Parkinson's disease: causes, symptoms, treatments and innovative cures
Parkinson’s disease is a brain disorder that causes involuntary or uncontrollable movements, such as tremors, stiffness, and difficulty with balance and coordination
Symptoms usually start gradually and get worse over time.
As the disease progresses, people may have difficulty walking and talking.
They may also have mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue.
While virtually anyone could be at risk of developing Parkinson’s disease, some research studies suggest that the disease affects more men than women.
It’s not clear why, but studies are underway to understand the factors that may increase a person’s risk.
One clear risk is age: although most people with Parkinson’s develop the disease for the first time after the age of 60, about 5-10% experience onset before the age of 50.
Early-onset forms of Parkinson’s are often, but not always, hereditary, and some forms have been linked to specific changes in genes.
What causes Parkinson’s disease?
The most important signs and symptoms of Parkinson’s disease occur when nerve cells in the basal ganglia, an area of the brain that controls movement, become impaired and/or die
Normally, these nerve cells, or neurons, produce an important brain chemical known as dopamine.
When neurons die or weaken, they produce less dopamine, which causes the movement problems associated with the disease.
Scientists still don’t know what causes neurons to die
People with Parkinson’s disease also lose the nerve endings that produce norepinephrine, the primary chemical messenger of the sympathetic nervous system, which controls many body functions, such as heart rate and blood pressure.
Loss of norepinephrine could help explain some of the non-movement features of Parkinson’s disease, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and a sudden drop in blood pressure when a person gets up from a sitting position or lying down position.
Many brain cells of people with Parkinson’s disease contain Lewy bodies, unusual clusters of the protein alpha-synuclein.
Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to the genetic variants that affect Parkinson’s and dementia with Lewy bodies.
Some cases of Parkinson’s disease appear to be hereditary, and some cases can be traced to specific genetic variants.
Although genetics are thought to play a role in Parkinson’s, in most cases the disease does not appear to be hereditary.
Many researchers now believe that Parkinson’s results from a combination of genetic and environmental factors, such as exposure to toxins.
Symptoms of Parkinson’s disease
Parkinson’s has four main symptoms:
- Trembling in hands, arms, legs, jaw or head
- Muscle stiffness, where the muscle remains contracted for a long time
- Slowness of movement
- Impaired balance and coordination, sometimes leading to falls
Other symptoms can include:
- Depression and other emotional changes
- Difficulty swallowing, chewing and speaking
- Urinary problems or constipation
- Skin problems
Parkinson’s disease symptoms and the rate of progression differ among individuals
The early symptoms of this disease are subtle and occur gradually.
For example, people may experience mild tremors or have difficulty getting out of a chair.
They may notice that they speak too softly or that their handwriting is slow and seems cramped or small.
Friends or family members may be the first to notice changes in someone with early-stage Parkinson’s.
They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.
People with Parkinson’s disease often develop a Parkinsonian gait that includes leaning forward; take small quick steps; and reduce arm swing.
They may also have difficulty starting or continuing to move.
Symptoms often start on one side of the body or even in a limb on one side of the body
As the disease progresses, it eventually affects both sides.
However, the symptoms can still be more severe on one side than the other.
Many people with Parkinson’s disease notice that before experiencing stiffness and shaking, they had trouble sleeping, constipation, loss of smell, and restless legs.
While some of these symptoms can also occur with normal aging, talk to your doctor if these symptoms get worse or start to interfere with daily life.
Parkinson’s disease diagnosis
There are currently no blood tests or laboratory tests to diagnose non-genetic cases of Parkinson’s.
Doctors usually diagnose the disease by taking a person’s medical history and performing a neurological exam.
If symptoms improve after starting medications, it is another indicator that the person has Parkinson’s.
Many disorders can cause symptoms similar to those of Parkinson’s disease.
People with Parkinson’s-like symptoms that result from other causes, such as multiple system atrophy and dementia with Lewy bodies, are sometimes said to have parkinsonism.
Although these disorders may initially be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, can help better assess the cause.
Many other diseases have similar characteristics but require different treatments, so it’s important to get an accurate diagnosis as soon as possible.
Treatments for Parkinson’s disease
While there is no cure for Parkinson’s disease, medications, surgical treatments, and other therapies can often relieve some symptoms.
Medicines for Parkinson’s disease
Medications can help treat the symptoms of Parkinson’s disease:
- Increase the level of dopamine in the brain
- Have an effect on other brain chemicals, such as neurotransmitters, which transfer information between brain cells
- Help control symptoms of not moving
The main therapy for Parkinson’s disease is levodopa
Nerve cells use levodopa to produce dopamine to replenish the brain’s dwindling supply.
Usually, people take levodopa together with another drug called carbidopa.
Carbidopa prevents or reduces some of the side effects of levodopa therapy — such as nausea, vomiting, low blood pressure, and restlessness — and reduces the amount of levodopa needed to improve symptoms.
People living with Parkinson’s disease should never stop taking levodopa without telling their doctor.
Stopping the drug suddenly can have serious side effects, such as being unable to move or having difficulty breathing.
Your doctor may prescribe other medicines to treat the symptoms of Parkinson’s disease, including:
- Dopamine agonists to stimulate dopamine production in the brain
- Enzyme inhibitors (e.g. MAO-B inhibitors, COMT inhibitors) to increase the amount of dopamine by slowing down the enzymes that break down dopamine in the brain
- Amantadine to help reduce involuntary movements
- Anticholinergic drugs to reduce tremors and muscle stiffness
- Deep brain stimulation
For people with Parkinson’s disease who don’t respond well to medications, their doctor may recommend deep brain stimulation.
During a surgical procedure, a doctor implants electrodes in part of the brain and connects them to a small electrical device implanted in the chest.
The device and electrodes painlessly stimulate specific areas of the brain that control movement in a way that can help stop many of the movement-related symptoms of Parkinson’s, such as shaking, slow movement, and stiffness.
Other therapies that can help manage Parkinson’s disease symptoms include:
- Physical, occupational, and speech therapies, which can help with gait and voice disturbances, tremors and stiffness, and decline in mental function
- A healthy diet to support general well-being
- Exercises to strengthen muscles and improve balance, flexibility and coordination
- Massage therapy to reduce tension
- Yoga and tai chi to increase stretching and flexibility
Support for people living with Parkinson’s disease
While the progression of Parkinson’s is usually slow, eventually a person’s daily routines can be affected.
Activities like working, taking care of the house, and participating in social activities with friends can become demanding.
Experiencing these changes can be difficult, but support groups can help people cope.
These groups can provide information, advice and links to resources for those living with Parkinson’s disease, their families and healthcare professionals.
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