Edit concept Create issue ticket

Parkinson's Disease

Parkinson Disease

Parkinson's disease is a form of neurological disorder characterized by gradual loss of those neurological functions that governs body movement. The disease is therefore also referred to as movement disorder.


Presentation

In the early stages of the disease, signs and symptoms are pretty less evident. However, as the disease progresses to more advance stages the following symptoms are prominent [7]:

  • Tremors characterized by shaking hands, fingers and legs.
  • Bradykinesia characterized by slowed movement making everyday simple tasks,difficult to achieve.
  • Muscle stiffness sets in as the disease advances.
  • Posture and balance of the individual get disrupted.
  • Individuals may experience difficulty in writing due to loss of motor movements.
  • Changes in the speech may occur.
  • Automatic movements such as blinking, swinging arms while walking and making gestures while talking are all lost.
Hypophonia
  • […] all of them) include: abnormal walking decreased arm swing excessive salivation feelings of depression or anxiety increase in dandruff or oily skin lack of facial expression ( hypomimia ) less frequent blinking and swallowing lowered voice volume ( hypophonia[medbroadcast.com]
  • […] micrographia) Lack of facial expression Slowed activities of daily living (for example, eating, dressing, and bathing) Trouble turning in bed Staying in a certain position for a long period of time Non-motor symptoms Diminished sense of smell Low voice volume (hypophonia[cedars-sinai.org]
  • A person with PD may speak very softly and may be hard to understand (hypophonia). Speech impairment is referred to as dysarthria and is often characterized as weak, slow, or uncoordinated speaking that can affect volume and/or pitch.[caregiver.org]
  • These so-called mirror movements may be observed in early asymmetric PD. 76 Bulbar dysfunction manifested by dysarthria, hypophonia, dysphagia and sialorrhoea, frequently observed in patients with PD, can be equally or even more disabling than the cardinal[jnnp.bmj.com]
  • Treatment of Parkinson hypophonia with percutaneous collagen augmentation. Laryngoscope . 1999 Aug. 109(8):1295-9. [Medline] . Kim HJ, Jeon BS, Paek SH. Effect of deep brain stimulation on pain in Parkinson disease.[emedicine.medscape.com]
Falling
  • A 62 year old male worker sustained a head contusion from a fall in the workplace. When assessing the mechanism of the fall, it was noted that the worker stated that his feet became "stuck" and would not move.[ncbi.nlm.nih.gov]
  • Participants then registered all prospective falls for 6 months.[ncbi.nlm.nih.gov]
  • However, use of vibrotactile feedback did not significantly alter dynamics of postural control in older adults with high risk of falling or reduce the magnitude of sway.[ncbi.nlm.nih.gov]
  • Whereas neurogenic orthostatic hypotension poses risks for falls and can be associated with cognitive impairment in the short term, chronic supine hypertension can be associated with stroke and myocardial infarction in the long term.[ncbi.nlm.nih.gov]
  • Falls are a frequent problem for people with Parkinson’s disease. Tips for preventing falls are listed. Falls are a frequent complication of Parkinson's disease (PD) .[my.clevelandclinic.org]
Fatigue
  • Apathy was examined by the self-report version of Starkstein Apathy Scale and fatigue was evaluated with the Parkinson's Disease Fatigue Scale.[ncbi.nlm.nih.gov]
  • These co-morbidities include constipation, depression, fatigue, and insomnia.[foodforthebrain.org]
  • We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: November 30, 2018[patientslikeme.com]
  • We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: November 23, 2018[patientslikeme.com]
  • Pain, apathy, fatigue, midlife obesity , impaired color discrimination, and/or restless leg syndrome. It is important to note that the symptoms of PD can be very different between patients, sometimes making it hard to diagnose.[my.clevelandclinic.org]
Difficulty Walking
  • Tremors, rigidity, slow movement (bradykinesia), poor balance, and difficulty walking (called parkinsonian gait) are characteristic primary symptoms of Parkinson's disease .[healthcommunities.com]
  • As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 60. Early symptoms of PD are subtle and occur gradually.[ninds.nih.gov]
  • An “off” episode is a time when a patient’s medications are not working well, causing an increase in Parkinson’s symptoms, such as tremor and difficulty walking.[fda.gov]
  • Once referred to as ' the shaking palsy ', Parkinson's disease is mostly characterised by tremors and a loss of fine motor control, later progressing into dementia, difficulty walking, and sometimes chronic depression.[sciencealert.com]
  • Balance and walking problems: Initially persons have difficulty walking at normal speeds or may find it difficult to fully lift a leg, causing the foot to “drag” behind the other foot.[caregiver.org]
Constipation
