Why Is Parkinson’s Difficult To Treat

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Can I Be Cured If I Get Parkinsons Disease

Unfortunately, Parkinsons disease is not curable. There has not been developed a method that completely remove or reverse the disease condition. However, the disease symptoms can be managed with treatment. The medication available today has not only increased the quality of life but also enormously prolonged the life expectancy of patients.

The History Of Parkinsons

Parkinsons disease was first defined as a shaking palsy in 1817 by James Parkinson. Half a century later, in 1872, the Parisian neurologist Jean-Martin Charcot coined the term Parkinsons disease.

Though Parkinson was the first to describe the disease in modern medicine, Charcot and his colleagues revolutionised treatments in the mid-19th century.. Parkinson was a proponent of blood-letting from the neck, in a bid to siphon off inflammatory pathogens and prevent them from reaching the brain. But Charcot and his colleagues favoured pharmaceutical approaches centred around anticholinergic drugs, which block the action of a neurotransmitter called acetylcholine. Anticholinergics are still in use today.

Around the same time, a host of other treatments were being explored at a hospital in Paris. Hyoscyamine, a plant-derived medication, was put in bread and fed to patients. Other medications, such as a derivative of quinine, were mixed with a syrup of orange rinds.

Charcot also claimed to see the symptoms of patients with Parkinsons improving when travelling by train and horse-carriage. He became a proponent of vibration therapy, where patients bodies and heads were shaken vigorously by a rigged motor.

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Tips For Coping With Speech Difficulties

• Exercise your voice by reading out loud or singing every day.
• Drink enough water, avoiding shouting and rest your voice when it is tired.
• Train your voice like an actorsit and stand with good posture, do exercises for articulation, breathing and projecting the voice.
• Get feedback from friends and family members about how others perceive your speech develop a cue or code word you can use in public to make you focus on speaking clearly.
• If you have soft speech, use tools such as a voice amplifier , placed on your shirt, and on the telephone . Ask an occupational therapist about other tools.
• Make eye contact with the person to whom you are speaking.
• Reduce background noise.
• Socialize in small groups or one-on-one.
• If you experience a facial masking, use feeling words to communicate your emotions . Use practice physical gestures to help convey emotions.
• Determine which times of day your speech is best. Plan social engagements around those times.

Even in the early stages of PD, many report that their voices are too soft, causing others to ask them to repeat themselves. Other people with PD may have a gruff or hoarse quality to their voice. Try these strategies:

Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.

For more insights on this topic, listen to our podcast episodeImportance of Early Detection of Swallowing Disturbances.

Who Will Keep Track Of My Progress Should I Keep A Diary To Monitor My Parkinsons

Your doctor will usually be your first point of contact. They will be able to help with making appointments with other members of the multidisciplinary team and will monitor your progress. They are also there to answer questions and follow up on any concerns you have regarding any aspect of your treatment.

Keeping a diary can be very helpful in monitoring how the symptoms of Parkinsons affect you and how you respond to your medications, including to adjustments that are made over time. A written record can be an accurate reflection of your life with Parkinsons over a period of weeks, months or years and can help in highlighting:

• the pattern of symptoms you experience
• the effectiveness of the medications you take and how long they last
• any side effects of medications
• any changes in your emotions or behaviour that may be related to medications.

Writing down your experiences on a day-to-day basis can also help you effectively communicate any changes to your symptoms or your feelings with your doctor. This can be very useful, particularly as appointments are often too short for doctors to ask lots of questions, and your visit may be on a day when your symptoms do not follow their general pattern. Being able to review how you have been over a period of time can help your doctor:

• understand how effective medications are for you personally
• pinpoint any particular difficulties or patterns of symptoms
• decide on any necessary adjustments in medication dosage.

Accept The Reality That You Have Parkinsons Disease

Have you seen those people who get some serious diseases but still deny it?

There are many people out there with apparent signs of Parkinsons, but they are still not ready to accept it. They think its just a temporary condition that will go away on its own with time.

Again, Parkinsons is not like flu or cold that completely disappear in a few days. Its a brain illness that lasts throughout your life. Its unfortunate but it is a fact. 

The more early you accept this reality the more it will be easy for you to deal with it.

