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Tell Me About Parkinson’s

Who Does The Disease Affect

Faces of Parkinson’s

There are an estimated 1 million people in the U.S. living with Parkinsons disease and more than 10 million people worldwide. Most people who develop the symptoms of Parkinsons disease do so sometime after the age of 50, but Parkinsons disease can affect younger persons as well. Approximately 10% of Parkinsons diagnoses occur before age 50these diagnoses are called Early Onset Parkinsons disease.

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

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.

How Will My Doctor Test For It

There’s no one test for Parkinson’s. A lot of it’s based on your symptoms and health history, but it could take some time to figure it out. Part of the process is ruling out other conditions that look like Parkinson’s. The docotor may do a DaT scan, which looks for dopamine in the brain. This can aid in a diagnosis.

Because there is no single test, it’s very important to go to a doctor who knows a lot about it, early on. It’s easy to miss.

If you do have it, your doctor might use what’s called the Hoehn and Yahr scale to tell you what stage of the disease you’re in. It ranks how severe your symptoms are from 1 to 5, where 5 is the most serious.

The stage can help you get a better feel for where your symptoms fall and what to expect as the disease gets worse. But keep in mind, some people could take up to 20 years to move from mild to more serious symptoms. For others, the change is much faster.

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How Is It Diagnosed

Diagnosing Parkinson’s disease is mostly a clinical process, meaning it relies heavily on a healthcare provider examining your symptoms, asking you questions and reviewing your medical history. Some diagnostic and lab tests are possible, but these are usually needed to rule out other conditions or certain causes. However, most lab tests aren’t necessary unless you don’t respond to treatment for Parkinson’s disease, which can indicate you have another condition.

Other Causes Of Parkinsonism

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“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.

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What Causes The Condition

Although there are several recognized risk factors for Parkinsons disease, such as exposure to pesticides, for now, the only confirmed causes of Parkinsons disease are genetic. When Parkinsons disease isnt genetic, experts classify it as idiopathic . That means they dont know exactly why it happens.

Many conditions look like Parkinson’s disease but are instead parkinsonism from a specific cause like some psychiatric medications.

Familial Parkinsons disease

Parkinsons disease can have a familial cause, which means you can inherit it from one or both of your parents. However, this only makes up about 10% of all cases.

Experts have linked at least seven different genes to Parkinson’s disease. They’ve linked three of those to early-onset of the condition . Some genetic mutations also cause unique, distinguishing features.

Idiopathic Parkinsons disease

Experts believe idiopathic Parkinsons disease happens because of problems with how your body uses a protein called -synuclein . Proteins are chemical molecules that have a very specific shape. When some proteins dont have the correct shape a problem known as protein misfolding your body cant use them and can’t break them down.

With nowhere to go, the proteins build up in various places or in certain cells . The buildup of these Lewy bodies causes toxic effects and cell damage.

Induced Parkinsonism

The possible causes are:

Symptoms Of Parkinsons Disease

Parkinsons has four main symptoms:

  • Tremor in hands, arms, legs, jaw, or head
  • Muscle stiffness, where muscle remains contracted for a long time
  • Slowness of movement
  • Impaired balance and coordination, sometimes leading to falls

Other symptoms may include:

The symptoms of Parkinsons and the rate of progression differ among individuals. Early symptoms of this disease are subtle and occur gradually. For example, people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinsons. They may see that the persons face lacks expression and animation, or that the person does not move an arm or leg normally.

People with Parkinson’s disease often develop a parkinsonian gait that includes a tendency to lean forward take small, quick steps and reduce swinging their arms. They also may have trouble initiating or continuing movement.

Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other.

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Trouble Moving Or Walking

Do you feel stiff in your body, arms or legs? Have others noticed that your arms dont swing like they used to when you walk? Sometimes stiffness goes away as you move. If it does not, it can be a sign of Parkinson’s disease. An early sign might be stiffness or pain in your shoulder or hips. People sometimes say their feet seem stuck to the floor.What is normal?If you have injured your arm or shoulder, you may not be able to use it as well until it is healed, or another illness like arthritis might cause the same symptom.

Myth : Parkinsons Disease Is Fatal

What is Parkinson’s Disease?

Fact: Although a diagnosis of Parkinsons is devastating, it is not as some people may still believe a death sentence. Parkinsons disease is not a direct killer, like stroke or heart attack. That said, much depends on the quality of your care, both from your medical team and yourself.

As the disease progresses, you may become more vulnerable to falls, which can be dangerous. Thats why exercise and physical therapy are so important.

Infection is another problem. In later stages of Parkinsons, people often miss those signals and may not notice somethings up until its too late. That can be, literally, a killer so be sure to stay up to date with checkups.

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Treating The Symptoms Of Parkinsons Diseasehow Palliative Care Can Help

While there is no cure for Parkinsons disease, there are a growing number of treatments that can provide you with relief from its symptoms. People with Parkinsons disease are often prescribed a combination of levodopa and carbidopa, which helps replenish the brains shrinking supply of dopamine.

A new therapy uses electrodes surgically implanted inside the brain, and a small electrical device called a pulse generator to provide electrical deep brain stimulation . Parkinsons patients also benefit from the expertise of physical, occupational and speech therapists to help them manage practical issues in their daily lives.

Other symptoms of Parkinsons disease include a variety of motion-related issues, as well as sleep disturbances, fatigue , constipation and other gastrointestinal problems, and low blood pressure.

