Stooping Or Hunched Posture
People who have Parkinsons disease may notice changes in their posture due to other symptoms of the disease, such as muscle rigidity.
People naturally stand so that their weight is evenly distributed over their feet. However, people who have Parkinsons disease may start bending forward, making them appear hunched or stooped over.
Dementia With Lewy Bodies
- Dementia with Lewy bodies is a progressive, neurodegenerative disorder in which abnormal deposits of a protein called alpha-synuclein build up in multiple areas of the brain.
- DLB first causes progressive problems with memory and fluctuations in thinking, as well as hallucinations. These symptoms are joined later in the course of the disease by parkinsonism with slowness, stiffness and other symptoms similar to PD.
- While the same abnormal protein is found in the brains of those with PD, when individuals with PD develop memory and thinking problems it tends to occur later in the course of their disease.
- There are no specific treatments for DLB. Treatment focuses on symptoms.
Stooping Or Hunching Over
Are you not standing up as straight as you used to? If you or your family or friends notice that you seem to be stooping, leaning or slouching when you stand, it could be a sign of Parkinson’s disease .
What is normal?If you have pain from an injury or if you are sick, it might cause you to stand crookedly. Also, a problem with your bones can make you hunch over.
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Link Between Parkinsons Disease And Als
Parkinsons disease and ALS are a lot more similar than you may think. The two neurological diseases share neurons that are highly sensitive to stress, misfolded proteins and reduced protein recycling, toxic proteins that spread from neuron to neuron, and neuroinflammation which is triggered by the immune system and aggravates the condition.
These commonalities between ALS and Parkinsons disease allow researchers to better hone in on more effective treatments for both diseases.
New Medications For Off Time
A number of new medications approved recently are designed to reduce OFF time. These medications fall into two major categories:
- Medications that lengthen the effect of a carbidopa/levodopa dose
- Medications that are used as needed if medication effects wear off
Well give specific examples below. In general, new medications that extend the length of a carbidopa/levodopa dose are used if OFF time is somewhat predictable and occurs prior to next dose. New medications that are used as needed are most beneficial when OFF time is not predictable.
New medications that lengthen the effect of a dose of carbidopa/levodopa
- Istradefylline is an adenosine A2A receptor antagonist which was approved in the US in 2019 as an add-on therapy to levodopa for treatment of OFF time in PD. Unlike many of the other medications, it has a novel mechanism of action and is the first medication in its class to be approved for PD. It acts on the adenosine receptor, which modulates the dopaminergic system, but is not directly dopaminergic. The drug was developed in Japan and underwent clinical trials both in Japan and in the US.
- Opicapone is a catechol-O-methyltransferase inhibitor that is taken once a day. It was approved in the US in 2020 as an add-on therapy to levodopa for motor fluctuations.
New formulations of levodopa designed to be used as needed if medication effects wear off
Other medications used as needed if medication effects wear off
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Conditions That Can Cause Tremors Besides Parkinsons:
The tremor of Parkinsons disease occurs even at rest. Hence it is called a rest tremor. Very few other conditions produce rest tremor.
But, many other diseases produce a tremor which is seen only when moving, for example when writing. This is called an Action tremor or posturokinetic tremor. Even these diseases are sometimes misdiagnosed as Parkinsons disease.
|Causes of Rest Tremor
2. Excessive stress, coffee or smoking
3. Medications such as bronchodilators, valproate and lamotrigine
4. Chromosomal problems such as Fragile-X syndrome
5. Parkinsons disease itself!
And many others
Parkinsons Disease Vs Als Differences In Symptoms Causes And Treatment
Written byDevon AndrePublished onJuly 25, 2016
Parkinsons disease and ALS can cause difficulties in movement and are both known to be progressive neurological diseases.
ALS is part of a cluster of disorders known as motor neuron diseases that involve gradual degeneration and death of motor neurons. In a healthy individual, messages from motor neurons in the brain are transmitted to the motor neurons in the spinal cord and sent to the particular muscles. In ALS, this communication degenerates and cells begin to die. As a result, the message that is transmitted is incomplete. Unable to function, the muscles begin to weaken and waste away over time. Eventually, communication from the brain to muscles is lost completely.
In its early stage, ALS also known as Lou Gehrigs disease may appear as Parkinsons disease, which is also a neurological disease similar to ALS. Here we will outline the causes, symptoms, and treatment options for both ALS and Parkinsons disease to help you understand the differences between the two.
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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.
Possible Link To Alzheimers
Though Alzheimers, Huntingtons, and Parkinsons are distinctly different diseases, some evidence has emerged that shows a common link between the three.
All three diseases have proteins within the cells that do not assemble properly. Though the molecular and cellular changes that occur in each disease vary greatly, this protein degradation has been shown to precede early clinical signs in each disease. This is promising news, as more studies are being done to determine whether this can either predict or prevent these neurodegenerative diseases.
