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Parkinson's disease is a neurological illness that affects mobility. Symptoms appear gradually, sometimes beginning with a barely perceptible tremor in only one hand. Tremors are prevalent, although the disease is sometimes associated with stiffness or slowness of movement.
Your face may display little or no expression in the early stages of Parkinson's disease. When you walk, your arms may not swing. Your speech may become slurred or soft. Parkinson's disease symptoms grow as the disease advances.
Although Parkinson's disease cannot be cured, drugs may help to alleviate your symptoms. Occasionally, your doctor may recommend surgery to regulate specific areas of your brain and alleviate your symptoms.
WHAT ARE THE SIGNS AND SYMPTOMS OF PARKINSON'S DISEASE?
Parkinson's disease indications and symptoms can vary from person to person. Early symptoms may be subtle and go unrecognized. Symptoms normally begin on one side of your body and worsen on that side, even if symptoms begin to impact both sides.
Among the signs and symptoms of Parkinson's disease are:
- Tremor: A tremor, or shaking, usually starts in a limb, most commonly in your hand or fingers. A pill-rolling tremor occurs when you rub your thumb and forefinger back and forth. When your hand is at rest, it may shake.
- Slowed movement (bradykinesia): Parkinson's disease may slow your mobility over time, making routine tasks complex and time-consuming. When you walk, your steps may become shorter. Getting out of a chair may be tough. You may find yourself dragging your feet as you try to walk.
- Muscles that are rigid: Muscle stiffness can happen anywhere on your body. Muscle stiffness can be uncomfortable and restrict your range of motion.
- Poor posture and balance: As a result of Parkinson's disease, your posture may become stooped, or you may experience balance issues.
- Loss of automatic movements: You may have a reduced capacity to do unconscious movements such as blinking, smiling, or swinging your arms while walking.
- Speech changes: You can speak softly, fast, slur, or pause before speaking. Your speech may be monotone rather than with the typical inflections.
- Changes in writing: Writing may become difficult, and your writing may appear little.
WHAT ARE THE CAUSES OF PARKINSON'S DISEASE?
Parkinson's disease causes particular nerve cells (neurons) in the brain to gradually degrade or die. Many of the symptoms are caused by a loss of neurons that produce dopamine, a chemical messenger in the brain. When dopamine levels fall, aberrant brain activity occurs, resulting in reduced mobility and other Parkinson's disease symptoms.
Parkinson's disease has no established etiology, however various factors appear to play a role, including:
- Genes: Specific genetic mutations that can cause Parkinson's disease have been identified by researchers. However, except in rare circumstances where there are multiple family members suffering by Parkinson's disease, they are unusual.
Certain gene variations, on the other hand, appear to enhance the chance of Parkinson's disease, but with a relatively low risk of Parkinson's disease for each of these genetic markers.
- Environmental triggers: Exposure to some poisons or environmental variables may raise the likelihood of developing Parkinson's disease later in life, but the risk is modest.
Researchers have also discovered that various changes occur in the brains of persons suffering from Parkinson's disease, yet it is unknown why these changes occur. Among the modifications are:
- The presence of Lewy bodies: Microscopic signs of Parkinson's disease include clumps of particular chemicals within brain cells. These are known as Lewy bodies, and scientists believe they offer a vital clue to the etiology of Parkinson's disease.
- Alpha-synuclein found within Lewy bodies: Although several compounds are discovered within Lewy bodies, experts believe one of the most crucial is a naturally occurring and widely distributed protein known as alpha-synuclein (a-synuclein). It can't be broken down by cells and is found in all Lewy bodies in clumped form. This is a major topic for Parkinson's disease researchers right now.
WHAT ARE THE RISK FACTORS FOR PARKINSON'S DISEASE?
Parkinson's disease risk factors include:
- Age: Parkinson's disease affects just a small percentage of young individuals. It usually starts in middle or late life, and the risk rises with age. People who are 60 or older are more likely to develop the condition.
- Heredity: Having a close family who has Parkinson's disease raises your chances of developing the disease. However, unless you have a large number of Parkinson's disease relatives in your family, your risks remain low.
- Sex: Men are more prone than women to develop Parkinson's disease.
