Parkinson’s Disease

Table of Contents

    What Is Parkinson’s Disease?

    Parkinson’s disease (PD) is a chronic neurological disorder that affects the nervous system, particularly the substantia nigra, a deep midbrain structure that produces the neurotransmitter dopamine. Dopamine projects to other nerve cells in the striatum within the brain’s hemispheres. When Parkinson’s strikes, cells in the substantia nigra gradually die and project less and less dopamine to the striatum. Parkinson’s also affects other areas of the brain and peripheral nervous system over time.

    In addition to many other functions, dopamine enables the neurons in your brain to communicate and control movement throughout the body. Therefore, Parkinson’s disease is a movement disorder since many of its chief symptoms affect movement. However, there are many non-motor symptoms associated with PD as well.

    One of the hallmarks of Parkinson’s disease is that no two patients experience the condition in the same way. “Once you’ve seen one Parkinson’s disease patient, you’ve seen one Parkinson’s disease patient,” says Jordan Harborth, a movement disorder specialist at Neurology Solutions. “Not only are the symptoms very different with each patient, but the disease’s overall progression is unique to each patient, too.”

    Facts About Parkinson’s Disease

    • Parkinson’s disease is the most common movement disorder we treat at Neurology Solutions. Well over half of our patients have a PD diagnosis.
    • PD is the fastest-growing neurological disease in the world.
    • The prevalence of PD has increased 35% in Americans over the last decade. About 1 in 15 people in the U.S. will be diagnosed with Parkinson’s over their lifetime.
    • Nearly 1 million people in the U.S are living with PD. This number is expected to rise to 1.2 million by 2030.
    • Nearly 60,000 Americans are diagnosed with PD yearly, but this number does not reflect the thousands of undetected cases.
    • There are more people with a PD diagnosis than the number of people that have multiple sclerosis, muscular dystrophy, and ALS combined.
    • Men are one-and-a-half times more likely to have PD than women.
    • The average onset of PD is age 60, but it is estimated that 5-10% of people experience symptoms before age 40. 
    • No two people with PD have the exact same symptoms.

    Parkinson’s Disease Symptoms

    Parkinson’s disease affects people differently. Not everyone will experience all the symptoms of PD, and the progression of the disease can also vary significantly from person to person. No two cases of PD are precisely alike, from the presence of specific symptoms to the symptoms’ severity.

    Tremor is usually the first symptom, typically in just one arm or leg or one side of the body. Usually, the disease will remain worse on the side of the patient’s body where the symptoms first appeared, even after the symptoms begin to affect both sides of the body.

    Joint and muscular pain, fatigue, and weakness also may occur. As the disease progresses, coordination, stiffness, and rigidity may worsen, and later in the disease, problems with cognition, behavior, posture, and balance may appear.

    After several years, the person with PD may no longer be able to care for themselves or perform daily tasks independently and may be confined to a wheelchair.

    You Are More Than Your Symptoms

    Movement disorders are incredibly complex diseases affecting multiple systems in the body. At Neurology Solutions, we believe that these challenging diseases require a comprehensive approach that treats the whole patient— not a list of symptoms. 

    How Are Parkinson’s Symptoms Measured?

    Parkinson’s is measured on the Unified Parkinson’s Disease Rating Scale (UPDRS) measuring aspects such as reflexes, tremor, rigidity, balance, coordination, posture, gait, and eye movement. Because PD is a multi-system disorder, it also includes non-motor symptoms.

    PD Motor Symptoms

    • Dystonia
    • Tremor at rest 
    • Rigidity or muscle stiffness
    • Facial masking
    • Slowness of movement (Bradykinesia)
    • Trouble walking or moving
    • Problems with balance
    • Stooped posture
    • Dizziness or fainting
    • Drooling

    PD Non-Motor Symptoms

    • Speech and swallowing problems
    • Breathing and respiratory problems
    • Sleep disorders
    • Mood problems including anxiety, apathy, and depression
    • Fatigue
    • Pain
    • Loss of smell or taste
    • Constipation and nausea
    • Orthostatic hypotension — “lightheadedness” (late-stage)
    • Urinary incontinence (late-stage)
    • Dementia (late-stage)
    • Cognitive decline or impairment

    Early Warning Signs of Parkinson’s Disease

    Parkinson’s disease often begins with mild symptoms that gradually increase over time. Because the symptoms are so subtle in the early stages, the disease can often go undiagnosed for years. In many cases, it is estimated the person has lost 70% of the cells that produce dopamine by the time Parkinson’s disease is diagnosed.

