Parkinson’s Disease

What is Parkinson’s Disorder (PD)?

Parkinson's Disorder (PD) is the second commonest neurodegenerative disorder in the United States, affecting approximately 1 in 300 people. It is named after Dr. James Parkinson who first described “the shaking palsy”.

The healthy brain produces a neurotransmitter called dopamine, which plays an important role in several functions including coordinating motor control. In Parkinson's patients, 80% or more of these dopamine-producing cells degenerate, leading to a loss of dopamine. This results in the clinical symptoms of Parkinson's Disease.

Symptoms

Although motor symptoms are the most visible manifestation of PD, the disorder is characterized by a range of several non-motor symptoms. Movement-related (“motor”) symptoms usually manifest as one or more of the following symptoms:

Tremor or trembling
Rigidity, or stiffness of limbs and trunk
Bradykinesia, or slowness of movement
Impaired balance and gait

The presenting symptoms are quite variable, such that every patient's experience is unique. Typical non-motor symptoms include apathy, depression, constipation, sleep behavior disorders, loss of sense of smell, and cognitive impairment for many years before motor symptoms become apparent.

Who Has Parkinson's?

Nearly one million people in the U.S. are living with Parkinson's disorder (PD) and approximately 60,000 Americans are diagnosed with PD each year. There is no single cause of Parkinson’s discovered yet, however, several risk factors have been identified.

Advancing age – Parkinson’s generally manifests in middle to late years of life and the risk increases with age.
Gender – Men are 1.5 times likely to get Parkinson’s than women.
Genetics – Genetics cause about 10-15% of all Parkinson’s. Having one or more close relatives with the disease increases the likelihood of a person having it but to a minimal degree. To learn more about genetic testing in Parkinson’s disease click here
Environmental Factors – Risk factors associated with PD include head injury, exposure to pesticides, and more.
Stages of Parkinson’s Disease
Parkinson’s disease impacts people in different ways. Not everyone will experience all the symptoms of Parkinson’s, and if they do, they won’t necessarily experience them in the same order or at the same intensity. The typical patterns of progression in Parkinson’s disease are defined in stages. Parkinson's stages correspond both to the severity of movement symptoms and to how much the disease affects a person’s daily activities.

Diagnosing PD

There is no single way to diagnose Parkinson’s Disorder, but there is a range of diagnostic tests that can be done to determine a prognosis. It can be even more difficult to diagnose in the early stages when fewer symptoms are present. Our physicians also use scales that focus on motor symptoms to determine disease progression.

A simple rating scale, first introduced in 1967 and known as Hoehn and Yahr, follows the stages of PD. Clinicians use it to describe how motor symptoms are progressing. It rates symptoms on a scale of 1 to 5. On this scale, 1 and 2 represent early-stage, 2 and 3 mid-stage, and 4 and 5 advanced-stage Parkinson's.
The Unified Parkinson’s Disease Rating Scale (UPDRS) is a more comprehensive tool used to account for non-motor symptoms, including mental functioning, mood, and social interaction. It accounts for cognitive difficulties, the ability to carry out daily activities, and treatment complications.
While symptoms and disease progression are unique to each person, knowing the typical stages of Parkinson’s can help you cope with changes as they occur. Some people experience the changes over 20 years or more. Others find the disease progresses more quickly.

Other diagnostic tests may include:

Neuroimaging

A DaTscan is an imaging technology that uses small amounts of a radioactive drug to help determine how much dopamine is available in a person's brain. A SPECT scanner is used to measure the amount and location of the drug in the brain. While a DaTscan cannot diagnose PD, doctors use them to confirm a diagnosis. A negative DaTscan result does not rule out a Parkinson’s diagnosis, but a positive result helps confirm it.

Treating Parkinson’s Disease

There is no cure for Parkinson’s Disorder known today, nor is there a standard treatment for all PD patients. Treatment for each patient is based on his or her symptoms, and many measures can be taken to diminish and control symptoms that improve quality of life. Levodopa replacement (Sinemet) is currently considered the gold standard medication option to treat PD. To discuss drug therapy options with one of our Parkinson’s Disease specialists, contact us at 404-351-0205.

Getting adequate sleep, sticking to a schedule, exercising regularly, and making accommodations as needed to your lifestyle can significantly benefit living a full life with PD.

There are some surgical options for treating PD that your physician may recommend. Some of these may include:

Pallidotomy – This procedure involves destroying some of the cells in a particular part of the brain that control movement. Pallidotomy has been found to reduce dyskinesia (involuntary movements).
Deep Brain Stimulation (DBS) – This involves implanting a small metal electrode into the brain. The electrode is then attached to a pulse generator which is implanted in the chest subcutaneously (under the skin). It is believed that while DBS does not cure Parkinson's Disorder, it may diminish drug-induced symptoms.
Thalamic stimulation
Pallidal stimulation
Subthalamic DBS
Other treatment options may include speech therapy to address difficulty speaking and difficulty swallowing.

FAQs

I was recently diagnosed with PD. What should I do next?

When you or a family member is diagnosed with Parkinson's disease, it is normal to experience a range of emotions and go through several stages of adjustment to the disease. As PD progresses, bringing new challenges, you will go through many of the emotions and stages of adjustment anew. Each person experiences stages in their own order and at their own pace. In addition, there are many resources available within ANI and through our community partners to find PD education and opportunities to connect with other patients.

We encourage you to make an appointment with one of our Parkinson’s specialists, who remain on the cutting-edge of research and treatment for PD. Our comprehensive care team will help you with other aspects of your care, such as our Care Manager and Specialty Pharmacist.

I feel helpless against PD. What can I do to improve my quality of life?

If I have Parkinson's disease (PD) will my child get it too? Will I inherit Parkinson's if my parent or grandparent has it?

Most people with Parkinson's (about 90%) have no known genetic link. Their children will likely never develop Parkinson's. Some known genetic variations increase the risk of getting Parkinson's, but most people with these variations do not get Parkinson's. Like many other diseases, Parkinson's is a result of a complex interaction between genes and environmental factors.

In a small number of people (up to 10%), Parkinson's is inherited and can affect multiple family members. Their children may have a higher risk of developing Parkinson's. However, there is no guarantee they will develop PD.

Does Parkinson’s only affect movement?

Will my PD symptoms be visible?

PD symptoms fluctuate, and not all of them are visible. Over time, people with PD notice an increasing tendency for their medications to wear off between doses. For this reason, the way that they appear at one moment may not reflect the way that they feel most of the time. Also, they may not feel well because of non-motor symptoms. Let your doctor know if you are experiencing this so they can optimize your treatment plan.

Am I more likely to have any other diseases or health issues if I have PD?

No two people have the same Parkinson’s disease. With diverse symptoms and varying speeds of progression, PD does not affect every person the same way. However, people with Parkinson’s share many common symptoms and are at greater risk of developing some conditions. Talk with our healthcare team to help understand your risks and learn prevention strategies to help you lead your best life with PD.

Does PD have “flare-ups”?

What is Young Onset Parkinson’s?

YOPD occurs in people younger than 50 years of age. It affects about 4% of the one million people with PD in the United States today. Symptoms are similar to late-onset PD, but it is important to understand the challenges YOPD individuals often face at financial, family, and employment levels.

In rare instances, Parkinson's-like symptoms can appear in children and teenagers. This form of the disorder is called juvenile Parkinsonism and is often associated with specific, high-PD risk genetic mutations.