Is Parkinson’s Disease A Neurological Disorder

What Is The Prognosis And Life Expectancy For Parkinson’s Disease

The severity of Parkinson’s disease symptoms and signs vary greatly from person to peson, and it is not possible to predict how quickly the disease will progress. Parkinson’s disease itself is not a fatal disease, and the average life expectancy is similar to that of people without the disease. Secondary complications, such as pneumonia, falling-related injuries, and choking can lead to death. Many treatment options can reduce some of the symptoms and prolong the quality of life.

Quantitative Study: Burdens Among Parkinsons Disease Caregiver

IntroductionParkinsons is the second most common neurological disease after Alzheimers. It has been described as a chronic, progressive, neurological disorder, which generally not life-threatening but is incurable . Parkinson disease has no antidote but has altered treatments. Patients require caregivers help when PD gradually starts to affects motor, cognitive and emotional functioning. Patients are hindered from fulfilling their daily needs, thus necessitating the caregivers

Causes Of Parkinson’s Disease

Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.

Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson’s disease.

Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.

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What Doctors Look For When Diagnosing Parkinsons

Certain physical signs and symptoms noticed by the patient or his or her loved ones are usually what prompt a person to see the doctor. These are the symptoms most often noticed by patients or their families:

• Shaking or tremor: Called resting tremor, a trembling of a hand or foot that happens when the patient is at rest and typically stops when he or she is active or moving

• Bradykinesia: Slowness of movement in the limbs, face, walking or overall body

• Rigidity: Stiffness in the arms, legs or trunk

• Posture instability: Trouble with balance and possible falls

Once the patient is at the doctors office, the physician:

• Takes a medical history and does a physical examination.

• Asks about current and past medications. Some medications may cause symptoms that mimic Parkinsons disease.

• Performs a neurological examination, testing agility, muscle tone, gait and balance.

Testing For Parkinsons Disease

There is no lab or imaging test that is recommended or definitive for Parkinsons disease. However, in 2011, the U.S. Food and Drug Administration approved an imaging scan called the DaTscan. This technique allows doctors to see detailed pictures of the brains dopamine system.

A DaTscan involves an injection of a small amount of a radioactive drug and a machine called a single-photon emission computed tomography scanner, similar to an MRI.

The drug binds to dopamine transmitters in the brain, showing where in the brain dopaminergic neurons are.

The results of a DaTscan cant show that you have Parkinsons, but they can help your doctor confirm a diagnosis or rule out a Parkinsons mimic.

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Referral To A Specialist

If your GP suspects Parkinson’s disease, you’ll be referred to a specialist.

This will usually be:

• a neurologist, a specialist in conditions affecting the brain and nervous system
• a geriatrician, a specialist in problems affecting elderly people

The specialist will most likely ask you to perform a number of physical exercises so they can assess whether you have any problems with movement.

A diagnosis of Parkinson’s disease is likely if you have at least 2 of the 3 following symptoms:

• shaking or tremor in a part of your body that usually only occurs at rest
• slowness of movement
• muscle stiffness

If your symptoms improve after taking a medication called levodopa, it’s more likely you have Parkinson’s disease.

Special brain scans, such as a single photon emission computed tomography scan, may also be carried out in some cases to try to rule out other causes of your symptoms.

Mood Changes In Parkinsons

When faced with a diagnosis of Parkinsons disease , it is understandable to feel depressed or anxious. But mood disorders such as depression and anxiety are clinical symptoms of Parkinsons, just as are slowness of movement and tremor. In fact, up to half of all people with Parkinsons may suffer from depression and/or anxiety at some point during the course of their disease. Like all symptoms of PD, mood changes are different for different people. Some people with depression feel sad and lose interest in things they used to enjoy, while others feel irritable and have difficulty sleeping. People with anxiety often feel overly worried or concerned, or say they are on edge.

The good news: Over the past decade, researchers have placed increasing focus on these aspects of PD, and today we have a better understanding of how to treat mood disorders in Parkinsons.

