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Parkinson's Disease

parkinsonism

Parkinson's disease (PD) is a chronic (persistent) disorder of part of the brain. It mainly affects the way the brain co-ordinates the movements of the muscles in various parts of the body.

Who gets Parkinson's disease?

PD mainly develops in people over the age of 50. It becomes more common with increasing age. It affects both men and women but is a little more common in men. PD is not usually inherited, and it can affect anyone.

What causes Parkinson's disease?

A small part of the brain called the substantia nigra is mainly affected. This area of the brain sends messages down nerves in the spinal cord to help control the muscles of the body. Dopamine is the main neurotransmitter that is made by the brain cells in the substantia nigra.

If you have PD, a number of cells in the substantia nigra become damaged and die. As cells are damaged, the amount of dopamine that is produced is reduced. A combination of the reduction of cells and a low level of dopamine in the cells causes nerve messages to the muscles to become slowed and abnormal.

Parkinson's disease symptoms
  • Slowness of movement (bradykinesia). For example, it may become more of an effort to walk or to get up out of a chair.
  • Stiffness of muscles (rigidity), and muscles may feel more tense. Also, your arms do not tend to swing as much when you walk.
  • Shaking (tremor) is common, but does not always occur. It typically affects the fingers, thumbs, hands, and arms, but can affect other parts of the body. It is most noticeable when you are resting. It may become worse when you are anxious or emotional. It tends to become less when you use your hand to do something such as picking up an object.

Some other symptoms may develop due to problems with the way affected brain cells and nerves control the muscles. These include:

  • Fewer facial expressions such as smiling or frowning.
  • Difficulty with fine movements such as tying shoe laces or buttoning shirts.
  • Difficulty with writing (handwriting tends to become smaller).
  • Difficulty with balance and posture and an increased tendency to fall.
  • Speech may become slow and monotonous.
  • Swallowing may become troublesome, and saliva may pool in the mouth.
  • Tiredness, and aches and pains.
  • Constipation.
  • Bladder symptoms.
  • Hallucinations.
  • Sweating.
  • Sexual difficulties.
  • Alterations in your sense of smell.
  • Difficulties with sleeping.
  • Weight loss.
  • Pain.
  • Depression.
  • Anxiety.
  • Also, for reasons that are unclear, people with PD have an increased risk of developing melanoma skin cancer.
How is Parkinson's disease diagnosed?

There is no test that can prove that you have PD. The diagnosis is based on your having the typical symptoms (described above). The specialist will be used to diagnosing PD and ruling out other causes of the symptoms. They will usually be either a neurologist or a doctor specialised in elderly care.

Does Parkinson's disease cause dementia?

The cells in the brain affected in PD are not in the 'thinking' parts of the brain and dementia is not a typical early feature of PD. However, if you have PD you have an increased risk of developing dementia.

What are the treatments for Parkinson's disease?

There is no cure for PD, and no treatment prevents the disease from progressing. However, treatments can usually ease symptoms. At first, you may not need any treatment when the symptoms are mild. Therapies such as physiotherapy, occupational therapy and speech therapy may also be useful as the disease progresses. Surgery may be an option for severe cases.

Which drugs are used to treat Parkinson's disease?
  1. Levodopa
  2. This drug has been used for many years. Nearly all people with PD notice a good improvement in symptoms after starting levodopa. The body converts levodopa to dopamine. Therefore, the low level of dopamine in the affected part of the brain increases with levodopa. A low dose is usually started at first. Over time, the dose often needs to be increased to control the symptoms.

    Levodopa is always combined with another drug (either benserazide or carbidopa). These prevent levodopa from being converted into dopamine in the bloodstream.

    Levodopa tends to work less well over time. Of particular concern is the “on-off” phenomenon. This is where you can switch quite suddenly between being 'on' and able to move, and being 'off' and immobile.

  3. Dopamine agonists
  4. Dopamine agonists are drugs that act on the same receptors in the brain as dopamine. So, in effect, they act like a substitute for dopamine. There are several types. Ropinirole, pramipexole, or rotigotine are used most commonly. Bromocriptine, cabergoline or pergolide are alternatives but are used less often because of the risk of possible (rare) side-effects, including thickening of the heart valves and thickening and scarring of the lung tissue.

  5. Monoamine oxidase-B inhibitors
  6. These drugs are another alternative to levodopa for early PD. They include selegiline and rasagiline. These drugs work by blocking (inhibiting) the effect of a chemical in the brain called monoamine oxidase-B (MAO-B). This chemical is involved in the breakdown of levodopa and dopamine. If the action of MAO-B is inhibited then the effect of any dopamine lasts longer.

Other drugs used for Parkinson's disease

Catechol-O-methyltransferase (COMT) inhibitors are relatively new drugs. They include tolcapone and entacapone. These help to stop the breakdown of levodopa by the body, so more of each dose of levodopa can get into the brain to work. A COMT inhibitor is sometimes advised in addition to levodopa when symptoms are not well controlled by levodopa alone.

Therapies

  1. A physiotherapist can advise on posture, walking and exercises.
  2. An occupational therapist can advise on such things as home adaptations which may ease many tasks.
  3. If difficulties with speech, swallowing or saliva occur, a speech and language therapist can help.
  4. The advice of a dietician and other therapists may be needed for some people.
  5. A psychologist may be able to help if you have problems with depression.

Surgery

Chronic deep brain stimulation is a technique that involves putting a pulse generator (like a heart pacemaker) in the chest wall. Fine cables are tunnelled under the skin to electrodes placed in the brain. The electrodes stimulate the parts of the brain that are affected by PD and can help to ease symptoms.

  • Stay as active as possible.
  • Exercise regularly as much as you are able.
  • Constipation is common in people with PD. Help to reduce the chance of this by having lots to drink, and eat plenty of vegetables, fruit, and foods high in fibre.

How do symptoms progress and what is the outlook (prognosis)?

The symptoms of PD tend to become gradually worse over time. However, the speed of progression varies greatly from person to person. When symptoms first begin, you may not need treatment when symptoms are relatively mild.

Most people with PD can expect to have some time of relatively mild symptoms, and then when the symptoms become worse, several years of good or reasonable control of the symptoms with medication.


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