Parkinson's Disease

Parkinson’s disease (PD) is a progressive neurological disorder. It first presents with problems of movement.

Smooth and coordinated muscle movements of the body are made possible by a substance in the brain called dopamine. Dopamine is produced in a part of the brain called the “substantia nigra.” In PD, the cells of the substantia nigra start to die. When this happens, dopamine levels are reduced. When they have dropped 60 to 80 percent, symptoms of PD start to appear.

There’s no cure for PD. This disorder is chronic and worsens over time. More than 50,000 new cases are reported in the U.S. each year. The actual incidence may be even higher, since PD is often misdiagnosed. The Center of Disease Control and Prevention’s National Center for Health Statistics reports that PD complications are the 14th major cause of death in the United States. (CDC)

The exact cause of PD is unknown. It may have both genetic and environmental components. Some scientists think that viruses can trigger PD as well.

Low levels of dopamine and norepinephrine, a substance that regulates dopamine, have been linked with PD. Abnormal proteins called Lewy bodies have also been found in the brains of people with PD. Scientists do not know what role, if any, Lewy bodies play a role in the development of PD.

Certain groups of people have an increased risk of PD.

Men are one and a half times more likely to get PD than women.

Whites are more likely to get PD than African-Americans or Asians.

PD usually appears between the ages of 50 and 60. It only occurs before the age of 40 in five to 10 percent of cases. People with a family history are more likely to develop this disorder.

Some of the earliest symptoms of PD are decreased ability to smell (anosmia) and constipation. These symptoms can precede motor problems by several years.

The four major motor problems seen in PD are:

• tremor—shaking that occurs at rest
• slow movements
• stiffness of arms, legs, and trunk
• problems with balance and tendency to fall

Secondary symptoms of PD include:

• blank facial expression
• a tendency to get stuck when walking
• small, cramped handwriting
• muffled, low-volume speech
• decreased blinking and swallowing
• tendency to fall backwards
• reduced arm swinging when walking

Other, more extreme, symptoms of PD are:

• flaky white or yellow scales on oily parts of the skin, known as seborrheic dermatitis
• sleep disturbances—including vivid dreams, talking, and movement during sleep
• depression
• anxiety
• hallucinations
• psychosis
• problems with attention and memory
• difficulty with visual-spatial relationships

There is no specific test for PD. Diagnosis is made based on health history and a physical and neurological exam. Tests such as CAT scan or MRI may be used to rule out other conditions.

Adequate rest, exercise, and a balanced diet are important. Speech therapy, occupational therapy, and physical therapy can also help to improve communication and self care.

Surgical interventions are reserved for people who don’t respond to medication, therapy, and lifestyle changes. So are procedures such as deep brain stimulation (DBS).

In almost all cases of PD, medication will be required to help control the various physical and mental health symptoms associated with the disease.

A number of different drugs can be used to treat PD.

Levodopa

Levodopa is the most common treatment for PD. It helps to replenish dopamine. About 75 percent of cases respond to levodopa, but not all symptoms are improved. Levodopa is generally given with cardiodopa. This delays the conversion of levodopa to carbidopa until it gets into the brain.

Dopamine Agonists

Dopamine agonistscan imitate the action of dopamine in the brain. Dopamine agonists are less effective than levodopa. However, they can be useful as bridge medications when levodopa is less effective. Drugs in this class include bromocriptine, pramipexole, and ropinirole.

Anticholinergics

Anticholinergics are used to block the parasympathetic nervous system. They can help with rigidity. Side effects may include impaired memory, dry eyes, dry mouth, and constipation. Benztropine (Cogentin) and trihexyphenidyl are anticholinergics used to treat PD.

Amantadine (Symmetrel)

Amantadine (Symmetrel) can be used along with carbidopa-levodopa. It is a glutamate blocking drug (NDMA). It offers short-term relief for the involuntary movements (dyskinesia) that can be a side effect of levodopa. Side effects of amantadine include hallucinations and patchy skin color.

COMT Inhibitors

Catechol O-methyltransferase (COMT) inhibitorsprolong the effect of levodopa. Entacapone (Comtan) and tolcapone (Tasmar) are examples of COMT inhibitors. Tolcapone can cause liver damage. It is usually saved for patients who don’t respond to other therapies. Ectacapone doesn’t cause liver damage. Stalevo is a drug that combines ectacapone and carbidopa-levodopa in one pill.

MAO B Inhibitors

MAO B inhibitorsinhibit the enzyme monoamine oxidase B. This enzyme breaks down dopamine in the brain. Side effects don’t occur often, but they can include headache, dizziness, confusion, and hallucinations. Selegiline (Eldepryl) and rasagiline (Azilect) are examples of MAO B inhibitors. Talk with your doctor before taking any other medications with MAO B inhibitors. They can interact with many drugs, including:

• antidepressants
• ciprofloxacin
• St. John’s wort
• some narcotics

Over time, the effectiveness of PD medications can decrease. However, they may still provide adequate control of symptoms.

People with PD have problems with activities of daily living. Doctors at the Mayo Clinic have recommended a number of very simple steps to help patients with PD move around and walk more safely.

To improve walking:

• Walk carefully.
• Pace yourself – try not to move too quickly.
• Let your heel hit the floor first.
• Check your posture and stand up straight. This will help you to shuffle less.

To avoid falling:

• Don’t walk backwards.
• Try to not carry things while walking.
• Try to avoid leaning and reaching.
• To turn around, make a U-turn. Don’t pivot on your feet.

When getting dressed:

• Allow yourself plenty of time to get ready. Avoid rushing.
• Select clothes that are easy to put on and take off.
• Try using items with velcro instead of buttons.
• Try wearing pants and skirts with elastic waist bands. These may be easier than buttons and zippers.