Parkinson's

May 4, 2020

4 min read

Parkinson’s disease is a progressive neurodegenerative disorder. The disease affects the area of the brain known as the substantia nigra, which produces dopamine. Dopamine is a neurotransmitter that sends chemical messages between nerve cells. People with Parkinson’s have low levels of this neurotransmitter.

Parkinson’s disease does not progress at the same rate in every patient.

While there is no cure for Parkinson’s disease, treatment can give patients a good quality of life. According to the Michael J. Fox Foundation for Parkinson’s Disease, founded by the actor diagnosed with the disorder at age 29, “Most people find acceptance and quality of life after the initial adjustment period.”

Parkinson’s Disease Symptoms

The first symptom of Parkinson’s disease is generally a slight hand tremor. Over time, it worsens and may progress to:

Balance issues
Handwriting changes
Inability to swing arms while walking
Lack of facial expression
Muscle rigidity
Speech slurring
Stooped posture

If you experience any of these symptoms, see a doctor as soon as possible.

In time, additional complications develop. These may include:

Bladder control
Changes in the ability to smell
Concentration problems
Constipation
Difficulty chewing and eating
Difficulty swallowing
Insomnia
Sexual dysfunction

The 5 Stages of Parkinson’s Disease

Parkinson’s disease patients may go through five distinct stages as the condition progresses.

Stage 1 – In this initial stage, symptoms are mild and manageable with medication. Any tremors or odd movements are usually limited to one side of the body.
Stage 2 –The second stage brings more noticeable symptoms. The patient is more likely to experience tremor and shaking, along with increased stiffness. Speech problems may become apparent. By Stage 2, symptoms usually appear on both sides of the body.
Stage 3 –In this stage, balance issues and slower movements occur. The person may have issues completing daily activities. Falls become an increasing worry. This is the last stage in which most patients can live independently.
Stage 4 –Most patients will need the assistance of a walker for mobility. Because reaction times and movement are now so slow, it is not safe for patients to live alone by Stage 4.
Stage 5 –In this final stage, most patients are confined to wheelchairs. Hallucinations and confusion are common, as is dementia.

Patients do not die from Parkinson’s disease per se. However, Parkinson’s-related issues, such as falling, may contribute to fatalities. Those with swallowing problems may choke or suffer from aspiration pneumonia.

Risk Factors

Parkinson’s disease affects men more often than women. Symptoms usually appear around age 60, although they may show up earlier or later. Parkinson’s disease has a genetic component, and those with close relatives diagnosed with the condition have a greater risk of developing it. Keep in mind that most people diagnosed with Parkinson’s disease do not have a family history of the disorder.

There is evidence that long-term pesticide or herbicide exposure may increase Parkinson's risk.

There is research indicating that people who do not consume caffeine may have an additional risk of developing Parkinson’s disease. However, that does not necessarily mean a person should start drinking tea, coffee, or other caffeinated items just to reduce the risk of the disease.

Parkinson’s Disease Diagnosis

There is no definitive test for Parkinson’s. If your primary care doctor suspects Parkinson’s based on symptoms and medical history, they will refer you to a neurologist for further diagnostics. Some patients may undergo a Dopamine Transporter Scan, and the results might indicate a probability of Parkinson’s disease. Blood tests are used to rule out other diseases.

For the most part, Parkinson’s is diagnosed via a neurological examination and symptoms. The doctor may prescribe a drug used to treat Parkinson’s called carbidopa-levodopa, marketed under the brand name Rytary, among others. If the patient experiences significant symptom improvement while on this medication, it will likely confirm a Parkinson’s diagnosis.

Parkinson’s Disease Treatment

Medications such as carbidopa-levodopa are the first stage of treatment with Parkinson’s disease. The doctor will likely recommend aerobic and other low-impact exercises, along with stretching and balancing. If the patient exhibits speech problems, a speech pathologist can help.

As time passes, the effectiveness of carbidopa-levodopa and other drugs may lessen. Some medications, such as catechol O-methyltransferase (COMT) inhibitors, may extend carbidopa-levodopa’s efficacy. The side effects of various Parkinson’s drugs are often severe and may include hallucinations.

Some patients may benefit from surgical procedures for symptom relief. Among these is deep brain stimulation, in which a surgeon implants electrodes into a particular area of the brain. A generator implanted near the collarbone has the electrodes attached. These electrodes send signals to the brain. These messages may relieve symptoms.

Deep brain stimulation is recommended for those who are no longer responding to medication. It can help control involuntary movements, and lower the number of tremors. It also reduces rigidity.

There are risks with any type of brain surgery. Doctors will need to perform regular monitoring and adjustments.