Parkinson's Basics

More than 10 million people worldwide have Parkinson’s disease. 60,000 people in the US and 10,000 in the UK are newly diagnosed each year. Four percent are diagnosed before age 50 (early onset). Men are 50% more likely to get PD than women. Numbers will increase due to an increasingly aging population.

WHAT IS PARKINSON’S?

Parkinson's disease (PD) is a progressive neurodegenerative brain disorder resulting in loss of motor function that is caused by the destruction of dopamine producing neurons in the substantia nigra area of the brain.

WHAT ARE THE SYMPTOMS?

The four main physical wsymptoms are tremor, bradykinesia (slow movement), rigidity, and postural instability. Tremor is the most noticeable symptom and loss of balance leading to falls one of  the most dangerous. There are also many non motor symptoms such as depression, anxiety, mood changes, fatigue, sleep problems, and cognitive difficulties. We are snowflakes. No two PWP have the exact same symptoms to the same degree.

HOW IS PARKINSON’S DIAGNOSED?

There is no definitive test for PD. If you have two or more major symptoms your doctor will make a diagnosis based on your medical history, a review of your signs and symptoms, and a neurological and physical examination. He may prescribe levodopa and a positive response to the drug will help confirm the diagnosis. A DatsScan cannot confirm that you have PD because it does not distinguish between PD and other forms of parkinsonism. One study estimated that doctors fail to diagnose or misdiagnose Parkinson’s up to 35% of the time.

WHAT CAUSES PARKINSON’S AND WHO GETS IT?

The cause of PD is unknown but researchers believe that both genetic and environmental factors are involved. Environmental means all causes that are not genetic. Age, the older you are the more your chances of getting PD. 1% of the population over 60, 0.001% under 45. It is not known why but men have a 50% higher risk than women. People who suffered traumatic head injuries, those exposed to toxic chemicals especially pesticides, and certain metals (manganese) and solvents have a higher incidence but there is no conclusive evidence that exposure to any single environmental factor acting alone can cause PD.

Specific genes have been linked to the disease. There are causal genes and associated genes. Causal genes occur in 1 - 2% of cases and guarantee that a person who lives long enough will develop PD without the influence of other genes or environmental factors. Associated genes increase the risk but do not develop PD on their own. A person with associated genes may never develop PD but is more likely to. They need to be combined with other genes or affected by the environment. Those with neither type gene may get PD due to environmental causes. 4 - 9% of those that have a parent or sibling with PD get it. 15 - 25% who have any relative with the disease get it.

It is more complicated than just environmental or genetic factors. Most researchers believe it is their interaction. That is, a person’s genetic makeup will determine the effect of an environmental exposure. Genetics make you a candidate for PD and environmental exposure triggers it. In order to develop treatments to stop or reverse the disease scientists are working to identify the combinations of genes and environmental exposures that result in PD and researchers are looking for the genetic trigger that starts the cell death process in dopamine neurons.

CAN PARKINSON’S BE PREVENTED? 

There is no proven way to prevent PD. Some studies show that people who eat more fruits and veggies, high-fiber foods, fish, and omega-3 rich oils (the Mediterranean Diet) and who eat less red meat and dairy have a lower incidence of the disease. Reduced risk of developing the disease is also associated with smoking (yes smoking), caffeine, high vitamin D levels, exercise (everyone’s favorite), and greater physical activity.

HOW IS PARKINSON’S TREATED?

Once you’ve been diagnosed, you should work with your doctor to develop a comprehensive treatment plan to manage your symptoms and improve your quality of life. There are a lot of different treatment options out there. Unfortunately, there’s no medication or treatment right now that can reverse the effects of the disease or cure it completely.

The most common medicine used to treat the symptoms of Parkinson’s disease is levodopa, which was developed in the 1960s and works by synthesizing into dopamine in the brain. When levodopa is taken on its own, it may cause nausea so it’s usually taken with carbidopa (benserazide in the EU), which prevents side effects and increases its efficacy. The levodopa/carbidopa combination is available in many forms and strengths. There are many other prescription medications available to lessen PD symptoms. If your symptoms do not respond to these medications, surgical options may be a possibility. These surgical options involve implants that either stimulate the brain’s movement center or provide a steady flow of levodopa/carbidopa. Deep-brain stimulation is available to help patients who experience intense tremors and dyskinesia as a side effect of their medication.

WHAT YOU CAN DO.

It is up to you to fight back. So much of how you fair with the disease is up to you. Be an active participant with your doctor to develop the best comprehensive treatment plan to improve your quality of life and suffer as little as possible. Learn all you can about the disease so you can make intelligent decisions. Exercise as much as possible. Exercise is believed to slow the progression of the disease and also helps you feel better. Try to be active and engaged with life. Get involved with the PD community. Your local PD community is a wealth of information and support. Be good to yourself.