What is Parkinson's
Parkinson's Disease |
Parkinson's FAQ's
Parkinson's FAQ's
What causes Parkinson's?
How is Parkinson's diagnosed?
Is there a cure?
Who develops Parkinson's? How prevalent is it?
What are the symptoms?
How does Parkinson's progress? What can be expected?
Does Parkinson's affect mental health?
If it's not Parkinson's, what else could it be?
Parkinson's disease is caused by a degeneration of the cells which produce dopamine in the substantia nigra
area of the brain. It is not known why the cells are damaged or destroyed although there are many theories.
It is possible that genetics and the environment work together to cause Parkinson's. Much more research is needed
to completely understand how, why and when this disorder occurs. The symptoms of Parkinson's appear when over half
of the dopamine-producing cells are lost.
Dopamine is a brain neurotransmitter which sends signals from one nerve cell to another. It affects
the parts of the brain which control smooth, voluntary movements such as walking, writing, throwing a ball or
buttoning a shirt. Dopamine is also essential for involuntary movements including control of
blood pressure and bowel function. Loss of dopamine can also affect mood and thinking.
There are no specific brain scans or laboratory tests to confirm the diagnosis of Parkinson's. Neurologists
diagnose it with a careful evaluation of a person's medical history and a physical examination. Tests may be
done to rule out other conditions which may resemble Parkinson's.
At the present time there is no known cure, however many people live full, productive lives. With the treatment
that is now available, life expectancy for someone with Parkinson's is fairly normal. Each year, more and
improved treatments are being introduced.
There are approximately 100,000 people with Parkinson's in Canada, 2,000 in Southern Alberta.
Up to 10% of individuals with Parkinson's develop symptoms before the age of 40
(Young OnSet Parkinson's WebSite).
Parkinson's is usually diagnosed between the ages of 55 and 65, with 60 being the average age of diagnosis.
Parkinson's affects 1% of adults over the age of 65 and is slightly more common in men.
Is Parkinson's genetic? A genetic cause of Parkinson's appears in only a very small number of cases,
approximately 5%. Where it may appear to run in families, researchers are looking at environmental factors
shared by the family or community in addition to examining potential genetic links. The vast majority of
cases of Parkinson's disease are from unknown causes.
Is Parkinson's contagious? Parkinson's disease is not contagious. A person cannot "catch" Parkinson's
and there is no need to worry about being in close contact with someone who has it.
Most common motor symptoms are:
-
Resting tremor - repetitive shaking movements occurring in the arms and/or legs
at rest. (Tremors are the first symptom to appear in about 70% of people with Parkinson's.
- Rigidity increased stiffness in muscles and joints.
- Bradykinesia - slowness of movement, including all actions such as walking and writing.
- Lack of coordination - postural impairment or loss of balance.
- Freezing - a temporary inability to initiate movement.
Other symptoms:
- Hypomimia - reduced facial expression, making a person appear uninterested or sad when they are not.
- Hypophonia - speaking in a very soft voice. This may involve deterioration in the rhythm and quality of the voice.
- Micrographia - small, cramped handwriting.
- Cognitive and mood changes, including:
- Depression
- Anxiety
- Forgetfulness and confusion
- Loss of impulse control
- Dementia, Hallucinations
- Delusions
- Constipation
- Urinary problems
- Pain
Early symptoms generally occur gradually, and progress more rapidly in some people than others.
The tremor may begin to interfere with daily activities, and other symptoms may appear. Parkinson is progressive,
meaning the symptoms may worsen over time, and the rate of this progression is different for each person.
There is no way of knowing how slowly or quickly Parkinson's may progress. Call our office if you would like more
information about this topic.
(adapted from Mind, Mood and Memory published by the National Parkinson Foundation, Miami, Fla.)
(What are the Symptoms of Parkinson's?)
Mental illness is a term used to describe a disruption in the balance between mind, body and spirit and a
change in one's mental or emotional wellbeing. Psychological symptoms of Parkinson's are considered to be
as important as the physical symptoms.
Some people feel there is a stigma associated with mental health issues and some may still feel that
psychological symptoms are an example of personal weakness.
Note: Do not allow these preconceptions to stop you from
talking to your healthcare professionals and getting the help you need!
Note to caregivers:
Some caregivers
report that the psychological changes that can accompany Parkinson's are more
difficult to deal with than the physical changes. It is therefore even more important for caregivers to look after
themselves. Click on the link above for more information. Also, refer to
Mind Mood and Memory for the section on caregivers.
There are many causes of tremors and other symptoms associated with Parkinson's disease and it may take
time to make an accurate diagnosis. A neurologist who specializes in movement disorders is the best person to make
or confirm a diagnosis. The following information describes other disorders that may be confused with Parkinson's.
Note: Many of the conditions described in this section
are extremely rare.
