What are the other Names for this Condition? (Also known as/Synonyms)
- Atherosclerotic Parkinsonism
- Parkinson Disease
- PD (Parkinson’s Disease)
What is Parkinson’s Disease? (Definition/Background Information)
- Parkinson’s Disease (PD) is a progressive neurodegenerative disorder that results from depletion of the neurotransmitter dopamine in the brain. It mostly affects elderly adults over the age of 55.
- Patients with PD experience mainly motor symptoms including impaired movement and posture. Cognitive, psychiatric, sensory, and autonomic symptoms may also be present.
- Some forms of PD are familial (due to genetic factors), while most are idiopathic (where the factors are not known). Parkinsonism may also develop due to secondary causes, such as injury to the brain or an infection.
- A diagnosis of Parkinson’s Disease may be made by recognizing the classical signs and symptoms and through a neurological evaluation.
- Currently, there is no cure for the condition, but the symptoms of PD may be treated using medications and physiotherapy. This can also slow the progression of the condition.
- The prognosis of Parkinson’s Disease depends on many factors. Some forms of PD are better controlled than others. For a majority of people, Parkinsonism may progress slowly and appear over time, but for some unknown reason, symptoms may rapidly progress in others.
Who gets Parkinson’s Disease? (Age and Sex Distribution)
- Parkinson’s Disease is common and typically occurs in middle-age and older adults. The average age of symptom onset is 55-65 years, although 5% of the cases are observed to occur in adults younger than 40 years
- As many as 15% of the individuals between ages 65 and 74, and 50% of the individuals over age 85 have symptoms of Parkinson’s Disease
- Men have a slightly higher incidence of the condition than women
- PD is seen worldwide in all racial and ethnic groups
What are the Risk Factors for Parkinson’s Disease? (Predisposing Factors)
The risk factors of Parkinson’s Disease include the following:
- The main risk factor for PD is advanced age
- There is also some genetic susceptibility, as first degree relatives of patients diagnosed with PD are twice as likely to develop the condition
- Environmental risk factors include exposure to certain toxins and medications, living in rural areas, drinking well water, working with pesticides, and working in wood/paper mills. These risk factors are not yet well categorized and are still being studied.
- Repeated head trauma and a prior brain infection
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Parkinson’s Disease? (Etiology)
- The cause of the symptoms of Parkinson’s Disease is a result of the death of neurons (brain cells) in localized brain structures, called the substantia nigra and locus coeruleus. These neurons normally produce dopamine, a neurotransmitter that acts as a chemical signal to brain regions responsible for motor activity
- As a consequence, fewer dopaminergic neurons result in decreased excitation of the brain regions that initiate and coordinate movement. The underlying cause of dopaminergic neuron loss is unknown in most cases. PD due to unknown causes is termed as Idiopathic Parkinsonism or Primary Parkinsonism, which is the most common form of PD
- 5% of the cases are due to inherited familial forms of PD (due to genetic mutations) that tend to have an earlier onset of symptoms (before age 45) and a longer course of illness. PD due to genetic factors is known as Hereditary Parkinsonism
- Secondary Parkinson’s Disease can however result from vascular diseases, AIDS, and other infections
- In some patients, toxins (such as copper, iron, lead, manganese, cyanide, methanol, and carbon monoxide) and certain medications (such as antipsychotics, antiseizure, and anti-nausea) may be the cause of Parkinson-like symptoms
What are the Signs and Symptoms of Parkinson’s Disease?
- Patients may experience weakness, fatigue, aches, and shoulder pain early in the course of the disease. The classic signs and symptoms of Parkinson’s Disease include:
- Muscular rigidity
- Slow movement (bradykinesia)
- Shuffling gait
- Stooped posture
- Tremors are usually worse at rest and begin in the hands or feet on one side of the body. A continuous ‘pill-rolling’ motion of the hand and wrist is very common. Later in the disease course, tremors of the lips, tongue, and chin may develop.
- Many patients have a flexed posture when standing due to increased muscular rigidity
- Initiation of voluntary movements and fine motor movements, such as handwriting, are often impaired
- Walking without swinging the arms and shuffling the feet are common features
- Facial expressions may be decreased and voice changes may occur
- Patients may also develop anxiety, depression, sleep problems, blurry vision, and decreased sense of smell (anosmia)
How is Parkinson’s Disease Diagnosed?
The diagnosis of Parkinson’s Disease may involve the following:
- Physical examination and medical history evaluation: The condition is diagnosed by the presence of clinical symptoms in adults experiencing tremor, slow or stiff movements, and balance or gait problems
- Thorough neurological examination by a qualified healthcare professional
- There are no specific laboratory tests or imaging studies to aid a diagnosis. Diagnosis early in the disease course, when symptoms are mild, can be difficult
- The individual’s family members may be the first to notice the appearance of symptoms, which may be subtle
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Parkinson’s Disease?
The complications of Parkinson’s Disease may include:
- Depression and anxiety occur in 50% of the individuals; it can be treated though
- Dementia is common with advanced PD
- Symptoms of autonomic dysfunction, such as urinary incontinence and constipation, excessive sweating, orthostatic hypotension (feeling lightheaded upon standing), and sexual dysfunction may develop
- Postural instability and balance problems may lead to falls and related injuries/fractures. Injuries from falls are a major cause of hospitalization and death.
