease generally occur as a result of injuries related to falling or due to manifestations of  pneumonia.  

  • Statistics
  • Causes of Parkinson’s Disease
  • Genetics and Parkinson’s Disease
  • Risk Factors
  • Symptoms of Parkinson’s Disease
  • Conditions that Resemble Parkinson’s Disease
  • Diagnosis of Parkinson’s Disease
  • Treatment for Parkinson’s Disease
  • Coping up with Parkinson’s Disease
  • Prevention and Prognosis of Parkinson’s Disease
  • Conclusion

Statistics

Parkinson’s disease is said to affect 5 million people worldwide and 1 million people in the United States. Patients who have been diagnosed with Parkinson’s disease are generally 60 years of age or more. As the life expectancy is on the rise, the number of individuals who will suffer from Parkinson’s disease are said to increase in the future. The most common form of the disease is the ‘adult-onset’ Parkinson’s disease. Other forms of Parkinson’s disease like early-onset Parkinson’s disease (between 21-40 years) and juvenile onset Parkinson’s disease (before 21 years) are also said to exist.

Causes of Parkinson’s Disease

Dopamine plays an important role in Parkinson’s disease. Dopamine is a neurotransmitter that acts as a messenger which carries messages between two areas of the brain: the substantia nigra and the corpus striatum. These messages help to smoothen out and control movement in the body. Thus, the movement disorders are brought about by the lack of the messenger, dopamine, in the brain. The lack of dopamine is brought about by the loss of the cells producing it which is located in the substantia nigra. As there is an insufficient amount of dopamine, the message- carrying capabilities from the substantia nigra and corpus striatum is poor resulting in impaired movement. Thus, the loss of dopamine brings about movement related symptoms of Parkinson’s disease.The non-movement related symptoms of Parkinson’s disease is brought by the degeneration of other cells in the brain.

The theory that the lack of dopamine is the factor which causes movement impairment in Parkinson’s disease, is widely accepted and well known. Unfortunately, the reason as to why the brain cells that produce the dopamine deteriorate is not clear. Dysfunctional cellular activities, stress and inflammation contributing to cell injury and death were revealed in genetic and pathological studies. Also, abnormal Lewy bodies containing the alpha-synuclein protein were found in the brain cells of Parkinson’s disease sufferers. The role these clumps of Lewy bodies play in Parkinson’s disease is also not clear. Thus, scientists reckon that genetic and environment factors might lead to the loss of dopamine.

Parkinson-3

Genetics and Parkinson’s Disease

Parkinson’s disease is said to be ‘idiopathic’ in many patients which loosely means that the disease emerge sporadically without any known cause for it. Nevertheless, around 15% of people with Parkinson’s disease report having a relative with the disease. Thus, by studying family history records of Parkinson’s disease, scientist have now come across several genes that are linked to the disease which can help understand the disease and aid in finding new therapies. Five genes are associated with Parkinson’s disease that have a definite role to play:

  1. SNCA (synuclein, alpha non A4 component of amyloid precursor)-  this makes the alpha-synuclein protein which aggregate in clumps called Lewy bodies. Mutations of this gene are found in early onset Parkinson’s disease.
  2. PARK2 (Parkinson’s disease autosomal recessive, juvenile 2)- This gene codes or makes the parkin protein. Mutation of this particular gene is almost always found in patients who suffer from juvenile Parkinson’s disease.
  3. PARK7( (Parkinson’s disease autosomal recessive, early onset 7)- This gene codes for the DJ-1 protein, which guard cells from oxidative stress. Mutation of this gene is found in patients who suffer from early onset Parkinson’s disease.
  4. PINK1 (PTEN-induced putative kinase 1)- Once again, mutations of this gene is found in early onset Parkinson’s disease. The precise function that the protein that is produced by this gene is still not known; but it is said that the protein may play a role in helping mitochondria (structure inside cell, produces energy) from stress.
  5. LRRK2 (leucine-rich repeat kinase 2)- This gene codes for the dardarin protein. Mutation of this gene is found in patients suffering from late-onset Parkinson’s disease.

Several other genes are also associated with Parkinson’s disease namely: GBA (glucosidase beta acid), SNCAIP (synuclein alpha interacting protein), and UCHL1 (ubiquitin carboxyl-terminal esterase L1).

