Who Gets Parkinson’s Disease
About 1 million people in the United States have Parkinson’s disease, and both men and women can get it. Symptoms usually appear when someone is older than 50 and it becomes more common as people get older.
Many people wonder if you’re more likely to get Parkinson’s disease if you have a relative who has it. Although the role that heredity plays isn’t completely understood, we do know that if a close relative like a parent, brother, or sister has Parkinson’s, there is a greater chance of developing the disease. But Parkinson’s disease is not contagious. You can’t get it by simply being around someone who has it.
Who Gets Parkinsons Disease
Estimates vary, but about 1 million people are living with Parkinsons disease in the U.S. Doctors diagnose about 60,000 cases a year, most in people over age 60. Younger people can also get Parkinsons. About 5-10% of patients have young-onset Parkinsons disease, diagnosed before age 50.
About 15% of patients have Parkinsons-plus syndromes, also known as atypical Parkinsons. Medications may be less effective for these syndromes, which can lead to disability sooner.
Risk factors for Parkinsons disease include:
- Age: Risk increases with age. Average age at diagnosis is 65.
- Gender: Men are at higher risk.
- Environmental exposure: Lifetime exposure to well water, which may contain pesticide runoff, can increase risk. So can exposure to air particles containing heavy metals, such as in industrial areas.
- Family history: Having a close relative with the disease could increase your risk. Researchers have identified a dozen genes that may be linked to Parkinsons disease.
- Sleep disorder: People who act out their dreams are up to 12 times more likely to develop Parkinsons disease. Its not clear whether this condition, called REM sleep behavior disorder or RBD, is a cause or symptom of Parkinsons disease.
- Head trauma: Traumatic brain injury increases risk of Parkinsons, even years later.
Who Does It Affect
The risk of developing Parkinsons disease naturally increases with age, and the average age at which it starts is 60 years old. Its slightly more common in men or people designated male at birth than in women or people designated female at birth .
While Parkinsons disease is usually age-related, it can happen in adults as young as 20 .
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Changes Inside The Brain
In Parkinson disease, nerve cells in part of the basal ganglia degenerate.
The basal ganglia are collections of nerve cells located deep within the brain. They help do the following:
Initiate and smooth out intended muscle movements
Suppress involuntary movements
Coordinate changes in posture
When the brain initiates an impulse to move a muscle , the impulse passes through the basal ganglia. Like all nerve cells, those in the basal ganglia release chemical messengers that trigger the next nerve cell in the pathway to send an impulse. A key neurotransmitter in the basal ganglia is dopamine. Its overall effect is to increase nerve impulses to muscles.
When nerve cells in the basal ganglia degenerate, they produce less dopamine, and the number of connections between nerve cells in the basal ganglia decreases. As a result, the basal ganglia cannot control muscle movement as they normally do, leading to tremor, slow movement , a tendency to move less , problems with posture and walking, and some loss of coordination.
Which Medicines Are Used To Treat Parkinsons Disease
Guidelines released by the Scottish Intercollegiate Guidelines Network recommend starting with a dopamine agonist, levodopa with a dopa-decarboxylase inhibitor or a monoamine-oxidase inhibitor. Other medicines are also sometimes used, usually in addition to one of these three main types of medication.
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How Soon After Treatment Will I Feel Better And How Long Will It Take To Recover
The time it takes to recover and see the effects of Parkinson’s disease treatments depends strongly on the type of treatments, the severity of the condition and other factors. Your healthcare provider is the best person to offer more information about what you can expect from treatment. The information they give you can consider any unique factors that might affect what you experience.
Support For People Living With Parkinsons Disease
While the progression of Parkinsons is usually slow, eventually a persons daily routines may be affected. Activities such as working, taking care of a home, and participating in social activities with friends may become challenging. Experiencing these changes can be difficult, but support groups can help people cope. These groups can provide information, advice, and connections to resources for those living with Parkinsons disease, their families, and caregivers. The organizations listed below can help people find local support groups and other resources in their communities.
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Medications For People With Parkinsons Disease
Symptoms of Parkinsons disease result from the progressive degeneration of nerve cells in the brain and other organs such as the gut, which produce a neurotransmitter called dopamine. This causes a deficiency in the availability of dopamine, which is necessary for smooth and controlled movements. Medication therapy focuses on maximising the availability of dopamine in the brain. Medication regimes are individually tailored to your specific need. Parkinsons medications fit into one of the following broad categories:
- levodopa dopamine replacement therapy
- dopamine agonists mimic the action of dopamine
- COMT inhibitors used along with levodopa. This medication blocks an enzyme known as COMT to prevent levodopa breaking down in the intestine, allowing more of it to reach the brain
- anticholinergics block the effect of another brain chemical to rebalance its levels with dopamine
- amantadine has anticholinergic properties and improves dopamine transmission
- MAO type B inhibitors prevent the metabolism of dopamine within the brain.
