Tuesday, July 16, 2024
Tuesday, July 16, 2024
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Secondary Symptoms Of Parkinson’s Disease

What Are The 5 Stages Of Parkinsons Disease

8 Early Warning signs of Parkinsonism – Dr. Guruprasad Hosurkar

The 5 stages of Parkinsons disease are completely unique as the side effects and symptoms can impact people in different ways. The main symptoms of Parkinsons include uncontrollable shaking or tremors, slowed movement, balance difficulties and stiffness in limbs.

The symptoms often vary between individuals, with each patients experience varying in intensity in the lead up to stage 5 Parkinsons disease. Not everyone will experience all Parkinsons symptoms, yet these are the typical stages of progression that have been outlined by experts as the disease begins to worsen. With that in mind, what are the 5 stages of Parkinsons Disease?

Why Is Distinguishing Young

Socially, people who are affected by PD at a younger age experience the disease differently they may be at a different stage of their career and often have less time to engage in their own care. They may also have children or are planning to have children and have questions regarding passing on PD genes.

Medically, doctors tailor treatment when it is a younger person with PD. The younger you are, the more likely the disease is genetic. Your care team may offer genetic testing or counseling. Younger brains also have a higher neuroplasticity potential which allows the brain to handle and respond to disease and therapy differently.

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Cognitive And Psychiatric Symptoms

  • depression and anxiety
  • mild cognitive impairment slight memory problems and problems with activities that require planning and organisation
  • dementia a group of symptoms, including more severe memory problems, personality changes, seeing things that are not there and believing things that are not true

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Is Parkinsons Disease Fatal

Parkinsons disease itself doesnt cause death. However, symptoms related to Parkinsons can be fatal. For example, injuries that occur because of a fall or problems associated with dementia can be fatal.

Some people with Parkinsons experience difficulty swallowing. This can lead to aspiration pneumonia. This condition is caused when foods, or other foreign objects, are inhaled into the lungs.

Whats Different About Young


The age of diagnosis matters for a variety of reasons, from probable causes of early cases to symptoms and treatment:

  • Genetics. As with any case of Parkinsons disease, the exact cause is usually unknown. That said, The young-onset cases of Parkinsons disease are, on average, a bit more likely to be familial or genetic, says Gregory Pontone, M.D., director of the Johns Hopkins Movement Disorders Psychiatry Clinic.
  • Symptoms. In many patients with YOPD, dystonia is an early symptom. People with YOPD also report more dyskinesia . They also tend to exhibit cognitive problems, such as dementia and memory issues, less frequently.
  • Progression. Patients with young-onset Parkinsons appear to have a slower progression of the disease over time, says Pontone. They tend to have a milder course, staying functional and cognitively intact for much longer.
  • Treatment. Most patients with Parkinsons take the medication levodopa. However, other drugs, such as MAO-B inhibitors, anticholinergics, amantadine, and dopamine receptor agonists, may be used before levodopa.

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How Can I Prevent This Condition Or Reduce My Risk Of Developing It

Parkinsonism happens unpredictably in most cases, so it’s usually impossible to prevent it or reduce your risk of developing it. However, there are specific types of secondary parkinsonism that you can reduce the risk of developing. These are:

  • Toxin-induced parkinsonism. Its possible to reduce your risk of developing this type of parkinsonism by avoiding toxins or substances that can cause it or by using safety equipment to reduce your exposure to these substances when you cant avoid them.
  • Post-traumatic parkinsonism. You can reduce your risk of developing this by using safety equipment to protect yourself from head injuries.
  • Vascular parkinsonism. Reducing your risk of developing this involves taking care of your circulatory health, especially the circulation in your brain. Managing this involves maintaining a weight that’s healthy for you, eating a balanced diet and staying physically active.

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.

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What Are The Important Points Regarding Duodopa At The End Of Life

Duodopa is a continuous infusion of dopaminergic medication administered as a gel into the gut, pumped via a percutaneously inserted gastrostomy tube . There is a requirement for care of the stoma and PEG tube together with functioning of the pump by the patient or carer.41 It reduces the time in motor off periods in advanced PD and quality of life.42 There is evidence of effective treatment up until death from within a case series.43

Why Is Proper Follow

What are the causes of Parkinson’s disease? Are there disorders that have similar symptoms?

A person with Parkinsons disease is supposed to go for regular checkups to his health care professional for the following reasons-

Check-ups: The check-ups help the health care professionals to check if the treatment procedure is working or not and also provides an insight about the necessary adjustments to be made.

