Parkinson's disease (PD or, simply, Parkinson's) is the most common form of parkinsonism, a group of motor system disorders. It is a slowly progressing, degenerative disease that is usually associated with the following symptoms, all of which result from the loss of dopamine-producing brain cells:
Dopamine is a substance produced in the body which has many effects, including smooth and coordinated muscle movement.
It is incorrectly believed that Parkinson's disease disappeared after the introduction of levodopa (L-dopa) in the 1960s. In fact, about 60,000 Americans are newly diagnosed with Parkinson's disease each year, with more than 1.5 million Americans affected at any one time. Further, more people suffer from Parkinson's disease than multiple sclerosis, muscular dystrophy, and amyotrophic lateral sclerosis combined.
The specific cause of PD is unknown, however, medical experts believe the symptoms are related to a chemical imbalance in the brain caused by brain-cell death. Parkinson's disease is chronic (persists over a long period of time), and progressive (symptoms grow worse over time).
Although the disease may appear in younger patients (even teenagers), it usually affects people in late middle age. It is not contagious, nor is it likely passed on from generation to generation.
The biggest risk factor for developing PD is advancing age. In addition, men have a slightly higher risk of developing it than women.
Family history is another important risk factor. Individuals with a parent or sibling who are affected have approximately two times the chance of developing PD. This increased risk is most likely because of a combination of environmental and genetic factors.
Environmental causes are being researched and the strong consistent findings are that rural living, exposure to well water, and exposure to agricultural pesticides and herbicides are related to PD. It is important to remember, however, that these factors do not guarantee the development of PD, nor does their absence prevent it. Less than one percent of PD is familial (occurring among members of a family).
Currently researchers believe that in most individuals the cause of PD is a combination of genetics and environmental exposure.
Parkinson's disease is also called primary parkinsonism or idiopathic Parkinson's disease. (Idiopathic is the term for a disorder for which no cause has yet been identified).
In the other forms of parkinsonism, either the cause is known or suspected, or the disorder occurs as a secondary effect of another primary neurological disorder that may have both primary and secondary symptoms of Parkinson's disease. These disorders, described as Parkinson's Syndrome, Atypical Parkinson's, or, simply, parkinsonism, may include the following:
The following are the most common symptoms of Parkinson's disease. However, each individual may experience symptoms differently. Symptoms may include:
Symptoms of Parkinson's disease vary from patient to patient. The symptoms may appear slowly and in no particular order. Early symptoms may be subtle and may progress over many years before reaching a point where they interfere with normal daily activities.
The four cardinal symptoms of PD are listed above. Other symptoms are divided into motor (movement related) and nonmotor symptoms.
As the disease progresses, walking may become affected, causing the patient to stop in mid-stride or "freeze" in place, and maybe even fall over. Patients also may begin walking with a series of quick, small steps as if hurrying forward to keep balance, a practice known as festination.
The symptoms of Parkinson's disease may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
Making an accurate diagnosis in the early stages of Parkinson's disease can be difficult, and may require observation of the patient for some time until it is apparent that the tremor is consistently present and is joined by one or more of the other classic symptoms.
Currently, there are no specific tests or markers for PD, although there are several methods for making the diagnosis. Diagnosis depends on the presence of two of the three major signs: tremor at rest, rigidity, and bradykinesia, as well as the absence of a secondary cause of the signs.
Other methods to assist with the diagnosis of PD include:
Specific treatment for a Parkinson's disease will be determined by your physician based on:
With today's medicine, we have yet to find a cure for Parkinson's disease. However, based upon the severity of the symptoms and medical profile, the physician will establish an appropriate treatment protocol. Treatment for Parkinson's disease may include the following:
Once the diagnosis of PD has been made, the next decision is whether a patient should receive medication, which depends on the following:
No two patients react the same way to a given drug, therefore, it takes time and patience to find an appropriate medication and dosage to alleviate symptoms.
Based on the severity of the condition and the medical profile, the physician may recommend surgery as one treatment option for Parkinson's disease.
There are several types of surgery that may be performed that can help patients with Parkinson's disease. Most of the treatments are aimed at helping the tremor or rigidity that comes with the disease. In some patients, surgery may decrease the amount of medication that is needed to control the symptoms of Parkinson's disease, including the following:
There are three types of surgeries that may be performed for Parkinson's disease, including the following:
It is important to remember that surgery may help with symptoms of Parkinson's disease, but does not cure the disease or stop the progression of the disease.
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© 2007 Montefiore Medical Center