Parkinson’s Disease (PD) is a neurological movement disorder that can limit one’s ability to complete daily tasks including walking. There are a wide variety and range of symptoms associated with PD. Most people will experience some motor and some non-motor symptoms.
Common Motor Symptoms:
• Tremors - which are involuntary slow, rhythmic quivering motion. Tremors typically start in one extremity but eventually affects both sides. Tremors can be present in jaw, chin, mouth, or tongue
o Classic tremors or resting tremors – are most intense when the body part is at rest. These tremors may disappear with movement or purposeful action
o Action Tremors are present with movement primarily
o Internal tremors can be present as well.
• Stiffness in muscles
• Slowness and smallness of movement which can include decreased facial expression, decreased blinking of the eyes, small handwriting, smaller motions with walking or turning.
• Decreased balance, coordination, and postural changes which can result in increased risk of falls especially backwards.
• Gait changes which can include more difficulty and fatigue with walking, shuffling gait pattern, and freezing especially when changing surfaces or turning.
• Voice production can be altered including speaking softer and in monotone. Speech may also become rapid and stuttered.
Common Non-Motor Symptoms:
• Sleep problems including insomnia, talking, or active in sleep.
• Anxiety
• Depression
• Fatigue
• Mental Processing: difficulty with word finding, judgement, difficulty multitasking, confusion
• Other symptoms: changes in sense of smell; weight loss; gastrointestinal issues; lightheadedness; urinary frequency/urgency
What causes Parkinson’s Disease?
The disease process itself is related to loss of nerve cells in certain parts of the brain including a region of the brain called the substantia nigra. This is where the brain produces a neurotransmitter (chemical messengers that allow the neurons to communicate with each other) called dopamine.
Dopamine: a chemical messenger that helps regulate movement, create/maintain normal movement patterns.
With Parkinson’s disease there is a loss of dopamine production by the brain resulting in decline in normal movement and alterations in movement patterns. In addition to loss of dopamine, there is a change in production and processing of a protein called alpha-synuclein which help neurons communicate with each other. There can be abnormal clumping of these proteins which are called Lewy bodies. Researchers believe these Lewy bodies build-up and contribute to PD development and progression.
Why do people get Parkinson’s Disease?
The answer is mostly unknown at this time but research is ongoing with focus on genetic and environmental factors.
• Genetic Factors: There are several genes that can mutate that result in increased risk for development of PD. Mutations in the alpha-synuclein gene can trigger PD but appears to be very rare.
• Environmental Factors: Potentially exposure to pesticides and/or heavy metals can contribute to PD risk. Multiple head injuries can put someone at greater risk for Parkinson’s Disease.
How to Diagnosis Parkinson’s Disease:
Generally a physician and/or neurologist will review someone’s clinical presentation. This will involve a complete medical history, taking vitals, assessing cognitive skills, assessing for tremors, assessing flexibility vs. stiffness thru body, and/or assessing transfers and walking pattern as well as balance.
Additional diagnostic testing may include an MRI.
How to treat Parkinson’s Disease?
Once Diagnosed, the first approach is to initiate a medication regimen which may have to be adjusted to find the right match, timing, and dosage. Staying active along with education about Parkinson’s and sleep quality are also important with symptom management. Physical Therapy, Occupational Therapy, and Speech Therapy can be an integral part of the treatment regimen as well.
Whats next?
We will focus on the role of therapy with treatment for PD symptoms in part 2 and 3 of our Parkinson's blog series.