Parkinson’s disease

Parkinson’s disease (PD) is a neurodegenerative brain disorder that progresses slowly in most people. What this means is that individuals with PD will be living with PD for twenty years or more from the time of diagnosis. While Parkinson’s disease itself is not fatal, the Center for Disease Control rated complications from the disease as the 14th top cause of death in the United States. There is currently no cure for Parkinson’s; however, your doctors will be focused and dedicated to finding treatments that help control the symptoms of PD and have a good quality of life.

Normally, there are brain cells (neurons) in the human brain that produce dopamine. These neurons concentrate in a particular area of the brain, called the substantia nigra. Dopamine is a chemical that relays messages between the substantia nigra and other parts of the brain to control movements of the human body. Dopamine helps humans to have smooth coordinated muscle movements. When approximately 60 to 80% of the dopamine-producing cells are damaged, and do not produce enough dopamine, the motor symptoms of Parkinson’s disease appear. This process of impairment of brain cells is called neurodegeneration.

The current theory (so-called Braak’s hypothesis) is that the earliest signs of Parkinson’s are found in the enteric nervous system, the medulla and in particular, the olfactory bulb, which controls your sense of smell. Under this theory, Parkinson’s only progresses to the substantia nigra and cortex over the years. This theory is increasingly borne out by evidence that non-motor symptoms, such as a loss of sense of smell, hyposmia, sleep disorders and constipation may precede the motor features of the disease by several years. For this reason, researchers are increasingly focused on these “non-motor” symptoms to both detect PD as early as possible and to look for ways to stop its progression.

Different types of atypical Parkinsonism Syndromes

Drug-induced Parkinsonism

Side effects of some drugs, especially those that affect dopamine levels in the brain, can actually cause symptoms of Parkinsonism.

Although tremor and postural instability may be less severe, this condition may be difficult to distinguish from Parkinson’s disease.

Medications that can cause the development of Parkinsonism include: Antipsychotics, Metaclopramide, Reserpine, Tetrabenazine, Some calcium channel blockers, Stimulants such as amphetamines and cocaine, Usually after stopping those medications Parkinsonism gradually disappears

 Progressive supranuclear palsy (PSP)

PSP is one of the more common forms of atypical Parkinsonism.

Symptoms of PSP usually begin after age 50 and progress more rapidly than PD.

These symptoms include: imbalance, frequent falls, rigidity of the trunk, voice and swallowing changes and (eventually) eye-movement problems including the ability to move eyes up and down.

Dementia develops later in the disease. There is no specific treatment for PSP.

Dopaminergic medication treatment is often tried and may provide some benefit.

Other therapies such as speech therapy, physical therapy, and antidepressants are important for management of patients with PSP.

No laboratory/brain scan testing exists for PSP. In rare cases, some patients may have shrinking of a particular part of the brain, called the “Pons”, which can be seen on an MRI of the brain.

Corticobasal Degeneration (CBD)

CBD is the least common of the atypical causes of Parkinsonism

CBD develops after age 60 and progresses more rapidly than PD.

The initial symptoms of CBD include asymmetric bradykinesia, rigidity, limb dystonia, postural instability, and disturbances of language.

There is often marked and disabling apraxia of the affected limb, where it becomes difficult or impossible to control the movements of the affected limb even though there is no weakness or sensory loss.

No laboratory/brain scan tests exist to confirm the diagnosis of CBD. CBD is a clinical diagnosis.

There is no specific treatment for CBD.

Supportive treatment such as botulinum toxin (Botox) for dystonia, antidepressants, speech and physical therapy may be helpful.

Levodopa and dopamine agonists (common PD medications) seldom help.

Multiple system atrophy (MSA)

MSA is a larger term for several disorders in which one or more system in the body deteriorates.

Included in the category of MSA are: Shy-Drager syndrome (DSD), Striatonigral degeneration (SND) and OlivoPontoCerebellar Atrophy (OPCA).

The mean age of onset is in the mid-50s.

Symptoms include: bradykinesia, poor balance, abnormal autonomic function, rigidity, difficulty with coordination, or a combination of these features.

Initially, it may be difficult to distinguish MSA from Parkinson’s disease, although more rapid progression, poor response to common PD medications, and development of other symptoms in addition to Parkinsonism, may be a clue to its diagnosis.

No laboratory/brain scan testing exists to confirm the diagnosis of MSA.

Patients respond poorly to PD medications, and may require higher doses than the typical PD patient for mild to modest benefits.

Vascular Parkinsonism

Multiple small strokes can cause Parkinsonism.

Patients with this disorder are more likely to present with gait difficulty than tremor, and are more likely to have symptoms that are worse in the lower part of the body.

