Parkinson’s disease is a chronic progressive, neurological disease that mainly affects movement. Parkinson’s disease results from the destruction of nerve cells in a part of the brain called the basal ganglia. The nerve cells in this part of the brain that are primarily affected are called “substantia nigra” (Latin for “black substance”). When neurons in the substantia nigra degenerate, the brain’s ability to generate body movements is disrupted. As a degenerative neurologic disease, Parkinson’s is not reversible and becomes increasingly worse overtime.
People with Parkinson’s disease often exhibit a “shuffling” gait, tremor of the arms and legs when they are resting, muscle stiffness, and stooped posture. Some individuals also have cognitive (thinking, judgment, memory) problems.
Who Gets Parkinson’s Disease?
Estimates regarding the number of people in the United States with Parkinson’s range from 500,000 to 1,500,000 with 60,000 new cases reported annually. There were nearly 17,000 Parkinson’s disease‑related deaths in 2002. Since Parkinson’s is more common in people 60 years old or older, it is expected that the incidence of Parkinson’s will increase with the aging of the baby boomers. Although Parkinson’s disease is more common in older persons, some people do begin to show symptoms before they are 40 years old.
Symptoms of Parkinson’s Disease
All persons with Parkinson’s do not develop the same symptoms and the symptoms change over time as the disease progresses. The primary symptoms of Parkinson’s disease are:
- Rigidity or Stiffness: In addition to making movement difficult, stiffness can also cause muscle ached and muscles may tire easily. The number of people with Parkinson’s disease who experience rigidity is estimated to be between 89% ‑ 99%. Muscle rigidity or stiffness is most common in the arms, shoulders, and neck.
- Tremor or Involuntary and Rhythmic Movements:Estimates of how many people with Parkinson’s disease develop tremors range from 69% ‑ 100%. Of those who do develop tremors and involuntary movement of the hands, arms, legs and jaw, only a few develop tremors that are disabling. The tremor is usually most pronounced at rest. Involuntary movement often starts on one side of the body.
- Slow Movement / Loss of Movement: Slow movement is sometimes referred to as “bradykinesia” and loss of movement is known as “akinesia”. Slowness occurs in 77% ‑ 98% of htose diagnosed with parkinson’s disease. Some individuals also experience episodes of “freezing” where they cannot move for several seconds or minutes. This is often called an “on‑off” symptom.
- Balance and Walking Problems: These may result in a stooped appearance and shuffling gait and can cause falls. Most people do not develop postural problems until many years after they have been diagnosed.
Although there are no specific tests for Parkinson’s disease, there are several ways of making a diagnosis. Usually a diagnosis is based on a neurological exam that covers evaluation of the symptoms and their severity. If symptoms are serious enough, a trial test of anti‑Parkinson’s drugs may be used. Brain scans may be made to rule out other diseases whose symptoms resemble Parkinson’s disease. Symptoms usually affect one side of the body more than the other side. There are always two primary symptoms present when a diagnosis of Parkinson’s disease is made.
Hoehn and Yahr Staging of Parkinson’s Disease
According to the Hoehn and Yahr scale there are five stages of Parkinson’s disease.
- Stage One
- Signs and symptoms on one side only
- Symptoms mild
- Symptoms inconvenient but not disabling
- Usually presents with tremor of one limb
- Friends have noticed changes in posture, locomotion and facial expression
- Stage Two
- Symptoms are bilateral
- Minimal disability
- Posture and gait affected
- Stage Three
- Significant slowing of body movements
- Early impairment of equilibrium on walking or standing
- Generalized dysfunction that is moderately sev
- Stage Four
- Severe symptoms
- Can still walk to a limited extent
- Rigidity and bradykinesia
- No longer able to live alone
- Tremor may be less than earlier stages
- Stage Five
- Cachectic stage
- Invalidism complete
- Cannot stand or walk
- Requires constant nursing care
People with Parkinson’s may also develop some of the following symptoms:
- Depression: Approximately 40% of people with Parkinson’s disease develop depression, which can be treated with medication andlor counseling. It is important for people with Parkinson’s disease and their caregivers to report signs of depression to the physician.