What Genes Are Linked To Parkinsons Disease

Several genes have been definitively linked to PD:

• SNCA. This gene, which makes the protein alpha-synuclein, was the first gene identified to be associated with Parkinsons. Research findings by the National Institutes of Health and other institutions prompted studies of the role of alpha-synuclein in PD, which led to the discovery that Lewy bodies seen in all cases of PD contain clumps of alpha-synuclein. This discovery revealed the link between hereditary and sporadic forms of the disease.
• LRRK2. Mutations in LRRK2 were originally identified in several English and Basque families as a cause of a late-onset PD. Subsequent studies have identified mutations of this gene in other families with PD as well as in a small percentage of people with apparently sporadic PD. LRRK2 mutations are a major cause of PD in North Africa and the Middle East.
• DJ-1. This gene normally helps regulate gene activity and protect cells from oxidative stress and can cause rare, early forms of PD.
• PRKN . The parkin gene is translated into a protein that normally helps cells break down and recycle proteins.
• PINK1. PINK1 codes for a protein active in mitochondria. Mutations in this gene appear to increase susceptibility to cellular stress. PINK1 has been linked to early forms of PD.
• GBA . Mutations in GBA cause Gaucher disease , but different changes in this gene are associated with an increased risk for Parkinsons disease as well.

Parkinson’s Treatments We Offer

There is no cure for Parkinson’s, but treatment at Cedars-Sinai can loosen the grip that symptoms have on your life. Parkinson’s is a progressive illness, meaning your needs change over time. We are here for you with a broad range of options and personalized recommendations.

Therapies that are best for you depend on your symptoms and how long Parkinson’s has been part of your life.

What Treatments Are Available

Many Parkinson’s patients enjoy an active lifestyle and a normal life expectancy. Maintaining a healthy lifestyle by eating a balanced diet and staying physically active contributes to overall health and well-being. Parkinson’s disease can be managed with self-care, medication, and surgery.

Self careExercise is as important as medication in the treatment of PD. It helps maintain flexibility and improves balance and range of motion. Patients may want to join a support group and continue enjoyable activities to improve their quality of life. Equally important is the health and well being of the family and caregivers who are also coping with PD. For additional pointers, see Coping With Parkinsons Disease.

These are some practical tips patients can use:

Medications There are several types of medications used to manage Parkinson’s. These medications may be used alone or in combination with each other, depending if your symptoms are mild or advanced.

After a time on medication, patients may notice that each dose wears off before the next dose can be taken or erratic fluctuations in dose effect . Anti-Parkinsons drugs can cause dyskinesia, which are involuntary jerking or swaying movements that typically occur at peak dosage and are caused by an overload of dopamine medication. Sometimes dyskinesia can be more troublesome than the Parkinsons symptoms.

What Are The Complications Of Parkinson Disease

Parkinson disease causes physical symptoms at first. Problems with cognitive function, including forgetfulness and trouble with concentration, may arise later. As the disease gets worse with time, many people develop dementia. This can cause profound memory loss and makes it hard to maintain relationships.

Parkinson disease dementia can cause problems with:

• Speaking and communicating with others
• Problem solving
• Forgetfulness
• Paying attention

If you have Parkinson disease and dementia, in time, you likely won’t be able to live by yourself. Dementia affects your ability to care of yourself, even if you can still physically do daily tasks.

Experts don’t understand how or why dementia often occurs with Parkinson disease. Its clear, though, that dementia and problems with cognitive function are linked to changes in the brain that cause problems with movement. As with Parkinson disease, dementia occurs when nerve cells degenerate, leading to chemical changes in the brain. Parkinson disease dementia may be treated with medicines also used to treat Alzheimer’s disease, another type of dementia.

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 stage

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.

Mid stage

Mid-late stage

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.

Advanced stage

If I Am Unhappy With My Treatment Can I Seek A Second Opinion

Each country has its own agreed process to follow if you are unhappy with your treatment. Who you complain to will depend on which part of your treatment you are unhappy with. If it is not your own doctor you are unhappy with, then it is usually a good idea to talk to them first.

If you are unhappy with your own doctor you may find it helpful to contact a patient advice service or patient liaison organisation. The Parkinsons association in your country should be able to provide contacts and advice – this website contains the contact details for Our members and Other Parkinson’s organisations.

Why This Disease Occurs

It is not exactly clear why Parkinsons disease occurs. Researchers think that several factors play a role in its development.

Increasing age is the strongest known risk factor for Parkinsons disease. The chances of developing the disease increase significantly as the person gets older. The current estimate shows that 1% of the population over the age of 60 is affected by Parkinsons disease. And it reaches to 5% with over age 80.

Genetics is another important cause of Parkinsons disease development. Approximately 15% of Parkinsons disease cases have a clear-cut genetic origin. Although the rest 85% of cases appear with no apparent cause, researchers believe that it mostly involved some genetic components.

In addition, researchers have identified several environmental factors that are linked to the onset of Parkinsons disease. These include pesticides , emotional or extreme psychological stress, diet-related factors like coenzyme Q10 and vitamin D, traumatic brain injury, and the lack of exercise.

Assembling Your Care Team

Assembling a team that will provide you with physical and emotional support and adapt to your needs over time is one of the best ways to remain healthy. Parkinsons disease is complex and requires an interdisciplinary approach to care. The care team may include, but is not limited to:

• Movement disorder specialist
• Rehabilitation specialists including physical, occupational, and speech therapists
• Nurse

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.