How is Parkinson’s Disease Treated?
- There is no cure for Parkinson’s Disease. Currently, there are no medications available that can slow the disease progression or completely restore normal movement. The symptoms of PD are treated so that the affected individuals can continue to work and maintain a good quality of life.
- There are many different types of medications for Parkinson’s Disease.
- Overall, tremors, rigidity, and bradykinesia respond better to treatment than cognitive and autonomic symptoms
- Drugs that are precursors to dopamine or that mimic dopamine often provide good symptom relief
- Other types of medications can help by increasing the production and release of dopamine, or by preventing its breakdown
- Almost all available medications (may) have side effects, so adjustments are often required to find optimal doses
- Following prolonged treatment, patient responses to medications may decrease over time
Most specialists believe that medications should be started when symptoms begin to interfere with normal functioning. Regular physical exercise is also very important to maintain strength, range of motion and balance, and to prevent further disability related to a sedentary lifestyle.
Occasionally, surgery is done to relieve symptoms that do not respond to medication. Tremors that are resistant to medication have been treated with high-frequency stimulation of particular brain areas with implanted electrodes. Current research is focused on gene therapy and stem cell transplantation to replace the dying dopaminergic neurons, as well as neuro-protective strategies to prevent neuron loss.
How can Parkinson’s Disease be Prevented?
Currently, there are no specific methods or guidelines to prevent most cases of Parkinson’s Disease. However, recognition of the following factors may be helpful with respect to PD:
- Avoidance of repeated head trauma, certain toxins, and occupations and medications known to be associated with PD may be beneficial
- Early diagnosis with close monitoring and treatment of PD is important. Prompt treatment and early recognition of the condition will help in having optimal outcomes
- Genetic testing of the expecting parents (and related family members) and prenatal diagnosis (molecular testing of the fetus during pregnancy) may help to better the understanding of the risks during pregnancy
- If there is a family history of the condition, then genetic counseling will help assess risks before planning for a child
What is the Prognosis of Parkinson’s Disease? (Outcomes/Resolutions)
- Parkinson’s Disease is a degenerative disorder affecting the brain and nervous system that cannot be cured, but only managed through proper treatment (that includes medication, exercises, and surgery in some cases). This can help decline the progression of the condition
- The symptoms of PD progress and worsen over many months to years. A slow increase in impairment may occur over 10 to 25 years
- In some PD patients, the disease slowly progresses, while for others, the symptom progression is rapid. Research is still being done to understand why this occurs
Additional and Relevant Useful Information for Parkinson’s Disease:
- After Alzheimer’s disease, Parkinson’s Disease is recognized as the second most common neurodegenerative condition affecting millions of individuals around the world
- Consumption of coffee/caffeine, smoking, use of NSAIDs (non-steroidal anti-inflammatory drugs), and postmenopausal estrogen replacement therapy are all factors that are associated with decreased risk of the condition
What are some Useful Resources for Additional Information?
Parkinson's Disease Foundation
1359 Broadway, Suite 1509, New York, NY 10018
Phone: (212) 923-4700
Fax: (212) 923-4778
National Institute of Neurological Disorders and Stroke
P.O. Box 5801 Bethesda, MD 20824
Phone: (301) 496-5751
Toll-Free: (800) 352-9424
TDD: (301) 468-5981
Fax: (301) 402-2186
References and Information Sources used for the Article:
DeLong Mahlon R, Juncos Jorge L, "Chapter 366. Parkinson’s Disease and Other Extrapyramidal Movement Disorders" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com.proxy.cc.uic.edu/content.aspx?aID=2905868. (accessed on 04/10/2015)
http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm (accessed on 04/10/2015)
Helpful Peer-Reviewed Medical Articles:
Boeve, B. F. (2013). Idiopathic REM sleep behaviour disorder in the development of Parkinson's disease. Lancet Neurol, 12(5), 469-482. doi: 10.1016/S1474-4422(13)70054-1
Chinta, S. J., Lieu, C. A., Demaria, M., Laberge, R. M., Campisi, J., & Andersen, J. K. (2013). Environmental stress, ageing and glial cell senescence: a novel mechanistic link to Parkinson's disease? J Intern Med, 273(5), 429-436. doi: 10.1111/joim.12029
Eluvathingol Jose, G., & Portillo, M. C. (2013). [Needs and support networks of informal caregivers of people with Parkinson's disease: a literature review]. Rev Enferm, 36(7-8), 52-60.
Grabli, D. (2013). [Parkinson's disease: new explanatory concepts focused on the cellular mechanisms]. Rev Prat, 63(5), 634-638.
McGhee, D. J., Royle, P. L., Thompson, P. A., Wright, D. E., Zajicek, J. P., & Counsell, C. E. (2013). A systematic review of biomarkers for disease progression in Parkinson's disease. BMC Neurol, 13, 35. doi: 10.1186/1471-2377-13-35