How Is Parkinson’s Disease Managed
Your doctors will tailor your treatment based on your individual circumstances. You will manage your condition best if you have the support of a team, which may include a general practitioner, neurologist, physiotherapist, occupational therapist, psychologist, specialist nurse and dietitian.
While there is no cure for Parkinson’s disease, symptoms can be treated with a combination of the following.
What If I Carry The Gene
There are ongoing clinical trials testing therapies to treat people who have Parkinson’s and carry certain gene mutations. Proving that it can be important to know which gene mutation you carry. Consult with your doctor when considering a genetic test to determine if you are eligible to participate in gene-based clinical trials.
The Parkinsons Foundation study, PD GENEration: Mapping the Future of Parkinsons Disease, is the first national study to offer genetic testing and counseling at no cost for those with a confirmed Parkinsons diagnosis. Learn more and enroll at Parkinson.org/PDGENEration.
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How Is A Diagnosis Made
Because other conditions and medications mimic the symptoms of PD, getting an accurate diagnosis from a physician is important. No single test can confirm a diagnosis of PD, because the symptoms vary from person to person. A thorough history and physical exam should be enough for a diagnosis to be made. Other conditions that have Parkinsons-like symptoms include Parkinsons plus, essential tremor, progressive supranuclear palsy, multi-system atrophy, dystonia, and normal pressure hydrocephalus.
Parkinsons Disease: What Is It
This is a progressive neurological condition.In the substantia nigra, dopamine is low.
Dopamine levels are low when this occurs. Symptoms of Parkinsons start when they have withdrawn 60 to 80 percent.
Parkinsons patients repeatedly record having sleep problems, constipation, distress smelling, and restless legs before encountering stiffness and tremor.
What Raises Someone’s Risk For Parkinson’s
It’s a complex picture, but you may be more likely to get Parkinson’s based on:
Age. Since it mostly affects people 60 and older, your risk goes up as the years go by.
Family history. If your parent, brother, or sister has it, you’re a little more likely to get it.
Job. Some types of work, like farming or factory jobs, can cause you to have contact with chemicals linked to Parkinson’s.
Race. It shows up more often in white people than other groups.
Serious head injury. If you hit your head hard enough to lose consciousness or forget things as a result of it, you may be more likely to get Parkinson’s later in life.
Gender. Men get it more than women. Doctors aren’t sure why.
Where you live. People in rural areas seem to get it more often, which may be tied to chemicals used in farming.
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What Is The Number 1 Cause Of Parkinson’s
“Scientists believe the disease is caused by an interaction of genes, environmental and lifestyle influences, so we are not able to narrow it down to one top cause,” says Beck. “One thing that all people with PD have in common is they have lost and continue to lose dopaminergic neurons in their brain. We are currently trying to understand why that happens and how we stop it.” Keep reading to learn about how your genetics may play a role.
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.
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.
What Are The Causes
The cause of Parkinson’s is largely unknown. Scientists are currently investigating the role that genetics, environmental factors, and the natural process of aging have on cell death and PD.
There are also secondary forms of PD that are caused by medications such as haloperidol , reserpine , and metoclopramide .
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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.
Can Parkinsons Disease Be Prevented
Unfortunately, no. Parkinsons disease is long-term disease that worsens over time. Although there is no way to prevent or cure the disease , medications may significantly relieve your symptoms. In some patients especially those with later-stage disease, surgery to improve symptoms may be an option.
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What Is The Main Cause Of Death In Parkinsons Disease Patients
Parkinson’s is often referred to as a “bespoke” disease because it affects each patient differently. Another factor worth considering is that Parkinson’s disease generally affects people in their 60s, most of whom die of unrelated conditions such as cancer, heart disease or stroke. However, the most common cause of death in those with Parkinson’s disease is pneumonia. This is because the disease can impair your ability to swallow in the later stages, putting you at risk for aspirating food or liquid into the lungs.
What Are The Symptoms
Symptoms of PD vary from person to person, as does the rate of progression. A person who has Parkinson’s may experience some of these more common “hallmark” symptoms:
- Bradykinesia – slowness of movement, impaired dexterity, decreased blinking, drooling, expressionless face.
- Tremor at rest – involuntary shaking that decreases with purposeful movement. Typically starts on one side of the body, usually the hand.
- Rigidity – stiffness caused by involuntary increase in muscle tone.
- Postural instability – sense of imbalance. Patients often compensate by lowering their center of gravity, which results in a stooped posture.
Other symptoms that may or may not occur:
Freezing or being stuck in place Shuffling gait or dragging of one foot Stooped posture Cognitive impairment
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What Medications Are Used To Treat Parkinsons Disease
Medications are the main treatment method for patients with Parkinsons disease. Your doctor will work closely with you to develop a treatment plan best suited for you based on the severity of your disease at the time of diagnosis, side effects of the drug class and success or failure of symptom control of the medications you try.
Medications combat Parkinsons disease by:
- Helping nerve cells in the brain make dopamine.
- Mimicking the effects of dopamine in the brain.
- Blocking an enzyme that breaks down dopamine in the brain.
- Reducing some specific symptoms of Parkinsons disease.