- Toxins exposure: Continuous exposure to herbicides and pesticides may increase your risk of Parkinson's disease slightly.
WHAT ARE THE COMPLICATIONS OF PARKINSON'S DISEASE
Parkinson's disease is frequently accompanied with the following additional issues, which may be treatable:
- Problems with thinking: You may develop cognitive issues (dementia) and difficulty thinking. These are more common in the advanced stages of Parkinson's disease. Medication does not help with such cognitive issues.
- Depression and emotional upheaval: You may suffer depression, even in its early stages. Receiving depression treatment may make it simpler to deal with the additional complications of Parkinson's disease.
Other emotional changes, such as dread, worry, or a loss of motivation, may occur. Medication may be prescribed by your doctor to relieve these symptoms.
- Problems with swallowing: As your illness worsens, you may have difficulty swallowing. Drooling may occur as a result of saliva accumulation in your mouth as a result of slower swallowing.
- Chewing and eating issues: Parkinson's disease in its late stages affects the muscles in your mouth, making chewing difficult. Choking and poor nutrition can result as a result of this.
- Sleep disorders and sleep issues: People with Parkinson's disease typically experience sleep issues, such as waking up repeatedly during the night, getting up early, or falling asleep during the day.
Rapid eye movement sleep behavior disorder, which involves acting out your dreams, can also occur. Medications may help with your sleep issues.
- Bladder issues: Parkinson's disease can produce bladder difficulties, such as inability to control pee or trouble urinating.
- Constipation: Constipation is common in persons with Parkinson's disease, owing to a sluggish digestive tract.
You may also encounter:
- Changes in blood pressure: Because of a quick drop in blood pressure, you may feel dizzy or lightheaded when you stand (orthostatic hypotension).
- Smell dysfunction: You may have issues with your sense of smell. You may have difficulties identifying specific odors or distinguishing between odors.
- Fatigue: Many patients with Parkinson's disease report exhaustion and loss of energy, especially later in the day. The root cause isn't always clear.
- Pain: Some Parkinson's disease patients experience pain, either in specific places of their bodies or throughout entire bodies.
- Sexual dysfunction: Some Parkinson's disease patients report a decline in sexual desire or performance.
WHAT ARE THE STAGES OF PARKINSON'S DISEASE?
Each person suffering from Parkinson's disease experiences symptoms in their own unique way. Not everyone has all of the symptoms of Parkinson's disease. It is possible that you will not experience symptoms in the same order as others. Some people may experience moderate symptoms, while others may experience severe problems. The rate at which symptoms worsen varies from person to person and is difficult to estimate at the onset.
In general, the disease evolves from early to mid-stage, then to mid-late stage, and finally to advanced stage. This is what usually happens at each of these stages:
- Early stage: Early symptoms of Parkinson's disease are often modest, appear gradually, and do not interfere with daily activities. Early symptoms are not always simple to identify, and you may mistake them for normal indicators of aging. You may experience weariness or a general sensation of unease. You may experience a small tremor or difficulty standing.
Often, a family member or a close friend will notice some of the subtle indicators before you do. They may observe bodily rigidity or a lack of typical mobility (for example, no arm swing when walking), slow or small handwriting, a lack of expression in your face, or trouble getting out of a chair.
- Mid stage: The symptoms begin to worsen. Tremor, muscle stiffness, and mobility issues on both sides of the body are now possible. Falls and balance issues are becoming increasingly widespread. You may still be entirely autonomous, but daily actions like washing and dressing are getting more difficult to perform and require longer to complete.
- Mid-late stage: Standing and walking are becoming increasingly difficult and may necessitate the use of a walker. To continue living at home, you may require full-time assistance.
- Advanced level: You are now confined to a wheelchair or are bedridden. You might have hallucinations or delusions. You now require round-the-clock nursing care.
HOW IS PARKON'S DISEASE DIAGNOSED?
Diagnosis of Parkinson's disease can be challenging at times since early symptoms might match those of other conditions and there are no specific blood or laboratory testing to detect the disease. CT (computed tomography) or MRI (magnetic resonance imaging) scans may be done to rule out other illnesses that cause similar symptoms.
