What Is Parkinson's Disease?
Parkinson's disease is a progressive nervous system disorder that affects movement. It limits your ability to control your body movements normally. Each person with Parkinson's disease is affected differently. The condition can range from mild to severe movement disability. Parkinson's disease tends to progress slowly over several years. In Singapore, about 6,000 to 8,000 people have Parkinson's disease, and this number is expected to increase with our aging population.
What Are The Causes of Parkinson's Disease?
Parkinson's disease results from a loss of brain cells in a specific part of the brain known as the substantia nigra. Some of the brain cells in the substantia nigra make an important brain chemical called dopamine which is needed to control movement. As the condition gets worse, brain cells make less dopamine. This makes it hard to move or control your movements.
The exact cause of why brain cells are lost or produce less dopamine is unknown. Genetic and environmental factors may contribute to the cause of Parkinson's disease.
Who Is At Risk for Parkinson's Disease?
This condition is more likely to develop in men than women. Reports of male to female ratios for incidence rates vary from 1.37 to 3.7. People who are 60 years of age or older and people who have a family history of Parkinson's disease are also at risk.
What Are The Signs And Symptoms of Parkinson's Disease?
Signs of this condition can vary from person to person. The primary signs are related to movement. These include:
- Uncontrolled shaking movements (tremor). Tremors usually start in a hand or foot when you are resting (resting tremor). The tremor may stop when you move around.
- Slowing of movement. You may lose facial expression and have trouble making small movements that are needed to button clothing or brush your teeth. You may walk with short, shuffling steps.
- Stiff movement (rigidity). This mostly affects your arms, legs, neck, and upper body. You may walk without swinging your arms. Rigidity can be painful.
- Loss of balance and stability when standing. You may sway, fall backward, and have trouble making turns.
Secondary motor signs of this condition include:
- Shrinking handwriting
- Stooped posture
- Slowed speech
- Trouble swallowing
- Sexual dysfunction
- Muscle cramps
- Loss of smell
Additional symptoms that are not related to movement include:
- Mood swings
- Depression or anxiety
- Sleep disturbances
- Loss of mental abilities (dementia)
- Low blood pressure
- Trouble concentrating
How Is Parkinson's Disease Diagnosed?
Parkinson's disease can be hard to diagnose in its early stages. A diagnosis may be made based on the symptoms, medical history, and physical exam. During the examination, your healthcare provider will look for lack of facial expression and resting tremor. Stiffness in your neck, arms, and legs, abnormal walk and trouble with balance are also signs that your healthcare provider will pay attention to.
You may have brain imaging tests done to check for a loss of dopamine-producing areas of the brain. Your healthcare provider may also grade the severity of your condition as mild, moderate, or advanced. Parkinson's disease progression is different for everyone. You may not progress to the advanced stage.
Is There A Cure for Parkinson's Disease?
There is no cure for Parkinson's disease. Treatment focuses on relieving your symptoms. Treatment may include medicines, physiotherapy and surgery.
Everyone responds to medicines differently. Your response may change over time. Work with your healthcare provider to find the best medicines for you. These may include:
- Dopamine replacement drugs. These are the most effective medicines. A long-term side effect of these medicines is uncontrolled movements (dyskinesias).
- Dopamine agonists. These drugs act like dopamine to stimulate dopamine receptors in the brain. Side effects include nausea and sleepiness, but they cause less dyskinesia.
- Other medicines to reduce tremor, prevent dopamine breakdown, reduce dyskinesia, and reduce dementia that is related to Parkinson's disease.
An alternative mode of treatment is deep brain stimulation surgery to reduce tremors and dyskinesia. This procedure involves placing electrodes in the brain. The electrodes are attached to an electric pulse generator that acts like a pacemaker for your brain. This may be an option if you have had the condition for at least four years and are not responding well to medicines.
What Can Be Done At Home?
- Install grab bars and railings in your home to prevent falls.
- Follow instructions from your healthcare provider about eating or drinking restrictions.
- Return to your normal activities as told by your healthcare provider. Ask your healthcare provider what activities are safe for you.
- Get regular exercise as advised by your healthcare provider or a physical therapist.
- Keep a record of all follow-up visits as advised by your healthcare provider. This is important. These include any visits with a speech therapist or occupational therapist.
- Consider joining a support group for people with Parkinson's disease.
Contact Your Healthcare Provider If:
- Medicines do not help your symptoms.
- You are unsteady or had a fall at home.
- You need more support to function well at home.
- You have trouble swallowing.
- You have severe constipation.
- You are struggling with side effects from your medicines.
- You see or hear things that are not real (hallucinate).
- You feel confused, anxious, or depressed.
In conclusion, Parkinson's disease is a progressive movement disorder. Currently there are treatment options to help slow the progression of the disease, however no cure has been found. It is important for people with Parkinson's disease and people living with patients with Parkinson's disease to understand the progression of the illness and make lifestyle adaptations for a better quality of life.
This information is not intended to replace professional medical advice. Make sure you discuss any questions you have with your health care provider.
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National Guideline Clearinghouse: Guideline Summary: EFNS/MDS-ES recommendations for the diagnosis of Parkinson's disease. (Summary of a guideline by the European Academy of Neurology and Movement Disorders Society-European Section.) NGC website. Published January 2013. Accessed April 14 2020. https://www.guideline.gov/summaries/summary/43845/efnsmdses-recommendations-for-the-diagnosis-of-parkinsons-disease?q=parkinson
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Pagonabarraga J et al: Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment. Lancet Neurol. 14(5):518-31, 2015
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Updated on 10 June 2020 by CaregiverAsia.
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