Joseph R. Anticaglia MD
Medical Advisory Board
Parkinson’s disease (PD) is a chronic, progressive, movement disorder of the brain that usually develops slowly over time that gives rise to unintentional or uncontrollable movements. It is classified as a movement (motor) disorder because it causes tremors, balance instability, slowness of movement and stiffening movements. But non-motor symptoms of PD such as depression, fatigue, anxiety, loss of taste and smell are serious concerns of people with PD.
It’s a “personalized disease,” meaning each person responds differently to PD, to the degeneration of nerve cells in the brain People with PD will not experience the same objective signs or subjective symptoms, progression of the disease or response to medications when compared to other individuals with the disease.
The death or crippling of dopamine producing neurons in the substantia nigra of the midbrain causes low levels of dopamine and the symptoms of PD. One of the functions of dopamine is to act as a neuro-transmitter. It helps sends messages to part of the brain in charge of movement, and coordination. As the level of dopamine decreases in the brain, the symptoms of PD increase. The cause of dopamine’s nerve cell death or damage is not yet known. Genetic factors, environmental concerns and blow to the head are considerations concerning the cause of this disease.
The diagnosis is a clinical one. Currently, there’s not a diagnostic test for PD. Usually, you need to have two of the four primary motor symptoms (tremor, slowness of movement (bradykinesia), rigidity and postural instability to consider a diagnosis of PD. If a trial dose of Parkinson’s medication, carbidopa-levodopa, improves a person’s movement symptoms, one can reasonably conclude the person has Parkinson’s.
Parkinsonism is a group of movement disorders of the central nervous system. It includes any combination of tremors, balance instability, stiffness and slowness of movement. Memory and thinking impairments can be prominent features as the disease progresses.
Parkinson disease is just one, but the most common example in this group of movement disorders accounting for approximately 80% of the cases.
Carbidopa/levodopa is the “gold standard” of medical treatment which is used to replace the lack of the brain’s dopamine. It treats the symptoms of PG; it doesn’t change the progression of this disease. Other medications are used to treat Parkinson’s depending on the stage of the disease and the patient’s symptoms. As with all medications, be aware of their side effects.
Surgery, Deep Brain Stimulation (DBS), is indicated only when medications fail to control severe motor symptoms of PD. Exercise, diet and psychological counseling are other practices used to treat Parkinson’s disease.
Because of the variation in the progression of the PD and the different motor and non-motor symptoms from one individual to another, there is not one best exercise of PD patients. Yet, one can say, the best exercise is the one that is safe and the one you do regularly.
Whatever your exercise program may be, if possible, include aerobic activity, stretching and strengthening exercises. In the early stages of Parkinson’s disease, people are encouraged to consider the benefits of an intense exercise program.
The best time to exercise is when you feel most alert and you have the time to do it. Also, coordinate the exercise session with your medication, so that it’s working at its best to control your PD symptoms and enabling you to exercise to the best of your ability.
The disease can be categorized into three stages: Refer to the references for a more detailed explanation of the stages.
Mild — movement symptoms such as tremor happens on one side of the body and don’t interfere with daily activities.
Moderate — movement symptoms take place on both sides of the body. Individuals may experience problems with medications wearing off and difficulty with balance and coordination. Also,’ freezing’ may occur, wherein a person feels as if his feet are stuck to the ground.
Advanced — the person may need a wheelchair or be confined to bed because of trouble with walking. In this stage of the disease, delusions and hallucinations may be prominent. The person needs assistance with daily activities.
Just because people with PD need to increase the dosage of carbidopa/levodopa doesn’t mean the medication has stopped working. As this disease progresses downhill, it destroys more of the dopamine producing neurons. With less of these dopaminergic neurons, there is a greater need for dopamine. Physicians adjust and increase the dosage of this medication.
Also, carbidopa/levodopa is indicated especially to treat motor symptoms such as tremor and slowness of movement. It doesn’t treat non-motor symptoms, such as, constipation, depression, fatigue or sleep problems that can develop over time with the progression of PD.
Drugs that block the work of dopamine in the brain will mimic the symptoms of Parkinson’s disease — tremor, slowness of movement, stiffness, balance problems and others. Cardiac drugs, medications for nausea and major tranquilizers have mimicked PD. Stopping these drugs allows the dopamine system to return to normal.
Robin Williams, several months before his suicide, was reportedly tormented by paranoia, confusion and severe memory problems. At autopsy, doctors identified Lewy bodies within Williams’ brain, which disrupted normal nerve function, afflicted his memory and contributed to his dementia. Lewy bodies are clumps of protein made up of a-synuclein that researchers believe hold an important clue as to the cause of Parkinson’s disease and PD Lewy dementia.
Parkinson disease is the most common example of Parkinsonism. In this group of movement disorders, PD accounts for approximately 80% of the cases which is most commonly diagnosed after the age of sixty. All individuals with PD will experience the malfunctioning of the dopamine-producing nerve cells in the substantia nigra of the midbrain causing motor and non-motor symptoms.
Research is ongoing, clinical trials are being conducted and scientists worldwide are working to discover solutions to prevent and treat this relentless brain disease. Work with your PD specialist and support groups to get the latest information concerning the management of this condition.
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.
