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Learning to Live with Parkinson’s

Following Alzheimer’s disease, Parkinson’s is the second-most common neurodegenerative disorder in the U. S. Approximately 60,000 Americans are diagnosed with the disease each year.

Parkinson’s disease is a chronic, degenerative neurological disorder that affects one in 100 people over age 60. While the average age at onset is 60, some have been diagnosed as young as 18. Unfortunately, there’s no test for Parkinson’s disease, so the rate of misdiagnosis can be relatively high, especially when the diagnosis is not made by a specialist. Estimates are hard to determine, but recent research indicates at least one million people in the U.S., and more than five million worldwide, have Parkinson’s disease.

What is it?

You’ve heard of this disease, but what do you know about it? The Michael J. Fox Foundation explains that Parkinson’s disease was first characterized extensively by an English doctor, James Parkinson, in 1817. Today, it’s understood to be a disorder of the central nervous system that results from the loss of cells in various parts of the brain, including a region called the substantia nigra. This region produces dopamine, a chemical messenger responsible for transmitting signals within the brain that allow for coordination of movement. Loss of dopamine causes neurons to fire without normal control, leaving patients less able to direct or control their movement. Parkinson’s disease is one of several diseases categorized by clinicians as movement disorders.

Because the causes of Parkinson’s disease are unknown, there is no proven preventive course to reduce the risk of its onset. The single biggest risk factor for the disease is advancing age—and men have a somewhat higher risk than women.

Signs and Symptoms

The effects of the disease on the central nervous system are both chronic (meaning they persist) and progressive (meaning the symptoms grow worse over time). By the time a diagnosis is made, Parkinson’s has typically already progressed to a point where people have difficulty controlling the movement of their bodies due to tremors, bradykinesia (slowness of movement and reflexes), stiffness in their limbs or trunk of their body, and impaired balance. As these symptoms progress, walking, talking, swallowing, and completing other simple tasks can become challenging.

Many researchers believe that non-motor symptoms appear as much as years before motor symptoms are seen. According to Drive Toward a Cure, the most recognizable early symptoms include:

  • Loss of sense of smell;
  • Constipation;
  • REM behavior disorder (a sleep disorder);
  • Mood disorders (that’s code for depression); and
  • Orthostatic hypotension (low blood pressure when standing up).

Other non-motor symptoms may include:

  • Bladder problems;
  • Sexual problems;
  • Excessive saliva;
  • Weight loss or gain;
  • Vision and dental problems;
  • Fatigue and loss of energy;
  • Fear and anxiety;
  • Skin problems;
  • Cognitive issues, such as memory difficulties, slowed thinking, confusion and, in some cases, dementia; and
  • Medication side effects, such as impulsive behaviors.

The onset of motor symptoms marks the clinical phase of the disease. People may have a variety of symptoms described below. The progression of these symptoms is typically gradual, often involving only one side of the body at first. This includes things like a reduction of arm swing on one side when walking, soft speech, or intermittent tremor.

Tremor: Your tremor, or shaking, usually begins with your hand or fingers. You may notice a back-and-forth rubbing of your thumb and forefinger known as a pill-rolling tremor. One characteristic of Parkinson’s is a tremor of your hand when it is relaxed.

Slowed movement (bradykinesia): Over time, Parkinson’s may reduce your ability to move and slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk, or you may find it difficult to get out of a chair. You may also drag your feet as you try to walk, making it difficult to move.

Rigid muscles: Muscle stiffness may occur in any part of your body. The stiff muscles can limit your range of motion and cause you pain.

Impaired posture and balance: Your posture may become stooped or you may have balance problems as a result of the 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. You may no longer gesture when talking.

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. A speech-language pathologist may help improve speech problems.

Writing changes: Writing may appear small and become difficult.

The cause of Parkinson’s remains largely unknown. Although there is no cure, treatment options vary and include medications and surgery. While the disease itself is not fatal, its complications can be serious. The Centers for Disease Control and Prevention (CDC) rated complications from Parkinson’s as the 14th cause of death in the U.S.

When to Seek Help

Even if you experience symptoms common among people with Parkinson’s disease, they may be brought on by a completely different condition altogether. If you notice a change in your body with no obvious cause, you should consult a health care professional.

The Michael J. Fox Foundation recommends you see a neurologist if you have trouble buttoning your shirt or tying your shoes; you feel stiff or rigid, or someone has told you your face seems less expressive; or if you’ve noticed your fingers, hands, or feet shake uncontrollably.

Dr. Joseph Jankovic, a member of the Foundation’s Scientific Advisory Board, developed the following screening questionnaire to help determine Parkinson’s disease.

  • Have you been getting slower in your usual daily activities?
  • Is your handwriting smaller?
  • Is your speech slurred or softer?
  • Do you have trouble getting up from a chair?
  • Do your lips, hand, arms and/or legs shake?
  • Have you noticed more stiffness?
  • Do you have trouble buttoning buttons or dressing?
  • Do you shuffle your feet and/or take smaller steps when you walk?
  • Do your feet seem to get stuck to the floor when walking or turning?
  • Have you or others noted that you don’t swing one arm when walking?
  • Do you have more trouble with your balance?
  • Have you or others noted that you stoop or have abnormal posture?

You Can Live Well with Parkinson’s

While medication and deep brain stimulation (DBS) surgery are the most effective treatments for Parkinson’s, many choose to delay such treatments because of their adverse side effects. Until a therapy is developed that can halt the progression of the disease, there’s a significant need for strategies that provide symptom relief without causing negative side effects.

Some find certain lifestyle changes bring relief other treatment options can’t provide, things like:

Nutritional diet: A healthy diet can increase energy, maximize the potential of medications, and promote overall well-being.

Exercise: A proper exercise program can include fitness training, resistance exercises, flexibility exercises (stretching), and gait and balance training.

Yoga: According to the National Institutes of Health, yoga is among the leading alternative therapies in the U.S. Tai chi and relaxation therapy are other related treatments.

Massage: Patients often report that massage is a great way to manage pain and/or stress.

There’s much you can do to proactively affect the course of Parkinson’s disease, and at least one very good reason to do it: Many neurologists report that symptom deterioration is often significantly slower in those who take a positive and proactive stance toward their condition than in those who do not.

Learn all you can about your disease. Knowledge is power, and continuous learning keeps you empowered, informed, and in control.

The doctors and staff at CCHC Neurology focus on disorders of the brain, spinal cord, muscles, and peripheral nerves—including the treatment of Parkinson’s disease. For more information, or to schedule an appointment, call (252) 637-7860 or visit www.cchchealthcare.com.

(Sources: Parkinson’s Foundation; The Michael J. Fox Foundation for Parkinson’s Research; National Institute of Neurological Disorders and Stroke; American Parkinson Disease Association; Centers for Disease Control and Prevention; National Institutes of Health; New Mexico Parkinson’s Coalition; and Drive Toward a Cure.)