What is Parkinson’s disease?

Parkinson’s disease occurs when some of the nerve centers in the brain lose the ability to control muscle movements. As a result, you may have rigid muscles, tremors, and trouble walking and swallowing.

Parkinson’s disease is one of the most common diseases affecting movement in people over age 55.

There is treatment for Parkinson’s disease but no cure. With treatment many people with Parkinson’s disease stay in fairly good health for years. However, the disease does get worse even with treatment and can become disabling over time.

What is the cause?

Parkinson’s disease happens when nerve cells in a certain part of the brain die or stop working properly. These nerve cells are in a small area called the substantia nigra, deep inside the lower part of the brain. They send nerve fibers upwards and outwards (fanning out like a large tree) to parts of the brain that control how you move, especially your voluntary movements–the ones you plan, like walking or reaching for things.

When you have Parkinson’s disease, the nerve cells in the substantia nigra stop making an important brain chemical called dopamine. Dopamine normally passes signals to the other parts of the brain that affect controlled muscle movement. Most dopamine signals slow down and smooth out the signals of other nerve cells. Losing dopamine in nerves is the root cause of the tremor at rest and the rigidity or frozenness of regular movements, like walking and turning around on your feet. The brain science is pretty complicated. For example, without enough dopamine, brain cells in a part of the brain called the globus pallidus fire out of control and you lose normal control of your movements. The increase in nerve signals from the globus pallidus goes to the part of the brain called the thalamus, and the increased signals turn down the nerves in the thalamus. The nerves in the thalamus normally help your brain plan and control movements. When the thalamus is turned down, you have trouble with voluntary movements and feel rigid or frozen.

No one knows why the nerve cells die or become impaired. Theories include:

• damage by chemical reactions in the body
• an infection in the brain
• poisons in the environment, such as carbon monoxide
• a problem with genes you have inherited

What are the symptoms?

The 4 main symptoms of Parkinson’s disease are:

• resting tremor
• rigidity (looking and feeling stiff and unable to start moving)
• slowed-down movements (called bradykinesia)
• postural instability, which means that you can fall over easily

A tremor is a rhythmic shaking that you cannot control. You may have tremors of the hands and sometimes the head as well as a constant rubbing together of thumb and forefinger (called a pill-rolling tremor). Tremors from Parkinson’s disease are more obvious when your arm and hand are resting, so they are called resting tremors. The tremors stop when you deliberately do something, such as move or change position. Other types of tremors not caused by Parkinson’s disease do just the opposite: They get worse when you try to move, so your hands shake as you reach to pick something up. These are called intention tremors and they are not caused by Parkinson’s disease.

In the earliest stages of the disease, symptoms may not be noticed or may be very slight. Someone close to you might notice a slight limp, stooped posture, or a mild hand tremor. Over time, you may stop making some movements that are normally automatic, such as the natural swinging of your arms when you walk. It may become harder to:

• write clearly
• speak clearly
• start to do something
• change positions
• keep your balance when you walk
• get out of a chair

Other symptoms may include drooling and abdominal cramps. You may have trouble swallowing. In later stages, it often gets harder to think and remember.

How is it diagnosed?

Your healthcare provider will ask about your medical history and examine you. He or she will look for the physical signs of tremor, rigid muscles, and slow movements that suggest Parkinson’s disease.

There are no tests that can confirm the diagnosis. However, tests may be done to rule out other diseases. Some other brain diseases also cause a break-down (degeneration) of parts of the brain. Severe depression can sometimes cause symptoms similar to Parkinson’s. In most cases you will have at least 1 brain imaging test, usually an MRI, to help rule out strokes or the general shrinkage of the brain that comes on with Alzheimer’s disease or a lifetime of alcoholism. However, if you have the typical symptoms of Parkinson’s disease–rigidity and tremor–without symptoms of other brain diseases, brain imaging may not be needed.

You may see a specialist called a neurologist to help with the diagnosis and treatment.

How is it treated?

There is no cure yet for Parkinson’s disease. However, medicines can help relieve a lot of the symptoms. The medicines help restore the balance of chemicals in your brain. Treatment may also include speech therapy and physical therapy. In severe cases not helped by medicine, surgery may help prevent the tremors.

You will need regular visits with a specialist or primary care doctor who has experience managing the symptoms of Parkinson’s disease.

Medicine

In mild cases of Parkinson’s disease, your healthcare provider may not prescribe medicine because the medicines used to treat Parkinson’s disease cause side effects. Your provider will want to see you regularly to keep track of your symptoms and determine when it might be time to start taking medicine. The goal of treatment will be to keep your movements as normal as possible with the smallest amount of medicine. It may not be possible to get rid of all of your symptoms.

Several different drugs are used to treat Parkinson’s disease. Levodopa is the main medicine used to treat the disease. The brain can make dopamine from levodopa. In pill form, levodopa is combined with carbidopa. Carbidopa protects levodopa from destruction in the gut while it is being absorbed. Possible side effects of levodopa are:

• abnormal movements of the face, trunk, arms, and legs
• nausea and vomiting
• short-term memory loss
• confusion

The rigidity and “freezing” caused by Parkinson’s disease can be quite a problem. Levodopa can help treat these symptoms quite successfully for many years. Sometimes, as the disease gets more severe, there will be times when the levodopa is working well, followed by times when the drug stops working (called off periods).

