Parkinson’s disease

Parkinson's disease

What is Parkinson's disease?

Parkinson’s disease is a chronic disorder that affects movement. People with Parkinson’s disease may find it hard to walk, talk, write, dress and do other everyday tasks.

Taking regular prescribed medication can greatly relieve the symptoms of Parkinson’s disease. Some people can also have surgery. There is a lot you can do to maintain your quality of life.

Symptoms

People will experience Parkinson’s disease in different ways. The most common symptoms are:

  • muscle tightness or rigidity in the legs and body
  • tremor or shaking of the hands, arms, legs or face
  • balance and coordination problems, which make falls fairly common
  • slowed movements, which is known as bradykinesia.

For many, the first sign is a tremor in their fingers or hand, which is present nearly all the time. However, about a third of people with Parkinson’s disease never have a tremor.

Most people with Parkinson’s have stiff muscles, which makes it hard to walk. It can also be hard to keep your balance. Many people become stooped, and move slowly. Some find it hard to move the muscles on their face.

Many people have what is known as a freezing of gait. They find they just can’t move their feet. It tends to happen in particular situations, such as when people are stepping through a doorway or turning to change direction. There are ways to deal with this.

Many people with Parkinson’s disease also have problems with sleep and memory. Some have episodes of depression, and some become emotionally up and down.

Some people with Parkinson’s disease also have:

  • slurred or soft of speech
  • loss of sense of smell
  • difficulty writing
  • bladder problems
  • constipation
  • a loss of involuntary movements such as blinking, smiling or swinging their arms
  • difficulty eating and swallowing
  • sexual problems.

Not everybody gets all symptoms.

Many people find that their symptoms slowly get worse over the years, although others don’t. Treatment can make quite a difference.

Types & Severity

Parkinson’s disease is also called typical Parkinson’s disease or idiopathic (no known cause) Parkinson’s disease.

Some people use names that note your age when first diagnosed.

  • Juvenile Parkinson’s disease is used when Parkinson’s symptoms are found in children or teenagers.
  • Early onset Parkinson’s disease is used if you are aged 21 to 40 when diagnosed.
  • Late onset Parkinson’s disease is used if you are over 50 when diagnosed.

Some people have only mild and manageable symptoms all their life. Some find the condition much more intrusive and, in time, become disabled by it.

There is also a term – Parkinsonism – that you might hear. Parkinsonism describes the situation where somebody has some of the signs and symptoms of Parkinson’s disease, but not enough to warrant a clear diagnosis of the disease.

Causes

The overall cause of Parkinson’s disease is not known clearly. It is thought that it might be a mix of genetics and things in the environment, such as pesticides and toxins. But it is understood fairly well why you get the symptoms.

It starts with dopamine, which is a chemical that helps transmit messages from one nerve cell to another in the brain. It is known as a neurotransmitter.

There is a part of the brain called the substantia nigra, or black substance.

In Parkinson’s disease, the cells in the substantia nigra that produce dopamine start to die off. The lack of dopamine has widespread effects in different parts of the brain, and in different parts of the body.

There are other changes in brains of people with Parkinson’s disease. Researchers are studying these changes in the hope of understanding Parkinson’s disease better.

 

Risk factors

While the overall cause of Parkinson’s disease is not known, it is known that some people are more likely to develop the condition than others.

Parkinson’s disease is more common in people who:

  • have a relative with the disease
  • have a relative with a tremor
  • have never smoked
  • have constipation regularly.

It is also slightly more common in people who:

  • have anxiety or depression
  • have been exposed to pesticides or herbicides
  • don’t drink coffee or alcohol
  • live in rural areas or have been employed in agriculture
  • have had a head injuries, particularly repeated head injuries such as those from boxing
  • take or have taken certain drugs known as beta blockers.

Diagnosis

It can take a long time to diagnose Parkinson’s disease because the symptoms usually develop slowly, and because there is no single blood test or other test that gives a definite diagnosis.

If you are being investigated for the possibility of having Parkinson’s disease, you will usually see a GP and then a neurologist. They will talk to you and examine you, and you might be asked to have tests such as:

  • blood tests
  • a magnetic resonance imaging (MRI) scan
  • a computerised tomography (CT) scan.