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What Causes Parkinson’s Disease

Parkinson’s disease occurs when nerve cells, or neurons, in an area of the brain that controls movement become impaired and/or die. Normally, these neurons produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems of Parkinson’s. Scientists still do not know what causes cells that produce dopamine to die.

People with Parkinson’s also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying-down position.

Many brain cells of people with Parkinson’s contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinsons disease and Lewy body dementia.

Living Well With Parkinson’s

While medication and DBS surgery are the most effective treatments for PD, individuals often choose to delay these treatments because of their adverse side effects. Until a therapy is developed that can halt the progression of PD, there is a significant need for strategies that provide symptom relief without causing negative side effects.

Diet, Exercise, and Stress Reduction

Findings from several studies suggest that exercise has the potential to provide relief from certain PD symptoms. Anecdotally, people with Parkinsons disease who exercise typically do better. However, many questions remain. Among them is whether exercise provides a conditioning effect by strengthening muscles and improving flexibility or whether it has a direct effect on the brain.

In an NINDS-funded trial comparing the benefits of tai chi, resistance training, and stretching, tai chi was found to reduce balance impairments in people with mild-to-moderate PD. People in the tai chi group also experienced significantly fewer falls and greater improvements in their functional capacity.

Technologies that Improve Quality of Life

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Parkinson ‘s Disease : Disease

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How Parkinsons Disease Affects The Brain

What makes Parkinsons disease distinctive from other movement disorders is that cell loss occurs in a very specific region of the brain called the substantia nigra . The nerve cells, or neurons, in this region actually appear dark under a microscope .

Those dark neurons produce a specific type of neurotransmitter called dopamine. The neurotransmitter dopamine helps to regulate movement. This loss of dopamine is the reason that many treatments for Parkinsons Disease are intended to increase dopamine levels in the brain. Future research will hopefully tell us more about alpha-synuclein. Learn more about APDA research initiatives here.

In addition to decreases in dopamine and the cells that make dopamine, you might also read or hear about alpha-synuclein . We do not yet know what this protein does in the healthy brain, but in Parkinsons disease it clumps up in what are called Lewy bodies. Researchers believe that alphasynuclein build-up contributes to the cause of Parkinsons disease and that it may be possible to develop new treatments based on this idea.

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Incidence Of Parkinsons Disease

Its estimated that approximately four people per 1,000 in Australia have Parkinsons disease, with the incidence increasing to one in 100 over the age of 60. In Australia, there are approximately 80,000 people living with Parkinsons disease, with one in five of these people being diagnosed before the age of 50. In Victoria, more than 2,225 people are newly diagnosed with Parkinsons every year.

How Is Parkinson’s 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 Parkinson’s disease, symptoms can be treated with a combination of the following.

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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

Anxiety And Depression In Parkinsons And How To Manage Them

Approximately 50-60% of people living with Parkinsons experience varying levels of depression and anxiety. Learn about the differences between depression and anxiety and how they are related different types of depression and anxiety causes of depression and anxiety in people living with PD when and how to treat depression and/or anxiety the latest in treatments, including non-pharmacological interventions. The speaker is Gregory Pontone, MD, director, Johns Hopkins Parkinsons Disease Neuropsychiatry Clinic.

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Discuss With Your Physician

Non-motor symptoms can sometimes be difficult to recognize. Therefore, it is important to make your doctor aware of them.

One useful resource is the PD NMS Questionnaire. You can use this to record your symptoms and discuss them with your doctor.

Dr. Ron Postuma, whose research was funded by donations to the Parkinson Canada Research Program, has also developed tools to help people with Parkinsons and their physicians identify and manage non-motor symptoms.

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Drugs And Medication Used To Treat Parkinsons Disease

A number of different drugs can be used to treat Parkinsons.

Levodopa

Levodopa is the most common treatment for Parkinsons. 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. Theyre 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 and trihexyphenidyl are anticholinergics used to treat Parkinsons.

Amantadine

Amantadine can be used along with carbidopa-levodopa. Its a glutamate-blocking drug . It offers short-term relief for the involuntary movements that can be a side effect of levodopa.