    Therefore, it’s important to know how to recognize potential early signs of Parkinson’s which include a wide range of cognitive, mood, and motor symptoms, including some or all of the following:

    • Anosmia, the loss of the sense of smell, can be an early warning sign for PD. People that develop anosmia with no apparent cause have at least a 50% chance of developing Parkinson’s in the next five to 10 years.
    • A  diagnosis of REM Sleep Behavior Disorder (RBD) is a significant early warning sign of Parkinson’s. RBD patients have a 40%-50% greater chance of developing PD than the average adult. Other sleep disorders such as obstructive sleep apnea (OSA) have been linked to PD as well. About 66% of PD patients also have OSA.
    • Difficulty walking, and the inability to walk naturally or swing one’s arms are early symptoms of PD. People with PD also may take short, uneven steps (shuffling), suffer from freezing spells, as well as experience difficulty judging obstacles and negotiating turns and corners. Pain or stiffness in your shoulders or hips can also be a sign.
    • Tremors, particularly a newly developed tremor in the arms or hands while at rest, is an early warning sign for PD. In the early stages of the disease, tremor is usually experienced in one limb or on one side of the body, but other parts of the body may be affected as the disease progresses.
    • Bradykinesia is the gradual degradation of movement caused by the brain’s lethargy in transmitting instructions to the desired parts of the body. Bradykinesia can manifest in a few different ways, including:
      • Affecting the facial muscles such that the patient may have a mask-like appearance, a sign known as face masking.
      • Changes in fine motor control that can make it more difficult to type on a keyboard or perform other tasks
    • A change in handwriting can be a sign of PD, especially micrographia which is abnormally small or cramped handwriting. Micrographia is typically assessed by asking patients to write a sentence — with micrographia, the handwriting will get smaller the longer they write. 
    • A change in your voice, particularly speaking more softly, more hoarsely, or trouble with enunciation can be an early warning sign for PD.
    • Memory loss, trouble with problem-solving, or a decline in mental abilities have all been linked to the development of PD in patients.
    • There is a high correlation between chronic, unexplained constipation and the development of PD.
    • Depression and anxiety — without a history of these symptoms earlier in life — are warning signs for PD. However, developing late-onset depression or anxiety does not mean that an eventual PD diagnosis is inevitable.
    • Skin disorders such as dry rough skin or dandruff can be a sign of PD.

    How Is Parkinson’s Diagnosed?

    No brain scan, blood test, or other test can be used to make a definitive Parkinson’s disease diagnosis. (However, your doctor may nevertheless order some of these tests so that they can rule out other diseases.)

    Parkinson’s disease is usually diagnosed clinically, ideally by a neurologist specializing in movement disorders. A “clinical diagnosis” requires a doctor to conduct a thorough review of the patient’s medical history and a comprehensive neurological exam.

    Even though no scan or test can make a definitive PD diagnosis, there is a tool called a DaTscan that can help support a Parkinson’s diagnosis. Developed by GE Healthcare and approved by the FDA in 2011, the DaTscan is used to differentiate the tremors and other motor symptoms experienced by PD patients from those observed in other movement disorders such as essential tremor or drug-induced atypical parkinsonism. A DaTscan will not distinguish between atypical forms of parkinsonism like multiple system atrophy or progressive supranuclear palsy.

    A DaTscan is not always necessary to reach a clinical PD diagnosis. In most cases, the distinct symptoms of PD — slowness of movement, tremors, and stiffness — are enough for a neurologist specializing in movement disorders to diagnose Parkinson’s disease correctly.