To diagnose Parkinson's disease, your medical history and family history of neurologic illnesses, as well as your present symptoms, medications, and possible exposure to toxins, will be asked. Your doctor will examine you for symptoms of tremor and muscle rigidity, as well as how you walk, posture, and coordination, and slowness of movement.
If you suspect you have Parkinson's disease, you should contact a neurologist, ideally one who specializes in movement disorders. Treatment decisions taken early in the illness can have a long-term impact on the treatment's outcome.
WHAT ARE THE TREATMENTS FOR PARKIN'S DISEASE?
Parkinson's illness has no known cure. Medication and other treatments, on the other hand, can help alleviate some of your symptoms. Exercise can considerably improve your Parkinson's symptoms. Physical therapy, occupational therapy, and speech-language therapy can also help with walking and balance issues, eating and swallowing difficulties, and speech disorders. For some people, surgery is an option.
WHAT ARE THE MEDICATIONS USED TO TREAT PARKINSON'S DISEASE?
Medications are the primary therapy option for Parkinson's disease sufferers. Your doctor will collaborate with you to establish the optimal treatment strategy for you based on the severity of your disease at the time of diagnosis, the adverse effects of the drug class, and the success or failure of symptom control with the medications you try.
Medications are used to treat Parkinson's disease in the following ways:
- Assisting nerve cells in the brain in the production of dopamine.
- Simulating the effects of dopamine in the brain.
- Blocking an enzyme in the brain that breaks down dopamine.
- Reducing certain specific Parkinson's disease symptoms.
Levodopa: Levodopa is a primary treatment for Parkinson's disease symptoms such as slowness of movement, tremor, and stiffness. Nerve cells use levodopa to produce dopamine, which replaces the low levels observed in Parkinson's disease patients' brains. Levodopa is commonly used with carbidopa (Sinemet®) to allow more levodopa to reach the brain and to avoid or minimize nausea and vomiting, low blood pressure, and other levodopa side effects. Sinemet® is available in two formulations: immediate release and long-acting, controlled release. Rytary® is a longer-acting capsule form of levodopa/carbidopa. Inbrija®, an inhaled levodopa, is the most recent addition. People who are already taking normal carbidopa/levodopa utilize it when they experience off episodes.
As patients live with Parkinson's for a longer period of time, the effects of their levodopa dosages don't last as long as they used to, causing their symptoms (tremor, muscle rigidity, slowness) to deteriorate before their next dose. This is referred to as 'wearing off.' They may also have dyskinesias, which are uncontrollable, fluid, dancing, or fidgeting-like motions of their body. These motions may indicate that the levodopa dose is excessive. These ups and downs in levodopa effects are known as motor fluctuations, and they are generally improved with prescription adjustments by a neurologist.
Dopamine agonists: These are medications that imitate the effects of dopamine in the brain. They are not as efficient in regulating sluggish muscle action and muscle rigidity as levodopa. Depending on the severity of your symptoms and your age, your doctor may try these medications first and then add levodopa if your symptoms are not adequately controlled.
Ropinirole (Requip®) and pramipexole (Mirapex®) are two newer dopamine agonists. Rotigotine (Neupro®) is administered as a patch. Apomorphine (Apokyn®) is an injectable medicine with a limited duration of action.
Nausea, vomiting, dizziness, lightheadedness, sleeping issues, leg swelling, confusion, hallucinations, and obsessive behavior are some of the side effects of dopamine agonists (such as excessive gambling, buying, eating, or sex). Some of these adverse effects are more common in adults over the age of 70.
Catechol O-methyltransferase (COMT) inhibitors: These medications inhibit an enzyme in the brain that breaks down dopamine. These medications, when combined with levodopa, decrease your body's capacity to eliminate levodopa, allowing it to last longer and be more reliable. COMT inhibitors include entacapone (Comtan®) and tolcapone (Tasmar®). Opicapone (Ongentys®) is the most recent drug in this class, having been approved by the FDA in April 2020. Because these medications boost levodopa's effectiveness, they may also increase its side effects, such as involuntary movements (dyskinesia). Tolcapone is infrequently administered since it might harm the liver and necessitates careful monitoring to avoid liver failure.