COMT inhibitors

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

Tolcapone can cause liver damage. Its usually saved for people who do not respond to other therapies.

Ectacapone does not cause liver damage.

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

MAO-B inhibitors

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Projected Estimates Of Parkinsons Disease With Aging Population

As the life expectancy has increased worldwide, it is expected that the burden of chronic diseases, like PD, will continue to grow. It is estimated that the number of people with PD in 2005 totaled between 4.1 million and 4.6 million and that number will more than double by 2030 to between 8.7 million and 9.3 million.7

Environmental Factors And Exposures

Exposure to pesticides and a history of head injury have each been linked with PD, but the risks are modest. Never having smoked cigarettes, and never drinking caffeinated beverages, are also associated with small increases in risk of developing PD.

Low concentrations of urate in the blood is associated with an increased risk of PD.

Drug-induced parkinsonism

Different medical drugs have been implicated in cases of parkinsonism. Drug-induced parkinsonism is normally reversible by stopping the offending agent. Drugs include:

• Phenothiazines

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Sidebar: Advances In Circuitry Research

The brain contains numerous connections among neurons known as neural circuits.

Research on such connections and networks within the brain have advanced rapidly in the past few years. A wide spectrum of tools and techniques can now map connections between neural circuits. Using animal models, scientists have shown how circuits in the brain can be turned on and off. For example, researchers can see correlations between the firing patterns of neurons in a zebrafishs brain and precise behavioral responses such as seeking and capturing food.

Potential opportunities to influence the brains circuitry are starting to emerge. Optogenetics is an experimental technique that involves the delivery of light-sensitive proteins to specific populations of brain cells. Once in place, these light-sensitive proteins can be inhibited or stimulated by exposure to light delivered via fiber optics. Optogenetics has never been used in people, however the success of the approach in animal models demonstrates a proof of principal: A neural network can be precisely targeted.

Thanks in part to the BRAIN Initiative, research on neural circuitry is gaining momentum. The Brain Research through Advancing Innovative Neurotechnologies Initiative is accelerating the development and application of new technologies that enable researchers to produce dynamic pictures of the brain that show how individual brain cells and complex neural circuits interact at the speed of thought.

NIH Publication No. 15-5595

Is Surgery An Option

If medicine doesnât work well enough, your doctor may suggest deep brain stimulation . In DBS, your doctor implants electrodes deep in the brain. A device connected to them delivers electrical pulses. Those pulses can help control the tremors caused by Parkinson’s.

In the past, doctors sometimes used other operations to damage the brain in ways to help with movement symptoms. But they rarely use those surgeries now.

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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.
• Sleeping disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
• Pain, lack of interest , fatigue, change in weight, vision changes.
• Low blood pressure.

What Is Parkinsons Disease

Parkinsons disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinsons disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.

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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.

How Is A Diagnosis Made

Because other conditions and medications mimic the symptoms of PD, getting an accurate diagnosis from a physician is important. No single test can confirm a diagnosis of PD, because the symptoms vary from person to person. A thorough history and physical exam should be enough for a diagnosis to be made. Other conditions that have Parkinsons-like symptoms include Parkinsons plus, essential tremor, progressive supranuclear palsy, multi-system atrophy, dystonia, and normal pressure hydrocephalus.

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What Are The Symptoms Of Parkinson’s Disease

The main symptoms of Parkinson’s disease are:

• tremor or shaking, often when resting or tired. It usually begins in one arm or hand
• muscle rigidity or stiffness, which can limit movement and may be painful
• slowing of movement, which may lead to periods of freezing and small shuffling steps
• stooped posture and balance problems

The symptoms of Parkinson’s disease vary from person to person as well as over time. Some people also experience:

• loss of unconscious movements, such as blinking and smiling
• difficulties with handwriting
• drop in blood pressure leading to dizziness
• difficulty swallowing
• sweating

Many of the symptoms of Parkinson’s disease could be caused by other conditions. For example, stooped posture could be caused by osteoporosis. But if you are worried by your symptoms, it is a good idea to see your doctor.