What is Parkinson's disease?
It is a movement disorder that is both chronic and progressive. The symptoms continue over time and they worsen over time. PD is a neurodegenerative disorder that primarily affects the elderly. Because of this disease, the brain's nerve cells that produce dopamine, the neurotransmitter that coordinates movement, are dying. By the time Parkinson's disease symptoms become obvious, 50% to 80% of these cells have already died.
Stages of Parkinson's Disease
Parkinson's disease (PD) impacts people in different ways. Not everyone will experience all the symptoms of Parkinson's, and if they do, they won't necessarily experience them in quite the same order or at the same intensity. There are typical patterns of progression in Parkinson's disease that are defined in stages.
Stage One
During this initial stage, the person has mild symptoms that generally do not interfere with daily activities. Tremor and other movement symptoms occur on one side of the body only. Changes in posture, walking and facial expressions occur.
Stage Two
Symptoms are getting worse. Tremor, rigidity and other movement symptoms affect both sides of the body. Walking problems and poor posture may be apparent. The person is still able to live alone, but daily tasks are more difficult and lengthy.
Stage Three
Considered mid-stage, loss of balance and slowness of movements are hallmarks. Falls are more common. The person is still fully independent, but symptoms significantly impair activities such as dressing and eating.
Stage Four
At this point, symptoms are severe and limiting. It's possible to stand without assistance, but movement may require a walker. The person needs help with activities of daily living and is unable to live alone.
Stage Five
This is the most advanced and debilitating stage. Stiffness in the legs may make it impossible to stand or walk. The person requires a wheelchair or is bedridden. Around-the-clock nursing care is required for all activities. The person may experience hallucinations and delusions. The Parkinson's community acknowledges that there are many important non-motor symptoms as well as motor symptoms.
What causes PD?
There is no clear answer to this. A growing theory among PD researchers is a combination of genetics and environmental factors. It's also possible to have been brought on by an illness or accident.
How prevalent is PD?
It's estimated to have affected 7 to 10 million worldwide and 1 to 1.5 million in the USA, with 60,000 new cases yearly. The PRMC estimates there are several thousand individuals in its six-county service area with PD. Parkinson's Disease affects 1 in 100 above the age of 60 and 1 in 10 above age 80 at some point in a person's lifespan.
What are the symptoms of PD?
There are four hallmark symptoms used to make a diagnosis.
• Tremor at rest - trembling in the hands, limbs, and face
• Rigidity - stiffness of the limbs and trunk
• Bradykinesia - slowness in initiating movement
• Gait disturbance - poor balance and coordination
• Diagnosis by Neurologist with special training using Unified Parkinson's Disease Rating Scale
Other motor symptoms include: shuffling and reduced arm swing, freezing when walking, mask-like facial expressions, loss of voice volume, small handwriting, reduced manual dexterity (affects eating, dressing, personal care, etc.), swallowing problems, reflux, drooling, muscle cramps or spasms (known as dystonia), abnormal involuntary movements (known as dyskinesias), sexual dysfunction, pain without obvious cause.
Non-motor symptoms include: constipation, urinary urgency & frequency, excessive perspiration, seborrhea, numbness of tingling, sleep issues, anxiety and depression, hallucinations, dementia, neuropsychiatric changes affecting memory, problem solving, multitasking, planning, abstract thinking, attention changes, cognitive speed, recalling learned information.
How do you treat PD?
There is no cure. The primary objective is dopamine replacement. The gold standard in medications is the combination Carbidopa/Levodopa (Brand name Sinemet). Levodopa is converted into dopamine in the brain, replacing lost dopamine and relieving symptoms. It is also converted elsewhere in the body but with side effects (nausea). Carbidopa prevents the conversion of levodopa in the body, thus ensuring the Levodopa reaches the brain. Carbidopa cannot cross the brain/blood barrier so it can no longer stop the conversion. The efficiency of Sinemet is reduced if taken too close to eating protein. Try to take the dose an hour or more before eating high-protein foods or wait 1-2 hours after eating. There are other drugs used at various stages of disease progression to treat symptoms or augment the efficacy of carbidopa/levodopa
• Dopamine Agonists - these agents mimic dopamine to stimulate the receptors in the brain
• MAO-B Inhibitors - Inhibit the breakdown of dopamine in the brain by the MAO-B enzyme
• COMT Inhibitors - Inhibit the breakdown of levodopa before it crosses the blood brain barrier by inhibiting the COMT enzyme
Surgery: Deep brain stimulation (DBS) - a battery-operated medical device is surgically implanted in the body to deliver electrical stimulation to electrodes implanted in certain areas of the brain that control movement. This reduces some motor symptoms and usually allows a reduction of medications. A "pacemaker" for the brain.
Exercise: Exercise is considered to be therapeutic and vital to maintaining the quality of life (affecting flexibility, balance, reducing falls, etc.). Done regularly at moderately intense levels, it is even considered neuroprotective and possibly neurodegenerative.
What's happening with PD Research?
Research typically falls into one of three categories:
1. Development of medicines or techniques to reduce or manage the symptoms of PD.
2. The discover or development of neuroprotective agents or processes that will slow or halt the progression of PD. (Exercise is thought to be therapeutic in slowing progression of symptoms).
3. The discover or development of neuroregenerative agents or processes that will reverse PD.
On the research horizon:
• Gene therapies that target specific regions of the brain
• Stem cell therapy using a patient's own cells, modified in the lab, to reverse the disease
• New drug delivery mechanisms such as the transdermal patch, intranasal and inhalation administration, direct continuous infusion pump to small intestine (Duopa).
What kind of support is available to the PD Community?
Research typically falls into one of three categories:
1. Development of medicines or techniques to reduce or manage the symptoms of PD.
2. The discover or development of neuroprotective agents or processes that will slow or halt the progression of PD. (Exercise is thought to be therapeutic in slowing progression of symptoms).
3. The discover or development of neuroregenerative agents or processes that will reverse PD.
On the research horizon:
• Gene therapies that target specific regions of the brain
• Stem cell therapy using a patient's own cells, modified in the lab, to reverse the disease
• New drug delivery mechanisms such as the transdermal patch, intranasal and inhalation administration, direct continuous infusion pump to small intestine (Duopa).