Parkinson's Disease: Causes, Symptoms and Treatments
A diagnosis of Parkinson’s disease (PD) for yourself or a family member is a life-altering event. It’s hard to know, however, exactly how your life or the life of your family member will change. Over 10 million people worldwide have Parkinson’s, and no two cases are exactly alike. We know that Parkinson’s mostly occurs in older adults and it affects more men than women. Doctors have a fairly good understanding of what causes the condition, but even doctors can’t predict the course of the disease in a particular individual.
What is Parkinson’s Disease?
A diagnosis of Parkinson’s for yourself or a family member means that you’ll soon have a whole new vocabulary. The first word that you may encounter is “neurodegenerative.” Parkinson’s is a neurodegenerative disease, meaning that it affects the nervous system and that it gets worse over time. The good news is that the progress of the disease is usually slow. Also, people with Parkinson’s may live a normal life span and often have an acceptable quality of life.
Parkinson’s disease also goes by its acronym PD but is usually simply called Parkinson’s. It has a long history. Ancient manuscripts describe disorders that sound like Parkinson’s. James Parkinson, a London surgeon, wrote the first clear description of the disease in 1817. He called it the “shaking palsy.” Jean-Martin Charcot, a Frenchman known as the father of modern neurology, proposed the name Parkinson’s disease. He recognized that not all of those with the disorder had shaking as a symptom.
Parkinson’s Disease Symptoms
About 70% of those with Parkinson’s do have involuntary shaking, known as tremor. Many texts call Parkinson’s a movement disorder, and it is. Those with Parkinson’s often have problems with gait, balance and coordination. They may have stiffness of the torso and limbs, and they often have a condition known as bradykinesia.
Bradykinesia is slowness of movement. Doctors look for bradykinesia plus either tremor or rigidity to reach a diagnosis of Parkinson’s. Besides general slowness, those with Parkinson’s have trouble starting a movement, such as getting out of a chair. They may seem abnormally still. Bradykinesia can affect facial muscles, resulting in a lack of expression sometimes described as masklike.
Freezing is another Parkinson’s symptom, which researchers believe is not part of bradykinesia but is a separate symptom. The person with Parkinson’s may stand up and then freeze in place. Some who have experienced this symptom say their feet feel stuck to the floor. Freezing usually occurs later in the disease, but may occur in a milder form early on.
Other signs of Parkinson’s disease have nothing to do with movement. These may include constipation, sleep problems, depression and loss of smell. These may appear even before other symptoms do.
Cognition and Parkinson’s Disease
Many people with Parkinson’s will experience cognitive impairment. Usually, their symptoms are mild. They may have trouble concentrating, problem-solving and multi-tasking. They may have difficulty visualizing things in three dimensions, so judging distances or mapping out a route can be hard. Often they struggle to find the right words when they are talking. They may forget some things, but memory lapses tend to be less severe than in other cognitive disorders, such as Alzheimer’s disease.
Sometimes those with Parkinson’s progress to Parkinson’s disease dementia. This form of the disease is caused by Lewy bodies, clumps of protein in the brain that interfere with brain function. When someone with Parkinson’s movement symptoms develops serious cognitive problems, doctors may make a diagnosis of Parkinson’s disease dementia. Lewy bodies in the brain cause a similar condition in which dementia occurs first and movement problems come later. This condition is known as dementia with Lewy bodies. Both Parkinson’s disease dementia and dementia with Lewy bodies fall under the umbrella term of Lewy body dementia.
Progression of Parkinson’s Disease
People progress through Parkinson’s disease at different rates. Although researchers have described five stages, many people live a normal life span and never reach stage five. Early diagnosis and treatment can also affect the rate at which the disease progresses.
Hoehn and Yahr first described the five stages in 1967. Their scale has since been modified. Here are the five stages of Parkinson’s in plain language:
- Stage One: In this stage, a person may experience tremor, stiffness or clumsiness. The symptoms usually occur on one side of the body. Diagnosis may not be possible in this stage.
- Stage Two: Symptoms may involve both sides of the body, but they are still mild. Friends and family members may notice that the person has stooped posture, general slowness or slurred speech, but they may attribute these to aging. Those with tremor may receive a diagnosis of Parkinson’s, but without a tremor, many individuals go undiagnosed.
