By Eduardo Gonzales, MD
My 70-year-old father developed shaking of the hands. We took him to a neurologist who diagnosed him as having Parkinson’s disease. We were told by the neurologist that the cause of this disease is unknown. Is this true? What is this disease all about?—email@example.com
Parkinson’s disease (PD) is a chronic and slowly progressive movement disorder, which means symptoms persist and worsen over time. The disease is named after Dr. James Parkinson, a British physician who described its symptoms in 1817.
Parkinson’s disease usually starts after age 50, is more common in men than in women, and affects about one percent of people who are above 65. It usually initially manifests, as in the case of your father, as a tremor or trembling of the hand at rest, which disappears when the hand is moved purposely. Other signs and symptoms include difficulty in walking, lack of facial expression, stiffness, slow movement, postural instability, as well as a wide range of non-movement symptoms such as depression, loss of sense of smell, gastric problems, cognitive changes, and many others.
The underlying cause of Parkinson’s disease is the death or malfunction of the nerve cells (neurons) in the brain that produce dopamine, a chemical that controls movement and coordination.
Parkinson’s Disease vs. Parkinsonism
Parkinson’s disease should be distinguished from Parkinsonism, which is a general term that refers to a group of neurological disorders whose signs and symptoms are similar to those of Parkinson’s. Parkinson’s disease is simply the most common form of Parkinsonism. It is the type of Parkinsonism where the cause of the degeneration of the nerve cells is still unknown. Parkinson’s disease tends to run in some families but genetics does not seem to play a major role in its development.
The other forms of Parkinsonism, which are sometimes called atypical Parkinson’s diseases, can be the aftermath of a stroke, brain tumor, encephalitis and meningitis, intake of certain drugs and toxins, other degenerative diseases of the brain, and head trauma as in case of repeated injuries sustained by boxers. In a typical Parkinson’s disease, the loss of neurons is more far-reaching. Thus, patients tend to progress more rapidly. They also do not respond or respond only for a short time to the standard drug treatment for Parkinson’s disease.
How PD is diagnosed
Diagnosis of Parkinson’s disease is based on history and signs and symptoms as there are no laboratory tests or imaging modalities that are confirmatory of the disease. Often, laboratory exams are performed simply to rule out other possible causes of the symptoms.
Course of Parkinson’s Disease
The evolution and ultimate outcome of PD varies. In some patients, the disease progresses slowly. In others, however, the symptoms evolve very fast.
PD itself is not fatal, but people with the illness have reduced life expectancy. As the disease progresses, the shaking or tremor begins to interfere with daily activities. Later, walking, talking or doing simple tasks becomes very tedious. As symptoms get worse, additional ones may arise such as depression, sleep problems, or difficulty in chewing and swallowing. Untreated, individuals lose independent ambulation after an average of eight years and become bedridden after 10 years. Terminally, they are not able to perform daily tasks even with assistance and become completely dependent on caregivers.
Treatment for PD
There is no cure for Parkinson’s disease, but medicines can help control its symptoms. The three main types of medication used are levodopa, dopamine agonists, and monoamine oxidase-B inhibitors. In some cases, surgery called deep brain stimulation may be appropriate.
Other supportive treatments for both Parkinson’s disease and Parkinsonisms include physical, occupational, and speech therapy.
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