Parkinson disease is a gradually progressive degenerative disorder of the central nervous system. Parkinson disease belongs to a group of conditions called movement disorders. There are four characteristic problems caused by Parkinson disease, including tremor at rest, balance problems, stiffness, and slowness of movement. Parkinson disease occurs when areas of the brain, including an area called the substantia nigra, is slowly destroyed. The exact reason for this destruction is not completely known. In some patients, it may be due to genetic, environmental, or a combination of both causes.
The end result is a deprivation in the brain of an important neurochemical, called dopamine. Dopamine helps regulate movement, and its loss leads to increased tone, rigidity, and slowness of movement. Lack of dopamine results in the symptoms associated with Parkinson disease . Approximately 50,000 Americans are diagnosed with Parkinson disease every year. 95% of those diagnosed are over 50 years old. At any given time, about 500,000 people, or 1% of those over age 50 in the US are struggling with this condition. Diagnosis of Parkinson disease is a clinical one, based on history and physical examination.
There are no lab tests to definitively diagnose the condition. Your doctor will ask about your medical history and perform a thorough physical exam. A systematic neurological exam will include testing your reflexes and observing things like muscle strength throughout your body, coordination, balance, and other details of movement, including: * Muscle tone * Rapid alternating movements * Gait, posture * Postural stability * Quickness and precision of movement * Observation of a tremor (during rest or activity) A mini mental status exam will be performed; questions pertaining to mood, thoughts, and behavior will be asked.
Activities of daily living will be evaluated, such as dressing, cutting and eating food, swallowing, hygiene, walking, and falls. The exact cause of PD is unknown. It may have both genetic and environmental components. Some scientists think that viruses can trigger PD as well. Low levels of dopamine and norepinephrine, a substance that regulates dopamine, have been linked with PD. Abnormal proteins called Lewy bodies have also been found in the brains of people with PD. Scientists do not know what role, if any, Lewy bodies play a role in the development of PD.
Certain groups of people have an increased risk of PD. Men are one and a half times more likely to get PD than women. Whites are more likely to get PD than African-Americans or Asians. PD usually appears between the ages of 50 and 60. It only occurs before the age of 40 in five to 10 percent of cases. People with a family history are more likely to develop this disorder. The four major motor problems seen in PD are: * tremor—shaking that occurs at rest * slow movements * stiffness of arms, legs, and trunk * problems with balance and tendency to fall
Secondary symptoms of PD include: * blank facial expression * a tendency to get stuck when walking * small, cramped handwriting * muffled, low-volume speech * decreased blinking and swallowing * tendency to fall backwards * reduced arm swinging when walking Other, more extreme, symptoms of PD are: * flaky white or yellow scales on oily parts of the skin, known as seborrheic dermatitis * sleep disturbances—including vivid dreams, talking, and movement during sleep * depression * anxiety * hallucinations * psychosis * problems with attention and memory.
* difficulty with visual-spatial relationships There is no specific test for PD. Diagnosis is made based on health history and a physical and neurological exam. Tests such as CAT scan or MRI may be used to rule out other conditions. Adequate rest, exercise, and a balanced diet are important. Speech therapy, occupational therapy, and physical therapy can also help to improve communication and self care. Surgical interventions are reserved for people who don’t respond to medication, therapy, and lifestyle changes. So are procedures such as deep brain stimulation (DBS).
In almost all cases of PD, medication will be required to help control the various physical and mental health symptoms associated with the disease. Drugs and Medication Used to Treat Parkinson’s Disease | Medication A number of different drugs can be used to treat PD. Levodopa Levodopa is the most common treatment for PD. It helps to replenish dopamine. About 75 percent of cases respond to levodopa, but not all symptoms are improved. Levodopa is generally given with cardiodopa. This delays the conversion of levodopa to carbidopa until it gets into the brain. Dopamine Agonists.
Dopamine agonistscan imitate the action of dopamine in the brain. Dopamine agonists are less effective than levodopa. However, they can be useful as bridge medications when levodopa is less effective. Drugs in this class include bromocriptine, pramipexole, and ropinirole. Anticholinergics Anticholinergics are used to block the parasympathetic nervous system. They can help with rigidity. Side effects may include impaired memory, dry eyes, dry mouth, and constipation. Benztropine (Cogentin) and trihexyphenidyl are anticholinergics used to treat PD. The main motor symptoms are collectively called parkinsonism, or a “parkinsonian syndrome”.
Parkinson’s disease is often defined as a parkinsonian syndrome that is idiopathic (having no known cause), although some atypical cases have a genetic origin. Many risk and protective factors have been investigated: the clearest evidence is for an increased risk of PD in people exposed to certain pesticides and a reduced risk in tobacco smokers. Thepathology of the disease is characterized by the accumulation of a protein called alpha-synuclein into inclusions called Lewy bodies in neurons, and from insufficient formation and activity ofdopamine produced in certain neurons within parts of themidbrain.
Lewy bodies are the pathological hallmark of the idiopathic disorder, and the distribution of the Lewy bodies throughout the Parkinsonian brain varies from one individual to another. The anatomical distribution of the Lewy bodies is often directly related to the expression and degree of the clinical symptoms of each individual. Diagnosis of typical cases is mainly based on symptoms, with tests such as neuroimaging being used for confirmation. Modern treatments are effective at managing the early motor symptoms of the disease, mainly through the use oflevodopa and dopamine agonists.
As the disease progresses and dopaminergic neurons continue to be lost, these drugs eventually become ineffective at treating the symptoms and at the same time produce a complication called dyskinesia, marked by involuntary writhing movements. Diet and some forms of rehabilitation have shown some effectiveness at alleviating symptoms. Surgery and deep brain stimulation have been used to reduce motor symptoms as a last resort in severe cases where drugs are ineffective.
Research directions include investigations into new animal models of the disease and of the potential usefulness of gene therapy, stem cell transplants and neuroprotective agents. Medications to treat non-movement-related symptoms of PD, such as sleep disturbances and emotional problems, also exist.
The disease is named after the English doctor James Parkinson, who published the first detailed description in An Essay on the Shaking Palsy in 1817. Several major organizations promote research and improvement of quality of life of those with the disease and their families.
Public awareness campaigns include Parkinson’s disease day (on the birthday of James Parkinson, April 11) and the use of a red tulip as the symbol of the disease. People with parkinsonism who have enhanced the public’s awareness include Michael J. Fox and Muhammad Ali. | | | | | | Parkkinson’s Disease Paper Social Implications of Medical Issues Instructor: Shane Davis Tina Bivens Monday 9, 2012 www. davisphinneyfoundation. org/ en. wikipedia. org/wiki/Parkinson’s_disease www. mayoclinic. com/health/parkinsons-disease/DS00295 www. webmd. com/parkinsons-disease/default. htm.