What is Parkinson's Disease?
How is Parkinson's diagnosed?
What are the symptoms?
Are there any non-motor symptoms?
What causes Parkinson's?
Is there a cure?
Conditions that resemble Parkinson's
What is Parkinson's?
British doctor Dr. James Parkinson, first discovered Parkinson’s in 1817. A renowned Dutch horticulturist, J.W.S. Van der Wereld, also a person with Parkinson's, honoured Dr. Parkinson by naming a tulip for him. The tulip has now become a national symbol of hope for all those living with Parkinson's in Canada.
Parkinson’s is a progressive neurodegenerative disorder, which involves the loss of cells in a part of the brain called the substantia nigra. These cells are responsible for producing a chemical called dopamine, which acts as a messenger between the brains cells that control movement. It is estimated that by the time the diagnosis is made, approximately 80% of dopamine-producing cells have already stopped functioning. The resulting significant decrease in dopamine leads to the appearance of the symptoms of Parkinson’s.
It is estimated that approximately 119,000 Canadians have Parkinson’s, 8,400 of those living in the Maritimes. Symptoms generally appear around age 60, although it can present in much younger people. The number of cases increase with age.
How is Parkinson's Diagnosed?
Parkinson’s is not always easy to diagnose. There are currently no x-rays or blood tests to confirm a diagnosis. Neurologists diagnose Parkinson's through analysis of medical history and careful clinical examination. Often, tests are done to rule out other conditions which may resemble Parkinson's.
What are the Symptoms of Parkinson's?
The clinical appearance of Parkinson’s is marked by four cardinal, signs:
- Tremor (or trembling) at rest
- Akinesia and Bradykinesia
- Rigidity
- Postural Instability
1. Tremor (Trembling) at Rest
Most people associate Parkinson’s with a tremor, as it can be the most common visible feature. It is estimated that about 70% of people living with Parkinson will indicate that the tremor is their first noticeable symptom. However, not all people with Parkinson’s will exhibit a tremor. The tremor generally first appears on one side of the body in the hand or foot. As the Parkinson’s progresses, it may affect both sides of the body.
A tremor is a rhythmic shaking and involuntary movement of body part(s), which may affect the limbs, and sometimes the head, neck, face and jaw. Tremors related to Parkinson’s can come in different forms, for example:
Resting Tremor: Shaking that occurs in a relaxed and supported limb
Bilateral Tremor: Occurring on both sides of the body overtime.
2. Akinesia and Bradykinesia (absence/slowness of movements)
Akinesia and Bradykinesia are signs, which are clinically defined as scarcity (akinesia) and slowness (bradykinesia) of movements. In the face, these signs appear as a decrease in facial expression and blinking of the eyes. Some people are affected by an excess of saliva in the mouth, a direct result of slowed swallowing.
The voice may become monotonous and low. There are also difficulties with slowness moving and beginning a movement. This results in a decrease in fine motor dexterity, and the person may experience difficulty buttoning clothes or shaving, will walk slower and have a tendency to take small steps.
3. Rigidity (stiffness of the muscles)
Rigidity is an increase in muscle tone. Most often, the patient reports stiffness and describes no other clinical symptoms of rigidity. Rigidity is mainly a sign noted by the physician during a physical examination and is especially useful in establishing a diagnosis. Rigidity may appear as a decrease in arm swing on the side of the body affected by Parkinson’s . Untreated, stiffness can affect your mobility and safety. Fortunately, drug treatment can be very effective, especially when combined with regular stretching and exercise.
4. Postural Instability (poor balance)
Postural instability is a late sign of Parkinson’s , which appears after many years of progression. What was once an unconscious decision to make a simple balance adjustment now takes deliberate effort for the person living with Parkinson’s. The major concern is risk of falling.
Here are a few of the most common balance issues that may be experienced by a person with Parkinson’s.
Postural Instability: Difficulty with balance.
Festination: Abnormal and involuntary increase in the speed of walking.
Freezing: Temporary, involuntary inability to move.
Ataxia: Loss of balance.
Propulsive Gait: During walking, steps become faster and faster with progressively shorter steps that pass from a walking to a running pace and may precipitate falling forward.
Low Blood Pressure can affect balance.
Non-Motor Symptoms
It is important to know that secondary symptoms may also be present and in addition to the above four cardinal signs, a person with Parkinson’s may experience any of the following symptoms:
- Fatigue
- Sleep Disturbances
- Depression
- Constipation
- Soft Speech
- Writing Problems
- Stooped Posture
- Changes in Facial Expression
- Swallowing
- Dyskinesia (Side Effect of Long Term Medication)
Fatigue
People living with Parkinson’s often report a constant feeling of fatigue. This is the result of the Parkinson’s as well as the drug therapy. This symptom can go hand-in-hand with sleep disturbances.
Sleep Disturbances
Difficulty sleeping is another common symptom of Parkinson’s.
Depression
Depression can be a symptom of Parkinson’s. For some people it may come even before a Parkinson’s diagnosis. It is treatable and does not need to affect daily living.
