What Causes Parkinsons Disease
Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.
People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.
Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.
Advancing Age And Parkinsons Disease
Age is perhaps the biggest risk factor for the onset of Parkinsons disease. The average age at which people will develop this movement disorder is 60. This is not usually something that affects younger people. The brain ages as people get older.
Even without external factors, cells in the substantia nigra can die on their own as an individual ages, causing symptoms to develop as the person gets older.
No One Definitive Cause Of Parkinsons
There are no biomarkers or objective screening tests that indicate one has Parkinsons. That said, medical experts have shown that a constellation of factors are linked to it.
Parkinsons causes are likely a blend of genetics and environmental or other unknown factors. About 10 to 20 percent of Parkinsons disease cases are linked to a genetic cause, says Ted Dawson, M.D., Ph.D., director of the Institute for Cell Engineering at Johns Hopkins. The types are either autosomal dominant or autosomal recessive .
But that leaves the majority of Parkinsons cases as idiopathic, which means unknown. We think its probably a combination of environmental exposure to toxins or pesticides and your genetic makeup, says Dawson.
Age. The biggest risk factor for developing Parkinsons is advancing age. The average age of onset is 60.
Gender. Men are more likely to develop Parkinsons disease than women.
Genetics. Individuals with a parent or sibling who is affected have approximately two times the chance of developing Parkinsons. Theres been an enormous amount of new information about genetics and new genes identified over the past 10 or 15 years that have opened up a greater understanding of the disease, says Dawson.
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How Can We Reduce Mobility Constraints In People With Parkinsons Disease
Over the last few decades, neuroscience has been providing us with exciting new findings regarding the effects of physical exercise on neuroplasticity , neuroprotection and slowing of neural degeneration. In fact, it has been proven that physical exercise can improve brain function in people with neurological disorders.
Aerobic exercise, such as treadmill training and walking programs, have been tested on individuals with Parkinsons Disease and has been shown to improve gait and quality of life in general. However, the type of exercise chosen should take into account a specific program provided by a specialist. The exercise shouldnt, by any means, put the patients physical integrity at risk, especially if the patient is a senior. In order to address complex mobility issues in people with Parkinsons Disease, a therapist could incorporate tasks such as balance training into the patients rehabilitation. These are exercises that challenge sensorimotor control of dynamic balance and gait to improve mobility.
According to a study by Dr. Ergun Y. Uc, of the University of Iowa, the results suggest that
walking may provide a safe and easily accessible way of improving the symptoms of Parkinsons disease and quality of life.
Other Causes Of Parkinsonism
“Parkinsonism” is the umbrella term used to describe the symptoms of tremors, muscle rigidity and slowness of movement.
Parkinson’s disease is the most common type of parkinsonism, but there are also some rarer types where a specific cause can be identified.
These include parkinsonism caused by:
- medication where symptoms develop after taking certain medications, such as some types of antipsychotic medication, and usually improve once the medication is stopped
- other progressive brain conditions such as progressive supranuclear palsy, multiple systems atrophy and corticobasal degeneration
- cerebrovascular disease where a series of small strokes cause several parts of the brain to die
You can read more about parkinsonism on the Parkinson’s UK website.
Page last reviewed: 30 April 2019 Next review due: 30 April 2022
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Falls And Common Household Hazards
If you or a loved one has Parkinson’s disease, here are tips for preventing falls around the home:
- Floors. Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its accustomed place.
- Bathroom. Install grab bars and nonskid tape in the tub or shower. Use nonskid bath mats on the floor or install wall-to-wall carpeting.
- Lighting. Make sure halls, stairways, and entrances are well lit. Install a night light in your bathroom or hallway. Make sure there is a light switch at the top and bottom of the staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
- Kitchen. Install nonskid rubber mats near the sink and stove. Clean up spills immediately.
- Stairs. Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it may be helpful to arrange most of your activities on the lower level to reduce the number of times stairs must be climbed.
- Entrances and doorways. Install metal handles on the walls adjacent to doorknobs of all doors to make it more secure as you travel through the doorway.
Physical Therapy And Exercise Therapy
Studies of motor learning indicate that repeated and continued physical training may be the best method to counteract the degradation in motor behavior seen in PD. Physical and exercise therapy have long been noted to be beneficial for patients with PD, improving cardinal symptoms activities of daily living and increasing subjective quality of life . Recently, technological advancements in therapy delivery and ability to calculate objective outcome measures has led to an increasing interest in the effects of such therapies on PIGD features of PD. Many studies have noted improvements in gait and balance following these therapies . Studies have focused on determining the best types, intensity, and duration of therapy, the effects of the incorporation of technology , and the duration of sustained effect or need for repeated doses of therapy.