- Stage Three: Balance may worsen in this stage, and slowness of movement becomes more apparent. Doctors sometimes diagnose patients by standing behind them and pulling on their shoulders. Those with Parkinson’s may lose their balance and fall backward. Still, those in this stage are mostly independent and can carry out the activities of daily living.
- Stage Four: In this stage, many individuals lose their ability to move about without help. They may need to use a walker. However, if they can still carry out the activities of daily living, they are still classed as Stage Three.
- Stage Five: In this stage, patients can’t get out of bed or out of a chair without help. They often fall, freeze or stumble. They require full-time help. Some will exhibit delusions and hallucinations.
Parkinson’s disease is rarely fatal, and at least one study shows that those without cognitive symptoms may live a normal life span. Some of those with Parkinson’s die from falls related to their disease. Others have difficulty swallowing and will get food or liquid in the lungs. This can cause aspiration pneumonia, the leading cause of death for those with Parkinson’s.
Causes and Risk Factors
Doctors believe that nerve cell death in the brain causes Parkinson’s disease. These nerve cells produce a chemical called dopamine. When the cells die and there is less dopamine, the brain doesn’t function well. Dopamine is especially important to the part of the brain that controls movement. A different chemical in the brain, called norepinephrine, controls processes such as heart function and digestion. Those with Parkinson’s often have a deficiency of that chemical, too, which is why they may have non-movement disorders. No one knows what causes the death of brain cells.
Researchers have found some gene variations that occur at a higher rate than normal in those with Parkinson’s. Still, they do not regard Parkinson’s as a hereditary disease. No one really knows what causes it. Exposure to environmental toxins is a risk factor, as is age. Most cases occur in those 60 or older.
Diagnosis and Treatment
There is no test for Parkinson’s. Neurologists can usually diagnose it through a clinical exam. They look for certain signs typical of Parkinson’s. A tremor that occurs during rest is an important sign. Doctors look for other distinctive features of posture and gait that an untrained person might not notice. These signs, combined with a medical history, usually lead to a Parkinson’s disease diagnosis.
Normal imaging tests are not helpful in diagnosing Parkinson’s, but there is one imaging test that shows dopamine levels in the brain. It is not widely used because it cannot distinguish between several similar conditions. It is no more accurate than a clinical exam in diagnosing Parkinson’s.
After making a diagnosis of probable Parkinson’s disease, many doctors prescribe a common Parkinson’s medication. If the patient improves, the diagnosis is confirmed.
Medications for Parkinson’s Disease
The most important medication for Parkinson’s is levodopa, sometimes called L-dopa, which was developed in the 1960s. It mimics dopamine in the brain. Today it is combined with carbidopa, which helps more of the levodopa reach the brain. Other drugs can keep the dopamine from breaking down so quickly or mimic the action of dopamine in the brain.
Drugs are available for the other symptoms associated with Parkinson’s. Researchers have found no medications to stop or slow the progress of the disease. Research is ongoing for better Parkinson’s disease treatments.
Deep brain stimulation is sometimes used when a person’s disease doesn’t respond well to medication. Doctors place an electrode in the brain and implant a second device in the chest or abdomen. The second device generates electrical impulses that travel to the brain. The patient uses a controller to turn the device off or on. Deep brain stimulation does not slow the course of the disease, but it can reduce symptoms.
Exercise can make those with Parkinson’s feel better and possibly slow the progress of the disease. Seeing a physical therapist is a good way to start. Finding an enjoyable exercise is key.
Parkinson’s Disease Care Options
Assisted living communities can be appropriate for those in any stage of Parkinson’s disease. A supportive living environment can help those in the early stages maximize their wellness. A range of fitness options, nutritious meals and stimulating pastimes can add up to a healthy lifestyle.
Those with mobility challenges may find that the accessibility of an assisted living community makes life easier. They may enjoy the convenience of on-site speech therapy, physical therapy and occupational therapy. Memory care communities are appropriate for those with Parkinson’s dementia disease who need a secure environment and staff trained in dementia care.
The Atrium at Boca Raton is an assisted living and memory care community located minutes from the ocean on Florida’s east coast. Our assisted living community provides help with the activities of daily living and luxury services like linen service and housekeeping. Specially trained staff in our memory care community support individuals with memory impairments such as dementia. At The Atrium at Boca Raton, we strive to help all residents live joyfully. Call us at 561-750-7555 to learn more, or request a free copy of our Guide for Finding the Right Assisted Living Community.