Conflict Of Interest Statement
Dr Isaacson has received honoraria and/or research grant support from the following pharmaceutical companies: Acadia, Allergan, Boehringer Ingelheim, Chelsea, Eisai, GlaxoSmithKline, Ipsen, Medtronics, Merck, Merz, Neurogen, Novartis, Ortho-McNeil, Pfizer, Santhera, Schwarz Pharma, Serono, Schering Plough, Solstice, Solvay, Teva, UCB Pharma, Valeant, Vernalis.
Dr Hauser has received honoraria from the following pharmaceutical companies for consulting, advisory or speaking service: Allergan Neuroscience, AlphMedica, ApotheCom, Axis Health Care, Bayer-Shering, Boehringer Ingelheim, CNS Schering Plough, Centopharm, Embryon, Eisai, Genzyme, GlaxoSmithKline, Impax, Ipsen Pharmaceuticals , Kyowa Pharmaceutical, Merck, Novartis, Ortho McNeil, Pfizer, Prestwick, Quintiles, Santhera, Schwarz Pharma, Schering Plough, Solvay, Teva Neuroscience, Valeant, Vernalis .
Stages Of Parkinsons Disease
Neurologists usually describe the progression of Parkinsons symptoms in stages, using the system known as the Hoehn and Yahr scale. These stages are:
- Stage I Symptoms are seen on one side of the body only.
- Stage II Symptoms are seen on both sides of the body. Theres no impairment of balance.
- Stage III Balance impairment has begun. In this mild- to moderate stage of the disease, the person is still physically independent.
- Stage IV This stage is marked by severe disability, but the person is still able to walk or stand unassisted.
- Stage V The person is wheelchair-bound or bedridden unless assisted.
What Causes Parkinsons Symptoms
While Parkinsons diseases impact on the brain is better understood today, the cause of the condition is unknown. Research points to a combination of environmental and genetic factors. Scientists are looking for links between Parkinsons disease and genetics, aging, toxins in the environment, and free radicals, which react with certain chemicals in the body and may interfere with the ability of cells to function normally.
The process of impairment of brain cells is called neurodegeneration. When approximately 60 to 80 percent of the dopamine-producing cells are damaged, the motor symptoms of Parkinsons disease appear. This results in an aggravation of motor and non motor symptoms.
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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.
Parkinsons Disease Impacts Estimated 1 Million Americans
Parkinsons disease is a neurological disorder that leads to motor symptoms such as shaking and difficulty with movement and coordination. The brain disorder affects an estimated 1 million Americans and 7 to 10 million people worldwide. Approximately 60,000 Americans are diagnosed with PD each year, according to the National Institutes of Health. This article will provide information on Parkinsons early signs and symptoms and help answer the question what is Parkinsons?
The 5 Stages Of Parkinsons Disease
Getting older is underrated by most. Its a joyful experience to sit back, relax and watch the people in your life grow up, have kids of their own and flourish. Age can be a beautiful thing, even as our bodies begin to slow down. We spoke with David Shprecher, DO, movement disorders director at Banner Sun Health Research Institute about a well-known illness which afflicts as many as 2% of people older than 65, Parkinsons Disease.
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Progress Toward Fda Approval
It will be a while yet, however, before Hoque and his researchers can start seeking permission to analyze peoples selfies, or even before neurologists can deploy the five-pronged test that the researchers have developed.
An algorithm will never be 100 percent accurate, Hoque says. What if it makes a mistake? We want to be very careful and follow guidance from the FDA if we want anybody from any part of the world to try this and get an assessment.
Moreover, there is a whole family of movement disorders that are closely related to Parkinsons disease, including ataxia, Huntingtons disease, progressive supranuclear palsy, and multiple dystrophy.
They all share similar symptoms of tremor, but the tremors are very different in nature, Hoque says. However, even expert neurologists find it very, very difficult to distinguish among them.
The researchers have made great progress in detecting Parkinsons disease by automatically analyzing expressions, voice and motor movements. Yet further work is needed to develop algorithms to differentiate how these involuntary tremors differ across other movement disorders, including Ataxia and Huntingtons.