Your provider may prescribe other medicines as well, including some for specific symptoms.

Exercise and physical or occupational therapy

A program of daily exercise will help you have better use and control of your muscles. Exercise can help prevent problems that happen if you are not using your muscles. It will increase your muscle strength and improve coordination. You will have less muscle rigidity. Physical therapists can teach you how to walk and move in a way that will reduce your risk of falling. Occupational therapists help you learn to adapt to your symptoms. You can learn the right way to use a walker or tools to help fasten buttons and belts.

Surgery

Two types of brain surgery can be helpful for people who have advanced Parkinson’s disease. One procedure destroys precise, small areas of the brain. The other implants an electrical probe or stimulator into other parts of the brain. Both surgeries require a surgeon to have strong skill and expertise in this type of surgery. There is a risk of brain damage or infection, so they are done only in hospitals with specially trained and experienced neurosurgeons.

• Thalamotomy or pallidotomy are surgeries that destroy small parts of the brain to shut off the nerves in these areas. The brain’s cortex seems to work better with no inputs from these brain areas, compared to having too much or too little input from these areas.
• Deep brain stimulation (DBS) does not destroy brain tissue. Instead, small amounts of electrical current from a probe stimulate the nerves in parts of the brain. When the nerves get constant stimulation, they seem to work better, helping your brain control movements.

Deep brain stimulation is more commonly done in the US than the other surgeries. The results are somewhat better, but DPS is more complicated to manage, more costly, and has a bit more risk of infection than the other surgeries. DBS is reversible—you can have an operation to remove the probe. Pallidotomy or thalamotomy are permanent surgeries. They cannot be reversed or undone.

How can I take care of myself?

To cope with Parkinson’s disease and to help relieve your symptoms

• Be sure you and your family know how your medicines work. Know what the side effects are and when you should call your healthcare provider. Carefully follow your provider’s instructions for taking your medicines.
• Watch how your body responds to the medicine you are taking. For example, are there times of day when your tremors are worse? Overall, are your symptoms getting worse or better? Are you having any problems with your medicine? Share this information with your healthcare provider.
• Don’t take any medicines, including nonprescription products, without first checking with your healthcare provider.
• Get your annual flu shots and get a pneumonia vaccine. Infections worsen symptoms and disability from Parkinson’s disease.
• Make your house safer:
  • Put up handrails along walkways.
  • Remove anything that might cause falls.
  • Use chairs with high arms.
  • Use carpeting to help cushion falls.
  • Be sure seats (including shower seats) have sturdy backs.
  • Put handrails in the bathroom.
  • Consider installing a device that raises the toilet seat.
• Use an electric shaver to avoid cuts from razors.
• Try to make it easy for you to dress yourself:
  • Wear loafers or shoes that close with Velcro strips instead of shoes with laces.
  • Wear clothing that is easy to get on and off. You can use a hook called a pull-through to help manage shirt buttons.
  • When possible, use Velcro strips on clothing instead of zippers or buttons.
• Be aware of safety issues if your tremor is not well controlled. For example, if you smoke, you can burn yourself or start a fire by dropping a cigarette. (Go outside on pavement or wet grass, or, even better, try to quit smoking.) You also can burn yourself by spilling hot liquids. Be extra careful if you are cooking.
• If you have problems swallowing:
  • Take as much time as you need to eat meals.
  • Sit upright.
  • Remember that thick liquids are easier to swallow than thin liquids.
  • Use an electric warming tray to keep food hot during the long time it may take to finish a meal.
  • Weigh yourself once a week to make sure that you are not losing too much weight.
• Drink plenty of fluids and eat more foods that are high in fiber to help prevent constipation. High-fiber foods include whole-grain breads and cereals, beans, fruits, and vegetables.
• Ask your healthcare provider if you should eat less protein to help the levodopa work better.
• If you have speech problems, work on other ways to make your needs known. Practice speech exercises your healthcare provider or speech therapist may give you.
• Focus on staying active, even though it may be hard to do some things. Keep involved in your work, hobbies, and other activities. Try to keep a positive attitude.
• Get support from family and friends.

Ask your healthcare provider:

• how and when you will hear your test results
• what activities you should avoid
• how to take care of yourself at home
• what symptoms or problems you should watch for and what to do if you have them

Your healthcare provider will want to check on how well your treatment is working. Keep your follow-up appointments on the schedule your provider recommends. Discuss any questions and concerns you have at these visits.

Learn as much as you can about your condition. For more information contact:

Parkinson’s Disease Foundation Phone: 1-800-457-6676 Web site: http://www.pdf.org

National Parkinson Foundation, Inc. Phone: 1-800-327-4545 Web site: http://www.parkinson.org

How can I help prevent Parkinson’s disease?

There is no known way to prevent Parkinson’s disease. Many drugs and supplements have been studied, but no treatment has shown consistent helpful effects