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
Young Onset Parkinsons : An Introduction
Although the average age to develop Parkinsons is around 60, young onset Parkinsons occurs in 5-10% of people diagnosed. 20% are under the age of 50. Some challenges in Parkinsons are universal, regardless of age, but there are a number of issues specific to younger people.
Generally, Parkinsons proceeds more slowly in younger people. While no two people are the same, someone whose onset age is 40 can expect to work for another 15-20 years on average. For someone with an onset age of 60, the average figure would be half that. These figures are based on the kinds of treatment available today. Future treatment will be even more effective in prolonging the productive life of people with Parkinsons.
Larry Gifford hosts a panel discussion on Living Well with Young Onset Parkinsons in May of 2020.
The following characteristics tend to be present in young onset Parkinsons:
- Young onset Parkinsons is less likely to lead to dementia and balance problems
- It is more likely to include focal dystonia, which is cramping or abnormal posturing of one part of the body.
- Younger people are more sensitive to the benefits of Parkinson medications, but they tend to experience the dyskinetic side effects of levodopa sooner than older people.
- They also tend to experience dose-related fluctuations at an earlier stage of the disease, including wearing off* and the on-off effect. See Parkinson Canada Information Sheet,;Parkinsons Medications: What you need to know!
Parkinson’s Disease And Dopamine
Parkinson’s disease develops slowly over time in most peoplesome people live with the disease for years before being diagnosed. Over time, a;person’s brain cells stop producing a neurotransmitter called dopamine.;Dopamine is a chemical that helps you to have smooth, coordinated muscle movements.
When a majority of dopamine-producing cells are;damaged, symptoms of Parkinson’s disease occur. When your brain begins to work with;less;dopamine, you become less able to control your movements, body, and emotions. These symptoms affect people differently, and at different times.;In some people, it takes years to get to an advanced stage while in others the disease progresses much more quickly.
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Is There A Risk Of Being Infected
Science is still working on determining what really causes Alzheimer’s disease. We know that risk factors like age, genetics, family history and lifestyle are all part of the picture. It’s also possible that an infectious property such as prions may be involved in Alzheimer’s disease, but this potential is unproven at this time and is based only on preliminary research with mice.
If it turns out that prions do play a role in Alzheimer’s disease, it’s important to remember that prion diseases are not spread through casual or even intimate physical contact with others. So, go ahead and hug that person with Alzheimer’s. Their disease is not contagious in any way, and they could experience some of the benefits related to appropriate physical touch for people with dementia, including lowering blood pressure, reducing pain and reducing challenging behaviors in dementia.
Parkinsons Disease Is A Progressive Disorder
Parkinsons Disease is a slowly progressive neurodegenerative disorder that primarily affects movement and, in some cases, cognition. Individuals with PD may have a slightly shorter life span compared to healthy individuals of the same age group. According to the Michael J. Fox Foundation for Parkinsons Research, patients usually begin developing Parkinsons symptoms around age 60. Many people with PD live between 10 and 20 years after being diagnosed. However, a patients age and general health status factor into the accuracy of this estimate.
While there is no cure for Parkinsons disease, many patients are only mildly affected and need no treatment for several years after their initial diagnosis. However, PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time. This progression occurs more quickly in some people than in others.
Pharmaceutical and surgical interventions can help manage some of the symptoms, like bradykinesia , rigidity or tremor , but not much can be done to slow the overall progression of the disease. Over time, shaking, which affects most PD patients, may begin to interfere with daily activities and ones quality of life.
What Genes Are Linked To Parkinson’s Disease
Several genes have now been definitively linked to Parkinson’s disease. The first to be identified was alpha-synuclein. In the 1990s, researchers at NIH and other institutions studied the genetic profiles of a large Italian family and three Greek families with familial Parkinson’s disease and found that their disease was related to a mutation in this gene. They found a second alpha-synuclein mutation in a German family with Parkinson’s disease. These findings prompted studies of the role of alpha-synuclein in Parkinson’s disease, which led to the discovery that Lewy bodies from people with the sporadic form of Parkinson’s disease contained clumps of alpha-synuclein protein. This discovery revealed a potential link between hereditary and sporadic forms of the disease.
In 2003, researchers studying inherited Parkinson’s disease discovered that the disease in one large family was caused by a triplication of the normal alpha-synuclein gene on one copy of chromosome 4. This triplication caused people in the affected family to produce too much of the normal alpha-synuclein. This study showed that an excess of the normal form of the protein could result in Parkinson’s disease, just as the abnormal form does.
