- What is Parkinson disease?
- What is Parkinsonism?
- Who are at risk for developing Parkinson disease?
- What are the symptoms of Parkinson disease?
- How does Parkinson disease progress?
- How can Parkinson disease be treated?
- What home precautions/ remedies are to be taken by family of Parkinson disease patient?
What is Parkinson disease?
Parkinson Disease is a common term which refers to “Idiopathic Parkinson disease”. It is a chronic, progressive, and disabling disorder that is characterized by both motor and non-motor symptoms. At its core, Parkinson’s disease is neurodegenerative disease with early prominent death of dopaminergic neurons resulting in dopamine deficiency in basal ganglia.
Patients experience progressive extrapyramidal motor symptoms, including tremor, bradykinesia, rigidity, imbalance, and a variety of non-motor symptoms such as sleep and mood disorders. Despite its progressive nature, it remains one of the few neuro degenerative diseases whose symptoms can be readily treated with dopaminereplacement therapy.
What is Parkinsonism?
Parkinsonism refers to the constellation of bradykinesia, rigidity, resting tremor, and postural and gait impairments (described in the section of “symptoms of Parkinson disease). While Parkinsonism can have a variety of causes, the most common cause of Parkinsonism is “Idiopathic Parkinson disease”. The causes of Parkinsonism can be grouped under 4 categories –
- Idiopathic Parkinson disease
- Atypical Parkinsonism (Multiple System Atrophy, Progressive Supranuclear Palsy, Corticobasal syndrome, Diffuse Lewy Body Dementia)
- Heredodegenerative Parkinsonism, this subset includes other additional neurological symptoms. Eg, – Neurodegeneration with Brain Iron Accumulation spectrum, Spinocerebellar ataxias, Lubag syndrome, etc.)
- Secondary Parkinsonism (Drug induced parkinsonism, structural, infectious, immunological, toxic-metabolic, post traumatic)
Who are at risk for developing Parkinson disease?
The disease affects millions of people worldwide and is the second most prevalent neurodegenerative condition next to Alzheimer disease.(1) The number of affected patients may double by 2030.(2) The annual median age-standardized incidence rates of Parkinson disease in people older than 65 years of age in high-income countries is 160 per 100,000.(3) The incidence of Parkinson disease prior to age 50 is low but increases with advanced age. The lifetime risk of Parkinson disease is 2% in men and 1.3% in woman aged 40 years and older, when accounting for competing risks.(3) Men carry a greater chance of having Parkinson disease than women.
What are the symptoms of Parkinson disease?
They can be broadly described as Motor and Non Motor symptoms.(4,5)
Motor Symptoms –
- Tremor – It is rhythmic oscillation of limbs around a fixed point in the “rest” or non-postural position. Tremor is often the first motor symptom of Parkinson disease and affects approximately 90% of patients at some point in their lives.
- Rigidity – Stiffness or resistance of a limb when it is flexed passively, and may also be referred to as “cog-wheeling”.
- Bradykinesia –slowness of movement (akinesia refers to lack of movement) and may occur during both initiation and continuation of movement.
- Postural instability, or balance dysfunction, is experienced later in the course of the disease, about a decade after initial diagnosis.
- Freezing – “an episodic inability (lasting seconds) to generate effective stepping. It is most commonly experienced during turning and step initiation.” Patients feel that their feet are glued to the ground, and this feeling is usually episodic in nature.
Non motor Symptoms –
- Neuropsychiatric non-motor symptoms including depression, apathy, impulse control disorders, anxiety, psychosis, hallucinations, and mood disorders.
- Cognitive non-motor symptoms including executive dysfunction, memory loss, and dementia.
- Autonomic disturbances including orthostatic hypotension, constipation, urinary incontinence, sexual dysfunction, altered cardiac reflexes, olfactory dysfunction, gastrointestinal dysfunction, and sweating.
- Sleep disorders including insomnia, somnolence, excessive daytime sleepiness, restless legs syndrome, sleep attacks, periodic limb movements of sleep, and rapid eye movement (REM) sleep behaviour disorder.
- Sensory abnormalities including pain, numbness, fatigue, and olfactory impairment.
Premotor Symptoms –
Symptoms that predate motor symptoms of Parkinson disease and include
- Constipation
- Anosmia
- REM sleep behaviour disorder
- Depression
How does Parkinson disease progress?
The Movement Disorder Task Force recently recognized three stages in early Parkinson disease: (6,7)
- The preclinical phase, in which neurodegeneration begins but patients lack clinical symptoms.
- The prodromal phase, in which symptoms are present but are insufficient to make a diagnosis of Parkinson disease.
- The clinical phase, in which parkinsonian motor symptoms are manifest and recognizable.
