What to know about Parkinson's disease

Parkinson’s disease is a neurodegenerative condition that develops over many years. It principally impacts the nervous system, causing involuntary movements which make independent living and daily tasks incredibly difficult. In this article, Dr Arup Sen, a celebrated consultation geriatrician, explains this disease and how it may be managed.

What are the symptoms of Parkinson’s disease?

Parkinson’s can affect a patient’s ability to do activities such as using utensils to eat, putting on and taking off clothes, driving a car, sleeping, or even swallowing food.

The symptoms will progress over time. They tend to start with imperceptible tremors in the hand, a foot, or jaw. These tremors will eventually grow in intensity and spread to other areas of the body. In the early stages, the arms may not swing whilst walking, and the facial expressions are not as exaggerated as normal. As the disease advances, the following symptoms are likely to occur:

• Slow and restricted movement, both in repetition (bradykinesia) and in initiation (akinesia)
• Slurred or softened speech
• Lack of coordination and balance
• Urinary incontinence
• Changes to writing style, becoming smaller

Whilst not strictly a symptom of Parkinson’s, patients may develop depression as a result of their struggles with this disease.

What causes Parkinson’s disease?

Parkinson’s disease happens due to neurons dying in the part of the brain called the basal ganglia, particularly those neurons that produce dopamine. The deficit of dopamine leads to irregular brain function which manifests as a loss of motor control, as dopamine usually acts as a messenger between parts of the brain and nerves that control movement. Parkinson’s normally affects people aged 60 and upwards, and it is slightly more common in men. There are cases of early-onset Parkinson’s disease happening in young adults, but this is extremely rare.

There are no known triggers of Parkinson’s disease, but there are risk factors that are recognised, such as genetics and family history, and exposure to toxins from pesticides or drugs.

How is Parkinson’s disease diagnosed?

As there are no specific tests that have been designed for it, the diagnosis of Parkinson’s disease primarily involves an evaluation of the displayed symptoms. It can take some time as doctors and neurologists assess the patient’s condition. In order to rule out other diseases, the doctors may order other tests like blood tests, MRIs and ultrasounds, and genetic testing.

Some tests can detect the presence of a possible indicator of Parkinson’s disease, the alpha-synuclein protein. Deposits of these proteins, called Lewy bodies, build up in the brain and are common characteristics of Parkinson’s disease. These tests include a spinal tap, in which some of the cerebrospinal fluid is extracted, and a biopsy of the surface-level nerve tissue.

How is Parkinson’s disease treated?

Parkinson’s cannot be cured at this point, and treatment will focus on its management and alleviating the symptoms for patients to improve their quality of life. Clinical treatment will vary from patient to patient, but plans can include physiotherapy, medications, and in some cases, surgery.

Physiotherapy helps patients retain muscle mass, balance control, and use of motor abilities through repetition and routine. Aside from physical fitness, it is also important for patients with Parkinson’s to try and keep their minds sharp by reading often, doing crafts, or doing brain puzzles – for example, Sudoku, crosswords, or Rubik’s cubes

Medications are used to improve the motor function of the patient. The main three medications used for Parkinson’s are levodopa, dopamine agonists, and monoamine oxidase-B inhibitors. They can be used separately or together.

• Levodopa works by replenishing dopamine levels, thus re-establishing the reception of signals between the brain and nerves. It is taken orally and is often taken in conjunction with other medication so that the levodopa doesn’t become absorbed into the blood too soon and has a chance to reach the brain; this also helps diminish side effects like nausea and fatigue.
• Dopamine agonists are a substitute for dopamine, similar to levodopa but milder. They are taken orally or as topical patches. They have similar side effects to levodopa, too, but also have a risk of causing hallucinations and high-risk behaviours, and so need to be used with caution for elderly patients.
• Monoamine oxidase-B(MAO-B) inhibitors, such as selegiline and rasagiline, halt the breaking down of dopamine in order to maintain levels. They are also taken orally or in a topical patch. They can cause side effects such as abdominal pain and irregular blood pressure.

Surgery is not suitable for every patient with Parkinson’s. The procedure, called deep brain stimulation, is only offered by select neurosurgeons, and involves the implantation of a pulse generator into the chest wall, which is connected to fine wires that are placed under the skin and fed into the brain. The pulse generator emits electric currents that run through the wire and into the brain to stimulate the areas where neurons are dying.

Are you caring for someone with Parkinson’s disease and are looking for expert medical support? Arrange a consultation with Dr Sen via his Top Doctors profile.