What Is The Prognosis

The average life expectancy of a person with PD is generally the same as for people who do not have the disease. Fortunately, there are many treatment options available for people with PD. However, in the late stages, PD may no longer respond to medications and can become associated with serious complications such as choking, pneumonia, and falls.

PD is a slowly progressive disorder. It is not possible to predict what course the disease will take for an individual person.

One commonly used scale neurologists use for describing how the symptoms of PD have progressed in a patient is the Hoehn and Yahr scale.

What Are The Symptoms Of The Disease

The four primary symptoms of PD are:

• Tremor. Tremor often begins in a hand, although sometimes a foot or the jaw is affected first. The tremor associated with PD has a characteristic rhythmic back-and-forth motion that may involve the thumb and forefinger and appear as a pill rolling. It is most obvious when the hand is at rest or when a person is under stress. This tremor usually disappears during sleep or improves with a purposeful, intended movement.
• Rigidity. Rigidity , or a resistance to movement, affects most people with PD. The muscles remain constantly tense and contracted so that the person aches or feels stiff. The rigidity becomes obvious when another person tries to move the individuals arm, which will move only in ratchet-like or short, jerky movements known as cogwheel rigidity.
• Bradykinesia. This slowing down of spontaneous and automatic movement is particularly frustrating because it may make simple tasks difficult. The person cannot rapidly perform routine movements. Activities once performed quickly and easilysuch as washing or dressingmay take much longer. There is often a decrease in facial expressions.
• Postural instability. Impaired balance and changes in posture can increase the risk of falls.

How Do I Know If I Have A Speech Or Voice Problem

• My voice makes it difficult for people to hear me.
• People have difficulty understanding me in a noisy room. 
• My voice issues limit my personal and social life. 
• I feel left out of conversations because of my voice.
• My voice problem causes me to lose income.
• I have to strain to produce voice.
• My voice clarity is unpredictable.
• My voice problem upsets me.
• My voice makes me feel handicapped.
• People ask, “What’s wrong with your voice?”

Early Signs Of Parkinson’s

Early physical signs include the common motor symptoms: tremor, muscle rigidity and slowness. They may also include the following:

• Symptoms starting on one side of the body
• Change in facial expression
• Failure to swing one arm when walking
• Stooped posture 
• Loss of sense of smell
• Depression or anxiety

Some of these symptoms are quite common and by no means exclusive to Parkinsons, so if you have some of them, it does not mean you have Parkinsons.

Parkinsons Is A Progressive Disease Whats Meant By That

Parkinsons is not like a flu or fever that you take antibiotics and recover in 2-3 days. It is a progressive disease; that means it develops and becomes worse over time.

At first, some abnormal changes appear in the brain that begins to damage parts of the brain responsible for movements. These changes are gradual and the effect is limited to the brain only.

After 15-20 years, the damage reaches the level where it begins to affect body normal movements. This is the early stage where typical symptoms of the disease start to develop. These early symptoms are mild and appear either on one or both sides of the body. At this stage, the disease can easily be diagnosed clinically.

After 10 years of diagnosis, the brains ability of performing movement functions is severely affected. The symptoms become severe and begins to affect the patients daily life activities. This is called the mid-stage of the disease.

When the disease has passed 20 years, it reaches its advanced stage. At this stage, the symptoms become very severe and most often the patient needs assistance for mobility.

The Lee Silverman Voice Treatment

The Lee Silverman Voice Treatment is the first speech treatment for PD proven to significantly improve speech after one month of treatment.

• Exercises taught in the LSVT method are easy to learn and typically have an immediate impact on communication.
• Improvements have been shown to last up to two years following treatment.
• LSVT methods have also been used with some success in treating speech and voice problems in individuals with atypical PD syndromes such as multiple-system atrophy and progressive supranuclear palsy . 

LSVT® Guidelines

• Must be administered four days a week for four consecutive weeks.
• On therapy days, perform LSVT exercises one other time during the day. On non-therapy days, perform LSVT exercises two times a day.
• Once you complete the four-week LSVT therapy, perform LSVT exercises daily to maintain your improved voice.
• Schedule six-month LSVT re-evaluations with your specialist to monitor your voice.
• If available in your area, participate in a speech group whose focus is on thinking loud.
• A Digital Sound Level Meter can help you monitor voice volume. Place the meter at arm distance to perform the measurement. Normal conversational volume ranges between 68-74dB.

Follow A Healthy Diet Plan

When it comes to diet, there is no restrict rule. However, you need to make sure to consume enough calories and nutrients. Eating well will maintain your body strength and weight. Additionally, it will help you to fight constipation, which is a common problem in Parkinsons patients.

