Parkinson's disease is a progressive, neurological disorder that typically strikes people in their 60s and 70s but also can affect people under the age of 40, according to the American Parkinson Disease Association. The disease does not have a cure. The biggest risk factor for developing Parkinson's is age, but exposure to pesticides and herbicides have also been implicated and a small percentage of people, less than 5 percent, are genetically disposed to develop the disease.
Pathogenesis
Parkinson's disease is characterized by a progressive loss of neurons in the part of the brain called the substantia nigra. These neurons produce a chemical called dopamine, an essential neurotransmitter that sends information to other parts of the brain that control movement, balance and coordination. As more neurons, die less dopamine is available in the brain and the disease progresses. Progression differs widely from person to person. Scientists have not discovered a marker in the body to identify how quickly the disease will progress.
Primary Signs and Symptoms
Before a person is diagnosed with Parkinson's, mild signs often go unnoticed, such as diminishing smell and constipation. Other signs and symptoms can also be mild and might be dismissed by the person experiencing them or might not be picked up by a physician. Because of this, it might take several years before Parkinson's is diagnosed. The book "PD for Dummies" uses the acronym TRAP to sum up the primary signs and symptoms that lead to diagnosis. "T" stands for tremor at rest as opposed to tremor with movement. "R" stands for rigidity or stiff muscles. "A" stands for akinesia or absence or slowness of movement. "P" stands for postural instability, which includes problems with balance, walking and freezing up.
Secondary Symptoms
Among the symptoms that can be part of the constellation of Parkinson's disease include lack of expression or what is called a facial mask. Other signs include a slow, slurred speech and soft voice, which is called hypophonia, and small handwriting, which is called micrographia. Constipation, anxiety and depression are also signs of Parkinson's. Cognitive changes, such as problems with memory, planning, multitasking and dementia, are signs of Parkinson's, as is drooling and sleep problems ranging from insomnia to acting out violently during the dream state. This is a comprehensive, but incomplete list of all the symptoms a patient with Parkinson's can experience. Not all patients will experience these symptoms.
Treatment
Treatment will vary as medications react differently depending on a person's biochemistry and stage of disease. However, two classes of drugs most commonly used to treat the disease are levodopa and dopamine agonists that help to restore motor function, according to Mayo Clinic Parkinson's specialist Dr. J. Eric Ahlskog. Some physicians also recommend coenzyme Q-10 to their patients based on a study at the University of California that showed high doses of the supplement slowed progression by almost 40 percent. A follow-up study is under way to validate the results of the earlier study. Most patients are treated by a neurologist or a movement disorder specialist who is a specially trained neurologist who specializes in Parkinson's disease and other movement disorders. In addition patients also are often referred to a physical therapist to deal with issues regarding movement, an occupational therapist who focuses on improving everyday activities such as personal care, chores, and can evaluate home safety and a speech therapist to help with voice and swallowing difficulties.
Emotional Stress and Social Support
Along with the physical symptoms come the emotional stresses on both the person who has it and his caregiver, according to the Michael J. Fox Foundation. Loss of physical and mental functioning can take a toll on the person who has it and can lead to depression, although depression can also be a result of the disease itself. Couples often experience role reversal. Good communication becomes essential in order to prevent anger and frustration within the relationship. Support groups provide a haven for expressing concerns and ideas for how to cope.
References
- Parkinson's Disease Hanbook: A Guide for Patients and their Families: What is PD?
- "PD for Dummies"; Michele Tagliati, Gary N. Guten, and Jo Horne; 2007
- "The Parkinson's Disease Treatment Book"; J. Eric Ahlskog, 2005
- Archives of Neurology: Effect of Coenzyme Q10 in Early Parkinson's Disease
- http://www.stlapda.org/content/pdfs/Booklet_Parkinson_Disease_Handbook.pdf