    What Are the Causes of Parkinson’s?

    The medical community believes that most cases of Parkinson’s disease are caused by a combination of environmental and genetic factors exacerbated by age.

    The environmental factors include head injuries to exposure to certain chemicals, pesticides, or other toxins. On the other hand, genetics are thought to play a role in about 5%-10% 30% of Parkinson’s cases. Over the past decade or so, medical researchers have identified several genes where a mutation might significantly increase one’s risk. However, not everyone who carries the mutated gene or genes will develop PD.

    Age is also a known risk factor for Parkinson’s — some in the medical community believe that an older person’s brain cells may be more susceptible to damage from exposure to a toxin or an injury than a younger person. Excessively damaged mitochondria, the energy-producing organelles in our cells, worsen with age and reduce the ability of cells to remove and recycle abnormal structures and proteins through a normal healthy process called autophagy (aka self-eating.) A misfolded protein called alpha-synuclein, which is usually removed as a regular part of healthy metabolism, aggregates as part of the disease and is the hallmark pathology of Parkinson’s. Scientists are also exploring how the expression of our genes changes as we age and where this change might trigger a chain reaction of events in our brain that eventually causes someone to develop PD.

    Everyone in the medical community agrees that the research into the causes of Parkinson’s disease still has a long way to go.

    What Is Early-Onset Parkinson’s Disease?

    The phrase “early-onset Parkinson’s disease” (also known as young-onset Parkinson’s disease or YOPD) refers to a PD diagnosis given to someone between the ages of 21 – 50. Around 10%-20% of PD patients begin to experience symptoms before the age of 50. One of the best-known examples of early-onset PD is Michael J. Fox who was only 29 years old when he was diagnosed.

    In very rare cases, Parkinson’s can appear in teenagers and children. This is called juvenile Parkinsonism and is often linked to specific genetic mutations known to be high-risk for PD. The bottom line is that the younger you are, the more likely the disease has a genetic cause.

    While the overall symptoms of PD tend to be the same no matter when it strikes, there are several distinguishing characteristics of early-onset PD that are worth mentioning.

    For starters, early-onset PD tends to be challenging to diagnose, often because, since the disease typically occurs in people over 60 years of age, PD symptoms in younger people are often overlooked. This can delay or obscure an accurate diagnosis for extended periods.

    Another aspect of early-onset PD is that the people affected are at a different stage of their lives than the more commonly occurring older patients. So, they may have young kids at home or might be thinking about having kids. They are likely to be at a more junior level in their career and generally have a busier lifestyle, making it more difficult for them to engage in their own care.

    Early-onset PD patients face the inevitable reality of a very long road ahead — they will have the disease for a very long time. Plus, they might feel like it emerged while they were still in the “prime” of their lives, robbing them of the ability to live joyfully.

    Some people with early-onset PD may experience a slower progression of their symptoms. However, they also tend to experience more side effects from the primary PD medication, levodopa. Early-onset PD patients are also prone to more frequent and painful dystonia, especially cramping and abnormal postures, including the arching or internal rotation of the foot, often with toe cramping.

    Additional Complications from Parkinson’s Disease 

    Problems with Sleep

    Patients with PD often complain of poor sleep. These sleep problems can be caused by the disease itself, or by the medicines used to treat the PD symptoms.

    Most commonly, patients with PD experience the inability to sleep through the night and difficulty returning to sleep after awakening. If you are encountering any of these symptoms, never take over-the-counter sleeping medicines to help the problem without consulting your doctor first. Some over-the-counter and prescription medicines cause or worsen sleep problems, and some have serious drug interactions with medications prescribed to treat PD.

    If you have Parkinson’s and are experiencing trouble getting to sleep, recommended practices for healthier sleep are: a regular rise time and bedtime, avoiding stimulants, shorter naps or no daytime napping, exercise, and avoiding the use of your bedroom for activities other than sleep. Problems staying asleep can be improved by: avoiding heavy exercise within 6 hours of bedtime, avoiding heavy late-night meals, and minimizing light and noise in your bedroom.

