Parkinson's Disease

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Introduction

What is Parkinson’s disease?

Parkinson’s disease is a neurodegenerative disease that damages nerve cells in the brain that are responsible for smooth, controlled and coordinated body movements. Parkinson’s disease is a seriously disabling disorder that progressively damages and destroys a person’s ability to move normally and function independently.

Parkinson’s disease is caused by loss or damage to the cells in a brain region that produce dopamine, a brain chemical that transmits nerve impulses. Curiously, individuals who smoke cigarettes are less likely to develop Parkinson’s disease.

When there is a deficiency of dopamine, the messages from the brain are disturbed, resulting in typical symptoms of Parkinson’s disease, such as trembling or tremor of the hands and feet. Symptoms most often begin in late middle age or older, but can occur earlier in life in rare cases.

There is no cure for Parkinson’s disease, but ongoing research into the progression and treatment of the disease is leading to treatments that can slow advancement of the disease and control symptoms.

Symptoms of Parkinson’s disease eventually progress to become severely disabling. Other complications of Parkinson’s disease include dementia and depression. Seek prompt medical care if you experience symptoms of Parkinson’s disease, such as trembling of the hands and problems with motor skills and balance. Early diagnosis and treatment can help to slow progression of the disease, minimize symptoms, and improve the quality of your life.

Symptoms

What are the symptoms of Parkinson’s disease?

The way in which the symptoms of Parkinson’s disease develop varies among individuals. Symptoms usually begin in late middle age, in people older than 50, but they can occur earlier in life in rare cases. In general, symptoms of Parkinson’s disease begin subtly and advance slowly.

Early symptoms of Parkinson’s disease include:

  • Depression

  • Feeling shaky

  • Irritability

  • Tremors, such as trembling in the hands, arms, legs and face

  • Unusually soft speech

As symptoms progress they eventually affect a variety of skills and body functions such as:

  • Balance and gait (walking pattern, postural instability)

  • Blood pressure

  • Digestion

  • Emotion

  • Motor skills and movement

  • Posture

  • Speech

Later symptoms of Parkinson’s disease include:

  • Akinesia (difficulty beginning or maintaining muscle movements)

  • Anxiety and emotional changes

  • Blank stare

  • Bradykinesia (a type of slowness of movement)

  • Constipation and urination difficulties

  • Difficulty speaking, chewing and swallowing

  • Fatigue and weakness

  • Hypotension (low blood pressure) and fainting

  • Impaired balance and coordination

  • Leg discomfort, such as cramps or burning

  • Muscle rigidity, especially in the arms, legs and trunk

  • Shuffling walk and stooped posture

Serious symptoms that might indicate a life-threatening condition

Life-threatening complications of Parkinson’s disease include pneumonia and choking, which is caused by difficulties with chewing and swallowing. Seek immediate medical care (call 911) if you, or someone you are with, have any of these symptoms:

  • Change in alertness or level of consciousness, such as passing out, lethargy or unresponsiveness

  • Choking or coughing

  • Difficulty breathing, shortness of breath, wheezing, or stridor (a high pitched noise made with breathing)

  • Gasping

  • Grabbing at the throat

  • High fever (higher than 101 degrees Fahrenheit)

  • Inability to speak

What causes Parkinson’s disease?

Parkinson’s disease is caused by the loss of dopamine-producing nerve cells in the brain that transmit messages that control muscle movement to the motor nerves in the spinal cord. The loss of dopamine results in impaired movement that is characteristic of Parkinson’s disease. The underlying cause of the loss of these nerve cells is not known, although theories about the cause include a combination of genetics and exposure to environmental toxins. In some cases, Parkinson’s disease is inherited, but most cases occur sporadically in families without a history of the disease.

What is parkinsonism?

In some cases, people can develop a group of symptoms that are very similar to those of Parkinson’s disease. This is called parkinsonism.

Parkinsonism can be caused by:

  • Carbon monoxide poisoning

  • Encephalitis (inflammation of the brain due to a viral or bacterial infection)

  • Head or neck injury, especially repeated head injuries such as from boxing

  • Medications, such as antipsychotics and metoclopramide, which is used to treat nausea or gastroesophageal reflux disease

  • Stroke and certain other neurological conditions

What are the risk factors for Parkinson’s disease?

A number of factors increase the risk of developing Parkinson’s disease or parkinsonism. Not all people with risk factors will get Parkinson’s disease or parkinsonism. Risk factors include:

  • Advanced age or late middle age (older than 50 years)

  • Carbon monoxide poisoning

  • Encephalitis (inflammation of the brain due to a viral or bacterial infection)

  • Exposure to certain toxins, such as pesticides and herbicides

  • Family history of Parkinson’s disease

  • Head or neck injury

  • Male gender

  • Mutations in certain genes

  • Postmenopause or hysterectomy

  • Stroke and certain other neurological conditions

  • Use of medications associated with the onset of secondary parkinsonism, such as antipsychotics and metoclopramide, which is used to treat nausea and gastroesophageal reflux disease

Reducing your risk of Parkinson’s disease and parkinsonism

Parkinson’s disease is not preventable, but you may be able to lower your risk of developing parkinsonism by :

  • Avoiding exposure to pesticides and herbicides and following the manufacturer’s instructions for their use

  • Using carbon monoxide detectors

  • Using recommended protective head and neck gear when performing dangerous activities or contact sports

How is Parkinson’s disease treated?

