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.
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.
How Do I Prevent Falls From Common Hazards
- Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
- Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
- Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
- Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
- Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
- Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.
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General Characteristics Of The Studies
In general, the studies were accomplished in Europe and USA . The number of channels varied between 2 and 128 , and the most utilized analysis method was the event related potential in different conditions . Other methods used were spectral analyses focused in alpha and beta frequency band , and somatosensorial evoked potential .
Methodological characteristics of EEG in the included studies
CNV, contingent negative variation; EEG, electroencefalography; ERD, event related desynchronization; ERO, event related oscillations; ERP, event related potential; ERS, event related synchronization; FFT, fast Fourrier Transform; Hz, hertz; NA, not applied; ND, not described; PD, Parkinsons disease; PS, power spectral analysis; SEP, somatosensory evoked potential.
The task during EEG executed by the volunteers consisted in upper limb movement or a balance task . Nine studies evaluated the participants in the resting .
We decided not to realize the quantitative analysis of the data because the acquisition and analysis EEG protocols were highly different among the studies . The studies results were summarized in Table;1.
Device Description And Outcomes That Can Be Measured
Ambulatory Parkinsons Disease Monitoring is both the name of the system as well as the company. The analysis software is called the Mobility Lab. The system comes with a Clinical Data Management System called Mobility Exchange.
It is a watch-sized device consisting of up to six sensors and hold a charge for over 16;h. It enables the registration of different outcomes such as, postural sway – ISway , lower limb gait , postural transitions , upper limb gait and trunk measures.
The software has several modules such as iSway and iTUG . The iTUG test enables the assessment of different parameters in all sub-tasks of the test: sit to stand ; gait and trunk movements; turning ; and Turn to sit .
Quantitative Electroencephalography Characteristics For Parkinsons Disease: A Systematic Review
Article type: Review Article
Affiliations: Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil | Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil | Neurodinamics Laboratory, Department of Physiology, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
Correspondence: Correspondence to: Katia Monte-Silva, Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil. Tel.: +55 81 2126 7579; E-mail:.
Keywords: Parkinsons disease, electroencephalography, biomarker, tremor dominant, postural instability/gait difficulty
Journal: Journal of Parkinson’s Disease, vol. 10, no. 2, pp. 455-470, 2020
Cortical Biomarkers Of Pd Patients In Resting State And During Movement
The spectral analysis of included studies in resting demonstrated an increase of spectral power of slower band waves and a decrease of faster band waves suggesting a slowing down of PD patients cortical activity. Similarly, a recent systematic review identifies lower dominant frequency or increased theta power in PD patients . The slowing down of cortical waves seems to related to some motor impairment as the bradykinesia at OFF state and freezing . Whereas the decrease of beta frequency band seems to be associated to general motor function impairment in PD .
During movement when compared to healthy subjects, we found an qEEG abnormal pattern , mainly in the contralateral cortex to the movement, in PD patients with motor impairment who performed complex task . However, some studies which the patients performed simple task failed to find this abnormality. This discrepancy could be justified by the difference of the complexity of tasks performed among the studies. More complex tasks would require higher cortical activation that are not observed during simple task . Moreover, Van den Heuvel and colleagues showed that PD patients seem to present higher power modulation of beta band during a task with incongruent visual feedback . In the same research, there was no difference between PD and controls during a task with visual feedback presented in real time .
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Review Of Literature And Searching In Databases
The systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines . An extensive literature search was conducted using the following databases: Medline , LILACS , Web of Science, CINAHL , and CENTRAL Cochrane library.
The descriptors used for the search strategy in all databases were: electroencephalography and Parkinson Disease, using the Boolean operator AND. The subheadings diagnosis, diagnostic imaging and analysis were applied for the search in the Medline database. None filter was applied in the search strategy. All searches were conducted in September 2019.
Two authors performed the search strategies and, independently, identified the articles that met the eligibility criteria from the reading of titles and abstracts. Any disagreements between reviewers were resolved by a third reviewer . Next, full-text studies were retrieved to verify the study eligibility and further advice was sought from a third reviewer when there was any disagreement. Cohen kappa for interrater agreement was calculated through the SPSS v. 23 for Windows.
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.
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How Is Parkinsons Disease Treated
While there is no known cure for PD, medications such as levadopa, which increases levels of dopamine, in the brain help control the symptoms. Another treatment is deep brain stimulation, which requires surgery to implant a probe in the brain that helps control the activity of the neurons in brain areas that control movement. These treatments can often manage or improve the motor symptoms. However, much more scientific research is needed to find treatments that stop the progression of the disease and treatments that help alleviate the non-motor symptoms.
It is also important to note that all the above-mentioned symptoms can be found in other diseases. Therefore, it is critical to visit a doctor, especially a movement disorders specialist, to diagnose and treat PD.
Possible Ways To Improve The Electrophysiology Biomarker
The measures examined here are only robust when there is a dominant waveform present. While this can be accessed by examining power spectral density , examining presence of spectral power for specific frequencies with cycle-by-cycle specificity would offer improved precision. Such algorithms are currently in development or becoming newly available .
Considering waveform shape as an inclusion-criteria for our group analyses improved the effect size, suggesting that development of a method to extract waveforms of a specific shape from a signal might result in an even more powerful biomarker. This may be especially important for EEG data, which is more likely to suffer from lower signal-to-noise ratio. Therefore, developing a method to select only data with specific shapes, perhaps by building a filter which only extracts signals with a canonical sensorimotor shape , might improve classification since it would isolate data with prototypical patterns consistent with a sensorimotor origin. Additionally, this filter could also be used to detect oscillatory bursts with this shape within the frequency range or to index the cycle-to-cycle variation in a signal . Alternatively, principal component analysis could be used to create an optimal waveform shape metric that is comprised of weighted components of each waveform measure.
