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Disease & Condition

Parkinson Disease

Parkinson’s disease is a progressive disorder of the nervous system that affects movement. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand. But while a tremor may be the most well-known sign of Parkinson’s disease, the disorder also commonly causes stiffness or slowing of movement.

In the early stages of Parkinson’s disease, your face may show little or no expression, or your arms may not swing when you walk. Your speech may become soft or slurred.

Symptoms

Parkinson’s signs and symptoms may include:

  • Tremor. A tremor, or shaking, usually begins in a limb, often your hand or fingers. One characteristic of Parkinson’s disease is a tremor of your hand when it is relaxed (at rest).
  • Slowed movement (bradykinesia). Over time, Parkinson’s disease may reduce your ability to move and slow your movement, making simple tasks difficult and time-consuming.
  • Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles can limit your range of motion and cause you pain.
  • Impaired posture and balance. Your posture may become stooped, or you may have balance problems.
  • Loss of automatic movements. You may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.
  • Speech changes. You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections.
  • Writing changes. It may become hard to write, and your writing may appear small.

When to see a doctor

See your doctor if you have any of the symptoms associated with Parkinson’s disease — not only to diagnose your condition but also to rule out other causes for your symptoms.

Causes

In Parkinson’s disease, certain nerve cells (neurons) in the brain gradually break down or die. Many of the symptoms are due to a loss of neurons that produce a chemical messenger in your brain called dopamine. When dopamine levels decrease, it causes abnormal brain activity, leading to signs of Parkinson’s disease.

The cause of Parkinson’s disease is unknown, but several factors appear to play a role, including:

  • Your genes.
  • Environmental triggers. Exposure to certain toxins or environmental factors may increase the risk of later Parkinson’s disease, but the risk is relatively small.

Risk factors

Risk factors for Parkinson’s disease include:

  • Age. People usually develop the disease around age 60 or older.
  • Heredity. Having a close relative with Parkinson’s disease increases the chances that you’ll develop the disease.
  • Sex. Men are more likely to develop Parkinson’s disease than are women.
  • Exposure to toxins. Ongoing exposure to herbicides and pesticides may put you at a slightly increased risk of Parkinson’s disease.

Complications

Parkinson’s disease is often accompanied by these additional problems, which may be treatable:

  • Thinking difficulties
  • Depression and emotional changes
  • Swallowing problems
  • Sleep problems and sleep disorders
  • Bladder problems
  • Constipation

You may also experience:

  • Blood pressure changes
  • Smell dysfunction
  • Fatigue
  • Pain
  • Sexual dysfunction

Tests and diagnosis

No specific test exists to diagnose Parkinson’s disease. Your doctor trained in nervous system conditions (neurologist) will diagnose Parkinson’s disease based on your medical history, a review of your signs and symptoms, and a neurological and physical examination.

Your doctor may order tests, such as blood tests, to rule out other conditions that may be causing your symptoms.

Imaging tests — such as MRI, ultrasound of the brain, SPECT and PET scans — may also be used to help rule out other disorders. Imaging tests aren’t particularly helpful for diagnosing Parkinson’s disease.

Treatments and drugs

Parkinson’s disease can’t be cured, but medications can help control your symptoms, often dramatically. In some later cases, surgery may be advised.

Your doctor may also recommend lifestyle changes, especially ongoing aerobic exercise. In some cases, physical therapy that focuses on balance and stretching also is important. A speech-language pathologist may help improve your speech problems.

Medications

Medications may help you manage problems with walking, movement and tremor. your doctor may prescribe include:

  • Carbidopa-levodopa. Levodopa, the most effective Parkinson’s disease medication, is a natural chemical that passes into your brain and is converted to dopamine. Levodopa is combined with carbidopa, which protects levodopa from premature conversion to dopamine outside your brain.
  • Carbidopa-levodopa infusion. This medication is made up of carbidopa and levodopa. However, it’s administered through a feeding tube that delivers the medication in a gel form directly to the small intestine.
  • Dopamine agonists. Unlike levodopa, dopamine agonists don’t change into dopamine. Instead, they mimic dopamine effects in your brain.
  • MAO-B inhibitors. These medications include selegiline and rasagiline. They help prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO-B). This enzyme metabolizes brain dopamine.
  • Catechol-O-methyltransferase (COMT) inhibitors. Entacapone is the primary medication from this class. This medication mildly prolongs the effect of levodopa therapy by blocking an enzyme that breaks down dopamine.
  • Anticholinergics. These medications were used for many years to help control the tremor associated with Parkinson’s disease. Several anticholinergic medications are available, including benztropine or trihexyphenidyl.
  • Amantadine. Doctors may prescribe amantadine alone to provide short-term relief of symptoms of mild, early-stage Parkinson’s disease.

Surgical procedures

  • Deep brain stimulation

Lifestyle and home remedies

  • Healthy eating
  • Exercise
  • Avoiding falls

Prevention

The cause of Parkinson’s is unknown, proven ways to prevent the disease also remain a mystery. However, some research has shown that caffeine — which is found in coffee, tea and cola — may reduce the risk of developing Parkinson’s disease. Green tea also may reduce the risk of developing Parkinson’s disease.

Some research has shown that regular aerobic exercise may reduce the risk of Parkinson’s disease.

 

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