All You Wanted To Know About Parkinson’s Disease

Parkinson’s disease (PD) is a brain disorder that can cause significant disability leading to poor quality of living. Most patients remain dependent on others or become institutionalized. Approximately, 0.58 million people in India are said to have been living with PD, according to a 2016 estimate.

About Parkinson’s Disease

Parkinson’s disease is a neurodegenerative brain disorder, that affect nerve cells that produce a chemical call ‘dopamine’ which carries messages between brain cells, especially facilitating movement of the body. In patients with Parkinson’s disease, dopamine secretion ceases, leading to several problems related to movement.

Signs and Symptoms

The symptoms of Parkinson’s disease usually develop gradually. It may begin as a discomfort in one hand and can stay overtime to be experienced in the other hand as well. Most of the symptoms are related to movement, however, there are some symptoms which are not associated with movement, these are known as non-motor symptoms.

Movement symptoms of Parkinson’s disease

There is no single test or scan available for the diagnosis of PD. However, three hallmark symptoms help your healthcare provider in the diagnosis.

• Bradykinesia (slowness of movement): You may experience slowness in your movement due to slowing down of your brain’s speed of sending signals or instructions to your body. One time you may have difficulty in walking, and may even drag your feet as your walk. Other time, the same activity is done with ease and with no help required. This symptom can affect your ability to do your everyday activities such as bathing, combing your hair and getting dressed.
• Tremor (Shaking): Shaking as a symptom may begin in one part or one side of the body. Disease progression can lead to shaking in other parts of the body or its severity. Common areas where shaking occurs is in hands, legs, feet, and jaw. However, shaking duration is not fixed and its frequency also various. Shaking often disappears during the sleep.
• Rigidity (Stiffness): Stiffness/tensed feeling in your muscles is another symptom of PD. You may often have muscle pain in the affected muscles, that is expressed in your limited ability to move.

Other symptoms associated with movement include posture disability, where a person has trouble with balance and coordination issues that may cause the patient to fall. This symptom usually occurs in the later stages of the disease.

Non-movement/non-motor symptoms of PD

• Problems with attention and memory (or even dementia at later stages)
• Feeling full with little quantity of food
• Fatigue
• Excessive sweating
• Swallowing problems
• Weight loss
• Hallucinations
• Vision problems
• Mood disorders such as depression, anxiety and irritability
• Sleep disorders like restless leg syndrome, insomnia
• Urinary urgency, frequency, and incontinence
• Sexual problems

Causes & Risk factors of PD

The cause of PD is not understood well. Some evidence suggest that loss of dopamine-producing nerve cells in the part of the brain called substantia nigra can lead to PD.

Other causes are also postulated, such as:

• Genes: Some of the variations in your genes (mutation) can result in occurrence of PD. This is a rare thing to happen and it is unlikely that many family members will be affected by Parkinson’s disease.
• Environmental factors: Exposure to certain harmful toxins can trigger the disease. However, this is not well researched.

Risk factors

Some of the risk factors include:

• Age: Age is biggest risk factors for PD. It is uncommon to occur in children or young adults. The average age of onset is 60 years.
• Heredity: If you have a family history of PD, you are more likely at risk to get the disease.
• Gender: Men are more likely to develop Parkinson's disease than women.

Diagnosis

There is currently no test for Parkinson’s disease. Its similarity to other conditions can make it hard to diagnose in the early stages. Your healthcare provider would start by by examining your medical history, doing a neurology examination (to check your nervous system condition) and determining the present symptoms.

Tools that help in diagnosis are:

• Imaging tests such as CT (computed tomography), MRI (magnetic resonance imaging) scan, PET (positron emission tomography (PET) scan, or Ultrasound of brain
• A Single-photon emission computerized tomography (SPECT) scan called a dopamine transporter scan (DaTscan) may be suggested for confirming PD. However, not many people require this scan.

Treatment & Management

Although there is no cure for Parkinson’s disease, medications and surgery can be used to treat and relieve the symptoms.

• Medications: Medications can help in controlling certain symptoms and ease the discomfort your symptoms bring. You may receive two kinds of medications
• Medications to relieve movement symptoms.
• Medication to replenish dopamine- These dopamine substitutes may help increase dopamine levels, but the effect usually wear out with time.
• Surgery: Deep brain stimulation (DBS) is the surgical procedure used in the treatment of PD. In this surgery electrical impulses are sent to your brain that will lower the symptoms of PD.
• Surgery is only required for patients who are in their advanced stage of PD.
• This procedure is opted in people when the medications are no longer showing a desired outcome/response in favour of the patient.
• Although DBS may provide sustained benefit for Parkinson's symptoms, it doesn't keep Parkinson's disease from progressing.

Supportive therapies

Supportive therapies such as exercise, physical therapy (physiotherapy), occupational therapy, speech-language therapy can help manage the symptoms such as walking and balance issues, eating, chewing and swallowing problems, and speech challenges. These therapies usually help to improve the patient’s quality of life.

Dietary changes may help with symptoms that arise out of reduced or inappropriate movements. You should include more amount of fibre in your diet and have more fluids to reduce constipation. Decreasing salt intake and taking small frequent meals usually helps to stay nourished.

At advanced stages of the disease, most patients may need assistance with living or may be institutionalized.

Although the disease cannot be prevented; an early diagnosis can help in timely interventions to slow down disease progression.

Dr Venkatraman Karthikeayan

M.B.B.S,M.D (General Medicine),D.M (Neurology),Diploma (Neurology)

Consultant Neurologist

Neurology