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Comparing Parkinsons Disease And Als Causes
When certain nerve cells in the brain begin to die or break down that is what causes Parkinsons disease, but why this occurs is unclear. Some factors that contribute to nerve cell death include genetics as specific gene mutations have been identified to contribute to Parkinsons disease, environmental factors such as exposure to certain toxins, the presence of Lewy bodies in the brain, as well as alpha-synuclein found in Lewy bodies.
There are many unanswered questions about ALS, including the root cause. What we do know is that nerve cells that control the movement of muscles gradually die in ALS patients.
Researchers around the world continue to investigate the possible causes of ALS, including whether the immune system plays a role in attacking the body cells, potentially killing nerve cells. Scientists are examining chemical imbalance and trying to determine if proteins in people with ALS are being incorrectly processed by nerve cells.
Environmental factors are also being put under the scrutiny. One study has stated that members of the military personnel in the Gulf region during the 1991 war were more likely to develop Lou Gehrigs disease than military personnel stationed anywhere else. The question is, could mechanical or electrical trauma, exposure to high levels of exercise, exposure to high levels of agricultural chemicals, or heavy metals play a role?
Conditions That Mimic Shuffling Gait Seen In Parkinsons:
Please read the article on shuffling gait. It describes 5 causes of shuffling of gait.
The most crucial mimic to remember is Normal Pressure Hydrocephalus .
The person with NPH feels like he is stuck to the ground. This is a magnetic gait. It is easy to mistake this for Parkinsons disease.
For example, see this video posted by the Hydrocephalus Association of America on youtube:
NPH can be treated by implanting a small shunt pipe. This shunt drains excess water around the brain into the abdomen.
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Surgery And Deep Brain Stimulation
Deep brain stimulation is a treatment for Parkinsonâs disease that uses an implantable pacemaker-like device to deliver electrical pulses to parts of the brain involved in movement. The DBS system consists of leads precisely inserted into a specific brain target, the neurostimulator implanted in the chest, and extension wires that connect the leads to the neurostimulator. Though implantation of the system requires a neurosurgical procedure, the treatment itself consists of long-term electrical stimulation. Advantages of DBS include its ability to reduce the high doses of medications , its adjustability , and its reversibility DBS was approved by the Food and Drug Administration as a treatment for PD in 2002 and according to Medtronic , more than 80,000 patients have undergone DBS surgery worldwide.
Typical candidates are those who have motor fluctuations or periods of âoffâ time with troublesome symptoms alternating with periods of âonâ time with good symptom control, and also with possible periods of excessive movement .
Not all patients with Parkinsonâs disease are good candidates for treatment with DBS. Approximately 10â20% of patients considered for possible treatment with DBS include those:
What Causes Parkinson’s Disease
Parkinson’s disease occurs when nerve cells, or neurons, in an area of the brain that controls movement become impaired and/or die. Normally, these neurons produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems of Parkinson’s. Scientists still do not know what causes cells that produce dopamine to die.
People with Parkinson’s also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying-down position.
Many brain cells of people with Parkinson’s contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinsons disease and Lewy body dementia.
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What Are The Symptoms Of Parkinson’s Disease How Is Parkinson’s Disease Diagnosed
People with Parkinsons disease suffer from motor symptoms as well as non-motor symptoms.
Motor symptoms include intermittent tremors, slow and rigid movements. Non-motor symptoms include loss of smell, pain and even dementia.
In the initial stages of Parkinsons disease a person may experience symptoms such as:
- Slight rigidity in the arms and legs
- unable to change facial expressions according to emotions spontaneously
- Slight back pain due to which the posture of the person may be slightly stooped
- Sudden stiffness in the body at times
- Tremor on one arm on one side of the body
- The symptoms may be experienced only on one side of the body
- Handwriting may get messier and smaller
In the intermediate stage of Parkinsons disease a person may experience symptoms such as:
- Slower movements and therefore takes longer to do the daily work such as combing, dressing etc
- Loss of balance
- Sudden falls due to frequent loss of balance
- Slurring of speech
- Inability to speak loudly and clearly
- Erratic footwork, as the person is unable to start walking immediately after getting up as if the feet are stuck to the ground, or change direction quickly while walking
- Taking smaller steps than normal while walking
- Trouble swallowing food
- May require aids while walking such as a walker
In the advanced stage of Parkinsons disease the symptoms include:
Causes Of Parkinson’s Disease
Parkinson’s disease is caused by a loss of nerve cells in part of the brain called the substantia nigra. This leads to a reduction in a chemical called dopamine in the brain.