Some will also report the abrupt onset of symptoms or give a history of step-wise deterioration (symptoms get worse, then plateau for a period).

Dopamine is tried to improve patients’ mobility although the results are often not as successful.

Vascular Parkinsonism is static (or very slowly progressive) when compared to other neurodegenerative disorders.

Dementia with Lewy bodies (DLB)

DLB is a neurodegenerative disorder that results in progressive intellectual and functional deterioration.

Patients with DLB usually have early dementia, prominent hallucinations, fluctuations in cognitive status over the day, and Parkinsonism.

Cognitive changes in patients with DLB include deficits in attention, executive function (problem solving, planning) and visuospacial function (the ability to produce and recognize figures, drawing or matching figures).

There are no known therapies to stop or slow the progression of DLB.

Diagnosis

There is no “one way” to diagnose Parkinson’s disease (PD). However, there are various symptoms and diagnostic tests used in combination. In this section, you will learn how PD is diagnosed as well as the various Parkinsonism syndromes that often mimic the symptoms of PD.

Treatment

Currently, there is no cure for Parkinson’s disease. Instead, therapy is directed at treating the symptoms that are most bothersome to an individual with Parkinson’s disease.  For this reason, there is no standard or “best” treatment for Parkinson’s disease that applies to every patient.  NPF is currently gathering the data to develop an individualized best approach to patient care.  

Treatment approaches include medication and surgical therapy.  Other treatment approaches include general lifestyle modifications (rest and exercise), physical therapy, support groups, occupational therapy and speech therapy. In this section, you will become more familiar with the different types of medications commonly prescribed for PD, other alternative therapies, and surgical treatment options.

Medications for motor symptoms

Since most symptoms of PD are caused by the lack of dopamine in the brain, many Parkinson’s drugs are aimed at either temporarily replenishing dopamine or mimic the action of dopamine. These types of drugs are called dopaminergic. These medications generally help reduce muscle rigidity, improve speed and coordination of movement and lessen tremor.

Caution: PD medications may have interactions with certain foods, other medications, vitamins, herbal supplements, over the counter cold pills and other remedies.  Anyone taking a PD medication should talk to their doctor and pharmacist about potential drug interactions.

While surgery can be an effective treatment option for different symptoms of PD, only the symptoms that previously improved on levodopa have the potential to improve after the surgery.

Surgical treatment is reserved for PD patients who have exhausted medical treatment of PD tremor or who suffer profound motor fluctuations (wearing off and dyskinesias).