Another whole area of Parkinsons symptoms is called cognitive decline, whereby ravages of the disease affect thinking and other uses of the brain. These include troubling mood disorders like depression and anxiety, unclear thinking, difficulty concentrating on a task and the potential emergence of dementia.

Some people become more disabled and dependent over time despite the best treatments. They may come to need so much help with the routine tasks of living that they require 24-hour care. This care may be provided at home or in a setting like assisted living, where they get the personal care they need.

Related Diagnosis: Lewy Body Dementia

Current research is helping to differentiate dementia related conditions in relationship to Parkinsonâs disease. Doctorâs use a 12-month arbitrary rule to aid in diagnosis. When dementia is present before or within 1 year of Parkinsonâs motor symptoms developing, an individual is diagnosed with DLB. Those who have an existing diagnosis of Parkinsonâs for more than a year, and later develop dementia, are diagnosed with PDD.

In the simplest terms, Lewy bodies are abnormal clumps of proteins that develop in nerve cells. Cholinesterase inhibitors, medications originally developed for Alzheimerâs disease, are the standard treatment today for cognitive DLB and PDD symptoms. Early diagnosis is important, as DLB patients may respond differently than Alzheimerâs disease patients to certain drug, behavioral, and dementia care treatments.

This challenging, multi-system disorder involving movement, cognition, behavior, sleep, and autonomic function requires a comprehensive treatment approach to maximize the quality of life for both the care recipient and their caregiver. It is very important to pay attention to symptoms of dementia and to search for an expert clinician who can diagnose the condition accurately.

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Myth : Parkinsons Is Only A Motor Condition

Fact: While its true that Parkinsons disease symptoms include shaking and tremor, rigid muscles, slowness of movement, and a frozen or flat expression, its a lot more than that.

Nonmotor symptoms deserve and are getting more attention from doctors and researchers. These symptoms include cognitive impairment or dementia , anxiety and depression, fatigue, sleep problems and more.

For some patients, nonmotor symptoms are more disabling than motor symptoms, which are the focus of treatment. Be sure to talk to your doctor about other issues so you can get all of your symptoms addressed.

What Are The Symptoms Of Parkinson Disease

10 Things Your Doctor Won

Parkinson disease symptoms usually start out mild, and then progressively get much worse. The first signs are often so subtle that many people dont 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

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What Are The Early Warning Signs Of Parkinson’s Disease

Parkinsons warning signs can be motor symptoms like slow movements, tremors or stiffness. However, they can also be non-motor symptoms. Many of the possible non-motor symptoms can appear years or even decades ahead of motor symptoms. However, non-motor symptoms can also be vague, making it difficult to connect them to Parkinson’s disease.

Non-motor symptoms that might be early warning signs include:

How Does Parkinsons Disease Affect The Brain

Explaining the Science Behind Parkinsons Disease

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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How Is Parkinsons Disease Diagnosed

There arent any specific tests to diagnose someone with Parkinsons disease.

Doctors typically make a diagnosis based on the following:

  • Medical history
  • Blood and lab tests

Sometimes, people who have a known inherited form of Parkinsons disease can take a gene test to determine their risk for developing the disease.

Walking Or Gait Difficulties

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Bradykinesia and postural instability both contribute to walkingor gaitdifficulties in Parkinsons, particularly as the disease progresses. A common, early symptom of Parkinsons disease is a decrease in the natural swing of one or both arms when walking. Later, steps may become slow and small, and a shuffling gait may appear. Gait problems in Parkinsons disease can also include a tendency to propel forward with rapid, short steps . People with advanced Parkinsons disease may experience episodes of freezing, in which the feet appear to be glued to the floor.

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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.

Signs Of Parkinsons Disease

In 1817, Dr. James Parkinson published An Essay on the Shaking Palsy describing non-motor, as well as, motor symptoms of the illness that bears his name. Parkinsons is not just a movement disorder, explained Dr. Shprecher. Constipation, impaired sense of smell, and dream enactment can occur years before motor symptoms of Parkinsons. The latter, caused by a condition called REM sleep behavior disorder, is a very strong risk factor for both Parkinsons and dementia . This has prompted us to join a consortium of centers studying REM sleep behavior disorder.

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Complementary And Alternative Therapies

Some people with Parkinson’s disease find complementary therapies help them feel better. Many complementary treatments and therapies claim to ease the symptoms of Parkinson’s disease.

However, there’s no clinical evidence they’re effective in controlling the symptoms of Parkinson’s disease.

Most people think complementary treatments have no harmful effects. However, some can be harmful and they shouldn’t be used instead of the medicines prescribed by your doctor.

Some types of herbal remedies, such as St John’s wort, can interact unpredictably if taken with some types of medication used to treat Parkinson’s disease.

If you’re considering using an alternative treatment along with your prescribed medicines, check with your care team first.

How Parkinsons Disease Affects The Brain

Parkinson

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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Myth : Parkinsons Medications Cause Symptoms

Fact: Even though the myth that Parkinsons disease medicines are toxic and make the condition progress faster was completely debunked, it persists. Levodopa is the main drug therapy for Parkinsons disease. Its a potent drug that helps patients with motor symptoms. But many people got the idea that over time, it makes the disease progress faster. The myth was that levodopa is somehow toxic and is somehow making the Parkinsons progression faster, hurting patients.

This misconception was debunked decades ago with a large clinical trial, where it was found that people exposed to levodopa versus a placebo werent worse. In fact, they were better at the end of the study.

Its true that levodopa isnt a cure as yet, there is no cure for Parkinsons disease but its not toxic.

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