Managing Cognitive Impairments In Parkinsons
After a thorough evaluation to rule out other causes of cognitive impairment, patients with PD may be treated with medication, occupational therapy, and/or speech therapy. The medications used to treat cognitive impairments in people with PD are based on treatments used for Alzheimers disease. Occupational therapy can help a person with PD by providing adaptive strategies for daily activities. Speech therapy can help with language functions, as well as information processing. 3,4
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How Does Parkinsons Affect The Brain
Parkinsons disease is a progressive neurological disease that affects the brain and body in different ways. The disease process is thought to be multifactorial, and much research has been done to attempt to uncover the cause. Environmental pollutants, pathogens , and genetics are some possible causes of the initiation of this disease process.
New research is continuously published that will assist in developing detection methods and treatment options for PD. Taking all the possible causes of Parkinsons into consideration, the pathogenesis is similar for patients. There is damage to the areas of the brain that brings about some of the classical symptoms of Parkinsons Disease.
Although the cause of Parkinsons disease is not yet 100% understood, we do understand that Parkinsons disease affects the brain in a variety of ways.
So What Do We Know So Far
Location of the substantia nigra. FrozenManCC BY-SA 4.0
The substantia nigra is an area of the mid brain located at the top of the spinal cord, which has been the focus of much work into how Parkinsons affects the brain.
There are a right and a left substantia nigra, and often one side is affected before the other. Because of this, people with Parkinsons often experience symptoms primarily on one side of their body, particularly in the early stages. Indeed, this common feature of the condition often helps to distinguish Parkinsons from other similar conditions.
When it comes to confirming a diagnosis, it is the substantia nigra where pathologists look for changes at the end of life in brain tissue that has been donated to research. And the loss of the dopamine-producing cells in this area of the brain, accompanied by the presence of clumps of alpha-synuclein protein , has been the hallmark of Parkinsons for decades.
You can read more about the alpha-synuclein protein, and how it plays a role in the spread of Parkinsons, in a previous blog post:
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How Is Parkinson Disease Treated
Parkinson disease can’t be cured. But there are different therapies that can help control symptoms. Many of the medicines used to treat Parkinson disease help to offset the loss of the chemical dopamine in the brain. Most of these medicines help manage symptoms quite successfully.
A procedure called deep brain stimulation may also be used to treat Parkinson disease. It sends electrical impulses into the brain to help control tremors and twitching movements. Some people may need surgery to manage Parkinson disease symptoms. Surgery may involve destroying small areas of brain tissue responsible for the symptoms. However, these surgeries are rarely done since deep brain stimulation is now available.
What Research Is Being Done
Current research programs funded by the National Institute of Neurological Disorders and Stroke are using animal models to study how the disease progresses and to develop new drug therapies. Scientists looking for the cause of PD continue to search for possible environmental factors, such as toxins, that may trigger the disorder, and study genetic factors to determine how defective genes play a role. Researchers are investigating how cellular processes controlled by genes contribute to neurodegeneration , including the toxic accumulation of the protein alpha-synuclein in nerve cells and how the loss of dopamine impairs communication between nerve cells. Other scientists are working to develop new protective drugs that can delay, prevent, or reverse the disease. Key NINDS programs include the Parkinsons Disease Biomarkers Program, which is aimed at discovering biomarkersnew ways to identify people at risk for developing PD and to track the progression of the disease and the Accelerating Medicines Partnership for Parkinsons Disease , in which the National Institutes of Health, multiple biopharmaceutical and life science communities, and nonprofit advocacy organizations work to identify and validate biomarkers for PD. More information about Parkinsons Disease research is available at:
The four primary symptoms of PD are:
The four primary symptoms of PD are:
The four primary symptoms of PD are:
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Changes In Brain Volume In Parkinsons Disease
Strong correlation exists between brain size and cognitive functions. In PD patients, atrophy of the brain was observed in many cortical and subcortical areas, which contributes in decrease in the volume of the brain. Interestingly, it was reported that volume of the frontal lobe, temporoparietal junction, parietal lobe, insula, anterior cingulate cortex, basal ganglia, and thalamus increased in PD patients. Prefrontal lobe plays a crucial role in cognitive functions and in PD patients loss of gray matter has been reported.
What Are The Complications Of Parkinson Disease
Parkinson disease causes physical symptoms at first. Problems with cognitive function, including forgetfulness and trouble with concentration, may arise later. As the disease gets worse with time, many people develop dementia. This can cause profound memory loss and makes it hard to maintain relationships.
Parkinson disease dementia can cause problems with:
- Speaking and communicating with others
- Problem solving
- Paying attention
If you have Parkinson disease and dementia, in time, you likely wont be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.
Experts dont understand how or why dementia often occurs with Parkinson disease. Its clear, though, that dementia and problems with cognitive function are linked to changes in the brain that cause problems with movement. As with Parkinson disease, dementia occurs when nerve cells degenerate, leading to chemical changes in the brain. Parkinson disease dementia may be treated with medicines also used to treat Alzheimers disease, another type of dementia.
