Parkinson

Parkinson disease

 Parkinson’s disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just

one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.

Sign and symptom

Parkinson’s signs and symptoms may include:

• Tremor, or shaking, usually begins in a limb, often your hand or fingers. You may rub your thumb and forefinger back-and-forth, known as a pill-rolling tremor. Your hand may tremor when it’s at rest.
• Slowed movement (bradykinesia), Over time, Parkinson’s disease may slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk. It may be difficult to get out of a chair. You may drag your feet as you try to walk.
• Rigid muscles, Muscle stiffness may occur in any part of your body. The stiff muscles can be painful and limit your range of motion.
• Impaired posture and balance, Your posture may become stooped, or you may have balance problems as a result of Parkinson’s disease.
• Loss of automatic movements, You may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.
• Speech changes, You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections.
• Writing changes, It may become hard to write, and your writing may appear small.

Causes

In Parkinson’s disease, certain nerve cells (neurons) in the brain gradually break down or die. Many of the symptoms are due to a loss of neurons that produce a chemical messenger in your brain called dopamine. When dopamine levels decrease, it causes abnormal brain activity, leading to symptoms of Parkinson’s disease. The cause of Parkinson’s disease is unknown, but several factors appear to play a role, including:

• Your genes.
• Environmental triggers.
• The presence of Lewy bodies.
• Alpha-synuclein is found within Lewy bodies.

Risk factors

Risk factors for Parkinson’s disease include:

• Age, Young adults rarely experience Parkinson’s disease. It ordinarily begins in middle or late life, and the risk increases with age. People usually develop the disease around age 60 or older.
• Heredity, Having a close relative with Parkinson’s disease increases the chances that you’ll develop the disease. However, your risks are still small unless you have many relatives in your family with Parkinson’s disease.
• Sex, Men are more likely to develop Parkinson’s disease than are women.
• Exposure to toxins. Ongoing exposure to herbicides and pesticides may slightly increase your risk of Parkinson’s disease.

Complications

Parkinson’s disease is often accompanied by these additional problems, which may be treatable:

• Thinking difficulties.
• Depression and emotional changes.
• Swallowing problems.
• Chewing and eating problems.
• Sleep problems and sleep disorders.
• Bladder problems.
• Constipation.

You may also experience:

• Blood pressure changes.
• Smell dysfunction.
• Pain.
• Sexual dysfunction.

Diagnosis

A physician will initially assess for Parkinson’s disease with a careful medical history and neurological examination. People may be given levodopa, with any resulting improvement in motor impairment helping to confirm the PD diagnosis. Other causes that can secondarily produce parkinsonism are stroke and drugs.

Medical organizations have created diagnostic criteria to ease and standardize the diagnostic process, especially in the early stages of the disease. The Queen Square Brain Bank criteria require slowness of movement (bradykinesia) plus either rigidity, resting tremor, or postural instability. Other possible causes of these symptoms need to be ruled out. Finally, three or more of the following supportive features are required during onset or evolution: unilateral onset, tremor at rest, progression in time, asymmetry of motor symptoms, response to levodopa for at least five years, clinical course of at least ten years and appearance of dyskinesias induced by the intake of excessive levodopa.

Imaging

Computed tomography (CT) scans of people with PD usually appear normal. MRI has become more accurate in diagnosis of the disease which can demonstrate absence of the characteristic ‘swallow tail’ imaging pattern in the dorsolateral substantia nigra. In a meta-analysis, absence of this pattern was highly sensitive and specific for the disease. Diffusion MRI has shown potential in distinguishing between PD and Parkinson plus syndromes, though its diagnostic value is still under investigation. CT and MRI are also used to rule out other diseases that can be secondary causes of parkinsonism.

The metabolic activity of dopamine transporters in the basal ganglia can be directly measured with PET and SPECT scans, with the DaTSCAN. It has shown high agreement with clinical diagnoses of Parkinson’s. Reduced dopamine-related activity in the basal ganglia can help exclude drug-induced Parkinsonism. This finding is not entirely specific, however, and can be seen with both PD and Parkinson-plus disorders.

Treatment

Parkinson’s disease can’t be cured, but medications can help control your symptoms, often dramatically. In some later cases, surgery may be advised. Your doctor may also recommend lifestyle changes, especially ongoing aerobic exercise. In some cases, physical therapy that focuses on balance and stretching also is important. A speech-language pathologist may help improve your speech problems.

• Medications

Medications may help you manage problems with walking, movement and tremor. These medications increase or substitute for dopamine. People with Parkinson’s disease have low brain dopamine concentrations. However, dopamine can’t be given directly, as it can’t enter your brain. You may have significant improvement of your symptoms after beginning Parkinson’s disease treatment. Over time, however, the benefits of drugs frequently diminish or become less consistent. You can usually still control your symptoms fairly well.

• Surgical procedures

Deep brain stimulation. In deep brain stimulation (DBS), surgeons implant electrodes into a specific part of your brain. The electrodes are connected to a generator implanted in your chest near your collarbone that sends electrical pulses to your brain and may reduce your Parkinson’s disease symptoms.

• Lifestyle and home remedies

If you’ve received a diagnosis of Parkinson’s disease, you’ll need to work closely with your doctor to find a treatment plan that offers you the greatest relief from symptoms with the fewest side effects. Certain lifestyle changes also may help make living with Parkinson’s disease easier.

• Healthy eating

While no food or combination of foods has been proved to help in Parkinson’s disease, some foods may help ease some of the symptoms. For example, eating foods high in fiber and drinking an adequate amount of fluids can help prevent constipation that is common in Parkinson’s disease. A balanced diet also provides nutrients, such as omega-3 fatty acids, that might be beneficial for people with Parkinson’s disease.

• Exercise

Exercising may increase your muscle strength, flexibility and balance. Exercise can also improve your well-being and reduce depression or anxiety such as walking, swimming, gardening, dancing, water aerobics or stretching etc.