Parkinson’s Disease

What is Parkinson’s disease?

Parkinson’s disease is a central nervous system disorder affecting movement. It is a progressive disease, meaning that in most cases it will continue to get worse over time. Parkinson’s develops gradually, sometimes starting with a subtle tremor in one of the hands, and then can progress to great stiffness, slurred speech, and even cognitive issues.

There are five stages of Parkinson’s:

• Stage One: mild symptoms such as light tremors in one side of the body
• Stage Two: symptoms become more noticeable, including tremors and rigidity in both sides of the body
• Stage Three: the mid-stage of the progression, characterized by loss of balance and slow movement
• Stage Four: symptoms become too strong for patient to live independently
• Stage Five: the most severe stage, patients can no longer stand or walk and non-motor symptoms like hallucinations and delusions can form.

The disease generally affects older people and typically begins after the age of 50.

What are the symptoms of Parkinson’s disease?

Symptoms often include:

• Tremor or shaking in one or both hands; one specific tremor patients often report is a back-and-forth rubbing of the thumb and index finger, known as a pill-rolling tremor
• Slowed movement (bradyknesia)
• Rigid muscles
• Impaired posture and balance
• Loss of automatic movements like blinking and smiling
• Speech changes (slurred or fast speech, stutters, etc.)
• Hallucinations, dementia, and other neuropsychiatric issues

What causes Parkinson’s disease?

In Parkinson’s disease, certain brain neurons break down or die, and when neurons that produce dopamine are lost, abnormal brain activity can occur. This leads to signs of Parkinson’s.  Dopamine transmits messages from the brain to the muscles, therefore reduced levels of dopamine has a critical affect on motor functions.

The cause behind why these neurons die is unknown, but certain factors can play a role, including:

• Genetics
• Environmental triggers (like toxins)
• The presence of Lewy bodies i.e. microscopic proteins in the neuron

How is Parkinson’s disease diagnosed?

Parkinson’s disease is often diagnosed after clinical evaluation, detailed patient history, and identification of characteristic symptoms.

A diagnosis may be confirmed through:

• Imaging tests (MRI, brain ultrasound, PET scan)
• Carbidopa-levodopa test

What treatment options are available for Parkinson’s disease?

There is currently no approved pharmacology indicated to treat or cure Parkinson’s disease. However, there are some medications that can be used to mitigate symptoms.

These include:

• Dopamine substitute
• Carbidopa-levodopa
• MAO-B inhibitors
• Catechol-O-methyltransferase (COMT) inhibitors
• Anticholinergics
• Amantadine

Surgical options are also available.

Where can I find out more about Parkinson’s disease?

• Mayo Clinic
• NIH
• The Parkinson Foundation