What you need to know about Parkinson’s disease

Parkinson’s disease is a movement disorder that affects at least 1 million people in the U.S. and about 6 million worldwide. This chronic neurologic disorder was first described in 1817. It’s the second most prevalent neurodegenerative disease after Alzheimer’s. As people age, the risk of developing Parkinson’s increases, with the average age of onset being 60 years old. However, 5-10% of patients are diagnosed under 40.

Symptoms and diagnosis of Parkinson’s disease

Cardinal motor symptoms are the primary signs of Parkinson’s disease, and the ones most people think of when the disease comes to mind. Resting tremors are often described as a “pill-rolling” tremor in the hands. Bradykinesia is another cardinal motor symptom, which is generalized slowness of movement. Additional symptoms, like stiffness of the limbs and posture instability, can lead to balance problems as the disease progresses.

Other motor symptoms include:

• Micrographia or small handwriting
• Hypomimia or decreased facial expression
• Hypophonia or soft speech
• Dysphagia or difficulty swallowing
• Shuffling gait
• Reduced arm swing when walking

The less visible symptoms often impact the quality of life more than the motor symptoms. The non-motor symptoms can appear years before diagnosis and include:

• Hyposmia or reduced sense of smell
• Constipation
• Depression and anxiety
• Sleep disorders
• Cognitive impairments
• Apathy
• Hallucinations
• Orthostatic hypotension or dizziness upon standing
• Urinary problems
• Excessive sweating
• Seborrheic dermatitis

Some of these symptoms aren’t characteristic only of Parkinson’s disease, and there is no definitive test for the disease. Diagnosis requires the expertise of a neurologist who will gather a medical history, assess symptoms and perform a physical examination.

A neurologist will look for the presence of cardinal motor symptoms and asymmetry of the symptoms. Additional diagnostic tools can be applied. A DaT scan is a brain imaging test that visualizes the dopamine system. This scan isn’t for everyone, but it can be used to differentiate Parkinson’s from other neurological conditions.

Causes and risk factors

The exact cause of Parkinson’s is unknown, but it is believed to result from a combination of genetic and environmental factors. Age is the most significant risk factor, with the average age of diagnosis being 60. Men are more often diagnosed than women, and family history may increase risk, with a higher diagnosis rate among white populations. There are identified links to certain genetic mutations indicative of an increased risk of developing Parkinson’s.

Environmental factors could play a role in the risk of developing Parkinson’s disease. Exposure to certain toxins, like pesticides, has been linked to increasing risk, and head injuries may also be associated with a higher risk.

Living with Parkinson’s disease

Currently, there are no treatments to slow or stop disease progression. The primary goals of treatment are to manage symptoms and improve quality of life. Treatment for each person is unique to their specific needs.

Medications are one line of defense against the progression of Parkinson’s. Levodopa is the gold standard treatment for dopamine replacement therapy. Other options are dopamine agonists, MAO-B inhibitors and COMT inhibitors. These medications are designed specifically for controlling Parkinson’s symptoms. Antidepressants, sleep aids and medications for cognitive issues may be used to treat the non-motor symptoms.

Some surgical interventions have been successful. Deep brain stimulation (DBS), which involves implanting electrodes in specific brain areas, can effectively manage motor symptoms. While this isn’t suitable for all patients, it’s considered when medication side effects outweigh the benefits. Focused Ultrasound (FUS) is a relatively new, non-invasive procedure that uses focused sound waves to help manage tremors in some patients.

Symptoms can be managed by implementing lifestyle changes and therapies, including:

• Exercise: Can help maintain balance, mobility and overall health. Regular exercise may also have neuroprotective effects.
• Diet: A balanced diet is important for everyone to support overall health, but a Mediterranean diet may benefit those with Parkinson’s. Proper hydration and fiber intake can help manage constipation.
• Cognitive stimulation: Mental exercises and brain activities could help retain cognitive function. Social interactions are important for mood and overall mental health.
• Stress management: Meditation or yoga can help manage stress and anxiety.
• Sleep hygiene: Good sleep habits can defend against sleep disturbances often experienced with Parkinson’s.
• Occupational therapy: Maintaining independence with daily activities is the focus of occupational therapy.
• Speech therapy: Working with a speech therapist is beneficial if speech disturbances or swallowing difficulties are experienced.
• Support groups: Connecting with others who have Parkinson’s disease can provide emotional support and advice that can help navigate the diagnosis.

Parkinson’s disease is a complex neurological condition that affects millions of people worldwide. However, with proper diagnosis and management, many people with the disease can maintain a good quality of life.