Levodopa: Levodopa is a main treatment for the slowness of movement, tremor, and stiffness symptoms of Parkinsons disease. Nerve cells use levodopa to make dopamine, which replenishes the low amount found in the brain of persons with Parkinsons disease. Levodopa is usually taken with carbidopa to allow more levodopa to reach the brain and to prevent or reduce the nausea and vomiting, low blood pressure and other side effects of levodopa. Sinemet® is available in an immediate release formula and a long-acting, controlled release formula. Rytary® is a newer version of levodopa/carbidopa that is a longer-acting capsule. The newest addition is Inbrija®, which is inhaled levodopa. It is used by people already taking regular carbidopa/levodopa for when they have off episodes .
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:
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The Nervous System & Dopamine
To understand Parkinson’s, it is helpful to understand how neurons work and how PD affects the brain .
Nerve cells, or neurons, are responsible for sending and receiving nerve impulses or messages between the body and the brain. Try to picture electrical wiring in your home. An electrical circuit is made up of numerous wires connected in such a way that when a light switch is turned on, a light bulb will beam. Similarly, a neuron that is excited will transmit its energy to neurons that are next to it.
Neurons have a cell body with branching arms, called dendrites, which act like antennae and pick up messages. Axons carry messages away from the cell body. Impulses travel from neuron to neuron, from the axon of one cell to the dendrites of another, by crossing over a tiny gap between the two nerve cells called a synapse. Chemical messengers called neurotransmitters allow the electrical impulse to cross the gap.
Neurons talk to each other in the following manner :
Parkinsons Disease Late Stages: What Will Happen To Me
With advanced Parkinsons disease, stage 5 life expectancy can be months or years depending on how your condition presents. You are likely to need round-the-clock care at this stage, and you may not be able to move around independently. Patients with late-stage Parkinsons disease are more susceptible to pneumonia, sepsis, pyelonephritis and decubitus ulcers. Late-stage Parkinsons also leads to Parkinsons disease dementia in 50% of cases. For all of these reasons, many late-stage Parkinsons patients are cared for by loved ones or in a hospice.
Two Areas In Which Parkinsons Disease May Bring About Death
PD patients are at an increased risk of falling and bad falls can lead to death. This usually occurs as a complication of a fall that requires hospitalization, particularly if it involves surgery. While most people do not fracture their hips when they fall, some do, and hip surgery, while routine, is still major surgery. It carries the risk of infection, delirium related to pain medications and anesthesia, heart failure, pneumonia, blood clots in the legs that then go to the lungs, and general weakness from immobility. Hip fractures are probably the main cause for death for those who fall, but people can fracture other bones and require surgery. They may fracture their ribs, which leads to reduced coughing, because of the pain, and an increased risk of lung infections . It is surprisingly uncommon for Parkinsons Disease patients to die from brain injuries related to falls, but it still may occur.
PD patients also may develop pneumonias completely unrelated to difficulties with swallowing, just like their non-PD friends and relatives.
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.
Family History & Genetics
Researchers have been able to identify certain genetic mutations that can increase the risk of developing Parkinsons disease.
These are the two types of Parkinsons disease, from a genetic standpoint:
- Hereditary Parkinsons disease: Roughly 15% of all cases of Parkinsons disease are inherited. In these cases, mutations in certain genes are passed down through families and increase the individuals risk of developing this condition.
- Sporadic Parkinsons disease: On the other hand, cases in which people dont have a family history of Parkinsons disease are referred to as sporadic cases. These cases are in fact the majority. Scientists have found that alterations in certain genes may also play a role in sporadic cases, in addition to other environmental and lifestyle-related factors.
However, the role that these genetic mutations play in the development of the condition hasnt been fully understood yet.
Clinical History And Testing
Diagnostic tests can be used to establish some features of the condition and distinguish them from symptoms of other conditions. Diagnosis may include taking the person’s , a physical exam, assessment of neurological function, testing to rule out conditions that may cause similar symptoms, brain imaging, to assess cognitive function,, or myocardial scintigraphy. Laboratory testing can rule out other conditions that can cause similar symptoms, such as abnormal , , , or vitamin deficiencies that may cause symptoms similar to dementia.
Dementia screening tests are the and the . For tests of attention, , , and can be used for simple screening, and the Revised Digit Symbol Subtest of the may show defects in attention that are characteristic of DLB. The , and are used for evaluation of executive function, and there are many other screening instruments available.
If DLB is suspected when parkinsonism and dementia are the only presenting features, PET or SPECT imaging may show reduced dopamine transporter activity. A DLB diagnosis may be warranted if other conditions with reduced dopamine transporter uptake can be ruled out.
Since 2001, – has been used diagnostically in East Asia , but not in the United States. MIBG is taken up by nerve endings, such as those that innervate the heart, and is for scintigraphy with radioactive 123iodine. Autonomic dysfunction resulting from damage to nerves in the heart in patients with DLB is associated with lower cardiac uptake of 123I-MIBG.
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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.
Other Causes Of Parkinsonism
“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.
Page last reviewed: 30 April 2019 Next review due: 30 April 2022
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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.
In Summary Reduce Your Stress
The most important thing we can do for our long-term health, both physical and cognitive, is to reduce the stress in our bodies. All stress physical, emotional and chemical causes inflammation and long-term damage throughout the body.
Whether youre seeking Parkinsons prevention techniques or ways to alleviate symptoms, any of the above dietary and lifestyle practices can have long-term health benefits. Drinking green tea, eating organic, local vegetables, and regular aerobic exercise all significantly reduce the long-term cumulative damage done by stress.
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