Life Desk :
Parkinson’s disease (PD) is a chronic and progressive disease of the nervous system which causes gradual loss of muscle control. Parkinson’s disease was discovered by British surgeon Dr. James Parkinson in 1817. It affects the body’s ability to control movement. Parkinson’s disease mostly affects people over 60 years and is progressive in nature.
Parkinson’s disease involves the malfunction and death of certain nerve cells in a small area [substantia nigra] of the brain stem which controls movement. These nerve cells make a brain chemical which relays messages between the substantia nigra and other parts of the brain to produce smooth coordinated muscle movements.
Without dopamine, the brain does not receive the signals, leading to progressive loss of muscle function and tremors.
Hence Parkinson was originally called a “shaking palsy”. As the disease progresses, patients have difficulty in walking, talking, or completing other simple daily tasks.
What are the Symptoms of Parkinson’s Disease?
Tremor at rest- Tremor is one of the early symptoms of Parkinson’s disease. It usually occurs in the hands, arms, legs, jaw or head when at rest. The tremor is of rhythmical type. Some patients have a pin rolling tremor as if a rolling a pin between the thumb and index finger. It decreases during movement. The tremor causes one’s handwriting to become smaller and illegible.
Rigidity or stiffness of the limbs and trunk- Even if someone tries to move the arms and legs, the muscles put up resistance. The muscles cannot be moved at all or stiffen up even more during such attempts causing pain.
Slowness in movement [Bradykinesia] – There is a normal tendency to slow down as one grows older. However, in Parkinson’s disease this slow movement impairs daily activities. They find it hard to start moving. Taking the first step is often the most difficult. Once they start moving, it becomes difficult to stop. Since the body does not respond promptly the person may suddenly stop or freeze. There is also difficulty in getting out of a chair, difficulty in swallowing, a mask like or expressionless face, monotonous speech, poor hand grip, difficulty in performing daily tasks such as tying shoelaces.
Problems in maintaining balance [postural instability]- People with Parkinson’s disease often develop a parkinsonian gait that includes a tendency to lean forward, taking small quick steps, as if hurrying forward, and reduced swinging of the arms. A stooped posture with drooping shoulders and head jutted forward is commonly found in Parkinson’s disease. Due to the problem in maintaining balance the risk of falling is greatly increased.
Sleep disorders- These occur commonly in Parkinson’s disease and significantly impair quality of life. They include insomnia, restless leg syndrome or RLS [a neurological disorder characterized by an uncontrollable urge to move the legs, often related to unpleasant sensations in the legs while at rest], rapid eye movement [REM] sleep behavior disorder in which individuals act out their vivid dreams, sleep apnea, and excessive daytime sleepiness.
Loss of smell (anosmia) which begins about four to six years before the movement disorders set in.Nine out of ten patients with Parkinson’s disease suffer from defects of the sense of smell in the early stages of the disease.
Mental symptoms – such as hallucinations, illusions, delusions and dementia, a deterioration in brain functioning such as thought process, memory, reasoning, behavior. These usually occur when one is suffering from Parkinson for a long time. These occur when the cells in the substantia nigra area of brain stem contain abnormal collections of a protein [alpha-synuclein] called “Lewy bodies.”
Statistics of Parkinson’s Disease
About 1 to 2 out of every 1,000 people has Parkinson’s disease. Around 18 out of 1,000 people over 65 are affected. This disease is much more common in the elderly.
In India at 8.5 deaths per 100,000 women in 2013, the peak mortality rate was higher than that of men which was 3.3 per 100,000. The highest death rate from PD in Indian women occurs at age of 80 or more.
The annual mortality rate per 100,000 people from Parkinson’s disease in India has increased by 87.9% since 1990, an average of 3.8% a year.
Approximately 15 percent of people with PD have a family history of the disorder. These are caused by mutations in the LRRK2, PARK2, PARK7, PINK1, SNCA gene or alterations in genes that have not yet been identified.
About one million Americans suffer from Parkinson’s disease. This is more than the combined number of people diagnosed with multiple sclerosis [a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged], muscular dystrophy [a group of inherited diseases that damage and weaken your muscles over time] and Lou Gehrig’s disease [a rapidly progressive, invariably fatal neurological disease that attacks the nerve cells responsible for controlling voluntary muscles]
Approximately 60,000 Americans are diagnosed with Parkinson’s disease each year. It is also believed that a large number of cases go undetected.
Approximately seven to ten million people worldwide suffer from Parkinson’s disease. Around 120,000 people in the UK have the condition.
Men are one and a half times more likely to have PD than women and it appears to affect white men more than African Americans or Asians.
The treatment is expensive. The combined direct and indirect cost of Parkinson is estimated to be nearly $25 billion per year in the United States alone. These include treatment, social security payments and lost income from inability to work. Medication costs for an individual person with averages $2,500 a year and therapeutic surgery can cost up to $100,000 dollars per patient.
Around 1 in 20 people are diagnosed under the age of 40 years. Symptoms of PD may progress longer than 20 years.
Facts about Parkinson’s Disease
The cause is unknown in most cases [idiopathic]. However, a small number of cases have been linked to head trauma, poisoning, side effects of antipsychotic medications, environmental factors such as smoking, pollution, heavy metals, illegal drugs, brain inflammation, and stroke.
Parkinson’s disease occurs globally, irrespective of the social, economic class or geographic area.
Symptoms of Parkinson’s develop when about 70 to 80% of dopamine has been lost.
The main drug for treating Parkinson’s disease is levodopa, also called L-dopa which mimics or replaces dopamine in the brain. For those who do not respond well to medications, deep brain stimulation [DBS] is advised.
Since the early signs of PD are often considered to be a normal part of the aging process it takes several years before the disease is actually diagnosed.
There is no cure for Parkinson’s disease, but a combination of therapies such as physiotherapy and speech therapy can help control the symptoms and maintain quality of life.
People with an affected first degree relative, such as a parent or sibling, have a four to nine percent higher chance of developing PD, as compared to the general population.
Daily exercises such as strength and flexibility training, yoga, treadmill, biking, dancing, tai chi have proved beneficial. Parkinson’s disease may be prevented by eating a well-balanced diet. The diet should be rich in a variety of foods, including numerous servings of vegetables and fruits, moderate amounts of omega-3 fatty acids, tea, caffeine, and wine as these provide neuroprotection. Vitamins C, D and E supplementation may also help in slowing the progress of Parkinson’s disease.
Life expectancy is about the same as for people without the disease. The rate at which symptoms evolve is variable. For some patients it may take even 20 years before the disease is detected.
Studies show that people who could not identify the scent of common household items such as bananas, lemons, cinnamon or other items were about five times more likely to develop Parkinson’s disease. The area in the brain responsible for helping us smell [olfactory center] is one of the earliest parts of the brain hit by Parkinson’s disease.
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