- Memory problems, mental confusion and/or dementia: Studies have indicated that more than 50% of people with Parkinson’s have mild intellectual changes; about 20% have more substantial cognitive impairment. Memory problems in Parkinson’s are typically milder than in Alzheimer’s disease. In Parkinson’s disease, the person may have difficulty concentrating, learning new information and recalling names.
- Speech problems: An estimated 60% to 90% percent of people with Parkinson’s will develop some difficulty speaking. A person with Parkinson’s disease may speak very softly in a monotone (hypophonia). Speech impairment is referred to as dysarthria and is often characterized as weak, slow, or uncoordinated speaking that can affect volume and/or pitch. The voice may sound hoarse or come out in short bursts. Often, speech problems worsen over time. Speech problems can be helped with speech therapy.
- Swallowing problems: At least 50% of people with Parkinson’s develop swallowing problems (dysphagia) that may cause the person to drool, to spill food or liquid from the mouth or to send food to the back of the throat before it is ready to be swallowed. People with Parkinson’s and their caregivers should take care to watch for signs of choking, food stuck in the throat, or increased congestion after eating. Due to difficulty coughing and clearing the lungs, people with Parkinson’s also run an increased risk of developing pneumonia. Swallowing problems can be helped with speech therapy.
Additional symptoms may include:
- Difficulty writing
- Urinary tract infections
- Excessive sweating
- Sexual problems
- Sleep disorders
- Eyelid Closure
- Skin problems
- Lack of Facial Expression
Parkinson’s and Dementia
People with Parkinson’s disease who develop dementia tend to be older and to have developed the disease later in life. It is very important to have the dementia diagnosed accurately. Depression, which is common in people with Parkinson’s disease, can sometimes cause the same symptoms as dementia. Also some of the medications used for Parkinson’s disease can cause hallucinations. These medications can also make the symptoms of dementia worse. In older people, the dementia may not be a symptom of Parkinson’s disease but could he a symptom of Alzheimer’s disease. Therefore it is important for the person with Parkinson’s disease and the family caregiver to work closely with his or her physician to rule out other possible causes for the changes in behavior and thinking.
Some of the signs of dementia in Parkinson’s disease include slowed thinking, a more passive personality, memory problems, and trouble with decision‑making. There is a form of dementia called Dementia with Lewy Body (DLB), in which the person suffering from dementia also shows signs of Parkinson’s disease such as slowness of movement, stiffness, tremor and falls. In general, if a person who has been diagnosed with Parkinson’s disease begins to show signs of dementia within 18 months, it is likely that they have DLB rather than Parkinson’s disease. People with DLB do not respond well to the medications used for Parkinson’s disease such as Jevodopa. Dementia in DLB is different from that in Parkinson’s. In DLB people may have very vivid hallucinations or delusions.
Living Well with Parkinson’s
A good exercise routine should include strengthening and flexing all limbs, stretching legs and feet, walking, facial and breathing exercises, and specific exercises to gain better control in swallowing. An in home aide or caregiver can help with walking and accomplishing every day activities. People with Parkinson’s lose the ability to move automatically. A good exercise program can help people with Parkinson’s disease learn how to think about their movements and to plan their movements one motion at a time. “Move it or lose it” is the phrase that most people with Parkinson’s learn to live by.
A speech therapist can help improve voice volume, quality, and articulation. Therapeutic exercises, including verbalizations and tongue movements, often can make a difference. In some cases where speech is severely impaired, a machine or computer‑generated voice can be used. It also may be important for families to learn new strategies to help the person communicate. If the person is confused, for example, it may be necessary to use verbal cues to understand or assist. The inability to articulate can be very frustrating. Offer reassurance and support. This may alleviate some of the person’s anxiety over not being able to express a thought or need.
Diet also plays an important role in keeping a person with Parkinson’s disease healthy and as active as possible. Choose foods that are easy to eat when someone is having problems swallowing. It is also important that people get enough nourishment. Some physicians recommend that people taking levodopa eat foods that are lower in protein because protein can make the levodopa less effective.
It is also very important for the person with Parkinson’s and his or her caregivers to take care of themselves emotionally. Support groups can be extremely helpful. Many of the organizations listed in the resource section below offer support groups, counseling and additional information on Parkinson’s disease and its treatment.