Table 1. Comparison of study design from studies regarding the effect of therapy and training on quantitative measures of gait and balance.
Table 2. Quantitative gait and balance outcomes from training studies.
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Problems With Blood Pressure
Problems with blood pressure can affect people generally as they get older, but some Parkinsons medication can cause side effects, including problems with blood pressure. This can lead to dizziness and falls. If youve felt dizzy, or fallen because of dizziness, ask your GP or practice nurse to check your blood pressure both when youre sitting and standing, to see if its too low.
Drugs used to treat other medical conditions, such as high blood pressure, can potentially make dizziness worse, especially if you are losing weight or not eating and drinking as well as you used to.
Postural hypotension is a sudden drop in blood pressure when changing position, for example getting up out of a chair. It can make you feel very light-headed, which will affect your balance. You may experience postural hypotension as a symptom of Parkinsons. But it can also be caused by the drugs used to treat Parkinsons.
You can avoid some dizzy spells by taking your time. For example, before you get out of bed, sit with your feet touching the floor for a few minutes to get your blood flowing. Then stand up slowly, but try not to walk away immediately stand for a while until you feel steady.
Gait & Balance Abnormalities
Parkinsons Disease Exam
Patients with Parkinsons disease can develop an alteration of the postural reflexes that causes instability in gait and balance control. Such alterations usually develop later in the course of the illness and are a major cause of disability, especially because of the high risk for falls that derives.
Using the exam to pick up postural instability is of the utmost importance for the management of patients with PD, since it will trigger either a medication adjustment or a physical therapy intervention both aimed at falls prevention.
We have three tests for this part of the PD exam:
1) Standing up from a chair
2) Free walking
3) Provoked pull test maneuver for balance
What Are The Symptoms Of Parkinson’s Disease
The symptoms of Parkinson’s disease include tremors or trembling difficulty maintaining balance and coordination trouble standing or walking stiffness and general slowness.
Over time, a person with Parkinson’s may have trouble smiling, talking, or swallowing. Their faces may appear flat and without expression, but people with Parkinson’s continue to have feelings even though their faces don’t always show it. Sometimes people with the disease can have trouble with thinking and remembering too.
Because of problems with balance, some people with Parkinson’s fall down a lot, which can result in broken bones. Some people with Parkinson’s may also feel sad or depressed and lose interest in the things they used to do.
The symptoms of Parkinson’s disease appear gradually and get worse over time. But because Parkinson’s disease usually develops slowly, most people who have it can live a long and relatively healthy life.
Models Of Tbi And Their Application In Pd Research
While no single animal model of TBI will ever recapitulate all features of human TBI, each of the models discussed below can answer specific questions about aspects of human TBI.
Certain mechanistic questions can be best addressed with primary or model neurons in culture. One such method involves growing neuronal cells on a silastic membrane that is then stretched using compressed gas mimicking torsional stress experience by neurons during TBI. This biaxial stretch injury model has been adopted for use in a variety of immortalized and primary cells and has led to a better understanding of primary astrocyte and immortalize neuron cell specific responses to injury . In both studies, cell injury controllers were used to deliver a stretch injury to a monoculture of cells on a silastic membrane. The in vitro studies show that cellular responses are quantifiable and track with severity of injury in both astrocytes and immortalized neuronal cells.
Table 1 Rodent TBI injury models. Controlled cortical impact , Fluid percussion injury , Penetrating ballistic brain injury , and closed head injury weight drop are the most commonly used injury methods
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Recurrent Falls In Parkinsons Disease: A Systematic Review
Natalie E. Allen
1Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, The University of Sydney, P.O. Box 170, Lidcombe, NSW 1825, Australia
Most people with Parkinsons disease fall and many experience recurrent falls. The aim of this review was to examine the scope of recurrent falls and to identify factors associated with recurrent fallers. A database search for journal articles which reported prospectively collected information concerning recurrent falls in people with PD identified 22 studies. In these studies, 60.5% of participants reported at least one fall, with 39% reporting recurrent falls. Recurrent fallers reported an average of 4.7 to 67.6 falls per person per year . Factors associated with recurrent falls include: a positive fall history, increased disease severity and duration, increased motor impairment, treatment with dopamine agonists, increased levodopa dosage, cognitive impairment, fear of falling, freezing of gait, impaired mobility and reduced physical activity. The wide range in the frequency of recurrent falls experienced by people with PD suggests that it would be beneficial to classify recurrent fallers into sub-groups based on fall frequency. Given that there are several factors particularly associated with recurrent falls, fall management and prevention strategies specifically targeting recurrent fallers require urgent evaluation in order to inform clinical practice.
