Last updated: March 23, 2021
Parkinson’s disease is a progressive nervous system disorder that affects movement. This neurodegenerative disorder affects cells in a specific area of the brain. According to the Centers for Disease Control and Prevention (CDC), the associated symptoms make Parkinson’s disease the 14th cause of death in the United States.
Parkinson’s disease causes stiffness or slowing of movement. It can start so gradually that it is often missed at the early stages. Empowering you and your family with information can help your family get an earlier diagnosis. This article will cover what to expect regarding Parkinson’s disease causes, symptoms, stages, diagnosis, and treatments.
The cause of Parkinson’s Disease is mostly unknown. Those with Parkinson’s have low dopamine concentrations in their brain.
Experts think that a combination of factors such as genetic mutations, lifestyle factors, and environmental effects cause the degenerative disorder. It is more likely to occur in men over the age of 60 years old. Chemicals like Trichloroethylene (TCEs) and Polychlorinated Biphenyls (PCBs) also increase the risk for Parkinson’s disease risk.
The symptoms of Parkinson’s disease vary depending on how far the disease has progressed. As the person with Parkinson’s advances along the spectrum, the disorder becomes worse. Symptoms are gradual and often start with a slight hand tremor.
Parkinson’s signs and symptoms include:
- Tremor: Shaking often begins in your hand or fingers. Some rub their thumb and forefinger (pill-rolling tremor), while others experience hand shaking while at rest.
- Bradykinesia: As it progresses, Parkinson’s disease slows movement. This means taking shorter steps, dragging feet while walking, or struggling to stand from sitting. For some, routine tasks now seem complicated and time-consuming.
- Muscle stiffness: Any muscle in your body can become stiff, painful, and limiting to one’s range of motion.
- Impaired balance: Initially, Parkinson’s disease may only affect your posture. However, eventually, you will experience balance problems.
- Loss of unconscious movements: Do you know the automatic actions you perform each day, like blinking, smiling, or swing your arms while walking? Some with Parkinson’s experience a decreased ability to perform these.
- Speech: Your speech may become monotone or soft-spoken. Some hesitate before talking, speak more quickly or slowly, or even slur.
- Writing changes: Handwriting may become more complicated, while some find that it appears smaller than it used to.
As the disease progresses, the following occurs as a result of the above symptoms:
- Loss of bladder control
- Swallowing problems
- Trouble sleeping
- Cognitive problems
There are five stages of Parkinson’s disease. Stage 1 means the symptoms are mild and may not even be diagnosed yet. In stage 2, the symptoms are more pronounced, but balance is not impaired. Those with stage 3 remain independent. Stage 4 can still stand unassisted but often have trouble walking and performing daily tasks. Stage 5 is the most advanced stage and requires around the clock care.
Diagnosing Parkinson’s disease may be challenging at first as the symptoms are mild at first. There is no specific test that diagnoses the illness. A neurologist, a doctor who specializes in nervous system conditions, will evaluate your case. If it is early in the process, a follow-up appointment may confirm worsening symptoms.
The neurologist will ask questions like:
- How long ago did you first experience symptoms?
- Are there any associated symptoms?
- Are these symptoms constant, or do they come and go?
- Where do you experience the symptoms?
- What makes the symptoms better?
- What makes your symptoms worse?
They will base their diagnosis on your medical history, signs, symptoms, and a neurological and physical exam. The neuro exam will cover mental status, balance, motor function, and a sensory exam. This will cover items like:
- Pushing and pulling against the provider’s hands with arms and legs
- Moving from seated position to standing and walking
- Standing with closed eyes and being pushed to one side or the other.
- Passive and active range of motion (ROM)
- Discussing person, place, and time (who you are, where you are, and when it is)
- Observation for speech and clarity
- Assessing sensation with dull needles, tuning forks, alcohol swab, and cotton bulls
Other tests may be ordered, such as blood work or imaging like an MRI. However, instead of diagnosing Parkinson’s, it is to rule out other conditions causing these symptoms. In rare cases, you may receive a dopamine transporter scan (DaTscan) to support the suspicion of Parkinson’s. However, most people do not receive this expensive test. A skilled neurologist can obtain the same diagnosis based on their clinical experience, and it is not needed for the diagnosis.
There are many medical and surgical options for treatments for Parkinson’s, but no cure. Some medications will manage problems with walking, tremors, and movement by increasing dopamine. Dopamine cannot directly enter your brain. Your medication options include:
- Carbidopa-levodopa is the most effective Parkinson’s disease medication. In fact, it is usually so effective that it is used as a diagnostic tool. If the symptoms improve significantly with the administration of this medication, it will confirm the diagnosis.
- Levodopa is a natural chemical that your body converts to dopamine once it passes into your brain. Carbidopa protects the levodopa from converting to dopamine before it passes into your brain and lessens side effects.
- It can be taken orally, inhaled, or as a continuous gel through a feeding tube.
- Dopamine agonists are not as effective as levodopa but last longer.
- MAO B inhibitors prevent the breakdown of dopamine in the brain.
- Catechol O-methyltransferase (COMT) inhibitors slightly prolong the effect of levodopa by blocking dopamine breakdown.
- Anticholinergics were used for many years to control the tremor associated with Parkinson’s disease. However, the risks often outweigh the benefits with side effects like memory impairment, confusion, and impaired urination or constipation.
- Amantadine alone provides short-term relief of mild, early-stage Parkinson’s symptoms. It can also be given during more advanced stages to control involuntary movements caused by carbidopa-levodopa.
There is also a surgical procedure called deep brain stimulation, in which the surgeon implants electrodes into your brain that connect to a generator in your chest. The generator near your collarbone sends impulses to your brain to reduce symptoms. There are risks like infection, stroke, or bleeding. It is best for those with advanced Parkinson’s disease who have unstable responses to their drug regimen.
While the cornerstone of Parkinson’s disease is worsening symptoms, there are ways to reduce them as the disease advances. The most crucial part of the treatment plan is a supportive network, coping tools, and safety measures. Coping tools include meditation, tai chi, yoga, or seeing a trusted therapist.
If balance is becoming a problem, it is crucial to prepare the bathroom with grab bars and remove rugs. An occupational therapist can help with other strategies.
Unfortunately, treatment cannot cure Parkinson’s disease, but you can manage the symptoms. If you suspect that you or a loved one is symptomatic with Parkinson’s disease, contact your healthcare provider or neurologist to start the conversation.
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