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Coping With Cognitive Changes
Some medications used to treat Alzheimer’s disease also may be used to treat the cognitive symptoms of LBD. These drugs, called cholinesterase inhibitors, act on a chemical in the brain that is important for memory and thinking. They may also improve hallucinations, apathy, and delusions. The U.S. Food and Drug Administration has approved one Alzheimer’s drug, rivastigmine, to treat cognitive symptoms in Parkinson’s disease dementia. Several other drugs are being tested as possible treatments for LBD symptoms or to disrupt the underlying disease process.
Movement Problems And Lewy Body Dementia
Some people with LBD may not experience significant movement problems for several years. Others may have them early on. At first, movement symptoms, such as a change in handwriting, may be very mild and easily overlooked. Movement problems may include:
- Muscle rigidity or stiffness
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Support For People With Parkinsons Disease
Early access to a multidisciplinary support team is important. These teams may include doctors, physiotherapists, occupational therapists, speech therapists, dietitians, social workers and specialist nurses. Members of the team assess the person with Parkinsons disease and identify potential difficulties and possible solutions.There are a limited number of multidisciplinary teams in Victoria that specialise in Parkinsons disease management. But generalist teams are becoming more aware of how to help people with Parkinsons disease.
Beyond The Substantia Nigra
In Parkinsons, other areas of the brain beyond the substantia nigra are involved as the condition progresses. Changes in higher brain areas are linked to non-motor symptoms that can affect people with Parkinsons later on in the condition, and often have a significant impact on quality of life.
For instance, symptoms that affect memory and thinking can be linked to the presence of Lewy bodies in the largest area of the brain the cerebral cortex as well as the limbic system. The limbic system is also believed to be involved in symptoms involving mood and pain, and similar changes in the inferior temporal gyrus, an area of the brain involved in processing what we see, are thought to be the reason for hallucinations.
But research into the spread of Parkinsons through these areas, and how we can stop it , is just one side of the story. There is also ongoing research into where Parkinsons starts, and the effects it is having before it reaches these areas.
The presence of non-motor symptoms many months and maybe even years before the physical symptoms, such as tremor and slowness of movement, points towards the presence of other changes in the body long before the loss of dopamine-producing cells in the substantia nigra. These early symptoms could even help researchers predict those who will go on to be diagnosed with Parkinsons, which would help in the development of new and better treatments.
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What Treatments Are Available
Many Parkinson’s patients enjoy an active lifestyle and a normal life expectancy. Maintaining a healthy lifestyle by eating a balanced diet and staying physically active contributes to overall health and well-being. Parkinson’s disease can be managed with self-care, medication, and surgery.
Self careExercise is as important as medication in the treatment of PD. It helps maintain flexibility and improves balance and range of motion. Patients may want to join a support group and continue enjoyable activities to improve their quality of life. Equally important is the health and well being of the family and caregivers who are also coping with PD. For additional pointers, see Coping With Parkinsons Disease.
These are some practical tips patients can use:
Medications There are several types of medications used to manage Parkinson’s. These medications may be used alone or in combination with each other, depending if your symptoms are mild or advanced.
After a time on medication, patients may notice that each dose wears off before the next dose can be taken or erratic fluctuations in dose effect . Anti-Parkinsons drugs can cause dyskinesia, which are involuntary jerking or swaying movements that typically occur at peak dosage and are caused by an overload of dopamine medication. Sometimes dyskinesia can be more troublesome than the Parkinsons symptoms.
Memory Difficulties In Parkinsons
The most common difficulty for people with PD is remembering information that has previously been learned. Memory has several different processes and types, and people with PD have trouble recalling information but their long-term memory function generally remains intact. Memory cues or choices can help people with PD to retrieve information from the brains long-term storage.3,4
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How Will The Disease Affect My Life
Most people who have Parkinsonâs live a normal to a nearly normal lifespan, but the disease can be life changing.
For some people, treatment keeps the symptoms at bay, and they’re mostly mild. For others, the disease is much more serious and really limits what you’re able to do.
As it gets worse, it makes it harder and harder to do daily activities like getting out of bed, driving, or going to work. Even writing can seem like a tough task. And in later stages, it can cause dementia.
Even though Parkinson’s can have a big impact on your life, with the right treatment and help from your health care team, you can still enjoy the things you love. It’s important to reach out to family and friends for support. Learning to live with Parkinson’s means making sure you get the backing you need.
Treatment And Care For Lewy Body Dementia
While LBD currently cannot be prevented or cured, some symptoms may respond to treatment for a period of time. An LBD treatment plan may involve medications, physical and other types of therapy, and counseling. A plan to make any home safety updates and identify any equipment can make everyday tasks easier.
A skilled care team often can suggest ways to improve quality of life for both people with LBD and their caregivers.
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