Regular Follow-ups: Regular follow-ups help in detection of new problems with cognition, behavior or mood which might need special treatment.

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Stiffness And Slow Movement

Parkinsons disease mainly affects adults older than 60. You may feel stiff and a little slow to get going in the morning at this stage of your life. This is a completely normal development in many healthy people. The difference with PD is that the stiffness and slowness it causes dont go away as you get up and start your day.

Stiffness of the limbs and slow movement appear early on with PD. These symptoms are caused by the impairment of the neurons that control movement. A person with PD will notice jerkier motions and move in a more uncoordinated pattern than before. Eventually, a person may develop the characteristic shuffling gait.

Normal Cognition Early In Pd Predicted Normal Life Expectancy

Parkinsons disease patients who had normal cognitive function at the start of a prospective, community-based study had a largely normal life expectancy, researchers reported.

But Parkinsons disease patients who had early freezing of gait, severe hyposmia, cognitive impairment, or subtle inflammation in their cerebrospinal fluid had a significantly shorter life span, reported David Backstrom, MD, of Umea University in Sweden, and colleagues in Neurology.

Action Points

  • Patients with Parkinsons disease who have mild disease and normal cognition at onset have a mortality rate equivalent to that of the general population, according to a Swedish study of 182 patients with new-onset, idiopathic parkinsonism.
  • Recognize that patients with incident parkinsonism have overall reduced survival, but that the survival is highly dependent on the type and characteristics of the parkinsonian disorder.

The prognosis of Parkinsons disease and parkinsonism is best studied by long-term follow-up of community-based incident cohorts, Backstrom told MedPage Today. Mortality among Parkinsons disease patients can be highly variable, and this study provides a better characterization of the neurobiological factors that are associated with short survival in Parkinsons disease.


Editorialists reported relationships with CurePSP, Biogen, AbbVie, American Parkinsons Disease Association, the Rutgers Foundation, and UBS.

Primary Source

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Diminished Sense Of Smell

Most people with Parkinson’s experience a reduced sense of smell, which is a secondary symptom of the disease. Doctors say this symptom has to do with changes to the olfactory bulb in the brain, the primary relay station for smell signals. This condition, hyposmia, usually occurs before more noticeable symptoms appear. Most individuals do not realize they are experiencing a diminished sense of smell and it goes unnoticed, but researchers now know it is a prevalent symptom, occurring in more than 90 percent of people in the early stages of Parkinson’s.

Fully Developed Severely Disabling Disease The Patient Is Still Able To Walk And Stand Unassisted But Is Markedly Incapacitated

Parkinsons Disease

The patient is unable to lead an independent life because of the need for help with some activities of daily living. It is this inability to live alone which marks the transition from Stage III to Stage IV. No matter how difficult it is for him/her, if the patient still is able to live alone, his/her disease is at Stage III not Stage IV. The patient at Stage IV however, does remain able to stand and walk unassisted.

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Consider A Medication Review

Choices about medications made early in the course of Parkinsons disease can have a lasting impact on the course of the illness. Individuals diagnosed with PD and other parkinsonism syndromes should seek the advice of doctors who specialize in treating these complex movement disorders, even when the illness is only suspected. A movement disorder specialist can help tailor your medications to treat both primary symptoms of PD such as tremor, dyskinesia and rigidity and secondary symptoms of Parkinsons, including depression and cognitive decline.

Request a medication review and talk with your doctor about the possibility of supplementing your regularly prescribed medication, which may help your current medication perform better, and potentially improve your mobility and symptom management.

Clinical Diagnostic Criteria For Parkinson Disease

  • Diagnostic certainty: The criteria distinguish between two levels of diagnostic certainty.
  • Clinically probable PD: a maximum of two red flags plus the absence of absolute exclusion criteria
  • Clinically established PD: two or more supportive criteria plus the absence of both red flags and absolute exclusion criteria
  • Supportive criteria
  • Clear response to dopaminergic therapy
  • Levodopa challenge test: The result is positive if the administration of levodopa relieves symptoms.
  • Resting tremor of a limb
  • The presence of either olfactory loss or cardiac sympathetic denervation on MIBG scintigraphy
  • Absolute exclusion criteria
  • Cerebellar abnormalities, including oculomotor dysfunction
  • Downward vertical supranuclear gaze palsy or selective slowing of downward vertical saccades
  • Diagnosis of probable frontotemporal dementia in the first 5 years of the disease
  • Parkinsonian features restricted to the lower limbs for > 3 years
  • Treatment with a dopaminereceptor blocker or a dopamine-depleting agent in a dose and time-course consistent with drug-inducedparkinsonism
  • Absence of observable response to high-doselevodopa despite at least moderate severity of the disease
  • Unequivocal cortical sensory loss , clear limb ideomotor apraxia, or progressive aphasia
  • Normal functional neuroimaging of the presynaptic dopaminergic system
  • Potential alternative condition associated with parkinsonism and plausibly connected to the patient’s symptoms.
  • Stability of motor symptoms or signs for 5 years
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    Eo Parkinsonism Associated With Additional Characteristic Features