One way of confirming the diagnosis of Parkinson’s disease is to take a short course of the drug levodopa, which counters the dopamine loss. If the medication helps you move more easily, then it is likely you have Parkinson’s disease.

Living with Parkinson's disease

The idea of living with Parkinson’s disease will take some time to get used to. You might feel shocked, or angry, or confused, or calm, or not believe it. It will take time for you to deal with the diagnosis and all that it means.

It is a good idea to find out what you can about Parkinson’s disease and about the support that is available from organisations such as Parkinson’s Australia. But take your time and do it at your own pace.

 

Psychological and emotional support

There is a lot to think about, and a lot to deal with and you may need to look at psychological and emotional support.  You might be able to get the support you need from your partner, your family and your friends, but you can also look for support from a professional such as a psychologist, counsellor or social worker.

 

Exercise, diet and lifestyle changes

Regular aerobic or stretching exercises can increase the strength and flexibility of your muscles and improve your balance, which will help prevent falls. Regular exercise also helps your mood.

A healthy diet might ease symptoms. For example, if you are constipated, a high-fibre diet can help. As time goes on, a dietitian can provide advice about foods that are easier to chew and swallow.

 

Physical therapies

At different times you might benefit from:

  • physiotherapy to improve your movement and balance
  • speech therapy to make your speech clearer
  • occupational therapy to help with daily tasks like bathing, dressing and writing.

 

Treatment

Treatment can make a significant difference to your symptoms for a long time, although they can’t cure you of the condition. Ideally, you will be cared for by a multidisciplinary team with skills to address your changing needs. It could include:

  • doctors such as a GP and a neurologist or geriatrician
  • a physiotherapist to help you remain active and mobile
  • a speech pathologist who can help you manage communication and swallowing problems
  • an occupational therapist who can help you with advice around mobility and independence
  • a dietitian to help you with food choices and preparation, particularly if you have difficulties with swallowing and eating
  • a social worker or a psychologist or counsellor to help you manage both the practical and the emotional aspects of the condition.

Your options for treatment include:

  • medication
  • physical therapies
  • deep brain stimulation surgery.

 

Medication

The most commonly prescribed medications are:

  • levodopa, a natural chemical that is converted into dopamine by the brain
  • dopamine agonists, which act like dopamine to stimulate a person’s brain cells
  • MAO-B inhibitors, which block the breakdown of dopamine in the brain
  • COMT inhibitors, which help levodopa work more smoothly by slowing its breakdown in the body
  • glutamate agonists, which are used to treat tremors and rigidity.

Most people who have Parkinson’s disease are prescribed levodopa, which is changed in the body into dopamine. It can make a real difference. Levodopa has side-effects, and can need some adjustments to make it work at its best, so talk to your doctor about it. Most people taking levodopa take other medications at the same time to ensure it is effective and to minimise side-effects.

One side-effect to be aware of with medications for Parkinson’s disease is involuntary movements, or dyskinesia. Talk to your doctor about how to best minimise the risk of dyskinesia.

If you are taking medication for Parkinson’s disease, you’ll need to see your doctor fairly regularly. Your needs will change and the medications might need regular adjustment.

 

Surgery

Deep brain stimulation is a form of surgery that’s effective for some people with Parkinson’s disease.

In this form of surgery, a surgeon would implant a thin electrode into your brain. The electrode is activated by a small battery operated device that is implanted under the skin in your shoulder, chest or abdomen. It is linked to the electrode by an insulated wire. The device generates electrical pulses that block the abnormal signals that cause tremor and other Parkinson’s disease symptoms like muscle rigidity.

Many people get relief from their symptoms and can reduce their medication.

 

Sources

Parkinson’s Australlia (What is Parkinson’s, Parkinson’s symptoms, diagnosis of Parkinson’s), Mayo Clinic (Parkinson’s disease definition, Parkinson’s disease symptons), Victoria Better Health Channel (Parkinson’s Disease), Healthdirect (Parkinson’s disease).

Last updated November 2017

Ever since she was old enough to understand adult topics, Martina Wonderley has negotiated the health and social welfare systems on behalf of her older brothers who live with significant disabilities.


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