Viral Infections And Pd Risk
The notion of a viral etiology to PD has been mooted for many years. One early example, and poi-gnant today in light of the recent SARS-CoV-2 pandemic, was the emergence of a parkinsonian disorder, encephalitis lethargica , that has been linked to the 1918 influenza pandemic. Viruses, particularly those that are neurotropic, are plausible causal agents of PD but have been relatively understudied compared to genetic risk factors and other environmental risk factors for PD. In this section we will consider the viruses that have been linked to PD in observational studies and evaluate the strength of evidence to support a causal link.
Hepatitis B and C viruses have also been investigated for their associations with PD in recent epidemiological studies. Understanding such associations are important given the prevalence of these infections. Hepatitis C virus is an RNA virus of the Flavivirus family and is estimated to infect 143 million people worldwide. It primarily involves the liver with chronic infection resulting in cirrhosis and hepatocellular carcinoma . Extrahepatic manifestations include a myriad of inflammatory and immune-mediated disorders .
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Historical Aspects Of Viruses And Parkinsonism
It is remarkable that a relationship between the presence of antibodies to coronaviruses that cause the common cold, coronavirus OC43 and 229E, in the cerebrospinal fluid and Parkinsons disease was reported nearly twenty years prior to the current pandemic by Stanley Fahn and colleagues. Prior coronaviruses have been occasionally reported to exhibit neurological manifestations and CSF invasion, including in children,.
Table 1 Mechanisms involved in the pathogenesis of viral-induced parkinsonism.
Other Symptoms Of Parkinson’s Disease
Symptoms of Parkinson’s disease vary from patient to patient. The symptoms may appear slowly and in no particular order. Early symptoms may be subtle and may progress over many years before reaching a point where they interfere with normal daily activities.These often include the following:
- Fatigue or general malaise
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What Is Parkinson’s Disease
Parkinson’s disease mostly affects older people but can also occur in younger adults. The symptoms are the result of the gradual degeneration of nerve cells in the portion of the midbrain that controls body movements. The first signs are likely to be barely noticeable — a feeling of weakness or stiffness in one limb, or a fine trembling of one hand when it is at rest. Eventually, the shaking worsens and spreads, muscles become stiffer, movements slow down, and balance and coordination deteriorate. As the disease progresses, depression, cognitive issues, and other mental or emotional problems are common.
Parkinson’s disease usually begins between the ages of 50 and 65, striking about 1% of the population in that age group; it is slightly more common in men than in women. Medication can treat its symptoms and decrease the disability.
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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Is Parkinsons Disease Fatal
It is important to understand that PD is not considered a fatal condition. As is the case with Alzheimers disease and other forms of dementia, complications and a patients comorbid conditions are more life-threatening than PD itself. For example, because Parkinsons affects movement, balance and coordination, a patients risk of falling increases as the disease progresses. Falls are notoriously dangerous and a leading cause of injury and death among older adults. Difficulty swallowing, known as dysphagia, is another complication that can develop at any point throughout ones journey with PD, and this can cause aspiration pneumoniaanother leading cause of death in patients.
Because a persons overall health is an important factor in how Parkinsons progresses, lifestyle choices are vitally important for prolonging both functionality and longevity. Regular exercise, a healthy diet, careful management of preexisting conditions and prevention of new medical issues is crucial.
It is important to work with a well-rounded medical team to understand PD symptoms, explore treatment options and devise a personalized care plan for improving ones overall health, maintaining a high quality of life, and preventing complications.
Give Yourself Time To Adjust
Over time, youll likely become an expert in Parkinsons disease but right now, youre a newbie. Give yourself time for the diagnosis and all it might mean to sink in. Then, get educated: Ask your doctor for information you can take home and read, find other people with Parkinsons in your community or online to talk to, and browse sites like the National Parkinson Foundation and the Michael J. Fox Foundation for Parkinson’s Research.
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What Is The Role Of The Ninds
As a world leader in research on neurological disorders, including Parkinson’s disease, the NINDS supports a wide range of basic laboratory studies and clinical trials at its Bethesda, Maryland , location and at grantee institutions around the world. Through these and other research projects, scientists are moving ever closer to unraveling the mysteries of Parkinson’s disease. For patients and their families, this research should offer encouragement and hope for the future.
The NINDS also supports 11 Morris K. Udall Parkinson’s Disease Research Centers of Excellence throughout the country. The Centers’ multidisciplinary research environment allows scientists to take advantage of new discoveries in the basic and technological sciences that could lead to clinical advances. Most of the Centers also provide state-of-the-art training for young scientists preparing for research careers investigating Parkinson’s disease and related neurological disorders. Among other topics, the Centers carry out studies of genes, of proteins involved in cell death and degeneration, and of the brain chemicals involved in Parkinson’s disease. They also study the brain using PET brain scans and test potential Parkinson’s disease treatments in animals. The NINDS hopes that research at these Centers of Excellence will lead to clinical trials of new therapies in humans with Parkinson’s disease.
