Parkinsons Disease
Parkinson disease is a progressive neurological disorder whose first symptoms affect movement. There is loss of the dopamine producing neurons in the brain.
Dopamine is an important neurotransmitter, a chemical messenger responsible for the proper functioning of our brain. An estimated 9.4 million individuals globally have a Parkinson disease diagnosis. It is also more common in men.
Dr Nicolas Kon is a specialist in Parkinson disease in Singapore, providing comprehensive evaluations and treatments including neuromodulation treatment.
In this article, we will discuss about:
Symptoms of parkinson disease
The symptoms can be broadly grouped into motor and non-motor categories. Common symptoms are listed below.
Movement related
The symptoms include slowness of movement, rigidity or stiffness, tremor, and balance impairment.
Non-motor symptoms
The symptoms include loss or decrease of smell, sleep problems, constipation, urinary problems, blood pressure variability, cognition problems, and softening of the voice.
Hoehn and Yahr Scale
The Hoehn and Yahr scale has been used to classify Parkinson disease into 5 stages
Stage 1: Mild
- Symptoms
- Stage 1 Parkinson is the mildest form and symptoms may not be noticeable. If they are, they may be only seen on one side of the body, typically in the form of a mild tremor, rigidity, or slowness of movement. Symptoms are unlikely to interfere with daily life and tasks at this stage.
- Diagnosis
- Because the symptoms are so mild, it may not cross the individual’s mind to seek medical attention, and even if they do, a doctor may not be able to make a correct diagnosis.
Stage 2: Early
- Progression
- Each person experiences Parkinson disease differently. Symptoms and progression will not be the same as someone else’s. The progression from stage 1 to stage 2 may happen as quickly as within months or as long as several years.
- Symptoms
- At stage 2, symptoms start to appear on both sides of your body, or at the midline without usually affecting your balance. Individuals may start to experience one or more of the following symptoms:
- Changes in facial expressions
- Decreased blinking
- Speech abnormalities (e.g., soft voice, fading volume after speaking loudly, slurring speech)
- Muscle stiffness leading to neck or back pain, stooped posture and general slowness in daily activities
- Tremors
- At stage 2, symptoms start to appear on both sides of your body, or at the midline without usually affecting your balance. Individuals may start to experience one or more of the following symptoms:
- Diagnosis
- Diagnosis is easier if tremor is present. Sometimes, if the only symptoms are slowness or lack of spontaneous movement, it may be misinterpreted as signs of aging.
Stage 3: Middle
- Symptoms
- Symptoms reach a turning point here. Individuals will likely experience most, if not all, of the symptoms of stage 2.
- Muscle movement and reflexes become noticeably slower.
- Balance and coordination problems make falls more common at this stage.
- However, many people still remain independent in daily activities without requiring much assistance in dressing and other self-care tasks.
- Diagnosis
- Diagnosis of Parkinson disease is generally quite clear at stage three.
Stage 4: Advanced
- Progression from stage 3 to 4 is usually marked by the loss of independence to perform daily activities.
- Individuals will experience great difficulty standing on their own, and may require a walker or assistive device.
- Living alone is not safe, possibly dangerous, as they will require some form of assistance with daily care.
Stage 5: Severely advanced
- Stage 5 is the most debilitating stage characterised by confinement to a bed or wheelchair. Around-the-clock assistance becomes a necessity, to reduce the risk of falling and all daily activities.
- Also, at this stage, individuals may start to experience hallucinations or delusions.
- While the symptoms worsen over time, some people never reach stage 5.
Causes of parkinson disease
Most cases have no known cause. In some individuals, there are:
Genetic (family history)
Environmental contributions (pesticide and heavy metal exposure)
Diagnosis of parkinson disease
History and physical examination are the mainstay of diagnosis
Sometimes, when the diagnosis is not clear, dopamine transporter single-photon emission computed tomography may be used
MRI scan may also be used to differentiate from diseases that may appear to be similar
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Prognosis of parkinson disease
Progression of Parkinson disease varies. There are both slower and faster progressing forms. Generally, individuals (about 15%) who are at risk of more rapid disease progression have:
Early cognitive impairment
Blood pressure that suddenly drops when the person stands (orthostatic hypotension)
Poor response levodopa medication
Treatment of parkinson disease
Medication is the first-line of treatment. Medication provides symptom relief but increasing doses over time can cause side effects.
When medication loses effectiveness or symptoms start to affect the quality of life, surgery should be considered.
Medication
There are many drugs that are used for Parkinson disease. The most commonly used drugs are carbidopa-levodopa, monoamine oxidase-B inhibitors and dopamine agonists. As new symptoms develop, additional medications will be required
Non-drug treatment
An exercise regimen may include gait and balance training, resistance training, aerobic exercise, and dance-based activities. Tai chi, occupational and speech therapy, and dietary modifications are also beneficial.
Surgery
These include deep brain stimulation, focused ultrasound, and enteral suspension gel.
When should deep brain stimulation (DBS) be considered?
Some years after diagnosis, individuals may start to experience periods when the medication wears off (“off periods”) before the next dose or develop dyskinesias, which are uncontrolled involuntary movements due to high medication concentration in the brain.
Other patients may have severe tremors that do not respond to medication. Individuals who experience any of these issues should consider speaking to their specialist. For more detailed information, read more on Deep Brain Stimulation (DBS).
Summary
Living well with a chronic illness can be difficult but not impossible.
Work with your doctor to come up with a tailored plan.
Selecting the most appropriate treatment at the appropriate time during the disease course is important.
