Everything You Want to Know About Parkinson’s Disease

Overview

Parkinson’s disease is a progressive neurological disorder. The first signs are problems with movement.

Smooth and coordinated muscle movements of the body are made possible by a substance in the brain called dopamine. Dopamine is produced in a part of the brain called the “substantia nigra.”

In Parkinson’s, the cells of the substantia nigra start to die. When this happens, dopamine levels are reduced. When they have dropped 60 to 80 percent, symptoms of Parkinson’s start to appear. There’s currently no cure for Parkinson’s, a disease which is chronic and worsens over time. More than 50,000 new cases are reported in the United States each year. But there may be even more, since Parkinson’s is often misdiagnosed.

Symptoms of Parkinson’s disease

Some of the early symptoms of Parkinson’s can come before motor problems by several years. These earliest signs include:

• decreased ability to smell (anosmia)
• constipation
• small, cramped handwriting
• voice changes
• stooped posture

The four major motor problems seen are:

• tremor (shaking that occurs at rest)
• slow movements
• stiffness of arms, legs, and trunk
• problems with balance and tendency to fall

Secondary symptoms include:

• blank facial expression
• a tendency to get stuck when walking
• muffled, low-volume speech
• decreased blinking and swallowing
• tendency to fall backward
• reduced arm swinging when walking

Other, more severe, symptoms may include:

• flaky white or yellow scales on oily parts of the skin, known as seborrheic dermatitis
• increased risk of melanoma, a serious type of skin cancer
• sleep disturbances including vivid dreams, talking, and movement during sleep
• depression
• anxiety
• hallucinations
• psychosis
• problems with attention and memory
• difficulty with visual-spatial relationships

Early signs of Parkinson’s disease may go unrecognized. 

Causes of Parkinson’s disease

The exact cause of Parkinson’s is unknown. It may have both genetic and environmental components. Some scientists think that viruses can trigger Parkinson’s as well.

Low levels of dopamine and norepinephrine, a substance that regulates dopamine, have been linked with Parkinson’s.

Abnormal proteins called Lewy bodies have also been found in the brains of people with Parkinson’s. Scientists don’t know what role, if any, Lewy bodies play in the development of Parkinson’s.

While there’s no known cause, research has identified groups of people who are more likely to develop the condition. These include:

• Sex: Men are one and a half times more likely to get Parkinson’s than women.
• Race: Whites are more likely to get Parkinson’s than African Americans or Asians.
• Age: Parkinson’s usually appears between the ages of 50 and 60. It only occurs before the age of 40 in 5-10 percent of cases.
• Family history: People who have close family members with Parkinson’s disease are more likely to develop Parkinson’s disease, too.
• Toxins: Exposure to certain toxins may increase the risk of Parkinson’s disease.
• Head injury: People who experience head injuries may be more likely to develop Parkinson’s disease.

Parkinson’s disease stages

Parkinson’s disease is a progressive disease. That means symptoms of the condition typically worsen over time.

Many doctors use the Hoehn and Yahr scale to classify its stages. This scale divides symptoms into five stages, and it helps healthcare providers know how advanced the disease signs and symptoms are.

Stage 1

Stage 1 Parkinson’s is the mildest form. It’s so mild, in fact, you may not experience symptoms that are noticeable. They may not yet interfere with your daily life and tasks.

If you do have symptoms, they may be isolated to one side of your body.

Stage 2

The progression from stage 1 to stage 2 can take months, or even years. Each person’s experience will be different.

At this moderate stage, you may experience symptoms such as:

• muscle stiffness
• tremors
• changes in facial expressions
• trembling

Muscle stiffness can complicate daily tasks, prolonging how long it takes you to complete them. However, at this stage, you’re unlikely to experience balance problems.

Symptoms may appear on both sides of the body. Changes in posture, gait, and facial expressions may be more noticeable.

Stage 3

At this middle stage, symptoms reach a turning point. While you’re unlikely to experience new symptoms, they may be more noticeable. They may also interfere with all of your daily tasks.

Movements are noticeably slower, which slows down activities. Balance issues become more significant, too, so falls are more common. But people with stage 3 Parkinson’s can usually maintain their independence and complete activities without much assistance.

Stage 4

The progression from stage 3 to stage 4 brings about significant changes. At this point, you will experience great difficulty standing without a walker or assistive device.

Reactions and muscle movements also slow significantly. Living alone can be unsafe, possibly dangerous.

Stage 5

In this most advanced stage, severe symptoms make around-the-clock assistance a necessity. It will be difficult to stand, if not impossible. A wheelchair will likely be required.

Also, at this stage, individuals with Parkinson’s may experience confusion, delusions, and hallucinations. These complications of the disease can begin in the later stages.