Infection And Pd: An Epidemiologic Perspective
Additional evidence for a role of an infectious trigger or risk factor for PD is found in studies showing a relationship between specific occupational exposures and PD. In some studies, occupations where there is higher interpersonal exposures show an increased risk of developing PD . There is also a significant body of literature on specific infections and subsequent risk of PD, which will be discussed later in this paper. However, there are significant challenges interpreting epidemiological evidence for etiology in PD. The very long prodromal period, spanning decades, makes measurement of initiating factors difficult due to inadequate availability of records or poor recall. In addition, there is undoubtedly a complex interplay of genetic and environmental factors influenced by the neurodegenerative process during the prodromal period that make interpretation difficult. These general challenges are amplified by the complexity of considering the timing and relative impact of multiple short infectious exposures over a lifetime, the widely varying types of infectious agents, variable severity of infections and the inevitable presence of unrecognized infections. For example, a recent epidemiological study tested the multiple microbe hypothesis and reported that PD risk was increased compared to healthy controls in individuals who were seropositive for five or six of the pathogens studied but not less .
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Parkinson’s Syndrome Atypical Parkinson’s Or Parkinsonism
Parkinson’s disease is also called primary parkinsonism or idiopathic Parkinson’s disease. . In the other forms of parkinsonism, either the cause is known or suspected, or the disorder occurs as a secondary effect of another primary neurological disorder that may have both primary and secondary symptoms of Parkinson’s disease.
These disorders may include the following:
- Tumors in the brain
- Repeated head trauma
- Drug-induced parkinsonism – prolonged use of tranquilizing drugs, such as the phenothiazines, butyrophenones, reserpine, and the commonly used drug, metoclopramide for stomach upset
- Toxin-induced parkinsonism – manganese and carbon monoxide poisoning
- Postencephalitic parkinsonism – a viral disease that causes “sleeping sickness”
- Striatonigral degeneration – the substantia nigra of the brain is only mildly affected, while other areas of the brain show more severe damage
- Parkinsonism that accompanies other neurological conditions, such as :
- Shy-Drager syndrome
- Progressive supranuclear palsy
Infection And Risk Of Parkinsons Disease
Article type: Review Article
Affiliations: Department of Neuroscience, Vickie and Jack Farber Institute of Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA | Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK | Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, London, UK | Department of Neurology, Mayo Clinic, Rochester, Minnesota and Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA | The Edmond J Safra Program in Parkinsons disease, Toronto Western Hospital and the University of Toronto, Toronto, Canada
Correspondence: Correspondence to: Connie Marras MD, PhD, 7-MCL 399 Bathurst St. Toronto, Ontario, M5T 2S8, Canada. Tel.: +1 416 603 6422; Fax: +1 416 603 5005; E-mail:.
Keywords: Parkinsons disease, infection, viruses, bacteria, etiology
Journal: Journal of Parkinson’s Disease, vol. 11, no. 1, pp. 31-43, 2021
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The Importance Of Dopamine
Dopamine is a neurotransmitter that facilitates messaging between nerve cells. The brain converts the amino acid tyrosine to dopa, and in turn, this is converted to dopamine. It is sometimes referred to as the happy hormone as increased levels are associated with pleasure and reward.
Dopamine affects the nervous system and is essential for both good physical and mental health i.e. body and mind. A vast array of functions depend on it, examples include mental facility, mood, pain, movement, blood vessels, heart rate, the immune system, as well as kidney and pancreas function.
Dysfunctions of the dopamine system leads to too little or too much being produced. The outcome of this can be serious and possibly life threatening. It appears that an imbalance of dopamine plays a role in a range of conditions such as addiction, ADHD, Schizoprenia, Tourettes syndrome, Alzheimers disease, obesity as well as Parkinsons disease.
What Are Other Parkinsons Disease Risk Factors
- Age: Parkinsons disease mainly affects people over 60 years of age and the risk of developing the disease increases over the years.
- Population: Parkinsons disease is more common among people with white skin.
- Sex: More men have Parkinsons disease than women.
- Career: Some occupations, such as farmers or factory workers, may be more exposed to certain chemicals or toxins that increase the risk of developing Parkinsons disease.
- Serious head injuries: Different types of serious head and brain injuries, such as concussions, increase the risk of developing the disease.
- Location: The number of people living with the disease in rural areas is higher. This seems to be related to agricultural pesticide exposure.
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Retrospective Study With Humans
In a study followeing up on more than 6,100 people who had been previously injected with human growth hormones, researchers tested those hormones and found that , they contained small amounts of the tau and beta amyloid proteins that are present in the brains of people who have Alzheimer’s. These people have since been monitored to determine if they have developed Alzheimer’s disease. Thus far, none of the participants have developed Alzheimer’s disease, although most are still fairly young for a typical onset of dementia.