Elimination Of Other Conditions
Although no test can diagnose Parkinsons disease itself, your doctor may order blood tests or imaging studies to rule out other causes of your symptoms.
Your doctor will want to know about any medication or recreational drugs you take, since some drugs can cause symptoms similar to those of Parkinsons.
Doctors sometimes order dopamine transporter SPECT imaging to determine whether a person with suspected Parkinsons has a different disorder called essential tremor.
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Deep Brain Stimulation For Parkinsons: Am I A Candidate
Deep brain stimulation is not a cure, but it can relieve your symptoms from Parkinsons disease when medications are not an option. Only you and your doctor can decide if this surgical procedure is right for you. You may be a candidate for deep brain stimulation if:
- You have idiopathic Parkinsons disease. Patients with atypical parkinsonism are not candidates.
- You have good motor function and independence during your best on state when taking the drug Sinemet.
Get Daily Living Aids That Can Help You Stay Independent And Safe
Among the tools that an occupational therapist might recommend are railings around your toilet and bathtub, a seat to use in the tub or shower, a pump soap dispenser instead of bar soap, an electric toothbrush and razor, a cordless phone that you can carry around with you, nonskid socks and Velcro-closure shoes, and an appropriate cane, walker, rollator or wheelchair to help you move around effectively.
What Are The Symptoms Of Parkinson Disease
Parkinson disease symptoms usually start out mild, and then progressively get much worse. The first signs are often so subtle that many people don’t seek medical attention at first. These are common symptoms of Parkinson disease:
- Tremors that affect the face and jaw, legs, arms, and hands
- Slow, stiff walking
How Is Parkinsons Disease Managed
Your doctors will tailor your treatment based on your individual circumstances. You will manage your condition best if you have the support of a team, which may include a general practitioner, neurologist, physiotherapist, occupational therapist, psychologist, specialist nurse and dietitian.
While there is no cure for Parkinsons disease, symptoms can be treated with a combination of the following.
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What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
How Patients Feel About The Parkinsons
After coming in contact with many Parkinsons patients, we have realized that nothing can make you fall if you have the resilience and courage to fight with it. Patients describe their pain and discomfort as a frustration when they were diagnosed with this disease. A patient said that it felt as if the life completely drained out of my right arm from the elbow down” when tremors began.
Some patients added that it is correct to use Parkinsons paralysis as a term for the rigidity, unfamiliar pain and stiffness they felt in their arms and limbs muscles.
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How Postural Instability May Appear
Patients with PD experience symptoms in varying severities, and with the progression of the disease, the severity of the symptoms changes over time. Postural instability may show up during a variety of activities, including:
- When rising from a chair
- When rising from bed
- While turning or pivoting, especially quick movements
- While standing upright1
Postural instability may be apparent at diagnosis, but it is more commonly seen and worsens as PD progresses. The inability to balance and recover from variations in movement often causes falls, which can lead to hospitalization or death in people with PD. Because of this, postural instability is one of the most distressing symptoms of PD and greatly diminishes the individuals level of mobility.2,3
What Causes Parkinson’s Disease
In the very deep parts of the brain, there is a collection of nerve cells that help control movement, known as the basal ganglia . In a person with Parkinson’s disease, these nerve cells are damaged and do not work as well as they should.
These nerve cells make and use a brain chemical called dopamine to send messages to other parts of the brain to coordinate body movements. When someone has Parkinson’s disease, dopamine levels are low. So, the body doesn’t get the right messages it needs to move normally.
Experts agree that low dopamine levels in the brain cause the symptoms of Parkinson’s disease, but no one really knows why the nerve cells that produce dopamine get damaged and die.
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What Can You Do If You Have Pd
- Work with your doctor to create a plan to stay healthy. This might include the following:
- A referral to a neurologist, a doctor who specializes in the brain
- Care from an occupational therapist, physical therapist or speech therapist
- Meeting with a medical social worker to talk about how Parkinsons will affect your life
For more information, visit our Treatment page.
Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.