  • This paper highlights the importance of early recognition and treatment of constipation to prevent volvulus developing and thevarious treatments currently available.[ncbi.nlm.nih.gov]
  • The patient also described a 10-year history of constipation, loss of smell and 'frequent collapses'.[ncbi.nlm.nih.gov]
  • Constipation and Digestive Issues As Parkinson’s disease progresses, your digestive tract will slow down and function less efficiently. This lack of movement may lead to increased bowel irritability and constipation.[healthline.com]
  • These co-morbidities include constipation, depression, fatigue, and insomnia.[foodforthebrain.org]
  • If the drug succeeds in reversing constipation, the researchers will conclude that it has disrupted the function of αS in the intestinal nerves.[sciencemag.org]
Muscle Rigidity
  • Upon evaluation, classic parkinsonian signs of muscle rigidity, tremor, bradykinesia, freezing of gait, and cognitive decline were observed.[ncbi.nlm.nih.gov]
  • Parkinson’s disease symptoms include muscle rigidity, tremors, and changes in speech and gait. After diagnosis, treatments can help relieve symptoms, but there is no cure.[webmd.com]
  • Parkinson's Disease is a progressive disorder of the nervous system marked by muscle tremors, muscle rigidity, decreased mobility, stooped posture, slow voluntary movements, and a mask-like facial expression.[patientslikeme.com]
Drooling
  • It can also increase the likelihood of drooling or choking while eating. Fear of choking and other eating problems may put you at risk for inadequate nutrition.[healthline.com]
  • Gradual loss of automatic movement, which may lead to decreased blinking, decreased frequency of swallowing and drooling A stooped, flexed posture with bending at the elbows, knees and hips Unsteady walk or balance Depression or dementia Presently, the[aans.org]
  • A person who has Parkinson's may experience some of these more common "hallmark" symptoms: Bradykinesia - slowness of movement, impaired dexterity, decreased blinking, drooling, expressionless face.[mayfieldclinic.com]
  • Saliva may accumulate in your mouth due to slowed swallowing, leading to drooling. Chewing and eating problems. Late-stage Parkinson's disease affects the muscles in your mouth, making chewing difficult. This can lead to choking and poor nutrition.[mayoclinic.org]
  • Excessive Salivation: Rather than an over production of saliva, excessive salivation (or drooling) is likely the result of an accumulation of saliva in the mouth due to less frequent swallowing.[hopkinsmedicine.org]
Blepharospasm
  • Practice Guideline Update Summary: Botulinum Neurotoxin for the Treatment of Blepharospasm, Cervical Dystonia, Adult Spasticity, and Headache April 2016 Current guideline.[aan.com]
  • These include decreased blink rate, ocular surface irritation, altered tear film, visual hallucinations, blepharospasm and decreased convergence. 82 The degree of abnormality in ocular pursuit and saccades as well as antisaccades 83 is related to the[jnnp.bmj.com]
Increased Sweating
  • sweating Urinary frequency or urgency Male erectile dysfunction As the disease progresses, walking may become affected, causing the person to stop in mid-stride or "freeze" in place, and maybe even fall over.[cedars-sinai.org]
Hypomimia
  • Other symptoms that are common in Parkinson's (though no one person will have all of them) include: abnormal walking decreased arm swing excessive salivation feelings of depression or anxiety increase in dandruff or oily skin lack of facial expression ( hypomimia[medbroadcast.com]
  • Other manifestations of bradykinesia include loss of spontaneous movements and gesturing, drooling because of impaired swallowing, 25 monotonic and hypophonic dysarthria, loss of facial expression (hypomimia) and decreased blinking, and reduced arm swing[jnnp.bmj.com]
Tremor
  • Treating the patients with hand tremors is clinically difficult, because a wide range of disorders can result in hand tremors. Therefore, when treatment for hand tremors begins, various pharmacological options have to be considered.[ncbi.nlm.nih.gov]
  • Thalamotomy is effective in treating refractory tremor in Parkinson's disease (PD).[ncbi.nlm.nih.gov]
  • Deep brain stimulation (DBS) in the thalamic ventral intermediate (Vim) or the subthalamic nucleus (STN) reportedly improves medication-refractory Parkinson's disease (PD) tremor.[ncbi.nlm.nih.gov]
  • Here, we present an illustrative rare case, a 65-year-old man with PD, at whom his unilateral parkinsonian tremor was totally recovered after stroke limited to lentiform nucleus.[ncbi.nlm.nih.gov]
  • We herein report the case of a 43-year-old man with a 4-year history of resting tremor and akinesia. His resting tremor and rigidity were more prominent on the left side. He also presented retropulsion.[ncbi.nlm.nih.gov]
Bradykinesia
  • We observed the exacerbation of bradykinesia, which might have been caused by edema around the target. This is the first report of thalamotomy using MRgFUS for PD patient from Japan.[ncbi.nlm.nih.gov]
  • Upon evaluation, classic parkinsonian signs of muscle rigidity, tremor, bradykinesia, freezing of gait, and cognitive decline were observed.[ncbi.nlm.nih.gov]