There are currently no treatments that can cure Parkinson’s disease. However, early recognition and a multifaceted treatment plan can help slow progression of the disease, minimize your symptoms, and enhance the quality of your life by improving coordination, walking and digestion. Treatment options include medications, physical therapy, and possibly surgery.

Medications used to treat Parkinson’s disease

Medications used to treat Parkinson’s disease help increase dopamine or decrease acetylcholine in the brain and can minimize trembling and other symptoms:

  • Anticholinergic medications, including amantadine, which help reduce trembling temporarily in some cases

  • COMT inhibitors, including entacapone (Comtan), which are used with levodopa and carbidopa

  • Dopamine agonists, including pramipexole (Mirapex) and ropinirole (Requip), which are medications that have some of the same actions as dopamine

  • Levodopa, either alone or in combination with carbidopa. Levodopa is a chemical that is converted to dopamine in the brain. Carbidopa helps prevent the breakdown of levodopa, allowing more of it to reach the brain. Levodopa often becomes less effective after several years of treatment.

  • MAO-B inhibitors, including rasagiline (Azilect) and selegiline (Eldepryl), which allows dopamine to have a longer-lasting effect on the brain

Other treatments for Parkinson’s disease

Parkinson’s disease may also be treated with physical therapy and nonconventional treatments:

  • Physical therapy and occupational therapy to improve muscle strength, maintain balance and coordination, and reduce the likelihood of falling

  • Stem cell transplants to regenerate nerve cells may be an option in some cases

  • Surgery may be an option for some people with severe symptoms or symptoms that do not improve with drug treatment. One surgical procedure (deep brain stimulation) involves placing special electrical wires in the brain to stimulate the brain in a way that controls tremors.

What are the possible complications of Parkinson’s disease?

Complications of Parkinson’s disease seriously affect the ability to function in everyday life and can be life threatening in some cases. You can slow the progression of symptoms and reduce the risk of some serious complications of Parkinson’s disease, such as falls, by following the treatment plan you and your health care professional design specifically for you. Complications of Parkinson’s disease include:

  • Adverse effects of treatment
  • Choking
  • Emotional isolation
  • Falls
  • Inability to communicate
  • Pneumonia
  • Problems with memory and thinking
  • Psychosis
Treatments

How is Parkinson’s disease treated?

There are currently no treatments that can cure Parkinson’s disease. However, early recognition and a multifaceted treatment plan can help slow progression of the disease, minimize your symptoms, and enhance the quality of your life by improving coordination, walking and digestion. Treatment options include medications, physical therapy, and possibly surgery.

Medications used to treat Parkinson’s disease

Medications used to treat Parkinson’s disease help increase dopamine or decrease acetylcholine in the brain and can minimize trembling and other symptoms:

  • Anticholinergic medications, including amantadine, which help reduce trembling temporarily in some cases

  • COMT inhibitors, including entacapone (Comtan), which are used with levodopa and carbidopa

  • Dopamine agonists, including pramipexole (Mirapex) and ropinirole (Requip), which are medications that have some of the same actions as dopamine

  • Levodopa, either alone or in combination with carbidopa. Levodopa is a chemical that is converted to dopamine in the brain. Carbidopa helps prevent the breakdown of levodopa, allowing more of it to reach the brain. Levodopa often becomes less effective after several years of treatment.

  • MAO-B inhibitors, including rasagiline (Azilect) and selegiline (Eldepryl), which allows dopamine to have a longer-lasting effect on the brain

Other treatments for Parkinson’s disease

Parkinson’s disease may also be treated with physical therapy and nonconventional treatments:

  • Physical therapy and occupational therapy to improve muscle strength, maintain balance and coordination, and reduce the likelihood of falling

  • Stem cell transplants to regenerate nerve cells may be an option in some cases

  • Surgery may be an option for some people with severe symptoms or symptoms that do not improve with drug treatment. One surgical procedure (deep brain stimulation) involves placing special electrical wires in the brain to stimulate the brain in a way that controls tremors.

What are the possible complications of Parkinson’s disease?

Complications of Parkinson’s disease seriously affect the ability to function in everyday life and can be life threatening in some cases. You can slow the progression of symptoms and reduce the risk of some serious complications of Parkinson’s disease, such as falls, by following the treatment plan you and your health care professional design specifically for you. Complications of Parkinson’s disease include:

  • Choking

  • Dementia

  • Falls

  • Pneumonia

  • Problems with memory and thinking

  • Severe depression

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 18
  1. Parkinson’s Diagnosis Questions. The Michael J. Fox Foundation for Parkinson’s Research. http://www.michaeljfox.org/living_aboutParkinsons_parkinsons101.cfm#q1.
  2. Parkinson’s Disease. PubMed Health, a service of the NLM from the NIH. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001762/.
  3. Parkinson’s Disease Information. Parkinson’s Disease.org. http://www.parkinsons.org/.
  4. Parkinson’s Disease Information Page. National Institute of Neurological Disorders and Stroke. National Institutes of Health. http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm.
  5. Parkinson’s Disease Overview. National Parkinson Foundation. http://www.parkinson.org/parkinson-s-disease.aspx.
  6. Secondary Parkinsonism. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000759.htm.
  7. Collins RD. Differential Diagnosis in Primary Care, 5th ed. Philadelphia: Lippincott, Williams & Williams, 2012.
  8. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy. Philadelphia: Saunders, 2013.
  9. Hussl A, Seppi K, Poewe W. Nonmotor symptoms in Parkinson's disease. Expert Rev Neurother 2013; 13:581.
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