We cant tell that just yet, Hoque says. But we are in a pursuit of differentiating those tremors using AI to prevent the potential harm of misdiagnosis while maximizing benefit.
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What Are Lewy Bodies
The affected neurons of people with Parkinsons disease have been found to contain clumped proteins called Lewy bodies, but researchers arent yet sure why Lewy bodies form or what role they play in the disease.
Lewy bodies are clumps of a protein called alpha-synuclein . Neurons cant break down these protein clumps, which may lead to the death of these cells.
Some other theories about what causes the death of brain cells in people with Parkinsons disease include free radical damage, inflammation, or toxins.
Tips For Better Sleep
- Keep a regular sleep schedule go to bed at the same time and get up at the same time.
- Choose your bedtime based on when you want to get up. Plan to spend seven to eight hours a night in bed.
- Make a bedtime routine for example, snack, bath, tooth-brushing, toileting and follow it every evening.
- Spend time outdoors and exercise every day, in the morning if possible. Avoid exercise after 8:00 p.m.
- If you cant get outdoors, consider light therapy sitting or working near a light therapy box, available at drug stores and department stores.
- If you nap, try to do so at the same time every day, for no more than an hour, and not after 3:00 p.m.
- Sleep in a cool dark place and use the bed only for sleeping and sexual activity.
- Do not read or watch television in bed.
- Use satin sheets and pajamas to make moving in bed easier.
- Minimize drinking liquids for three hours before bedtime to avoid frequent nighttime urination.
- Go to the bathroom immediately before retiring.
- Place a commode next to the bed, to minimize the effort, and light to get up during the night.
- Alcohol, caffeine and other stimulants such as nicotine
- Heavy late-night meals
- Heavy exercise within six hours of bedtime
- Thoughts or discussions before bedtime about topics that cause anxiety, anger or frustration
- Clock watching
- Screen time television, phones, tablets one or two hours before bed.
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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.
What Are The Stages Of Parkinsons
Every case of Parkinsons is different and so is the progression of the disease. The disease is typically diagnosed in those who are 60 or older, but there are instances where a diagnosis is made much earlier. The Parkinsons Foundation recognizes five stages of the disease based on the severity of symptoms.
Studies Of Patients With Non
The Parkinsons Associated Risk Study is an ongoing large study whose goal is to evaluate specific tests for their ability to predict an increased risk of PD. The ultimate goal is to find a set of tests that can predict the future development of PD. The study has evaluated smell tests, questionnaires that probe mood, bowel habits and sleep disorders, as well as the dopamine transporter imaging test, commonly referred to as DaTscan.
A DaTscan involves injecting a small amount of a radioactive tracer into the bloodstream. The tracer makes its way into the brain and binds to the dopamine transporters, which are molecules on the surface of the dopamine neurons. In PD, there are fewer of these neurons and therefore there is less uptake of the tracer in the brain. A brain scan then determines if the amount of uptake of the tracer is normal or decreased. Currently, this test is approved to distinguish between PD and a neurologic condition known as essential tremor, a tremor disorder which is not caused by an abnormality of the dopamine system.
DaTscan is not yet approved to determine if patients who are experiencing only the non-motor symptoms of PD, in fact have PD. However, it is known that a DaTscan can be abnormal even before motor symptoms are present. The PARS study is investigating whether in the future, a DaTscan can be part of an algorithm to determine who is at risk of developing PD.
Tips and takeaways
Dr. Rebecca Gilbert
APDA Vice President and Chief Scientific Officer
Parkinson’s Disease Diet And Nutrition
Maintaining Your Weight With Parkinson’s Disease
Malnutrition and weight maintenance is often an issue for people with Parkinson’s 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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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.