  • The clinical diagnosis of Parkinson's disease (PD) is established through clinical signs such as bradykinesia, rigidity, and resting tremor.[ncbi.nlm.nih.gov]
  • On examination, moderate rigidity, asymmetric bradykinesia, and bilateral action tremor were present. He was started on levodopa with significant improvement. Two years later, he developed wearing off phenomena.[ncbi.nlm.nih.gov]
  • The cardinal features include resting tremor, rigidity, bradykinesia, and postural instability. Patients may demonstrate a combination of these motor symptoms, as well as other non-motor symptoms.[bestpractice.bmj.com]
Resting Tremor
  • We herein report the case of a 43-year-old man with a 4-year history of resting tremor and akinesia. His resting tremor and rigidity were more prominent on the left side. He also presented retropulsion.[ncbi.nlm.nih.gov]
  • Right-side resting tremor and rigidity were abolished immediately following the ultrasound energy delivery. In addition, left-side resting tremor and rigidity also improved. No adverse events occurred during the procedure.[ncbi.nlm.nih.gov]
  • After treatment, although the bradykinesia, rigidity, and resting tremor of the patient significantly decreased, the dexterity of the patient's hands did not improve.[ncbi.nlm.nih.gov]
  • Upon physical examination, a resting tremor was noted as well as upper and lower body rigidity, and a festinating gait. The worker was evaluated by a neurologist and diagnosed with early Parkinson's disease.[ncbi.nlm.nih.gov]
  • At the age of 35, the patient attended a hospital due to impaired left-hand movement and resting tremor. He was previously diagnosed with multiple system atrophy based on the lack of effectiveness of levodopa treatment.[ncbi.nlm.nih.gov]
Postural Instability
  • Management of postural instability is challenging as it is often resistant to dopaminergic therapy. Greater knowledge of postural control is essential to understand postural instability in PD.[ncbi.nlm.nih.gov]
  • Our results indicate that patients with early PD have subtle signs of postural instability when their attention is diverted or reduced. In addition, deficits of stereopsis may be common in early PD patients.[ncbi.nlm.nih.gov]
  • The cardinal features include resting tremor, rigidity, bradykinesia, and postural instability. Patients may demonstrate a combination of these motor symptoms, as well as other non-motor symptoms.[bestpractice.bmj.com]
  • Although motor subtypes of Parkinson's disease (PD), such as tremor dominant (TD) and postural instability and gait difficulty (PIGD), have been defined based on symptoms since the mid-1990s, no underlying neural correlates of these clinical subtypes[ncbi.nlm.nih.gov]
  • Postural instability (impaired balance and coordination) – A person with postural instability may have a stooped position, with head bowed and shoulders drooped. They may develop a forward or backward lean and may have falls that cause injuries.[medtronic.com]
Dystonia
  • Six patients with Parkinson's disease with deep brain stimulation experiencing disabling foot dystonia.[ncbi.nlm.nih.gov]
  • We report a 61 years-old patient with PD, afflicted by severe On and Off dystonia, treated with Subthalamic Nucleus DBS that developed post-DBS stuttering while on 130 Hz stimulation.[ncbi.nlm.nih.gov]
  • Dystonia was common symptom, and dysautonomia and cognitive decline were uncommon in our PD and DRD. All patients presented mild parkinsonism or dystonia with excellent response to levodopa.[ncbi.nlm.nih.gov]
  • Our results indicate that to analyze the relationship between dopa-responsive dystonia-related genes and PD, it is important to screen GCH1 and test rs6356 of TH in a larger sample.[ncbi.nlm.nih.gov]
  • […] patients with PD who are treated with L-dopa chronically, a new use of pramipexole and an increase in dose to alleviate the symptoms of PD should be implemented with caution while closely observing the occurrence of drug-induced complications such as dystonia[ncbi.nlm.nih.gov]
Sexual Dysfunction
  • Sexual dysfunction. Some people with Parkinson's disease notice a decrease in sexual desire or performance. Prevention Because the cause of Parkinson's is unknown, proven ways to prevent the disease also remain a mystery.[mayoclinic.org]
  • Sexual Dysfunction: Sex can be more difficult in part because individuals with Parkinson's disease have difficulty with mobility. The tremors in Parkinson's disease are often greatly increased with excitation and this can be an interference.[hopkinsmedicine.org]
  • The major complication in Parkinsons disease are blood pressure changes, depression, emotional changes, thinking difficulties, fatigue, sexual dysfunction, smell dysfunction, pain and sleep disorders .[parkinsons.conferenceseries.com]
  • dysfunction, seborrheic dermatitis) A general feeling of weakness, malaise, or lassitude Depression or anhedonia Slowness in thinking Onset of motor signs include the following: Typically asymmetric The most common initial finding is a resting tremor[emedicine.medscape.com]