Diagnosing Parkinson’s disease

There’s no specific test for diagnosing Parkinson’s. Diagnosis is made based on health history, a physical and neurological exam, as well as a review of signs and symptoms.

Imaging tests, such as a CAT scan or MRI, may be used to rule out other conditions. A dopamine transporter (DAT) scan may also be used. While these tests don’t confirm Parkinson’s, they can help rule out other conditions and support the doctor’s diagnosis.

Treatments for Parkinson’s disease

Treatment for Parkinson’s relies on a combination of lifestyle changes, medications, and therapies.

Adequate rest, exercise, and a balanced diet are important. Speech therapy, occupational therapy, and physical therapy can also help to improve communication and self-care.

In almost all cases, medication will be required to help control the various physical and mental health symptoms associated with the disease.

Drugs and medication used to treat Parkinson’s disease

A number of different drugs can be used to treat Parkinson’s.

Levodopa

Levodopa is the most common treatment for Parkinson’s. It helps to replenish dopamine.

About 75 percent of cases respond to levodopa, but not all symptoms are improved. Levodopa is generally given with carbidopa.

Carbidopa delays the breakdown of levodopa which in turn increases the availability of levodopa at the blood-brain barrier.

Dopamine agonists

Dopamine agonists can imitate the action of dopamine in the brain. They’re less effective than levodopa, but they can be useful as bridge medications when levodopa is less effective.

Drugs in this class include bromocriptine, pramipexole, and ropinirole.

Anticholinergics

Anticholinergics are used to block the parasympathetic nervous system. They can help with rigidity.

Benztropine (Cogentin) and trihexyphenidyl are anticholinergics used to treat Parkinson’s.

Amantadine (Symmetrel)

Amantadine (Symmetrel) can be used along with carbidopa-levodopa. It’s a glutamate blocking drug (NMDA). It offers short-term relief for the involuntary movements (dyskinesia) that can be a side effect of levodopa.

COMT inhibitors

Catechol O-methyltransferase (COMT) inhibitors prolong the effect of levodopa. Entacapone (Comtan) and tolcapone (Tasmar) are examples of COMT inhibitors.

Tolcapone can cause liver damage. It’s usually saved for people who don’t respond to other therapies.

Ectacapone doesn’t cause liver damage.

Stalevo is a drug that combines ectacapone and carbidopa-levodopa in one pill.

MAO B inhibitors

MAO B inhibitors inhibit the enzyme monoamine oxidase B. This enzyme breaks down dopamine in the brain. Selegiline (Eldepryl) and rasagiline (Azilect) are examples of MAO B inhibitors.

Talk with your doctor before taking any other medications with MAO B inhibitors. They can interact with many drugs, including:

• antidepressants
• ciprofloxacin
• St. John’s wort
• some narcotics

Over time, the effectiveness of Parkinson’s medications can decrease. By late-stage Parkinson’s, the side effects of some medicines may outweigh the benefits. However, they may still provide adequate control of symptoms.

Parkinson’s surgery

Surgical interventions are reserved for people who don’t respond to medication, therapy, and lifestyle changes.

Two primary types of surgery are used to treat Parkinson’s:

Deep brain stimulation

During deep brain stimulation (DBS), surgeons implant electrodes in specific parts of the brain. A generator connected to the electrodes sends out pulses to help reduce symptoms.

Pump-delivered therapy

In January 2015, the U.S. Food and Drug Administration (FDA) approved a pump-delivered therapy called Duopa.

The pump delivers a combination of levodopa and carbidopa. In order to use the pump, your doctor will have to perform a surgical procedure to place the pump near the small intestine.

Parkinson’s prognosis

Complications from Parkinson’s can greatly reduce quality of life and prognosis. For example, individuals with Parkinson’s can experience dangerous falls, as well as blood clots in the lungs and legs. These complications can be fatal.

Parkinson’s prevention

Doctors and researchers don’t understand what causes Parkinson’s. They’re also not sure why it progresses differently in each person. That’s why it’s unclear how you can prevent the disease.

Each year, researchers investigate why Parkinson’s occurs and what can be done to prevent it. Recent researchTrusted Source suggests lifestyle factors — like physical exercise and a diet rich in antioxidants — may have a protective effect.

If you have a family history of Parkinson’s, you may consider genetic testing. Certain genes have been connected to Parkinson’s. But it’s important to know that having these gene mutations does not mean you’ll definitely develop the disease.

Parkinson’s heredity

Researchers believe both your genes and the environment may play a role in whether or not you get Parkinson’s. How great their impact can be, however, is unknown. Most cases occur in people with no apparent family history of the disease.

Hereditary cases of Parkinson’s are rare. It’s uncommon for parents to pass Parkinson’s to a child.

According to the National Institutes of Health, only 15 percent of people with Parkinson’s have a family history of the disease.