    Dehydration

    Dehydration in Parkinson’s disease patients is a major concern because the risks associated with becoming dehydrated can significantly worsen already compromised neurological function. Complicating matters even more, it is very easy to misread symptoms of dehydration for symptoms common to PD.

    People with PD drink half as much fluids as people without due to the lack of thirst sensation, medication side effects, and trouble swallowing. Some medications may cause nausea, which can make it difficult for patients to actively remember to stay hydrated especially if that means increasing their water consumption. Many affected by Parkinson’s also experience depression, which can create difficulty in committing to a regimen. Likewise, concerns about incontinence may make an individual avoid much-needed fluids.

    Depression and Anxiety

    Depression and anxiety are clinical symptoms of Parkinson’s disease that researchers believe are due to the changes in brain chemistry caused by the disease itself. It’s estimated that up to half of all Parkinson’s patients may suffer from depression and/or anxiety at some point over the course of their disease.

    We don’t want to minimize the seriousness of Parkinson’s disease. Obviously, it’s a very serious diagnosis that can cause tremendous difficulty for the patient. But PD is not a death sentence — with the proper treatment that includes the patient actively participating in their care, many people with PD are able to live a relatively full and productive life with a normal life expectancy.

    Famous People With Parkinson’s

    PD is a disease that can affect anyone — from the very wealthy to the very poor, and everything in between. It also does not spare celebrities. Here are just a few celebrities that are known to have Parkinson’s:

    Michael J. Fox

    Fox was diagnosed with young-onset PD in 1991. He was just 29 years old. There isn’t another person on the planet — celebrity or otherwise — that has done more to bring attention to PD and raise money for research than Fox. The Michael J. Fox Foundation for Parkinson’s Research is an essential resource for anyone with the disease. 

    Muhammed Ali

    The legendary boxer was 42 years old when he received his PD diagnosis in 1984. However, the public had noticed changes in Ali’s speech and speed in the late 1970s while he was still boxing — he didn’t retire from the ring until 1979.

    Linda Ronstadt

    Ronstadt was diagnosed with PD in 2013 when she was 67 years old, but she started having trouble with her singing voice 5 or 6 years before that. Even with numerous symptoms, she resisted seeing a neurologist for years and was shocked to receive her diagnosis.

    Neil Diamond

    The singer announced his PD diagnosis in January 2018 at age 77. Unlike Ronstadt’s symptoms, Diamond’s voice has not been affected by PD.  While he no longer tours, he’s still singing and releasing albums.

    Pope John Paul II

    The pontiff’s PD diagnosis was first reported in 2001 but not confirmed by the Vatican until 2003. However, many papal observers had suspected that he had PD for many years before that. 

    Alan Alda

    Alda was diagnosed in 2015 at age 79. His first observed symptom was acting out a dream — REM Sleep Behavior Disorder. Alda keeps his PD symptoms at bay by exercising — walking, biking, treadmills, and physical therapy, including Parkinson’s disease exercise.

    Ozzy Osbourne

    Osbourne was reportedly first diagnosed with PD in 2019 at age 70. His first symptoms included numbness in his arm, and feeling like his legs were cold.

    Bob Hoskins

    Hoskins announced his retirement from acting in 2012 after receiving a PD diagnosis in 2011 at 69 years old.

    Janet Reno

    The former US Attorney General was diagnosed with PD in 1995, in the second year of her 8-year AG tenure. She was just 57 years old. Her diagnosis did not slow her down — Reno finished her full AG term, appeared on “Saturday Night Live” in 2001, on “The Simpsons” in 2013, and ran for Governor of Florida in 2002.

    Robin Williams

    Tragically, Williams never knew that he had Lewy Body Dementia while he was still alive. The post-mortem diagnosis was given to his widow. Reportedly, Williams had been experiencing paranoia, confusion, insomnia, constipation, and anosmia. On the set of his last on-screen role — Night at the Museum: Secret of the Tomb — he was said to have trouble remembering his lines.

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