MAO B inhibitors: These medications inhibit a specific brain enzyme, monoamine oxidase B (MAO B), which breaks down dopamine in the brain. This allows dopamine to have a longer duration of action in the brain. Selegiline (Eldepryl®, Zelapar®), rasagiline (Azilect®), and safinamide (Xadago®) are examples of MAO B inhibitors. These medications have side effects such as nausea and sleeplessness. The combination of carbidopa-levodopa and an MAO B inhibitor increases the risk of hallucinations and dyskinesia. If you are on certain antidepressants or narcotic drugs, MAO B inhibitors are not recommended. Your doctor will analyze all of your existing medications and determine the best course of treatment for you.
Anticholinergics: These medications aid in the reduction of tremor and muscle stiffness. Benztropine (Cogentin®) and trihexyphenidyl (Artane®) are two examples. These are the most traditional Parkinson's disease treatments. Blurred vision, constipation, dry mouth, and urinary retention are some of the side effects. Anticholinergics should not be taken by those over the age of 70 who are prone to disorientation and hallucinations or have memory impairment. These drugs are less widely used due to the high likelihood of negative effects.
Amantadine: Amantadine (Symmetrel®), which was originally created as an antiviral medicine, is effective in reducing the involuntary movements (dyskinesia) induced by levodopa therapy. The medicine is available in two extended-release formulations: Gocovri® and Osmolex ER®. Confusion and memory issues are among the side effects.
Istradefylline: The adenosine A2A receptor antagonist is istradefylline (Nourianz®). It is prescribed for those who are taking carbidopa-levodopa but are suffering side effects. They, like the other medications that boost levodopa's effectiveness, may also exacerbate its side effects, such as involuntary movements (dyskinesia) and hallucinations.
WHAT SURGICAL TREATMENTS ARE AVAILABLE FOR PARKINSON'S DISEASE?
Most Parkinson's disease patients can maintain a good quality of life with treatment. However, as the condition progresses, drugs may lose their effectiveness in some patients. Medication effectiveness becomes inconsistent in some people, with drugs lowering symptoms during "on" moments but no longer managing symptoms during "off" periods, which usually occur when the medication is wearing off and shortly before the next dose is to be given. These variances can sometimes be controlled with drug modifications. However, this isn't always the case. Your doctor may discuss some of the possible surgical alternatives with you based on the type and severity of your symptoms, the failure of medication changes, the loss in your quality of life, and your overall health.
- Deep brain stimulation (DBS): This is a procedure that involves implanting electrodes in the brain that send electrical impulses to block or alter the aberrant activity that causes symptoms. DBS can treat the majority of Parkinson's disease's primary movement symptoms, including tremor, slowness of movement (bradykinesia), and stiffness (rigidity). It has no effect on memory, hallucinations, sadness, or other non-movement symptoms of Parkinson's disease. Only patients who are unable to control their symptoms despite drug trials and who fulfill additional stringent requirements may be candidates for DBS. Your doctor will determine whether this is the best treatment for you.
- Carbidopa-levodopa infusion: This procedure includes surgically inserting a feeding tube into the small intestine. This tube delivers a gel form of the drug carbidopa-levodopa (Duopa®). This method of continuous medication infusion maintains a steady dose in the body. This is beneficial to people who had a variable response to the oral form of carbidopa-levodopa but are still benefiting from the combo therapy.
- Pallidotomy: This procedure involves removing a little piece of the brain that governs movement (the globus pallidus). Pallidotomy can aid in the reduction of involuntary movements (dyskinesias), muscle stiffness, and tremor.
- Thalamotomy: This is the surgical removal of a tiny portion of the thalamus. This may benefit a limited proportion of patients who have significant arm or hand tremors.
HOW CAN PARKISON'S DISEASE BE PREVENTED?
Because the cause of Parkinson's disease is unclear, reliable ways to avoid the condition are also unknown.
According to certain studies, regular aerobic exercise may lessen the risk of Parkinson's disease.
Other studies have found that persons who eat caffeine, which is found in coffee, tea, and cola, are less likely to develop Parkinson's disease than those who do not. Green tea consumption has also been linked to a lower chance of acquiring Parkinson's disease. However, it is still unclear whether caffeine genuinely protects against Parkinson's disease or if it is related in some other way. There is currently insufficient evidence to show that drinking caffeinated beverages can protect against Parkinson's disease.