Symptoms Of Parkinson’s Disease
The symptoms of Parkinson’s disease usually develop gradually and are mild at first.
There are many different symptoms associated with Parkinson’s disease. Some of the more common symptoms are described below.
However, the order in which these develop and their severity is different for each individual. It’s unlikely that a person with Parkinson’s disease would experience all or most of these.
Patients May Show Signs Of Disease Years Before Their Diagnosis
Parkinsons disease is caused by the death and dysfunction of cells in the brain that make a chemical messenger called dopamine. The disease usually is characterized by toxic clumps of the alpha-synuclein protein in the brain, which are thought to drive disease progression.
Scientists in the U.S. and Mexico conducted a series of experiments using a mouse model of Parkinsons in which the mice were engineered genetically to produce excessive amounts of alpha-synuclein protein. Compared to wild-type mice, the Parkinsons mice showed marked deficits on measures of coordination and had fewer dopamine-producing cells in their brains.
The Parkinsons mice also showed pronounced reduction in gut motility and gastric emptying the ability to move food through and out of the intestines during the process of digestion. Analyses of bacteria in the mices feces suggested pronounced changes in their gut microbiome .
Both gut and brain from mice exhibited upregulation of inflammation-associated microbiota and cytokines , the researchers wrote.
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, brain imaging, to assess cognitive function,, myocardial scintigraphy, or laboratory testing to rule out conditions that may cause symptoms similar to dementia, such as abnormal , , , and vitamin deficiencies.
Typical dementia screening tests used are the and the . The pattern of cognitive impairment in DLB is distinct from other dementias, such as AD the MMSE mainly tests for the memory and language impairments more commonly seen in those other dementias and may be less suited for assessing cognition in the Lewy body dementias, where testing of visuospatial and executive function is indicated. The MoCA may be better suited to assessing cognitive function in DLB, and the scale and the may help understand cognitive decline relative to fluctuations in DLB. 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.
There is no to determine if an individual will develop DLB and, according to the , genetic testing is not routinely recommended because there are only rare instances of hereditary DLB.
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Behavioral And Mood Symptoms Of Lewy Body Dementia
Changes in behavior and mood are possible in LBD and may worsen as the persons thinking abilities decline. These changes may include:
- Apathy, or a lack of interest in normal daily activities or events and less social interaction
- Anxiety and related behaviors, such as asking the same questions over and over or being angry or fearful when a loved one is not present
- Agitation, or restlessness, and related behaviors, such as pacing, hand wringing, an inability to get settled, constant repeating of words or phrases, or irritability
- Delusions, or strongly held false beliefs or opinions not based on evidence. For example, a person may think his or her spouse is having an affair or that relatives long dead are still living.
- Paranoia, or an extreme, irrational distrust of others, such as suspicion that people are taking or hiding things
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Complications Related To Parkinsons Can Affect Survival
Claudia Chaves, MD, is board-certified in cerebrovascular disease and neurology with a subspecialty certification in vascular neurology. She is an associate professor of neurology at Tufts Medical School and medical director of the Lahey Clinic Multiple Sclerosis Center in Lexington, Massachusetts.
Parkinsons is a common neurodegenerative disease, and although it is not fatal, research suggests it may influence life expectancy.
A 2012 study in Archives of Neurology examined the six-year survival of nearly 140,000 Medicare beneficiaries with Parkinsons disease in the United States. During the six-year period, 64% of the participants with Parkinsons disease passed away.
The risk of death of those with Parkinsons was then compared to Medicare beneficiaries who did not have Parkinsons or any other common diseases, including:
When controlling for variables like age, race, and gender, the six-year risk of death among people with Parkinsons was found to be nearly four times greater than those Medicare beneficiaries without the disease or other common diseases.
At the same time, the rate of death among those with Parkinsons disease was similar to those with hip fracture, Alzheimers dementia, or a recent heart attackalthough it was higher than those who had been newly diagnosed with either colorectal cancer, stroke, ischemic heart disease, or chronic obstructive pulmonary disease.