Parkinsons disease

Parkinsons disease (PD) is a neurodegenerative brain disorder that progresses slowly in most people. What this means is that individuals with PD will be living with PD for twenty years or more from the time of diagnosis. While Parkinsons disease itself is not fatal, the Center for Disease Control rated complications from the disease as the 14th top cause of death in the United States. There is currently no cure for Parkinsons; however, your doctors will be focused and dedicated to finding treatments that help control the symptoms of PD and have a good quality of life. Normally, there are brain cells (neurons) in the human brain that produce dopamine. These neurons concentrate in a particular area of the brain, called the substantia nigra. Dopamine is a chemical that relays messages between the substantia nigra and other parts of the brain to control movements of the human body. Dopamine helps humans to have smooth coordinated muscle movements. When approximately 60 to 80% of the dopamine-producing cells are damaged, and do not produce enough dopamine, the motor symptoms of Parkinsons disease appear. This process of impairment of brain cells is called neurodegeneration. The current theory (so-called Braaks hypothesis) is that the earliest signs of Parkinsons are found in the enteric nervous system, the medulla and in particular, the olfactory bulb, which controls your sense of smell. Under this theory, Parkinsons only progresses to the substantia nigra and cortex over the years. This theory is increasingly borne out by evidence that non-motor symptoms, such as a loss of sense of smell, hyposmia, sleep disorders and constipation may precede the motor features of the disease by several years. For this reason, researchers are increasingly focused on these non-motor symptoms to both detect PD as early as possible and to look for ways to stop its progression. Different types of atypical Parkinsonism Syndromes Drug-induced Parkinsonism Side effects of some drugs, especially those that affect dopamine levels in the brain, can actually cause symptoms of Parkinsonism. Although tremor and postural instability may be less severe, this condition may be difficult to distinguish from Parkinsons disease. Medications that can cause the development of Parkinsonism include: Antipsychotics, Metaclopramide, Reserpine, Tetrabenazine, Some calcium channel blockers, Stimulants such as amphetamines and cocaine, Usually after stopping those medications Parkinsonism gradually disappears Progressive supranuclear palsy (PSP) PSP is one of the more common forms of atypical Parkinsonism. Symptoms of PSP usually begin after age 50 and progress more rapidly than PD. These symptoms include: imbalance, frequent falls, rigidity of the trunk, voice and swallowing changes and (eventually) eye-movement problems including the ability to move eyes up and down. Dementia develops later in the disease. There is no specific treatment for PSP. Dopaminergic medication treatment is often tried and may provide some benefit. Other therapies such as speech therapy, physical therapy, and antidepressants are important for management of patients with PSP. No laboratory/brain scan testing exists for PSP. In rare cases, some patients may have shrinking of a particular part of the brain, called the Pons, which can be seen on an MRI of the brain. Corticobasal Degeneration (CBD) CBD is the least common of the atypical causes of Parkinsonism CBD develops after age 60 and progresses more rapidly than PD. The initial symptoms of CBD include asymmetric bradykinesia, rigidity, limb dystonia, postural instability, and disturbances of language. There is often marked and disabling apraxia of the affected limb, where it becomes difficult or impossible to control the movements of the affected limb even though there is no weakness or sensory loss. No laboratory/brain scan tests exist to confirm the diagnosis of CBD. CBD is a clinical diagnosis. There is no specific treatment for CBD. Supportive treatment such as botulinum toxin (Botox) for dystonia, antidepressants, speech and physical therapy may be helpful. Levodopa and dopamine agonists (common PD medications) seldom help. Multiple system atrophy (MSA) MSA is a larger term for several disorders in which one or more system in the body deteriorates. Included in the category of MSA are: Shy-Drager syndrome (DSD), Striatonigral degeneration (SND) and OlivoPontoCerebellar Atrophy (OPCA). The mean age of onset is in the mid-50s. Symptoms include: bradykinesia, poor balance, abnormal autonomic function, rigidity, difficulty with coordination, or a combination of these features. Initially, it may be difficult to distinguish MSA from Parkinsons disease, although more rapid progression, poor response to common PD medications, and development of other symptoms in addition to Parkinsonism, may be a clue to its diagnosis. No laboratory/brain scan testing exists to confirm the diagnosis of MSA. Patients respond poorly to PD medications, and may require higher doses than the typical PD patient for mild to modest benefits. Vascular Parkinsonism Multiple small strokes can cause Parkinsonism. Patients with this disorder are more likely to present with gait difficulty than tremor, and are more likely to have symptoms that are worse in the lower part of the body. Some will also report the abrupt onset of symptoms or give a history of step-wise deterioration (symptoms get worse, then plateau for a period). Dopamine is tried to improve patients mobility although the results are often not as successful. Vascular Parkinsonism is static (or very slowly progressive) when compared to other neurodegenerative disorders. Dementia with Lewy bodies (DLB) DLB is a neurodegenerative disorder that results in progressive intellectual and functional deterioration. Patients with DLB usually have early dementia, prominent hallucinations, fluctuations in cognitive status over the day, and Parkinsonism. Cognitive changes in patients with DLB include deficits in attention, executive function (problem solving, planning) and visuospacial function (the ability to produce and recognize figures, drawing or matching figures). There are no known therapies to stop or slow the progression of DLB. Diagnosis There is no one way to diagnose Parkinsons disease (PD). However, there are various symptoms and diagnostic tests used in combination. In this section, you will learn how PD is diagnosed as well as the various Parkinsonism syndromes that often mimic the symptoms of PD. Treatment Currently, there is no cure for Parkinsons disease. Instead, therapy is directed at treating the symptoms that are most bothersome to an individual with Parkinsons disease. For this reason, there is no standard or best treatment for Parkinsons disease that applies to every patient. NPF is currently gathering the data to develop an individualized best approach to patient care. Treatment approaches include medication and surgical therapy. Other treatment approaches include general lifestyle modifications (rest and exercise), physical therapy, support groups, occupational therapy and speech therapy. In this section, you will become more familiar with the different types of medications commonly prescribed for PD, other alternative therapies, and surgical treatment options. Medications for motor symptoms Since most symptoms of PD are caused by the lack of dopamine in the brain, many Parkinsons drugs are aimed at either temporarily replenishing dopamine or mimic the action of dopamine. These types of drugs are called dopaminergic. These medications generally help reduce muscle rigidity, improve speed and coordination of movement and lessen tremor. Caution: PD medications may have interactions with certain foods, other medications, vitamins, herbal supplements, over the counter cold pills and other remedies. Anyone taking a PD medication should talk to their doctor and pharmacist about potential drug interactions. While surgery can be an effective treatment option for different symptoms of PD, only the symptoms that previously improved on levodopa have the potential to improve after the surgery. Surgical treatment is reserved for PD patients who have exhausted medical treatment of PD tremor or who suffer profound motor fluctuations (wearing off and dyskinesias).