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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.
Falling
  • Abstract 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]
  • Implications for fall prediction were also explored.[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]
  • Further research is required to investigate whether there are specific benefits of tai chi for people with PD, such as its potential effect on balance and on the frequency of falls.[ncbi.nlm.nih.gov]
Fatigue
  • […] of experienced fatigue.[ncbi.nlm.nih.gov]
  • 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]
  • We assessed the need for additional antiparkinsonian therapy and changes in non-motor experiences of daily living and fatigue scales (prespecified outcomes) and changes in unified Parkinson's disease rating scale (UPDRS) scores and subscores in placebo[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: January 31, 2019[patientslikeme.com]
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.[web.archive.org]
  • 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]
Painter
Hypophonia
  • Supporting parkinsonian features include stooped posture, masked facies, micrographia (small handwriting), drooling, speech changes (eg, hypophonia or soft speech, stuttering, slurring, monotonic speech), and a shuffling, festinating gait (quick short[dx.doi.org]
  • […] 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]
  • Mechanism of action of voice therapy in Parkinson's hypophonia-a PET study. Poster presented at: the 11th Annual Meeting of the Organization for Human Brain Mapping 2005 Toronto, Ontario, Canada; 51 Farley B G, Koshland G F.[oadoi.org]
Constipation
  • ., dysphagia and constipation); prevention and treatment of nutritional deficiencies (micronutrients or vitamins).[ncbi.nlm.nih.gov]
  • 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 strongest risk factors associated with later PD diagnosis are having a family history of PD or tremor, a history of constipation, and lack of smoking history.[ncbi.nlm.nih.gov]
  • They include disturbed autonomic function with orthostatic hypotension, constipation and urinary disturbances, a variety of sleep disorders and a spectrum of neuropsychiatric symptoms.[ncbi.nlm.nih.gov]
  • Dopamine replacement therapy considerably reduces motor handicap, and effective treatment of associated depression, pain, constipation, and nocturnal difficulties can improve quality of life.[ncbi.nlm.nih.gov]
Muscle Rigidity
  • Signs and symptoms include tremor which is most pronounced during rest, muscle rigidity, slowing of the voluntary movements, a tendency to fall back, and a mask-like facial expression.[icd9data.com]
  • Upon evaluation, classic parkinsonian signs of muscle rigidity, tremor, bradykinesia, freezing of gait, and cognitive decline were observed.[ncbi.nlm.nih.gov]
  • Vascular parkinsonism Clinical Information A disease characterized as a progressive motor disability manifested by tremors, shaking, muscular rigidity, and lack of postural reflexes A progressive disorder of the nervous system marked by muscle tremors, muscle[icd9data.com]
  • 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]
Drooling
  • […] include: Problems with balance and walking Rigid or stiff muscles Muscle aches and pains Low blood pressure when you stand up Stooped posture Constipation Sweating and not being able to control your body temperature Slow blinking Difficulty swallowing Drooling[nlm.nih.gov]
  • Advanced disease is often characterized by loss of facial expression, reduced rate of swallowing leading to drooling, severe depression, dementia, and paralysis.[britannica.com]
  • Supporting parkinsonian features include stooped posture, masked facies, micrographia (small handwriting), drooling, speech changes (eg, hypophonia or soft speech, stuttering, slurring, monotonic speech), and a shuffling, festinating gait (quick short[dx.doi.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]
  • Vittorio Mantero, Roberto Balgera, Andrea Rigamonti, Francesco Basso and Andrea Salmaggi, Efficacy of high dose methylprednisolone in a patient with cervical dystonia and blepharospasm and Sjögren’s syndrome, Neurological Sciences, 10.1007/s10072-014-[dx.doi.org]
  • Ramírez-Gómez, Carlos Zúñiga-Ramírez, María Laura Contartese, Verónica Montilla, Jorge Gramajo and Federico Micheli, Blepharospasm as a Manifestation of Peak of Dose Dyskinesia in Parkinson Disease, Clinical Neuropharmacology, 10.1097/WNF.0000000000000316[doi.org]
Increased Sweating
  • sweating Urinary frequency or urgency Male erectile dysfunction As the disease gets worse, walking may become affected.[cedars-sinai.org]
Hypomimia
  • Other clinical features include secondary motor symptoms (eg, hypomimia, dysarthria, dysphagia, sialorrhoea, micrographia, shuffling gait, festination, freezing, dystonia, glabellar reflexes), non-motor symptoms (eg, autonomic dysfunction, cognitive/neurobehavioral[ncbi.nlm.nih.gov]
  • 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]
Tremor
  • RATIONALE: 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]
  • KEYWORDS: Deep brain stimulation; Parkinson’s disease; Subthalamic nucleus; Thalamic ventral intermediate nucleus; Tremor[ncbi.nlm.nih.gov]
  • A disease characterized as a progressive motor disability manifested by tremors, shaking, muscular rigidity, and lack of postural reflexes.[icd9data.com]
  • KEYWORDS: Pallidotomy; Parkinson’s disease; Stroke; Treatment; Tremor; iv TPA[ncbi.nlm.nih.gov]
  • Abstract Thalamotomy is effective in treating refractory tremor in Parkinson's disease (PD).[ncbi.nlm.nih.gov]
Bradykinesia
  • Upon evaluation, classic parkinsonian signs of muscle rigidity, tremor, bradykinesia, freezing of gait, and cognitive decline were observed.[ncbi.nlm.nih.gov]
  • Abstract The clinical diagnosis of Parkinson's disease (PD) is established through clinical signs such as bradykinesia, rigidity, and resting tremor.[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]
  • Bradykinesia and rigidity respond best, while tremor may be only marginally reduced. Problems with balance and other symptoms may not be alleviated at all. Anticholinergics may help control tremor and rigidity.[web.archive.org]
Resting Tremor
  • Abstract 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]
  • Rest tremor, bradykinesia, rigidity and loss of postural reflexes are generally considered the cardinal signs of PD. The presence and specific presentation of these features are used to differentiate PD from related parkinsonian disorders.[ncbi.nlm.nih.gov]
  • OUTCOMES: 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. 2016 The Author(s).[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]
  • CONCLUSION: 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]
  • KEYWORDS: Parkinson’s disease; local field potentials; microelectrode recordings; postural instability and gait difficulty; tremor dominant[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]
  • Postural instability usually develops later rather than sooner in the disease progression. The patient may need to hold onto someone to maintain balance when getting up or walking.[dx.doi.org]
Dystonia
  • SUBJECTS/PATIENTS: Six patients with Parkinson's disease with deep brain stimulation experiencing disabling foot dystonia.[ncbi.nlm.nih.gov]
  • KEYWORDS: Deep brain stimulation; Dystonia; Parkinson’s disease; Stuttering[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. Copyright 2018 Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • The prevalence of GCH1 mutations in probands was different between PD [1.9% (5/268)] and DRD [26.9% (7/26)] (p value KEYWORDS: Dopa-responsive dystonia; Dystonia; GCH1; Genetics; Parkinson’s disease[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
  • Parkinson’s patients also suffer incontinence, constipation, and sexual dysfunction and are at higher risk for developing depression, anxiety, memory, and emotional problems.[sleepfoundation.org]
  • Bladder, bowel, and sexual dysfunction in Parkinson’s disease. Parkinsons Dis 2011; 2011 :924605. [ PMC free article ] [ PubMed ] [ Google Scholar ] 34. Connolly BS, Lang AE. Pharmacological treatment of Parkinson disease: a review.[ncbi.nlm.nih.gov]

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.

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Last updated: 2018-06-22 05:43