Different medical drugs have been implicated in cases of parkinsonism. Drug-induced parkinsonism is normally reversible by stopping the offending agent. Drugs include:
What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
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What Is The Treatment For Parkinson’s Disease
There is currently no treatment to cure Parkinson’s disease. Several therapies are available to delay the onset of motor symptoms and to ameliorate motor symptoms. All of these therapies are designed to increase the amount of dopamine in the brain either by replacing dopamine, mimicking dopamine, or prolonging the effect of dopamine by inhibiting its breakdown. Studies have shown that early therapy in the non-motor stage can delay the onset of motor symptoms, thereby extending quality of life.
The most effective therapy for Parkinson’s disease is levodopa , which is converted to dopamine in the brain. However, because long-term treatment with levodopa can lead to unpleasant side effects , its use is often delayed until motor impairment is more severe. Levodopa is frequently prescribed together with carbidopa , which prevents levodopa from being broken down before it reaches the brain. Co-treatment with carbidopa allows for a lower levodopa dose, thereby reducing side effects.
In earlier stages of Parkinson’s disease, substances that mimic the action of dopamine , and substances that reduce the breakdown of dopamine inhibitors) can be very efficacious in relieving motor symptoms. Unpleasant side effects of these preparations are quite common, including swelling caused by fluid accumulation in body tissues, drowsiness, constipation, dizziness, hallucinations, and nausea.
Surgical Options For Parkinsons Disease
As of 2019, there are two surgeries prescribed to treat Parkinsons. These are only ordered if medications previously helped control movement symptoms but are no longer effective.
The first is called deep brain stimulation. The surgeon inserts a wire, or lead, into the subthalamic nucleus, which is the part of the brain that controls movement. The wire extends to an external device called a neurostimulator. This sends electrical pulses through the lead to stimulate the subthalamic nucleus.
The second surgery is prescribed in cases where the patient suffers too many side effects from the levodopa or requires too strong a dose. A surgeon inserts a tube in the small intestine, through which the patient receives doses of carbidopa. This enhances the effect of levodopa, allowing the patient to receive a smaller dose.
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Is There A Way To Slow The Progress Of Parkinson’s
Parkinson’s disease is a progressive disorder, which means its symptoms worsen slowly over time. There is no cure for Parkinson’s disease yet and no known way to slow its progress.
But there are treatments and medications that can control or reduce the symptoms and help people live productive lives. Some research suggests that regular exercise may slow the progress of Parkinson’s. Physical activity can also alleviate stiffness and other symptoms.
There are other things a person can do to feel better after a diagnosis of Parkinson’s, such as joining social support groups and learning as much as possible about the disease. It’s also important to make the home safer and less cluttered, since a person with Parkinson’s is more likely to fall.
While it’s not always easy, neurologists say a positive mindset can also help.
What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms
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 Parkinson’s. 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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How Many People Have Parkinsons Disease
Worldwide, there are more than 10 million Parkinsons patients and the Parkinsons Foundation predicts nearly 1 million Americans will have PD by 2020. Each year, the U.S. sees around 60,000 new diagnoses. Age and gender are the greatest risk factors. Around 96 percent of patients are over the age of 50 and men are around 1.5 times more likely to have PD.
Tapering And Discontinuing Das
Recommendation 5 Rationale
Adverse effects associated with DAs can lead to substantial impairments in psychosocial functioning, interpersonal relationships, and quality of life for the patient and caregivers. The consequences of medication-related adverse effects may be mitigated through adjustments to prescribed medications, including DAs, or through additional behavioral or pharmacologic interventions, if appropriate.
Patients may experience undesirable side effects when attempting to decrease dopaminergic medications, especially DAs, including dopamine agonist withdrawal syndrome or low mood and apathy. These side effects can make it difficult to taper or discontinue DAs. Staged reduction in dosing may reduce the severity of withdrawal symptoms and improve compliance with medication recommendations.
Recommendation 5 Statements
5a. Clinicians should recommend tapering or discontinuation of DAs if patients experience disabling medication-related adverse effects, including ICDs, EDS, sudden-onset sleep, cognitive impairment, or hallucinations .
5b. When DAs must be discontinued due to adverse effects, clinicians should monitor patients for symptoms of DAWS and, when possible, gradually decrease the dosage to minimize symptoms .