Constipation
Constipation is another very common problem for people living with Parkinson’s and may be due to the slowness of movement in your intestines or the medication you take. To better manage these symptoms, ensure you drink plenty of water, eat a well balanced diet and get some exercise. It is very important to consult a doctor if severe constipation is a problem.
Soft Speech
Some people with Parkinson's experience speech or voice problems. Sometimes, their voices may be very weak or start off strong but fade toward the end of a sentence. Parkinsonians with this symptom should consult a speech therapist. There are specific exercises to improve voice volume and projection.
Inappropriate silences or delays when starting to speak may also occur. Sometimes, it may just be difficult to find the right words (which is not necessarily due to intellectual impairment). It may be helpful to take the time to organize your thoughts and then take a deep breath before beginning to speak. Swallowing prior to speaking will also help clear the mouth of saliva, making it easier to speak clearly.
Writing Problems
There is a tendency for people with Parkinson’s to notice a change in their penmanship. This is due to difficulty with fine motor movement and is often characterized by a change to very small handwriting.
Stooped Posture
One of the more common symptoms of Parkinson’s is a stooped posture. By itself it may not appear too serious, however, stooped posture can affect balance, cause gait deviation, compromise breathing and cause problems with the back.
Changes in Facial Expression
People living with Parkinson’s may have a change in their facial expressions; often appearing less expressive. The person is not unhappy or bored, they are just unable to move the facial muscles as well as before because of an increased rigidity. Thus, they may not project emotions through their facial expression as one might expect given the circumstance.
Nutrition & Swallowing
Like everyone, you should eat a healthy, well balanced diet based on Canada's Food Guide. However, there are several aspects of Parkinson's that may affect your ability to eat properly. They include:
Loss of smell and taste - Using more spices and paying special attention to visual appeal and the texture of the food may make foods more palatable.
Swallowing difficulty - In severe cases, this can lead to impaired nutrition and chest infections because food gets into the lungs. However, for most patients, this can be controlled. Swallowing can become an effort for some people living with Parkinson’s. Here are some of the symptoms that may indicate that a person with Parkinson's is having difficulty swallowing:
Excessive coughing
A change in the voice after swallowing
Excessive throat clearing
Increased congestion after eating
An increase in the length of time it takes to eat a meal
An increase in the effort needed to eat
Weight loss or dehydration
Complaints of food sticking in the throat
Complaints of food or liquid "going down the wrong way"
Liquid is needed to wash the food down
Low-grade fever
Pneumonia
Dyskinesia
Dyskinesia can be described as abnormal or involuntary movement of muscles. This is not a symptom of Parkinson’s, but is generally a side-effect caused by long term use of Parkinson medication. These medications are necessary to assist the person living with Parkinson’s with movement. If you are experiencing dyskinesia’s, speak with your Doctor to determine if anything can be done to alleviate these side-effects.
What causes Parkinson’s?
It is not known exactly what causes Parkinson’s . Some researchers claim that people in rural areas are more at risk of developing Parkinson’s, placing the blame on factors such as well water and pesticides. Research studies are in progress to determine possible causes. Recent research suggests that both environment and heredity play a role, the prevailing theory currently is that "while genetics loads the gun, environment pulls the trigger".
Parkinson's is not thought to be inherited and it is not contagious. The genetics theory stems from the discovery in recent years of genes involved in Parkinson’s and we do know that people who have an immediate family member with Parkinson’s present a higher risk. Recent studies have shown that the genetic contribution is particularly significant in those who develop Parkinson’s when they are young.
Is There a Cure for Parkinson’s?
Although there is no cure, modern treatments and therapies can allow people with Parkinson's to lead active lives. Researchers are working hard to determine the cause of Parkinson’s and are working toward a cure.
Conditions that Resemble Parkinson’s
There is a grouping of conditions called Parkinson Plus Disorders or Parkinsonism or Parkinson Syndrome. This grouping includes:
Progressive Supranuclear Palsy (PSP)
Multiple System Atrophy (MSA)
Corticobasal Degeneration (CBD)
Neurologists carefully observe the patient for symptoms that would give them a diagnosis in the Parkinson Plus Grouping.
Medication or Toxin Induced Symptoms that Resemble Parkinson’s
Sometimes a patient might present symptoms that occur in Parkinson’s, however these are temporary symptoms caused by exposure to toxins or certain drugs.
Benign Essential Tremor or Familial Tremor
This is a fairly common condition and as suggested by the ‘benign’ part in its name is not an overly serious condition. There is a family history with half the patients with this type of tremor. People with the benign tremor tend to have a poorer response to the anti-Parkinson medications.
This information is not intended as medical advice or as a substitute for the advice of your physician. Parkinson Society Maritime Region does not advocate, endorse or promote any particular drug therapy, treatment regime, or specific company or institution. We strongly recommend you consult with your physician or other qualified medical professionals on any decisions related to your Parkinson’s care or treatment plan