Workup

So far no laboratory tests exist for diagnosing Parkinson's disease. A neurologist will diagnose the disease based on the past medial history of the affected individual followed by thorough analysis of the signs and symptoms. In addition, certain tests may also be required to rule out the possibility of any underlying disease condition. In order to arrive at an appropriate diagnosis, the neurologist will give medications meant for Parkinson's disease to the individual. If the individual benefits from the drug then the diagnosis is confirmed [8].

Treatment

Parkinson's disease cannot be cured; the symptoms can be effectively managed and progression of the condition slowed down with appropriate treatment methods. Medications form an important part of treatment regime. In more advanced stages, however surgery may be advised. The following are the various medications prescribed for treating Parkinson's disease.

  • Carbidopa-levodopa is one of the most effective medications for Parkinson disease. This is a natural chemical that gets converted to dopamine when it reaches the brain [9].
  • Medications containing dopamine antagonists are prescribed which unlike levodopa do not get converted to dopamine but mimic the effects of the brain chemical.
  • Monoamine oxidase B (MAO-B) inhibitors do not allow the breakdown of dopamine. However, this class of medication has various side effects when taken with other drugs.
  • Anticholinergics help in controlling the tremors; however are seldom prescribed due to associated side effects.
  • Amantadine is prescribed for short term relief from the symptoms. It is also given in association with levodopa to reduce dyskinesias that may accompany as a side effect of carbidopa-levodopa drug [10].

Prognosis

As the disease progresses, there is gradual loss of neurological functions in the affected individuals. Individuals who do not receive proper treatment often suffer from other secondary debilitating conditions. There is absolute loss of movement making the individual completely bed ridden for rest of the life. However, with introduction of newer generation medications, it has now been possible to effectively manage the symptoms and improve the quality of life [6].

Etiology

Parkinson disease occurs due to necrosis of certain nerve cells in the brain which are responsible for producing dopamine. The exact cause that triggers the development of such a type of movement disorder is yet to be known. However, interplay of several factors such as environment and genetic are known to play a role. Genetic factors attribute to 10% cases of Parkinson disease.

Genetic factors

Certain genes have been identified to play a major role in causation of Parkinson's disease. Individuals with family history of this disease are at an increased risk of contracting it as they age.

Environmental factors

Exposure to certain toxins can predispose an individual to develop Parkinson's disease [2].

Epidemiology

Parkinson disease is the second most common neurological disorder affecting about 7 million individuals across the globe. An estimated 1 million individuals of United States suffer from this neurodegenerative disorder [3]. Individuals aged 60 years and above fall easy prey to this disease. Men are 1.5 times more likely to contract Parkinson's disease, compared to women. Statistics have revealed that a small percentage of individuals (5 – 10%) between the age group of 20 – 50 years have been known to develop this kind of movement disorder [4].

