Parkinson's disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement. Parkinson’s patients often talk about the disease also impacting their mind. Complaints can be related to the slowness of thinking and or speech. When this happens it can be referred to as Parkinson’s dementia or dementia with Lewy Bodies.
What Causes Parkinson’s?
Parkinson's disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra. Nerve cells in this part of the brain are responsible for producing a chemical called dopamine. Dopamine acts as a messenger between the parts of the brain and nervous system that help control and co-ordinate body movements. If these nerve cells die or become damaged, the amount of dopamine in the brain is reduced. This means the part of the brain controlling movement cannot work as well as normal, causing movements to become slow and abnormal. The loss of nerve cells is a slow process. The symptoms of Parkinson's disease usually only start to develop when around 80% of the nerve cells in the substantia nigra have been lost.
Parkinson’s is usually diagnosed in people who are in their early 60s. People who are diagnosed before age 50 are said to have early-onset Parkinson’s.
About 4 percent of the approximately 1 million Americans with Parkinson’s are diagnosed before age 50. That number may be higher because the disease is often under-diagnosed in younger people. Sometimes seniors may mistakenly consider some of the symptoms of Parkinson’s to be a regular part of aging. This can delay getting to the doctor for a proper examination. Because the disease is progressive recognizing the symptoms early can help reduce the overall impact.
Stages and Symptoms
Parkinson’s disease is marked by the presence of certain recognizable symptoms. These include uncontrollable shaking or tremors, lack of coordination, and speaking difficulties. However, symptoms vary and may worsen as the disease progresses.
The main symptoms of Parkinson’s include:
In the first stage of Parkinson's disease, your face may show little or no expression. Your arms may not swing when you walk. Your speech may become soft or slurred. Tremors are usually just on one side of the body.
During Stage 2 the body starts to become stiffer which slows down the person's ability to do everyday tasks. Tremors and trembling occur more often and changes to facial expression are generally much more noticeable.
In stage 3 you are experiencing all of the effects of stage 2 plus you’re now more likely to experience loss of balance and decreased reflexes. Your movements become slower overall. This is why falls become more common in stage 3 and people are often no longer able to live alone.
During stage 4, it’s possible to stand without assistance. However, movement may require a walker or other type of assistive device. Many people are unable to live alone at this stage of Parkinson’s because of significant decreases in movement and reaction times. Living alone at stage 4 or later may make many daily tasks impossible, and experts feel it can be extremely dangerous.
Stage 5 has advanced difficulties in standing or walking as the leg muscles begin to freeze up. The issues for mobility generally require a wheelchair. Around the clock, care is often required. This stage can also include confusion, hallucinations, and delusions. Dementia is also generally prevalent in stage 5.
According to the Mayo Clinic website “no specific test exists to diagnose Parkinson's disease. Your doctor trained in nervous system conditions (neurologist) will diagnose Parkinson's disease based on your medical history, a review of your signs and symptoms, and a neurological and physical examination.”
Doctors will generally run a battery of tests to help determine if someone’s condition might be Parkinson’s. This might include a specialized scan called a DaTScan, a radioactive tracer, Ioflupane 123I, also known as DaTscan, which is injected into the blood, where it circulates in the body and makes its way into the brain. It attaches itself to the dopamine transporter, a molecule found on dopamine neurons. The results of this test along with a proper neurological examination will help the doctor determine if the patient has Parkinson’s disease.
The doctor may order lab tests, such as blood tests, to rule out other conditions that may be causing your symptoms. Imaging tests — such as an MRI, ultrasound of the brain, and PET scans — also may be used to help rule out other disorders. However, imaging tests aren't particularly helpful for diagnosing Parkinson's disease.
In addition to your examination, the doctor may prescribe carbidopa-levodopa (Rytary, Sinemet, others), a Parkinson's disease medication. This must be given in a sufficient dose to show the benefit, as low doses for a day or two aren't reliable. Significant improvement with this medication will often confirm a diagnosis of Parkinson's disease.
Living with Parkinson’s
If you or a loved one is diagnosed with Parkinson’s there are many resources available in Minnesota to help you. The Parkinson’s Foundation has a list of local resources and specialists that serve Parkinson’s patients.
There are so many facets to Parkinson’s one of the keys is getting emotional support from friends, family, and even other people with the disease. There are many things people can do to live as near to normal as possible with the disease. This includes staying active, eating right, taking your medications, getting your rest, and working with a medical team to actively manage the disease.
Many of us know the story of Michael J. Fox who was diagnosed with early-onset Parkinson’s at the age of 29. Fox is an extremely successful, Author, Movie, and TV star that continued working after his diagnosis while starting his foundation that provides both education and looks for a cure. The messages of hope and opportunity are abundant on this site.
Quote from the Michael J. Fox Foundation site “There is no simple way to deal with the life-changing event of a Parkinson’s diagnosis. The good news: Most people find acceptance and quality of life after the initial adjustment period.”
For additional information and resources check out our Blog posts:
Stress and Relief of Parkinson's Symptoms
The Successes and Challenges of Living with Parkinson's Disease
Parkinson's Disease and Exercise
Managing Parkinson's Disease Symptoms: Nutrition