Risk Factors

  • Age is the biggest risk factor associated with the development as well as progression of Parkinson’s disease. Many are above 60 years of age when they develop Parkinson’s disease.
  • Statistics have shown that men are affected more (1.5-2 times) often than women.
  • Some, a small number of individuals, are at risk due their family medical background.
  • Other risk factors include: head trauma, illness and exposure to certain pesticides and herbicides (environmental toxins).

Symptoms of Parkinson’s Disease

Primary Symptoms

The main symptoms of Parkinson’s disease are all linked to motor function capabilities involving both voluntary and involuntary movements. These primary symptoms usually begin on one side of the patient’s body. Symptoms are generally mild at the beginning and will progress as the disease progresses over time. Some sufferers of Parkinson’s disease are more affected than some others. Statistics have also shown that patients will have lost about 605-80% of cells producing dopamine in the brain by the time the primary symptoms emerge. The following are some motor symptoms which can be seen in a Parkinson’s disease sufferer:-

  • Tremors- in hands, fingers, arms, legs, feet, jaw or head. These can be seen when the patient is resting but not seen when they are performing a task. Tremors are said to worsen when the patient is tired, excited or under stress. 
  • Rigidity- is the stiffness of limbs and the trunk which during movement may increase. Rigidity also can bring about muscle aches and pains. Cramped handwriting (microphagia) may arise due to loss of fine hand movements. In addition, the patient may experience eating difficulties.
  • Bradykinesia- is defined as the slowness in voluntary movement. As the disease progresses, one may find it hard to initiate movement and complete movement. Bradykinesia along with rigidity can affect facial muscles that can result in “mask-like” or expressionless appearance.
  • Postural instability- Impairment of reflexes can make it difficult to maintain balance by adjusting one’s posture; this results in falls.
  • Parkinsonian gait- Individuals who have developed a more advanced Parkinson’s disease state will have a characteristic shuffling walk along with a crouched or stooped position. Arm swing while walking may be diminished or entirely absent. Patients may also find it hard to start walking and making turns. Thus, sufferers may become motionless in mid stride and appear to be falling forward while walking.

Secondary Symptoms

The primary symptoms related to Parkinson’s disease are diminished motor functions while secondary symptoms are in relation to progressive loss of muscle strength and brain damage. The severity it manifests itself vary from one patient to another and not every other patient will experience all of them. Some of these secondary symptoms are as follows:-

  • Stress
  • Anxiety
  • Confusion, loss of memory and dementia (common in older patients)
  • Depression
  • Constipation
  • Swallowing difficulties
  • Excessive salivation
  • Decreased sense of smell
  • Sweating increased
  • Erectile dysfunction in males
  • Problems of the skin
  • Frequent Urination
  • Slowed and soft speech with a monotone voice.

Conditions that Resemble Parkinson’s Disease

Parkinson’s disease can resemble a number of other medical conditions in its early stages. Parkinsonism is a term used to describe Parkinson-like symptoms. These medical conditions include multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, Lewy body dementia, encephalitis (brain inflammation), stroke and certain head traumas. Primary lateral sclerosis and Alzheimer’s disease are other medical conditions which can be misinterpreted as Parkinson’s disease. Other medical conditions include dystonic tremor, essential tremor, vascular Parkinsonism and drug induced Parkinsonism.

Diagnosis of Parkinson’s Disease

A good treatment plan can be administered when an  accurate diagnosis of Parkinson’s disease is made at its early stages. This will result in high quality of life for a relatively long period of time. There are no tests that are available that can diagnose Parkinson’s disease with certainty. Diagnosing Parkinson’s disease is quite a challenge due to the similarities of its symptoms with other movement disorders and medical conditions. There is a chance that some individuals suffering from Parkinson’s disease may be diagnosed as having another disorder and some other individuals who are having Parkinson-like symptoms may be misdiagnosed as having Parkinson’s disease. On that basis, it is very important to evaluate and re-evaluate the patients in the early stages on a regular basis to eliminate and rule out other possible medical conditions that may have similar symptoms.

An accurate diagnosis can be made by a neurologist who has specialised in movement disorders. An initial assessment will be made by referring to one’s medical history, a neurological exam and by the symptoms one shows. When evaluating one’s medical history it is important to know the medical history of their family, if they have had Parkinson’s disease, what medications they were under and whether they have had head traumas in the past and whether they were exposed to certain toxins. A neurological exam, on the other hand, will evaluate ones movement, coordination, walking and certain hand movement related tasks.