Patients usually have a “good” period early on after diagnosis, in which they benefit from medications. However, the disease eventually progresses and is marked by uneven response to medications with development of motor complications and fluctuations, speech and swallowing deficits, freezing, falls, and imbalance. Patients with younger-onset disease are more prone to drug induced complications, while patients with older-onset disease have more cognitive issues and autonomic disturbances.
How can Parkinson disease be treated?
- It is important to note that there is no permanent for Parkinson disease.
- However, there are a wide variety of medical and surgical treatments available for Parkinson disease.
- Medical treatment includes medications, education, support, exercise, physical and speech therapy, and nutrition.
- There are six main types of medications available to treat symptoms of Parkinson disease: levodopa, dopamine agonists, inhibitors of enzymes that inactivate dopamine (monoamine oxidase type B [MAO B] inhibitors and catechol-O-methyl transferase [COMT] inhibitors), anticholinergic drugs, and amantadine.
- For some people with Parkinson disease, surgical treatment with deep brain stimulation is another option.
- The optimal combination of treatments depends upon the person’s signs and symptoms, age, stage and severity of disease, and level of physical activity. It is best decided by the treating physician. Patient and family should share in the decision making process.
What home precautions/ remedies are to be taken by family of Parkinson disease patient?
- Prevention of falls – An individual with Parkinson disease is highly probe for falls. As falls can be life threatening or have serious consequences, it is of major importance to prevent falls. Some common remedies –
- Usage of walking aids in those with postural instability.
- Avoid sudden turning to either side.
- Avoid overly crowded/ narrow places as the tendency to freezing increases.
- Install support bars at toilet and places commonly used.
- Have adequate lighting in the house, especially at night. Use of light-sensitive night lights or lamps on a timer may be helpful.
- Secure loose carpets/ floor mats so as to reduce the risk of tripping.
- Nutrition –
- There is no specific diet recommended for people with Parkinson disease.
- Some patients notice that protein in a meal can block the effect of a dose of medications taken around meal time. People who notice this effect should speak to their healthcare provider about adjusting the timing of their medications, rather than simply avoiding protein, which can lead to loss of muscle mass.
- It is important to be sure that the person is getting an adequate number of calories and nutrients to maintain strength, bone structure, and muscle mass.
- Safe swallowing –
- Problems with swallowing and speaking are common in people with Parkinson disease. These problems develop as muscles weaken in the voice box, throat, mouth, tongue, and lips.
- Difficulty in swallowing increases risk of coughing, choking, or inhaling food (aspiration), which can lead to pneumonia.
- Home remedies to reduce aspiration include
i. Sitting up straight while eating
ii. Tilting the head slightly forward
iii. Eating small bites and chewing completely
iv. Not speaking while eating.
v. Use of a flour to thicken liquids or thin food, making them easier to swallow
- Driving vehicles –
- As the core feature of this disease include postural instability and slowness of movements, it become difficult for individual to quickly change gears and apply sudden breaks in case of need.
- Most patients with Parkinson disease can continue to drive till their motor symptoms remain mild. The individual’s driving ability needs to be periodically re-evaluated formally if and when motor symptoms worsen.
- When feasible, it is best to avoid self-driving and to use alternate means of transportation.
References:
- Hirtz D, Thurman DJ, Gwinn-Hardy K, et al. How common are the “common” neurologic disorders? Neurology 2007:68(5):326–327. doi:10.1212/01.wnl.0000252807.38124.a3.
- Cell Signaling Technology. Cell Signaling Technology web site. Dopamine signaling in Parkinson’s disease interactive pathway. cellsignal.com/ reference/pathway/parkinsons_disease.html. Accessed June 9, 2019.
- Elbaz A, Bower JH, Maraganore DM, et al. Risk tables for parkinsonism and Parkinson’s disease. J Clin Epidemiol 2002;55(1):25–31. doi:10.1016/ S0895-4356(01)00425-5.
- Goldman JG, Postuma R. Premotor and nonmotor features of Parkinson’s disease. Curr Opin Neurol 2014;27(4):434–441. doi:10.1097/WCO. 0000000000000112.
- Chaudhuri KR, Healy DG, Schapira AH; National Institute for Clinical Excellence. Non-motor symptoms of Parkinson’s disease: diagnosis and management. Lancet Neurol 2006;5(3):235–245. doi:10.1016/S1474-4422(06)70373-8.
- Obeso J, Stamelou M, Geotz CG, et al. Past, present, and future of Parkinson’s disease: a special essay on the 200th anniversary of the shaking palsy. Mov Disord 2017;32(9):1264–1310. doi:10.1002/mds.27115
- Kalia LV, Lang AE. Parkinson’s disease. Lancet. 2015;386:896–912.
Dr. Mohan V. Sumedha Maturu
Dr. Mohan V. Sumedha Maturu
Consultant Neurologist
Medicover Hospitals, Visakhapatnam
Consultation fee: 500
Ratings: 4.5
Timings: 10:00 AM – 3:30 PM
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