What is Parkinson's Disease? - October 2017

By Miscellaneous

Parkinson's Disease

What is Parkinson's disease? 
According to Statistics Canada, Parkinson's disease is the second most common neurodegenerative disorder after Alzheimer's disease. There are over 100,000 Canadians living with Parkinson's disease today and an estimated 6,600 new cases are diagnosed annually (based on an annual incidence of 20 new cases per 100,000 people). This disease involves a problem with certain nerve cells located in the brain. The nerve cells make dopamine, a chemical that sends signals to the part of the brain that controls and allows for smooth coordinated muscle movements. In the case of Parkinson’s, these nerve cells break down, so that there is not enough dopamine. This in turn decreases one’s ability to regulate movements, the body and emotions. 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 surface.

This is a progressive condition and progression usually takes place over several years, but can progress at different rates depending on the person. Each person's experience is unique and treatment is customized to the individual. The intensity of symptoms varies from person to person. Some people live with only minor symptoms for several years. For an overview of the disease, you can view the infographic provided by the Michael J. Fox Foundation website.

What is the cause of Parkinson's disease?
The cause of the breakdown of nerve cells is not known. While in some cases abnormal genes seem to result in Parkinson’s, there is still not enough evidence to show that it is always inherited. According to the National Parkinson Foundation, about 10 to 15 percent of all cases of Parkinson’s are thought to be genetic forms of the disease. The other 85 to 90 percent of cases are classified as idiopathic, meaning the exact cause is unknown.  Experts believe that Parkinson’s disease is caused by a complex interaction of genetic and non-genetic factors.

People with Parkinson’s disease are at greater risk of developing related conditions, but this is a possibility and not a certainty. Related conditions include melanoma, Orthostatic hypotension or OH (a persistent drop in blood pressure that occurs within three minutes of standing) and Pseudobulbar Affect or PBA (a condition that is characterized by frequent, uncontrollable outbursts of crying or laughing).

How is Parkinson's disease diagnosed?
Getting a diagnosis can take time. Your family doctor may be the first to notice symptoms and may refer you to a neurologist, a specialist in the brain.  Individuals usually start to have symptoms between the ages of 50 and 60, but sometimes symptoms can appear at an earlier age. Consult your doctor if you notice changes. Other health professionals, such as physiotherapists and occupational therapists, can also assist. Unfortunately, there is no single way to diagnose this condition. Health care providers will look at a combination of symptoms and diagnostic tests. For a diagnosis, two of the four main symptoms must be present over a period of time. These four main symptoms include:
Shaking or tremor - this may be the first noticeable symptom. It's one of the most common signs of the disease, although not everyone has it. People experience a tremor or shaking in a finger, thumb, hand, chin or lip, or a shaking leg when they sit down or relax.
Slowness of movement, called bradykinesia.
Stiffness or rigidity of the arms, legs or trunk. A person experiences trouble moving or walking e.g., feeling stiff in body, arms or legs that doesn’t go away as they move, or arms don’t swing when walking, or people have commented that the person looks stiff.  They may have a feeling that their feet feel stuck to the floor.
Trouble with balance and possible falls, also called postural instability

Other symptoms include:
Small handwriting e.g., letter sizes smaller and words crowded together  a sudden change)
Loss of smell e.g. scents from foods like bananas, licorice or dill pickles cannot be detected
Trouble sleeping from sudden movements during sleep
Constipation i.e., straining when having a bowel movement
Change in the voice to a soft or low voice e.g., people comment that you speak softly or hoarsely
Masked, serious looking, blank face or not blinking eyes often – friends and family notice that the person's face is less expressive
Dizziness or fainting on a regular basis– feeling dizzy or faint when standing up from low blood pressure
Stooping or hunching over, or not standing up straight as one used to
There are no lab or blood tests that can help your doctor know whether you have Parkinson's but you may have tests to rule out other diseases that could be causing symptoms. For example, you might have an MRI to look for signs of a stroke or brain tumor. While people are most familiar with the motor symptoms of Parkinson’s disease, they are less familiar with the non-motor symptoms e.g., cognitive impairment and mood disorders. The Michael J Fox Foundation website has a screening questionnaire which can be completed and shared with a family doctor or movement disorders specialist.

How is Parkinson's disease treated?
If you are diagnosed with Parkinson's disease, medications are available to make the condition easier to live with.  If symptoms are mild, you may not even require medications and may initiate their use when the condition interferes with your daily life. Each case is different and you may need to take several medicines for the best outcome. L-dopa or Levodopa is the best medication for controlling symptoms but the negative is that over the longer-term or at a high dose it can cause problems. Your health care provider will work with you regarding medications and may use a different medication than L-dopa in the beginning stages. Sometimes deep brain stimulation is used. This involves placing wires in the brain that carry electrical signals to the parts of the brain responsible for movement control, therefore making these parts of the brain work better.

What can you do?
Follow a healthy lifestyle, which includes:
Eating in a healthful way.
Getting adequate sleep.
Pacing yourself.
Engaging in regular physical activity. While it is not clear if exercise can slow the progression of the disease, it can help people feel better both mentally and physically. 
Consulting a physiotherapist and occupational therapist.

Can you prevent Parkinson’s disease?
The Michael J. Fox Foundation notes that studies have looked at associations but they do not suggest causation. For example, head injury and exposure to pesticides have been associated with higher rates of Parkinson's disease. Research continues to investigate potential prevention and treatment actions. At this time, there is no known way to prevent Parkinson’s disease. You may have some protection against the disease by eating a Mediterranean-style diet high in fruits and vegetables, high-fibre foods, fish and omega-3 rich oils and limiting consumption of red meat and dairy. Researchers currently do not know why this diet may be protective and research continues to seek answers.

Resources for Parkinson's disease
Parkinson Canada website www.parkinson.ca. You can subscribe to their free newsletter.
Michael J Fox Foundation for Parkinson's Research website
US National Parkinson Foundation website
Watch and share this public service announcement featuring U.S. Senator Cory Booker discussing the early warning signs of Parkinson's disease.

HealthLink BC website, Parkinson Canada website, Michael J Fox Foundation for Parkinson's Research website, Mayo Clinic website, UptoDate.com website, Parkinson's News Today website 

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