• Try to eat a variety of foods to get enough proteins, vitamins, carbs, and fibers.
• Eat plenty of vegetables and fruits.
• Consume foods with a low level of saturated fats and cholesterol.
• Avoid eating food containing a high amount of sugar or salt.
• Drinking alcohol has shown to be protective, but excessive use can be harmful. Therefore, try to avoid or use it moderately.

A Cure Means Different Things To Different People But What We Can Be Certain Of Is That We Dont Yet Have One For Parkinsons

Charities these days are all promising their research will lead to a cure, but while humanity has eradicated, or is on the way towards eradicating, some infectious diseases such as small pox, measles and polio it is unlikely that we will ever see a day when humans do not get cancer, heart disease or neurological conditions like Parkinsons.

Key Programs And Resources

The Parkinsons Disease Biomarkers Programs , a major NINDS initiative, is aimed at discovering ways to identify individuals at risk for developing PD and Lewy Body Dementia and to track the progression of the disease. It funds research and collects human biological samples and clinical data to identify biomarkers that will speed the development of novel therapeutics for PD. Goals are improving clinical trials and earlier diagnosis and treatment. Projects are actively recruiting volunteers at sites across the U.S. NINDS also collaborates with the Michael J. Fox Foundation for Parkinsons Research on BioFIND, a project collecting biological samples and clinical data from healthy volunteers and those with PD. For more information about the PDBP and how you can get involved, please visit the PDBP website.

The NINDS Morris K. Udall Centers of Excellence for Parkinsons Disease Research program supports research centers across the country that work collaboratively to study PD disease mechanisms, the genetic contributions to PD, and potential therapeutic targets and treatment strategies.

The NINDS Intramural Research Program conducts clinical studies to better understand PD mechanisms and develop novel and improve treatments.

The NINDS Biospecimens Repositories store and distribute DNA, cells, blood samples, cerebrospinal fluid, and autopsy tissue to PD researchers around the world.

What Causes Parkinson Disease

Parkinson disease arises from decreased dopamine production in the brain. The absence of dopamine makes it hard for the brain to coordinate muscle movements. Low dopamine also contributes to mood and cognitive problems later in the course of the disease. Experts don’t know what triggers the development of Parkinson disease most of the time. Early onset Parkinson disease is often inherited and is the result of certain gene defects.

Living With Parkinson Disease

These measures can help you live well with Parkinson disease:

• An exercise routine can help keep muscles flexible and mobile. Exercise also releases natural brain chemicals that can improve emotional well-being.
• High protein meals can benefit your brain chemistry
• Physical, occupational, and speech therapy can help your ability to care for yourself and communicate with others
• If you or your family has questions about Parkinson disease, want information about treatment, or need to find support, you can contact the American Parkinson Disease Association.

How Do I Remain Positive

Being diagnosed with Parkinsons disease is a life-changing event but it is still possible to maintain a good quality of life.

Getting used to having Parkinson’s may be frustrating at first; you may have to take a shorter walk than normal, or play a shorter round of golf. But keeping an open mind and embracing a few lifestyle changes will help you to adapt better, for example, you may need to change the way you travel or spend leisure time, but ultimately all of these small changes will enable you to continue to lead a fulfilling and happy life.

There is no doubt that a positive outlook, along with determination to overcome obstacles, will help in adapting to life with Parkinsons and, given time and an optimistic attitude, you will be able to continue with the activities and relationships that make your life enjoyable and meaningful.

Remember, having Parkinsons does not mean everything is over.

See also Living well.

So Why Is Finding A Cure So Difficult

In the 1960s, when levodopa was first discovered, it was heralded as a cure for Parkinsons. Researchers had identified that Parkinsons symptoms were due to a lack of dopamine in the brain and had discovered a treatment that replaces this missing chemical messenger. For the first time, they had a drug with the ability to reduce and relieve symptoms of the condition. Today, levodopa is still the gold standard for Parkinsons treatment. When it comes to effective medical treatment it is actually very good, particularly in the early stages.

However, no current Parkinsons medication could be called a cure. Despite numerous improvements that have been made over the last 50 years, which make these drugs more effective and longer lasting, in the long term, these medications fail to completely relieve the symptoms of Parkinsons. The condition continues to have an ever-increasing impact on quality of life and, for many of the 145,000 people in the UK with Parkinsons, is a battle that is fought every day. Additionally, there are many symptoms, particularly non-motor symptoms like sleep problems, anxiety and pain, that are not adequately controlled by any medication. And these too progress as the condition becomes more severe.

When it comes to slowing Parkinsons, we can slow the progression of symptoms with exercise, but research has yet to provide a treatment that stops further damage to the brain. But the reasons why are actually quite simple, and can be overcome.