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Is Parkinsons Disease Inherited
Scientists have discovered gene mutations that are associated with Parkinsons disease.
There is some belief that some cases of early-onset Parkinsons disease disease starting before age 50 may be inherited. Scientists identified a gene mutation in people with Parkinsons disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinsons disease and in people with a type of dementia called Lewy body dementia.
Several other gene mutations have been found to play a role in Parkinsons disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinsons disease.
Scientists think that about 10% to 15% of persons with Parkinsons disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.
Data Extraction And Analysis
The data for bias risk assessment was performed independently by the two authors . For the bias risk analysis, only the following aspects were observed: Blinding of participants and personnel ; Blinding of outcome assessment ; Incomplete outcome data ; Selective reporting ; Other bias. A graph for bias risk analysis was constructed using Revman software version 5.6.
Relevant data as the study information, sample characteristics and EEG parameters were extracted independently using a standardized data extraction form. We also performed the calculation of levodopa equivalent dosage , using the tool Levodopa Equivalent Dose Calculator, available in parkinsonsmeasurement.org.
The data of each group were presented as means and standard deviation . When means and SDs were not provided, median values were considered to be equal to mean values if data were normally distributed and interquartile ranges were divided by 1.35 to obtain the SD . If necessary, we also calculated the SD from confidence interval data informed in the studies as recommended by Chapter 7 of Cochrane Handbook .
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Diagnosis Of Parkinsons Disease
A number of disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, may help to distinguish them from Parkinson’s. Since many other diseases have similar features but require different treatments, it is important to make an exact diagnosis as soon as possible.
There are currently no blood or laboratory tests to diagnose nongenetic cases of Parkinson’s disease. Diagnosis is based on a person’s medical history and a neurological examination. Improvement after initiating medication is another important hallmark of Parkinson’s disease.
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.
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Potential Biases Of Studies
The studies that assessed qEEG in PD patients had small sample size and potential critical biases. Indeed, the most of studies presented no sample size calculation and blinding of qEEG analyst. Blinding analysis is considered the only way to trust results and a precise and accurate conclusion with lesser probability to leading a type II error can only be made by an appropriate sample size . Thus, the results of our study should be extrapolated with caution.
Other minor biases of included studies could be cited, as the lack of the information about medication intake dosage, H&Y stage and motor subtypes of the patients. The clinical sample characteristics are relevant to external validity of findings. Moreover, PD prognosis seems to be linked to stage of the disease and subtypes classification , reinforcing the importance of the adequate description of clinical data.
What Are The Surgical Treatments For Parkinsons Disease
Most patients with Parkinsons disease can maintain a good quality of life with medications. However, as the disease worsens, medications may no longer be effective in some patients. In these patients, the effectiveness of medications becomes unpredictable reducing symptoms during on periods and no longer controlling symptoms during off periods, which usually occur when the medication is wearing off and just before the next dose is to be taken. Sometimes these variations can be managed with changes in medications. However, sometimes they cant. Based on the type and severity of your symptoms, the failure of adjustments in your medications, the decline in your quality of life and your overall health, your doctor may discuss some of the available surgical options.
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Medicines For Parkinson’s Disease
Medicines prescribed for Parkinson’s include:
- Drugs that increase the level of dopamine in the brain
- Drugs that affect other brain chemicals in the body
- Drugs that help control nonmotor symptoms
The main therapy for Parkinson’s is levodopa, also called L-dopa. Nerve cells use levodopa to make dopamine to replenish the brain’s dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapysuch as nausea, vomiting, low blood pressure, and restlessnessand reduces the amount of levodopa needed to improve symptoms.
People with Parkinson’s should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, such as being unable to move or having difficulty breathing.
Other medicines used to treat Parkinsons symptoms include:
- Dopamine agonists to mimic the role of dopamine in the brain
- MAO-B inhibitors to slow down an enzyme that breaks down dopamine in the brain
- COMT inhibitors to help break down dopamine
- Amantadine, an old antiviral drug, to reduce involuntary movements
- Anticholinergic drugs to reduce tremors and muscle rigidity
Demographic Characteristics And Clinical Symptoms
Basic information was collected from all participants including age, sex, years of education, age at PD onset, PD duration, and body mass index . Total daily antiparkinsonian drugs were estimated as LED.
Motor symptom severity was assessed using part III of the Movement Disorders Society Unified Parkinsons disease rating scale and H&Y. PD participants were then classified as PD-FOG if they answered yes to the third question of the Freezing of Gait Questionnaire and classified as PD-FOG if their answer was no. Balance function was assessed via the Tinetti mobility test, which included balance gait scores. Activities of daily living involved basic ADL and instrumental ADL . The Hamilton Depression Scale and Hamilton Anxiety Scale were used to measure depression and anxiety symptoms, respectively. The Neuropsychiatric Inventory Questionnaire was used to evaluate participants neuropsychiatric symptoms. All PD patients were assessed in the practical On medication state.
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The Characteristics And Treatment Patterns Of Patients With Parkinsons Disease In The United States And United Kingdom: A Retrospective Cohort Study
Roles Conceptualization, Formal analysis, Methodology, Writing review & editing
Affiliation UCB Pharma, Slough, United Kingdom
Roles Conceptualization, Formal analysis, Methodology, Writing review & editing
Affiliation UCB Pharma, Slough, United Kingdom
Roles Conceptualization, Methodology, Writing review & editing
Affiliation UCB Pharma, Raleigh, North Carolina, United States of America