A number of guidelines are available which can assist one to diagnose Parkinson’s disease correctly. Hoehn and Yahr scale and the Unified Parkinson’s disease rating scale are few of the many.Tests can be used to measure the patient’s mental capacity, mood, behaviour, day to day tasks and motor function. They can help with initial diagnosis and in monitoring the progression of the disease so that necessary therapeutic adjustments can be made. Sometimes, brain scans and laboratory tests are also performed in order to rule other medical conditions which may resemble Parkinson’s disease.

One can diagnose Parkinson’s disease if:-

  • At least two out of three major symptoms are shown in the patient. These three major symptoms are the resting tremor, rigidity and slowness. 
  • Onset of symptoms on one side of the body.
  • Symptoms not present due to secondary causes (medications, strokes).
  • Symptoms are significantly improved by certain medications.

Treatment for Parkinson’s Disease

Currently, no treatment is available to cure Parkinson’s disease. Many therapies and treatment plans are available to postpone the emergence of motor symptoms of the disease and to improve the motor symptoms as well. These therapies target to increase the availability of dopamine in the brain . This can be achieved by replacing dopamine, imitating the action of dopamine, or prolonging the effect of the available dopamine by blocking its break down in the brain. Studies have proved that the quality of life of a Parkinson’s disease sufferer can be prolonged by administering therapy in its early stages in the non motor phase.

There are effective drugs used in the treatment for Parkinson’s disease which converts itself to dopamine in the brain.  As usage of this drug for a long period of time can lead to side effects, such as painful cramps and involuntary movement, it is given at a later stage where motor impairment is quite severe.

In early stages of the disease, dopamine agonists and MAO-B inhibitors are given to the patient. Dopamine agonists imitate the action of dopamine and MAO-B inhibitors act to reduce dopamine break down. These are said to be very effective in relieving motor symptoms. Side effects may take the form of swelling caused by accumulation of fluid in body tissue, sleepiness, dizziness, constipation, hallucinations and nausea.

For severe motor symptoms that cannot be managed, surgery may be performed. Deep brain stimulation or DBS is a surgical procedure which stimulate specific areas of the brain which seems to block signals causing motor symptoms. It involves placing a small electrode in the brain and attaching the electrode to a pulse generator.

Parkinson’s disease researchers are currently researching with stem cells to produce specific cell types like dopamine producing cells which can be used to treat the disease. While this approach is promising, more research is required before it can have any therapeutic value.

General lifestyle  changes including rest and exercise, physical therapy , occupational therapy, speech therapy and so on, work towards making the patient feel better. Thus, in addition to medications and surgery this too may be beneficial to the patient.

Coping up with Parkinson’s Disease

The progression of Parkinson’s disease may be slow but it eventually will affect one’s life in every way, be it social engagements, work, or basic tasks and routines. It can also have a psychological impact in the patient, as accepting to losing one’s independence can be difficult. When one is well informed of the disease, it can reduce the stress and anxiety felt by one in dealing with what is in the near future. Many support groups for the disease are available which function to provide helpful information for the patient and their families about coping up with the disease. Local groups may also be beneficial as they work towards providing emotional support and advise about the best doctors out there, therapists, and other information related to the disease. Most importantly, being in touch with health care providers is also beneficial as they will monitor the progression of Parkinson’s disease and adjust and alter therapies which will best benefit you.

Prevention and Prognosis of Parkinson’s Disease

As the exact cause for Parkinson’s disease is still not known, the disease cannot be prevented at present. However, scientists believe that genetic susceptibility, exposure to toxins and other environmental factors, illness and trauma contribute to triggering the disease.

The severity of the symptoms of Parkinson’s disease is not the same from one individual to another. Therefore, you cannot predict how quickly the disease will progress in one suffering from the disease. The disease itself is not deadly, where the life expectancy of one suffering from it is close to one who is not. Secondary problems like pneumonia, injuries that come due to falls, and choking may lead to death. Furthermore,  there are many treatment strategies that can be applied to reduce the severity of some of the symptoms and improve one’s quality of life.

Conclusion

Parkinson’s disease is a neurodegenerative disorder which brings about a progressive decline in motor function as a result of reduction of dopamine producing cells in the brain. Main symptoms related to Parkinson’s disease include tremor, rigidity, slowness, impaired balance and shuffling gait. Other secondary symptoms include depression, anxiety and dementia. Most of the sufferers of Parkinson’s disease have been diagnosed when they are 60 years of age or older. Having said that, early onset Parkinson’s disease also can occur. With proper and effective treatment, individuals can lead long productive lives for several years after the diagnosis.  

 

Video of Parkinson

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The Team Manager Web Diseases

 

 

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