Dopamine plays a vital role in regulating the movement of the body. A reduction in dopamine is responsible for many of the symptoms of Parkinson’s disease.
Exactly what causes the loss of nerve cells is unclear. Most experts think that a combination of genetic and environmental factors is responsible.
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Movement Disorders Similar To Parkinsons
Conditions causing excess movement or decreased movement that are sometimes associated with Parkinson’s disease-like symptoms include:
What Movement Disorder Could I Have?
When making a Parkinson’s diagnosis, your doctor will review your medical history and symptoms, perform a careful neurological exam, and, if necessary, carry out further tests to rule out other movement disorders.
Your symptoms may be caused by a movement disorder other than Parkinson’s disease if:
- You display Parkinson’s disease symptoms and features that are characteristic of an additional movement disorder.
- The results of a brain imaging study or laboratory test, such as a blood test, confirm the presence of another movement disorder.
- Your symptoms do not respond to Parkinson’s disease medication.
Because movement disorders are not all treated the same way, it is important to get a proper diagnosis as early as possible so you can formulate the right treatment plan with your doctor.
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:
Causes Of Parkinsons Disease
At present, we do not know the cause of Parkinsons disease. In most people there is no family history of Parkinsons Researchers worldwide are investigating possible causes, including:
- environmental triggers, pesticides, toxins, chemicals
- genetic factors
- combinations of environment and genetic factors
- head trauma.
Parkinsons Disease Vs Als: Us Prevalence
One million Americans live with Parkinsons disease. The average cost of Parkinsons disease including treatment, lost work wages, and social security payments is $25 billion annually in the U.S.
It is not clear how many people are affected by ALS, but the estimates range between 12,000 and 15,000. Doctors tell roughly 5,000 patients annually that they have ALS. Records on ALS have not been well kept across the country, so estimates may fall way below the actual rates. Common age of ALS diagnosis is between 55 and 75, and life expectancy is anywhere between two and five years after the onset of symptoms. Longevity in ALS is strongly linked to a persons age. Younger individuals with ALS tend to live longer than those diagnosed at an older age.
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Support For People With Parkinsons Disease
Early access to a multidisciplinary support team is important. These teams may include doctors, physiotherapists, occupational therapists, speech therapists, dietitians, social workers and specialist nurses. Members of the team assess the person with Parkinsons disease and identify potential difficulties and possible solutions.There are a limited number of multidisciplinary teams in Victoria that specialise in Parkinsons disease management. But generalist teams are becoming more aware of how to help people with Parkinsons disease.
Advanced Parkinsons Disease Symptoms
Parkinsons disease typically occurs in adults as they age and is characterized by tremors in the hands, arms, legs, and face, as well as slow movement, poor balance, and lack of coordination.
- Tremors or shaking
- Changes in posture, walking, and facial expression
- Difficulty walking, talking, eating, or dressing
In the final two stages, when the disease has progressed to advanced Parkinsons, the symptoms become more severe and limiting. These include:
- Needing a walker or wheelchair to move
- Needing help with daily activities
- Having stiffness in the legs that makes it difficult to stand or walk
- Becoming bedridden
- Experiencing hallucinations and delusions
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Drugs And Medication Used To Treat Parkinsons Disease
A number of different drugs can be used to treat Parkinsons.
Levodopa is the most common treatment for Parkinsons. It helps to replenish dopamine.
About 75 percent of cases respond to levodopa, but not all symptoms are improved. Levodopa is generally given with carbidopa.
Carbidopa delays the breakdown of levodopa which in turn increases the availability of levodopa at the blood-brain barrier.
Dopamine agonists can imitate the action of dopamine in the brain. Theyre less effective than levodopa, but they can be useful as bridge medications when levodopa is less effective.
Drugs in this class include bromocriptine, pramipexole, and ropinirole.
Anticholinergics are used to block the parasympathetic nervous system. They can help with rigidity.
Benztropine and trihexyphenidyl are anticholinergics used to treat Parkinsons.
Amantadine can be used along with carbidopa-levodopa. Its a glutamate-blocking drug . It offers short-term relief for the involuntary movements that can be a side effect of levodopa.
Catechol O-methyltransferase inhibitors prolong the effect of levodopa. Entacapone and tolcapone are examples of COMT inhibitors.
Tolcapone can cause liver damage. Its usually saved for people who do not respond to other therapies.
Ectacapone does not cause liver damage.
Stalevo is a drug that combines ectacapone and carbidopa-levodopa in one pill.
Depression And Parkinsons Disease
Depression is common in people with Parkinsons disease, occurring in about 40% to 50% of patients. Depression can worsen when the disease becomes more advanced and treatment becomes less effective. Mental health counseling and treatment options are available to help people living with APD. Seek help if you or a loved one is experiencing depression with their Parkinsons.