Essential Tremor (ET)
Tremor refers to rhythmic shaking of a body part. There are more than 20 kinds of tremor and ET is the most
common. It is called "essential" because in the past, it had no known cause. It is not caused by another neurological
condition or the side effect of a medication. ET usually affects the hands, but it may also affect the head and
neck (causing shaking), face, jaw, tongue, voice (causing a shaking or quivering sound), the trunk and, rarely,
the legs and feet. Severity of the tremors can vary greatly from hour to hour and day to day. As many as 1 in 20
people older than age 40 and 1 in 5 people over 65 may have ET.
Although called benign essential tremor in the past, it may be far from benign. Indeed, for some it may
be quite frustrating, embarrassing or disabling. Fortunately, effective treatments are available for ET.
Source:
http://www.essentialtremor.org/about_us/about_essential_tremor.php
(The remainder of the information in this section is adapted from "What Else Could it Be" National Parkinson
Foundation, (www.npf.org
)
Medication-Induced Parkinsonism
Some common medications can cause Parkinson-like symptoms. Medications frequently associated with the development
of Parkinsonism (the name given to a group of disorders with similar features including four primary symptoms:
tremor, rigidity, slowness of movement and postural instability) include antipsychotics, metaclopramide,
reserpine, tetrabenazine and some blood pressure medications such as cinnarizine and flunarizine.
Fortunately, the symptoms usually abate within weeks to months after discontinuing the problem medication.
Note: This is one reason why it is very important to inform
the medical staff in a hospital or clinic that you have Parkinson's and what medications you are taking.
Dementia with Lewy Bodies (DLB)
This disorder is characterized by early dementia, prominent hallucinations, changes in cognitive functioning
throughout the day, and symptoms similar to Parkinson's disease. Other symptoms include difficulties with
attention, problem solving, planning, and with recognizing figures and images.
Progressive Supranuclear Palsy (PSP)
Early development of balance problems, frequent falls, rigidity or stiffness of the trunk of the body,
and (eventually) eye-movement problems can be symptoms of PSP. Symptoms usually begin after age 50 and
progress more rapidly than those associated with Parkinson's disease. The most characteristic eye movement
abnormality is called vertical gaze paralysis, making looking up and looking down very difficult.
People with PSP may experience frequent falls while walking down stairs because they cannot look down.
Dementia, depression and alterations in mood may develop later in the disease. Speech therapy, physical therapy,
and antidepressants may alleviate symptoms and while there is no specific treatment for PSP, some Parkinson's
medications may provide some symptom relief.
More information on the following conditions can be found on the website of
the National Organization for Rare Disorders.
Corticobasal Degeneration (CBD)
The least common cause of symptoms similar to Parkinson's is CBD. It often affects one side far more than the
other and it may progress more rapidly than Parkinson's disease. The initial symptoms of CBD usually develop
after age 60 and include asymmetric bradykinesia (uncontrolled movement focusing on one side or the other),
rigidity, limb dystonia (abnormal, prolonged, and repetitive muscle contractions
that may cause twisting or jerking), balance problems, and speech/language problems. There is often marked and
disabling apraxia, (the loss of ability to carry out an intended movement even though
there is no weakness or sensory loss in the arm or leg). There is no specific treatment for CBD.
Supportive treatment such as botulinum toxin for dystonia, antidepressant medications
and speech and physical therapy may help. Levodopa and dopamine agonists seldom offer benefit.
Multiple System Atrophy (MSA)
MSA is a neurodegenerative disease of unknown cause. Initially it may be difficult
to distinguish from Parkinson's disease, but it is far less common and progresses more rapidly. The average age
of onset is in the mid-50s. Symptoms include one, or a combination of the following: bradykinesia, poor balance,
abnormal autonomic function, rigidity, or difficulty with coordination. Abnormalities of autonomic function
include impotence, low blood pressure upon standing (orthostatic hypotension),
excessive or reduced sweating, and constipation.
There are three different subtypes of MSA:
-
Striatonigral degeneration (SND) is characterized by Parkinson's symptoms but
without much tremor and with poor response to Sinemet.
-
Shy-Drager syndrome is characterized by Parkinson's symptoms and autonomic abnormalities.
-
Olivopontocerebellar atrophy (OPCA) may involve a lack of coordination and
clumsiness which affect balance and gait.
Vascular Parkinsonism
Multiple small strokes can cause Parkinson's-like symptoms. People with this disorder are more likely to have
gait difficulty rather than tremors and are more likely to have symptoms that are worse in the lower limbs rather
than the upper limbs. Some will also report the abrupt onset of symptoms or give a history of a step form of
symptom development (symptoms get worse, then plateau for a period, then get worse again). Treatment is the
same as for Parkinson's disease, but the results are often not as positive.