Let’s look at everything you need to know about Parkinson’s Disease.
Parkinson's disease is a progressive* neurological disorder that affects movement. It develops gradually, and the signs and symptoms can vary from person to person.
You must know these 3 facts about Parkinson's Disease so you can easily recognize it and get immediate treatment.
- If you see these signs and symptoms, you will keep a journal and then contact your physician.
- Here is also a list of items the neurologist will perform based on the signs and symptoms you discuss with them.
- Then we will look at the stages of Parkinson’s Disease and move on to the medications you or your loved ones may be placed on.
Signs & Symptoms of Parkinson's Disease
Tremor: One of the most recognizable symptoms of Parkinson's is a tremor or shaking, usually starting in the hands or fingers. The tremor often occurs when the affected limb is at rest and may decrease or disappear with movement.
Bradykinesia: This refers to slowness of movement. People with Parkinson's disease may find it difficult to initiate and execute movements. Simple tasks such as buttoning a shirt or walking may become slow and challenging.
Muscle rigidity: Stiffness or rigidity in the muscles can occur in any part of the body. It can cause discomfort and limit the range of motion, making it difficult to perform daily activities.
Postural instability: Parkinson's disease can affect balance and coordination, leading to difficulties with posture and an increased risk of falls. People with Parkinson's may have trouble maintaining their balance while standing or walking.
Impaired coordination: Coordination problems may arise as Parkinson's progresses, making it harder to perform tasks that require precise movements, such as writing or typing.
Speech changes: Parkinson's can affect speech by causing slurring, softness, or monotone. Some individuals may also experience difficulty in initiating speech or a decrease in voice volume.
Mask-like expression: Reduced facial expressions, also known as hypomimia or "masked face," is another common symptom of Parkinson's disease. This can make the affected person appear expressionless or less animated.
Micrographia: Handwriting may become smaller and more cramped, a condition known as micrographia, which can make writing difficult to read.
Freezing episodes: Some individuals with Parkinson's may experience freezing episodes, where they feel as if their feet are glued to the floor and have difficulty initiating movement, especially when starting to walk or turning.
Non-motor symptoms: Parkinson's disease can also cause non-motor symptoms, including cognitive changes (such as difficulty with memory and concentration), mood disorders (such as depression and anxiety), sleep disturbances, constipation, loss of sense of smell (anosmia), and urinary problems.
Diagnosis Criteria - what the neurologist should do!
Neurological Examination: A thorough neurological examination by a healthcare professional, often a neurologist specializing in movement disorders, is crucial for evaluating the presence and severity of motor symptoms associated with Parkinson's disease, such as tremor, bradykinesia (slowness of movement), muscle rigidity, and postural instability.
Medical History Review: A detailed review of the patient's medical history is essential to identify any symptoms suggestive of Parkinson's disease, as well as to evaluate for potential risk factors and other medical conditions that could contribute to or mimic Parkinsonian symptoms.
Response to Levodopa Challenge: In some cases, a trial of levodopa medication may be conducted to assess the patient's response to treatment. Improvement in motor symptoms following administration of levodopa can support a diagnosis of Parkinson's disease.
DaTscan Imaging: DaTscan is a type of nuclear medicine imaging test that can help differentiate Parkinson's disease from other conditions that cause similar symptoms, such as essential tremor or drug-induced parkinsonism. It works by measuring dopamine transporter levels in the brain, which are typically reduced in Parkinson's disease.
MRI or CT Scans: Magnetic resonance imaging (MRI) or computed tomography (CT) scans of the brain may be performed to evaluate for structural abnormalities or other conditions that could cause Parkinsonian symptoms. While these imaging tests are not typically diagnostic of Parkinson's disease, they can help rule out other potential causes of symptoms.
Blood Tests: Blood tests may be ordered to assess for specific biomarkers associated with Parkinson's disease or to rule out other medical conditions that could contribute to similar symptoms.
Other Assessments: Additional assessments, such as neuropsychological testing to evaluate cognitive function, autonomic function testing, and sleep studies, may be conducted to assess for non-motor symptoms commonly associated with Parkinson's disease.
It's important to note that the diagnostic process for Parkinson's disease can vary depending on the individual patient's symptoms, medical history, and the expertise of the healthcare provider.
A very thorough evaluation by a neurologist or movement disorder specialist is typically recommended for accurate diagnosis and appropriate management of Parkinson's disease. Early diagnosis and intervention can help improve outcomes and quality of life for individuals living with Parkinson's disease.
Which Stage Am I?
Parkinson's disease is a progressive neurological disorder that typically progresses through stages, although the rate and severity of progression can vary widely among individuals. While there is no universally agreed-upon staging system for Parkinson's disease, healthcare professionals often use the Hoehn and Yahr scale or the Unified Parkinson's Disease Rating Scale (UPDRS) to assess and categorize the progression of the disease.
