Parkinson`s disease (PD) is a neurodegenerative disorder that affects predominantly the dopamine-producing (“dopaminergic”) neurons in a specific area of the brain called the substantia nigra.
What are the symptoms of PD?
PD symptoms can be different for everyone. Early symptoms maybe mild and go unnoticed. Symptoms often begin on one side of the body and usually remain worse on that side, even after symptoms begin to affect limbs on both sides.
Parkinson`s symptoms may include:
- Tremor: Rhythmic, shaking, “pill-rolling” tremors usually begin in hands or fingers. Tremors are prominent at rest and often reduce when performing tasks.
- Bradykinesia: is the term referring to slowing of movements as a result of disease progression in PD. It results in increased difficulty and time-consumption of daily tasks with extra energy expenditure. Reduction of stride and feet shuffle while walking and difficulty in getting out of chair.
- Rigid muscles: may occur in any part of the body leading to stiffness, pain and limited range of movement.
- Loss of automatic movements: including blinking, smiling or arm swinging while walking.
- Speech changes: Speech softens, becomes monotonous with slurring with the loss of usual pitch and rhythm regulation.
- Handwriting: may become smaller with increased difficulty to write.
- Drooling: due to loss of facial or swallowing muscle control
- Mask-like facial expression: known as “hypomimia” occurs when facial expressions change very little or not at all.
- Dysphagia: is trouble swallowing due to reduced throat muscle control. It increases the risk of pneumonia or choking.
Non-motor symptoms include:
- Autonomic nervous system symptoms: these include orthostatic hypotension (low blood pressure when standing up), constipation and gastrointestinal problems, urinary incontinence and sexual dysfunctions.
- Depression.
- Loss of sense of smell (anosmia).
- Sleep problems such as periodic limb movement disorder (PLMD), rapid eye movement (REM) behavior disorder and restless leg syndrome.
- Trouble thinking and focusing (Parkinson`s related dementia).
(https://my.clevelandclinic.org/health/diseases/8525-parkinsons-disease-an-overview)
What are the causes of PD?
When Parkinson’s disease isn’t genetic, experts classify it as “idiopathic” (this term comes from Greek and means “a disease of its own”). That means they don’t know exactly why it happens.
- Familial PD: Inheriting Parkinson`s from on or both parents comprise about 10% of all cases. Experts have linked at least seven different genes to Parkinson’s disease. They’ve linked three of those to early onset of the condition (meaning at a younger-than-usual age). Some genetic mutations also cause unique, distinguishing features.
- Idiopathic PD: Dysfunctional protein synthesis leads to difficulty in uptake and break down of protein molecules in the body. Build up of these molecules in brain are called Lewy bodies which are cellular toxic markers of PD.
- Induced Parkinsonism: There are conditions or circumstances experts have linked to parkinsonism. While these aren’t true Parkinson’s disease, they have similar features, and healthcare providers may consider these causes while diagnosing Parkinson’s disease. The possible causes are
- Medications: Several medications can cause a parkinsonism-like effect. The Parkinson's-like effects are often temporary if you stop taking the medication that caused them before the effects become permanent. However, the effects can linger for weeks or even months after you stop taking the medication.
- Encephalitis: Inflammation of the brain, known as encephalitis, can sometimes cause Parkinsonism.
- Toxins and poison: Exposure to several substances, such as manganese dust, carbon monoxide, fumes from welding or certain pesticides, can lead to parkinsonism.
- Damage from injuries: Repeated head injuries, such as those from high-impact or contact sports like boxing, football, hockey, etc., can cause brain damage. The term for this is “post-traumatic parkinsonism.” (https://my.clevelandclinic.org/health/diseases/8525-parkinsons-disease-an-overview)
What are the risk factors for PD?
- Age: Young adults rarely experience Parkinson's disease. It ordinarily begins in middle or late life, and the risk increases with age. People usually develop the disease around age 60 or older. If a young person does have Parkinson's disease, genetic counselling might be helpful in making family planning decisions. Work, social situations and medicine side effects are also different from those of an older person with Parkinson's disease and require special considerations.
- Heredity: Having a close relative with Parkinson's disease increases the chances of developing the disease. However, risks are still small unless you have many relatives in your family with PD.
- Gender: Men are more likely to develop PD than are women.
- Exposure to toxins: Ongoing exposure to herbicides and pesticides may slightly increase the risk of getting PD. (https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055)
How is PD assessed and monitored?
Today, the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) is healthcare providers’ main tool to classify this disease. The MDS-UPDRS examines four different areas of how Parkinson’s disease affects you:
- Part 1: Non-motor aspects of experiences of daily living. This section deals with non-motor (non-movement) symptoms like dementia, depression, anxiety and other mental ability- and mental health-related issues. It also asks questions about pain, constipation, incontinence, fatigue, etc.
- Part 2: Motor aspects of experiences of daily living. This section covers the effects on movement-related tasks and abilities. It includes your ability to speak, eat, chew and swallow, dress and bathe yourself if you have tremors, and more.
- Part 3: Motor examination. A healthcare provider uses this section to determine the movement-related effects of Parkinson’s disease. The criteria measure effects based on how you speak, facial expressions, stiffness and rigidity, walking gait and speed, balance, movement speed, tremors, etc.
- Part 4: Motor complications: This section involves a provider determining how much of an impact the symptoms of Parkinson’s disease are affecting your life. That includes both the amount of time you have certain symptoms each day, and whether or not those symptoms affect how you spend your time. (https://my.clevelandclinic.org/health/diseases/8525-parkinsons-disease-an-overview)
How is PD diagnosed?
Diagnosing Parkinson’s disease is mostly a clinical process, meaning it relies heavily on a healthcare provider examining your symptoms, asking questions and reviewing your medical history. Some diagnostic and lab tests are possible, but these are usually needed to rule out other conditions or certain causes.
But most lab tests aren’t necessary unless you don’t respond to treatment for Parkinson’s disease, which can indicate you have another condition. When healthcare providers suspect Parkinson’s disease or need to rule out other conditions, various imaging and diagnostic tests are possible. These include:
- Blood tests (these can help rule out other forms of Parkinsonism)
- Computed tomography (CT) scan
- Genetic testing
- Magnetic resonance imaging (MRI)
- Positron emission tomography (PET) scan
- Alternatively, spinal tap (lumbar puncture) or skin biopsy can be done to detect alpha-synuclein in cerebrospinal fluid or dermal nerves respectively. (https://my.clevelandclinic.org/health/diseases/8525-parkinsons-disease-an-overview)
There is currently no cure for Parkinson’s, but medication, surgical treatment and lifestyle changes can provide effective symptom control for a long time. Along with managing motor symptoms, several medications treat specific symptoms of Parkinson’s disease for e.g. fatigue or sleepiness, constipation, depression, dementia, anxiety, hallucinations and other psychosis symptoms.
