Parkinson's Disease

Overview
Parkinson’s disease is a progressive neurological disorder. The first signs are problems with movement.

Smooth and coordinated muscle movements of the body are made possible by a substance in the brain called dopamine. Dopamine is produced in a part of the brain called the “substantia nigra.”

In Parkinson’s, the cells of the substantia nigra start to die. When this happens, dopamine levels are reduced. When they have dropped 60 to 80 percent, symptoms of Parkinson’s start to appear.

There’s currently no cure for Parkinson’s, a disease which is chronic and worsens over time. More than 50,000 new cases are reported in the United States each year. But there may be even more, since Parkinson’s is often misdiagnosed.

It’s reported that Parkinson’s complications are the 14th major cause of death in the United States.

Symptoms of Parkinson’s disease
Some of the early symptoms of Parkinson’s can come before motor problems by several years. These earliest signs include:

decreased ability to smell (anosmia)
constipation
small, cramped handwriting
voice changes
stooped posture
The four major motor problems seen are:

tremor (shaking that occurs at rest)
slow movements
stiffness of arms, legs, and trunk
problems with balance and tendency to fall
Secondary symptoms include:

blank facial expression
a tendency to get stuck when walking
muffled, low-volume speech
decreased blinking and swallowing
the tendency to fall backward
reduced arm swinging when walking
Other, more severe, symptoms may include:

flaky white or yellow scales on oily parts of the skin, known as seborrheic dermatitis
increased risk of melanoma, a serious type of skin cancer
sleep disturbances including vivid dreams, talking, and movement during sleep
depression
anxiety
hallucinations
psychosis
problems with attention and memory
difficulty with visual-spatial relationships
Early signs of Parkinson’s disease may go unrecognized. Your body may try to alert you to the movement disorder many years before movement difficulties begin with these warning signs.

Causes of Parkinson’s disease
The exact cause of Parkinson’s is unknown. It may have both genetic and environmental components. Some scientists think that viruses can trigger Parkinson’s as well.

Low levels of dopamine and norepinephrine, a substance that regulates dopamine, have been linked with Parkinson’s.

Abnormal proteins called Lewy bodies have also been found in the brains of people with Parkinson’s. Scientists don’t know what role, if any, Lewy bodies play in the development of Parkinson’s.

While there’s no known cause, research has identified groups of people who are more likely to develop the condition. These include:

Sex: Men are one and a half times more likely to get Parkinson’s than women.
Race: Whites are more likely to get Parkinson’s than African Americans or Asians.
Age: Parkinson’s usually appears between the ages of 50 and 60. It only occurs before the age of 40 in 5-10 percent of cases.
Family history: People who have close family members with Parkinson’s disease are more likely to develop Parkinson’s disease, too.
Toxins: Exposure to certain toxins may increase the risk of Parkinson’s disease.
Head injury: People who experience head injuries may be more likely to develop Parkinson’s disease.
Each year, researchers are trying to understand why people develop Parkinson’s. Learn more about what’s been discovered and what’s known about Parkinson’s risk factors.

Parkinson’s disease stages
Parkinson’s disease is a progressive disease. That means symptoms of the condition typically worsen over time.

Many doctors use the Hoehn and Yahr scale to classify its stages. This scale divides symptoms into five stages, and it helps healthcare providers know how advanced the disease signs and symptoms are.

Stage 1
Stage 1 Parkinson’s is the mildest form. It’s so mild, in fact, you may not experience symptoms that are noticeable. They may not yet interfere with your daily life and tasks.

If you do have symptoms, they may be isolated to one side of your body.

Stage 2
The progression from stage 1 to stage 2 can take months or even years. Each person’s experience will be different.

At this moderate stage, you may experience symptoms such as:

muscle stiffness
tremors
changes in facial expressions
trembling
Muscle stiffness can complicate daily tasks, prolonging how long it takes you to complete them. However, at this stage, you’re unlikely to experience balance problems.

Symptoms may appear on both sides of the body. Changes in posture, gait, and facial expressions may be more noticeable.

Stage 3
At this middle stage, symptoms reach a turning point. While you’re unlikely to experience new symptoms, they may be more noticeable. They may also interfere with all of your daily tasks.

Movements are noticeably slower, which slows down activities. Balance issues become more significant, too, so falls are more common. But people with stage 3 Parkinson’s can usually maintain their independence and complete activities without much assistance.

Stage 4
The progression from stage 3 to stage 4 brings about significant changes. At this point, you will experience great difficulty standing without a walker or assistive device.

Reactions and muscle movements also slow significantly. Living alone can be unsafe, possibly dangerous.

Stage 5
In this most advanced stage, severe symptoms make around-the-clock assistance a necessity. It will be difficult to stand, if not impossible. A wheelchair will likely be required.

Also, at this stage, individuals with Parkinson’s may experience confusion, delusions, and hallucinations. These complications of the disease can begin in the later stages.

This is the most common Parkinson’s disease stage system, but alternative staging systems for Parkinson’s are sometimes used.

Diagnosing Parkinson’s disease
There’s no specific test for diagnosing Parkinson’s. Diagnosis is made based on health history, a physical and neurological exam, as well as a review of signs and symptoms.

Imaging tests, such as a CAT scan or MRI, may be used to rule out other conditions. A dopamine transporter (DAT) scan may also be used. While these tests don’t confirm Parkinson’s, they can help rule out other conditions and support the doctor’s diagnosis.


Treatments for Parkinson’s disease
Treatment for Parkinson’s relies on a combination of lifestyle changes, medications, and therapies.

Adequate rest, exercise, and a balanced diet are important. Speech therapy, occupational therapy, and physical therapy can also help to improve communication and self-care.

In almost all cases, medication will be required to help control the various physical and mental health symptoms associated with the disease.