Sex distribution
Age distribution

Pathophysiology

Parkinson's disease is a result of death of neurons in the brain. These are responsible for producing dopamine. Dopamine is a chemical messenger of the brain that transmits information to control the movements in various parts of the body [5]. The inability of the neurons to produce dopamine causes motor impairment which is the major cause of disability amongst the affected individuals. It has also been found that about 60 – 80% of necrosis of the nerve cells occurs even before the preliminary signs and symptoms of Parkinson's disease occur.

Prevention

Till date, no methods have been developed to prevent Parkinson's disease. Since the cause is unknown, ways to prevent the onset of the disease also remains a mystery. However, there have been some pieces of evidence suggesting the use of caffeine to help prevent Parkinson's disease.

Summary

Individuals over the age of 60 years are the most affected.The disease steadily causes disability greatly interfering with the individual’s ability to carry out daily functions. The preliminary stage of the disease may showcase little or no symptoms. Parkinson's disease cannot be cured. The symptoms can be effectively managed with appropriate medications. In some cases, surgical procedures may be required to improve the symptoms [1].

Patient Information

Definition

Parkinson's disease is a neurodegenerative disorder characterized by loss of neurological functions due to necrosis of the nerve cells in the brain. It is known to be the second most common neurological disorder after Alzheimer disease. Individuals above the age of 60 years are more prone to develop this condition. Parkinson's disease greatly affects the movement ability of the individuals and therefore the disease is also commonly referred to as movement disorder.

Cause

The exact factor that leads to development of Parkinson's disease is not clear. However certain genetic factors and exposure to environmental toxins is known to cause this type of neurological disorder.

Symptoms

In the initial stages, Parkinson's disease may show little or no signs at all. As the disease progresses to more advance stages, individuals experience tremors of the hands, fingers and legs. They also have difficulty in walking and their movements slow down to a great extent. Difficulty in talking is evident with slurred speech.

Diagnosis

No laboratory tests help in diagnosing the condition. A thorough examination of the signs and symptoms help in confirming Parkinson's disease.

Treatment

Medications form the basis of the treatment regime. Various classes of drugs are prescribed to keep the symptoms under control. Carbidopa-levodopa is the most effective drug for treating Parkinson's disease. It works by getting converted into dopamine once it reaches the brain.

References

Article

  1. Langston JW. The Parkinson's complex: parkinsonism is just the tip of the iceberg. Ann Neurol 2006; 59:591.
  2. Pezzoli G, Cereda E. Exposure to pesticides or solvents and risk of Parkinson disease. Neurology. May 28 2013;80(22):2035-41.
  3. Wirdefeldt K, Adami HO, Cole P, Trichopoulos D, Mandel J. Epidemiology and etiology of Parkinson's disease: a review of the evidence. Eur J Epidemiol. Jun 2011;26Suppl 1:S1-58.
  4. Van Den Eeden SK, Tanner CM, Bernstein AL, et al. Incidence of Parkinson's disease: variation by age, gender, and race/ethnicity. Am J Epidemiol 2003; 157:1015.
  5. Hornykiewicz O. The discovery of dopamine deficiency in the parkinsonian brain. J Neural TransmSuppl 2006; :9.
  6. Jeffrey S. Biomarkers for Parkinson's Diagnostic, Prognostic. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/810262.
  7. Politis M, Wu K, Molloy S, et al. Parkinson's disease symptoms: the patient's perspective. MovDisord 2010; 25:1646.
  8. Tolosa E, Gaig C, Santamaría J, Compta Y. Diagnosis and the premotor phase of Parkinson disease.Neurology. Feb 17 2009;72(7 Suppl):S12-20.
  9. Stocchi F, Rascol O, Kieburtz K, et al. Initiating levodopa/carbidopa therapy with and without entacapone in early Parkinson disease: the STRIDE-PD study. Ann Neurol. Jul 2010;68(1):18-27.
  10. Weintraub D, Sohr M, Potenza MN, Siderowf AD, Stacy M, Voon V, et al. Amantadine use associated with impulse control disorders in Parkinson disease in cross-sectional study. Ann Neurol. Dec 2010;68(6):963-8.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 05:43