Putting Down Parkinson’s Disease

You experience tremors when you try to move. Your speech is slow like molasses dripping down a bottle. In fact, everything about your movements proceeds at a slower pace. You may have Parkinson’s disease.

Parkinson’s disease is a progressive nervous system disorder that affects movement. Some symptoms may start gradually like a barely noticeable tremor in your hand. Tremors are common, but the disorder also commonly causes stiffness and slowing of movement.

In the early stages of this disorder, your face may lack expression. Your arms may not swing when you walk. Your speech becomes soft or slurred. As the disease progresses, Parkinson’s disease symptoms may worsen. As the disease worsens, you may have trouble sleeping, talking, have mental and memory problems, experience behavioral changes and have other symptoms.

According to the Parkinson’s Foundation, approximately 60,000 Americans are diagnosed with Parkinson’s disease each year. Men are 1.5 times more likely to have the disorder than women. The combined direct and indirect cost of Parkinson’s, including treatment, social security payments and lost income, is estimated to be nearly $52 billion per year in the United States alone. Medications alone cost an average of $2,500 a year and therapeutic surgery can cost up to $100,000 per person.

Scientists think that about 10 to 15 percent of persons with Parkinson’s disease may have a genetic mutation that predisposes them to the development of the disease. There are also environmental factors which are not fully understood.

There is some belief that some cases of early onset Parkinson’s disease, disease starting before age 50, may be inherited. Scientists identified a gene mutation in people with Parkinson’s disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinson’s disease and in patients with a type of dementia referred to as Lewy body dementia.

Parkinson’s disease occurs when nerve cells in an area of the brain called the substantia negra become impaired or die. These cells normally produce dopamine, a chemical (neurotransmitter) that helps the cells of the brain communicate. When these cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of your brain called the basal ganglia. This part of the brain is responsible for organizing the brain’s commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinson’s disease.

People with Parkinson’s disease also lose another neurotransmitter called norepinephrine. This chemical is needed for the proper functioning of the sympathetic nervous system. This system controls some of the body’s autonomic functions such as digestion, heart rate, blood pressure, and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinson’s disease. Scientists are unsure what causes the neurons that produce these neurotransmitter chemicals to die.

Symptoms vary from patient to patient but the most common symptoms are tremors that begin in your hands and arms; slowness of movement (bradykinesia) which results from the brain’s slowness in transmitting the necessary instructions to the other appropriate parts of the body; rigid muscles/stiff limbs from the body’s inability to relax normally; unsteady walk, balance, and coordination problems where you develop a forward lean which makes easier to fall when bumped; muscle twisting, spasms, or cramps (dystonia) which is when you develop a painful cramp in your foot or curled clenched toes; and a stooped or hunched over posture.

Some other symptoms are decreased facial expressions; speech/vocal changes; handwriting changes; depression and anxiety; chewing and swallowing problems, drooling; urinary problems; mental “thinking” difficulties/memory problems; hallucinations/delusions; constipation; skin problems such as dandruff; loss of smell; sleeping disturbances including disrupted sleep, acting out dreams and restless leg syndrome; pain, lack of interest (apathy), fatigue, change in weight, vision changes; and low blood pressure.

There are different stages of Parkinson’s disease: early stage, mid stage, mid-late stage, and advanced stage. In the early stage symptoms are mild, tend to occur slowly and don’t interfere with daily activities. You may have fatigue or a general sense of uneasiness. You might experience a slight tremor or have difficulty standing. A family member might notice small things like no arm movement when walking (swinging), slow or small handwriting, lack of expression in the face; or difficulty getting out of a chair.

In mid-stage, symptoms get worse. Tremor, muscle stiffness, movement problems now affect both sides of the body. Balance issues and falls are becoming common. Still fully independent but daily tasks such as bathing and dressing are becoming more difficult to do and take longer to complete.

In the mid-late stage, standing and walking are becoming more difficult and require assistance of a walker. You may need full time help in order to continue to live at home.

In advanced stage, you need a wheelchair to get around or you are bedridden. You may experience hallucinations or delusions. You require full time nursing care.

No specific tests exist to diagnose Parkinson’s disease. Your doctor will take your medical history, a review of your signs and symptoms, plus a neurological and physical examination.

Your doctor may suggest a specific single-proton emission computerized tomography scan (SPECT) called a dopamine transporter scan (DaTscan). Although this may support the suspicion that you have Parkinson’s it is ultimately your symptoms and a neurological examination that determine your diagnosis. Most people do not require a DaTscan.

Your doctor may order lab tests including blood tests to rule out other conditions. Imaging tests like MRI, ultrasound of the brain, and PET scans may be used to rule out other disorders. Imaging tests aren’t that helpful for diagnosing Parkinson’s disease.

In addition to your examination, your doctor may give you carbidopa-levodopa (Rytery, Sinemet, others), a Parkinson’s disease medication. You must be given a sufficient dose to show the benefit, as low doses for a day or two aren’t reliable. Significant improvement with this medication will often confirm a diagnosis of Parkinson’s disease.

It takes time to diagnose Parkinson’s disease. Your doctor may recommend follow-up appointments with a neurologist who specializes in movement disorders to evaluate your condition and symptoms over time and diagnose Parkinson’s disease.

There is no cure for Parkinson’s disease but medications can help control the symptoms of this disorder. Your doctor may recommend other lifestyle changes such as ongoing aerobic exercise. In some cases, physical therapy for balance and stretching is also important. A speech pathologist may prove beneficial for speech problems.

Medications may help with walking, movement and tremor. These medications increase or substitute for dopamine.

People with Parkinson’s disease have low brain dopamine concentrations. But dopamine can’t be given directly, as it can’t enter your brain. You should have significant improvement of symptoms once you begin treatment.

Some of the medications that your doctor might prescribe include carbidopa-levodopa, inhaled carbidopa-levodopa, carbidopa-levodopa infusion, dopamine agonists, MAO B inhibitors, catechol O-methyltransferase (COMT) inhibitors, anticholinergics, and amantadine.

A surgical procedure that might be recommended is deep brain stimulation where surgeons implant electrodes into a specific part of your brain. The electrodes are connected to a generator implanted in your chest near your collarbone that sends electrical pulses to your brain and may reduce the Parkinson’s disease symptoms.

But it is important to note although deep brain stimulation does provide benefits regarding this condition, it doesn’t stop the disorder from progressing.

Your doctor may recommend other alternative treatments in addition to medication and/or surgery. Massage, tai chi (some studies suggest tai chi may improve balance issues), yoga, meditation are all beneficial in terms of being adjunct to traditional treatments.

Having a reliable support system is invaluable to Parkinson’s disease patients. That may include hearing about similar experiences from people diagnosed with this disorder. But don’t be afraid to lean on family and friends for help with Parkinson’s disease symptoms. With that in mind, you and your family may need the help of a mental health professional like a psychologist in order to navigate the stresses associated with Parkinson’s disease.

It's okay to feel whatever you are feeling regarding your condition. The right kind of support will help you through this trying time. You are not in this alone.