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Surgery For People With Parkinsons Disease
Deep brain stimulation surgery is an option to treat Parkinsons disease symptoms, but it is not suitable for everyone. There are strict criteria and guidelines on who can be a candidate for surgery, and this is something that only your doctor and you can decide. Surgery may be considered early or late in the progression of Parkinsons. When performing deep-brain stimulation surgery, the surgeon places an electrode in the part of the brain most effected by Parkinsons disease. Electrical impulses are introduced to the brain, which has the effect of normalising the brains electrical activity reducing the symptoms of Parkinsons disease. The electrical impulse is introduced using a pacemaker-like device called a stimulator. Thalamotomy and pallidotomy are operations where the surgeon makes an incision on part of the brain. These surgeries aim to alleviate some forms of tremor or unusual movement, but they are rarely performed now.
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Coping With Cognitive Changes
Some medications used to treat Alzheimer’s disease also may be used to treat the cognitive symptoms of LBD. These drugs, called cholinesterase inhibitors, act on a chemical in the brain that is important for memory and thinking. They may also improve hallucinations, apathy, and delusions. The U.S. Food and Drug Administration has approved one Alzheimer’s drug, rivastigmine, to treat cognitive symptoms in Parkinson’s disease dementia. Several other drugs are being tested as possible treatments for LBD symptoms or to disrupt the underlying disease process.
Treating Movement Symptoms In Lewy Body Dementia
LBD-related movement symptoms may be treated with medications used for Parkinson’s disease, called carbidopa-levodopa. These drugs can help make it easier to walk, get out of bed, and move around. However, they cannot stop or reverse the disease itself. Side effects of this medication can include hallucinations and other psychiatric or behavioral problems. Because of this risk, physicians may recommend not treating mild movement symptoms with medication. Other Parkinson’s medications are less commonly used in people with LBD due to a higher frequency of side effects.
People with LBD may benefit from physical therapy and exercise. Talk with your doctor about what physical activities are best.
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Exercise And Healthy Eating
Regular exercise is particularly important in helping relieve muscle stiffness, improving your mood, and relieving stress.
You should also try to eat a balanced diet containing all the food groups to give your body the nutrition it needs to stay healthy.
Parkinson’s Treatment: Dopamine Agonists
Although carbidopa-levodopa is the usual first-choice drug to treat Parkinson’s disease, other drugs that mimic the action of dopamine, termed dopamine agonists, may be used when the effects of carbidopa-levodopa wane. Such drugs as Apokyn, Mirapex, Parlodel, and Requip are used these drugs have side effects similar to carbidopa-levodopa .
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What Causes Parkinson’s Disease
In the very deep parts of the brain, there is a collection of nerve cells that help control movement, known as the basal ganglia . In a person with Parkinson’s disease, these nerve cells are damaged and do not work as well as they should.
These nerve cells make and use a brain chemical called dopamine to send messages to other parts of the brain to coordinate body movements. When someone has Parkinson’s disease, dopamine levels are low. So, the body doesn’t get the right messages it needs to move normally.
Experts agree that low dopamine levels in the brain cause the symptoms of Parkinson’s disease, but no one really knows why the nerve cells that produce dopamine get damaged and die.
Slowness Of The Movement
Due to the lack of Dopamine, the signals from the brain to the muscles slowdown, that leads to Bradykinesia Bradykinesia slows down day to day activities of the patient, such as walking, bathing or dressing etc, and this is very disabling as it interferes routine life style. The patient may begin to shuffle and their walking steps become shorter and shorter and more likely they will have problems like starting and stopping and turning while walking and some patients may feel to be falling forward. All these walking complications are known as Parkinsons gait. Bradykinesia is considered to be a hallmark of basal ganglia disorders, and it includes difficulties with planning, initiating and executing movement and with performing sequential and simultaneous tasks .
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Support For People Living With Parkinsons Disease
While the progression of Parkinsons is usually slow, eventually a persons daily routines may be affected. Activities such as working, taking care of a home, and participating in social activities with friends may become challenging. Experiencing these changes can be difficult, but support groups can help people cope. These groups can provide information, advice, and connections to resources for those living with Parkinsons disease, their families, and caregivers. The organizations listed below can help people find local support groups and other resources in their communities.
Realities Of Living With Parkinsons
Parkinsons disease is unpredictable, so it can be difficult to make any plansbig or smallwithout worrying you have to cancel at the last minute. Living with the painful symptoms, both physical and mental, can be draining.