    EO parkinsonism and metals in the brain

    Brain metal accumulation can manifest clinically as early-onset parkinsonism in several neurological disorders. Various metals can be accumulated in the brain and other body tissues in these conditions , calcium in Fahrs disease, and manganese in hypermanganesemia). Some of these disorders are genetically inherited, while others are acquired .

    Typically, the clinical suspect for these conditions emerges after brain imaging studies . However, associated systemic findings, such as hepatic involvement in Wilsons disease and hypermanganesemia, can be the first clue to suspect metal accumulation in the brain .

    Wilsons disease

    Wilsons disease is distributed worldwide, with an estimated prevalence of 1 case per 30,000 live births in most populations . However, in some isolated populations, such as a small mountain village on the island of Crete, the prevalence is much higher , due to high rates of consanguinity .

    Copper accumulation is associated with a progressive neurodegeneration of basal ganglia leading to a complex movement disorder often associated with bulbar symptoms. The movement disorder is usually characterized by tremor, dystonia, and/or parkinsonism. Bulbar symptoms consist of dysarthria, drooling and/or dysphagia. In addition, a range of additional neurologic features may be present, including cerebellar ataxia, chorea, hyperreflexia, seizures, cognitive impairment, and psychiatric features .

    Fahrs disease

    When Should I See My Healthcare Provider

    Emese’s (30) early stage secondary Parkinson’s disease symtoms (anoxic-ischemic brain injury)

    You should see your healthcare provider as recommended or if you notice changes in your symptoms, especially if the symptoms start to interfere with your life and routine. You should also see your provider if you notice any changes in the effectiveness of your medication.

    When should I go to ER?

    Your healthcare provider can give you guidance and information on signs or symptoms that mean you need to go to the hospital or get medical attention. In general, you should get medical attention if you fall, especially when you lose consciousness or might have an injury to your head, neck, chest, back or abdomen.

    A note from Cleveland Clinic

    Parkinsonism is a term that covers a wide range of conditions that affect your ability to move and live independently. While these conditions all share certain similarities, they also can have major differences from each other. If youre diagnosed with parkinsonism, its important to talk to your healthcare provider about what condition you have , and what that diagnosis means for you. Not all parkinsonism conditions are the same, so understanding your specific case can make a big difference in managing it and how it affects your life.

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    What Is The Outlook For Persons With Parkinsons Disease

    Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.

    Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.

    The future is hopeful. Some of the research underway includes:

    • Using stem cells to produce new neurons, which would produce dopamine.
    • Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
    • Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.

    Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.

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    Parkinsons Disease Diet And Nutrition

    Maintaining Your Weight With Parkinsons Disease

    Malnutrition and weight maintenance is often an issue for people with Parkinsons disease. Here are some tips to help you maintain a healthy weight.

    • Weigh yourself once or twice a week, unless your doctor recommends weighing yourself often. If you are taking diuretics or steroids, such as prednisone, you should weigh yourself daily.
    • If you have an unexplained weight gain or loss , contact your doctor. He or she may want to modify your food or fluid intake to help manage your condition.
    • Avoid low-fat or low-calorie products. . Use whole milk, whole milk cheese, and yogurt.

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    Stage One Of Parkinsons Disease

    In stage one, the earliest stage, the symptoms of PD are mild and only seen on one side of the body , and there is usually minimal or no functional impairment.

    The symptoms of PD at stage one may be so mild that the person doesnt seek medical attention or the physician is unable to make a diagnosis. Symptoms at stage one may include tremor, such as intermittent tremor of one hand, rigidity, or one hand or leg may feel more clumsy than another, or one side of the face may be affected, impacting the expression.

    This stage is very difficult to diagnose and a physician may wait to see if the symptoms get worse over time before making a formal diagnosis.

    What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms

    Ideal Cure...: Parkinson

    Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.

    Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.

    Preventing falls and maintaining balance: Falls are a frequent complication of Parkinsons. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.

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