Here's a general overview of the stages commonly observed in Parkinson's disease:
- Stage 1 - Mild: In the early stage of Parkinson's disease, symptoms are typically mild and may be subtle or easily overlooked. Common motor symptoms, such as tremors, bradykinesia (slowness of movement), and mild muscle rigidity, may be present but are usually not disabling. Symptoms are often confined to one side of the body (asymmetrical).
- Stage 2 - Moderate: As Parkinson's disease progresses, symptoms become more pronounced and may begin to affect both sides of the body (symmetrical). Bradykinesia, rigidity, and tremor may worsen, making daily activities more challenging. Postural instability may also begin to develop, increasing the risk of falls.
- Stage 3 - Moderate to Severe: In stage 3, motor symptoms become significantly more pronounced, and balance and coordination problems become more apparent. Patients may experience more frequent falls and difficulty with activities such as walking and maintaining balance. However, individuals in stage 3 can still typically perform daily tasks independently with some difficulty.
- Stage 4 - Severe: Stage 4 is characterized by severe motor symptoms and functional limitations. Patients may require assistance with activities of daily living (ADLs), such as dressing, bathing, and mobility. Postural instability and gait disturbances are prominent, increasing the risk of falls and injuries.
- Stage 5 - Advanced: The most advanced stage of Parkinson's disease is marked by severe motor symptoms and significant disability. Patients may be unable to walk or stand unassisted and may require a wheelchair or assistance for mobility. Cognitive impairment and other non-motor symptoms, such as dementia, hallucinations, and behavioral changes, may also become more prominent in this stage.
It's important to note that while this staging framework provides a general overview of the progression of Parkinson's disease, not all individuals will experience the same symptoms or progress through the stages at the same rate. Additionally, advancements in treatment and management strategies, such as medication, physical therapy, and surgical interventions, can help alleviate symptoms and improve the quality of life at any stage of the disease. A healthcare professional, typically a neurologist specializing in movement disorders, can provide personalized guidance and support throughout the course of Parkinson's disease.
Medications
Parkinson's disease is typically managed through a combination of medications, lifestyle modifications, and sometimes surgical interventions. The choice of medication and treatment approach depends on the individual's symptoms, disease stage, and overall health.
Here are some common medications used to treat Parkinson's disease:
Levodopa (L-DOPA): Levodopa is the most effective medication for managing the motor symptoms of Parkinson's disease, particularly bradykinesia and rigidity. Levodopa is converted into dopamine in the brain, replenishing dopamine levels depleted in Parkinson's disease. It is often combined with carbidopa (a peripheral decarboxylase inhibitor) to prevent levodopa breakdown in the bloodstream before it reaches the brain, increasing its effectiveness and reducing side effects such as nausea.
Dopamine Agonists: Dopamine agonists mimic the action of dopamine in the brain, helping to alleviate motor symptoms of Parkinson's disease. These medications may be used alone or in combination with levodopa. Common dopamine agonists include pramipexole, ropinirole, and rotigotine.
MAO-B Inhibitors: Monoamine oxidase type B (MAO-B) inhibitors help prevent the breakdown of dopamine in the brain, prolonging its effects and improving motor symptoms. Examples of MAO-B inhibitors include selegiline and rasagiline.
COMT Inhibitors: Catechol-O-methyltransferase (COMT) inhibitors help prolong the effects of levodopa by inhibiting its breakdown in the bloodstream. These medications are often used in combination with levodopa/carbidopa. Examples include entacapone and tolcapone.
Anticholinergics: Anticholinergic medications can help reduce tremor and some other motor symptoms of Parkinson's disease by blocking the action of acetylcholine, a neurotransmitter in the brain. However, these medications are generally less commonly used due to their side effects, such as cognitive impairment and dry mouth. Examples include trihexyphenidyl and benztropine.
Amantadine: Amantadine is a medication that can help alleviate dyskinesias (involuntary movements) associated with long-term levodopa use. It may also provide some relief from other Parkinsonian symptoms. Amantadine is sometimes used as an adjunct therapy in Parkinson's disease management.
Antidepressants and Antipsychotics: These medications may be prescribed to manage mood disorders, such as depression and anxiety, or psychotic symptoms that can occur in Parkinson's disease. However, caution must be exercised when using antipsychotic medications due to the risk of exacerbating motor symptoms.
NOTE: Keep this list handy to be sure and ask about these medications and the tests the neurologist want to order or will not order. It's OK for you to ask questions.
In addition to medication, other treatment approaches for Parkinson's disease may include physical therapy, occupational therapy, speech therapy, and deep brain stimulation (DBS) surgery in advanced cases.
It's important for individuals with Parkinson's disease to work closely with their healthcare providers to develop a personalized treatment plan that addresses their specific needs and goals while minimizing side effects and maximizing quality of life.
Regular monitoring and adjustments to treatment may be necessary as the disease progresses.
*Progressive - once the disease starts it doesn't stop but continues to get worse. Patients and doctors will "manage" progressive diseases. Unlike a cold, which is not progressive, doctors or patients can cure it.