Daily tasks may require a lot of energy for someone with Parkinsons disease to complete or are taken away altogether. For example, a person without a chronic disease can drive to the grocery store, come home and do laundry, cook dinner for their family, and still have time to relax at the end of the day. However, a person with Parkinsons will have to put much more effort and time into each task and may not be able to drive at all.
As the disease progresses to its later stages, many people are forced to give up their independence and autonomy when it comes to taking care of themselves. This makes coping with a diagnosis and the disease incredibly difficult.
However, with the right treatments, you can slow disease progression and remain independent for as long as possible.
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Why Do People Get Parkinsons Disease
The first thing you might ask after getting the diagnosis is why did I get Parkinsons disease? Scientists dont know for sure what causes some people to develop Parkinsons while others dont. If you ask your doctor why you have Parkinsons, they will likely not be able to give you a definitive answer. But scientists have pinpointed a couple of factors that may increase your risk of Parkinsons: genetics and environmental factors.
What Is Parkinsons Disease
Parkinsons disease is a type of movement disorder that can affect the ability to perform common, daily activities. It is a chronic and progressive disease, meaning that the symptoms become worse over time. It is characterized by its most common of motor symptomstremors , stiffness or rigidity of the muscles, and slowness of movement but also manifests in non-motor symptoms including sleep problems, constipation, anxiety, depression, and fatigue, among others.
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What Is The Best Test For My Doctor To Order To Diagnose Parkinsons Disease
There is no reliable blood test to diagnose Parkinsons disease. The best way to make a diagnosis is to have a neurological examination by someone experienced in the care of Parkinsons disease patients. There are diagnostic criteria for the diagnosis of Parkinsons disease , which usually include:
I: Is Bradykinesia (slowness of movement present?
II: Are two of the below present?
___ Postural instability not caused by primary visual, vestibular, cerebellar,
III: Are at least 3 of the below present?
___ Unilateral onset
___ Persistent asymmetry affecting side of onset most
___ Excellent response to levodopa
___ Levodopa response for 5 years or more
___ Clinical course of 5 years or more
Very rarely, there exists confusion about the diagnosis, and in these cases other tests such as Positron Emission Tomography, and Beta SPECT scanning may be useful .
Learn more about Parkinson Disease and its treatment by watching videos from our educational Parkinson Symposiums
Read more about Parkinsons Disease in Dr. Michael S. Okuns Book, Ask the Doctor about Parkinsons Disease. Dr. Okun works at the University of Florida Gainesville, and also serves as the National Medical Director for the Parkinsons Foundation.
What Doctors Look For When Diagnosing Parkinsons
Certain physical signs and symptoms noticed by the patient or his or her loved ones are usually what prompt a person to see the doctor. These are the symptoms most often noticed by patients or their families:
Shaking or tremor: Called resting tremor, a trembling of a hand or foot that happens when the patient is at rest and typically stops when he or she is active or moving
Bradykinesia: Slowness of movement in the limbs, face, walking or overall body
Rigidity: Stiffness in the arms, legs or trunk
Posture instability: Trouble with balance and possible falls
Once the patient is at the doctors office, the physician:
Takes a medical history and does a physical examination.
Asks about current and past medications. Some medications may cause symptoms that mimic Parkinsons disease.
Performs a neurological examination, testing agility, muscle tone, gait and balance.
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.
Diagnosis And Management Of Parkinsons Disease
There are no diagnostic tests for Parkinsons. X-rays, scans and blood tests may be used to rule out other conditions. For this reason, getting a diagnosis of Parkinsons may take some time.
No two people with Parkinsons disease will have exactly the same symptoms or treatment. Your doctor or neurologist can help you decide which treatments to use.
People can manage their Parkinsons disease symptoms through:
- seeing a Doctor who specialises in Parkinsons
- multidisciplinary therapy provided for example, by nurses, allied health professionals and counsellors
- deep brain stimulation surgery .
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Parkinson’s Or Benign Essential Tremor
Essential tremors may be confused with the tremors in Parkinson’s disease. However, essential tremors usually affect both extremities equally and get worse when the hands are used, in contrast to Parkinson’s tremors. Also, Parkinson’s tremors are reduced or temporally stopped with carbidopa-levodopa medication while essential tremors respond to other medications. Parkinson’s disease does not usually occur in multiple family members but essential tremors do and are more common than Parkinson’s tremors.