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A Q&A On Parkinson’s Disease

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What is Parkinson’s Disease?     

Neurotransmitters, the chemicals that communicate information throughout our brain, play a role in controlling one’s heartbeat, breathing and even digestion.  They can affect mood, sleep, concentration and weight, and can cause symptoms when they are not functioning correctly. 

Simply put, Parkinson’s disease happens when a deep structure in the brain called the substantia nigra or “black substance” starts to die, which causes the amount of the neurotransmitter “dopamine” to become depleted. Much of the treatment for Parkinson’s is aimed at restoring the amounts of dopamine in the brain. 

Why do people get Parkinson’s disease?    

There are many theories as to why people get Parkinson’s, which basically means we don’t know why. While there are families in which Parkinson’s disease is common (15% of the cases), the majority (85% of the cases) are “sporadic” or occur without clear reason. Unfortunately, Parkinson’s disease is not rare. From 2-4 percent of people over the age of 60 are expected to get Parkinson’s disease, with a lower percentage in people younger than 60.

What are the symptoms?

The most noticeable symptom of Parkinson’s disease is the tremor. Not everyone with a tremor has Parkinson’s disease, however. An evaluation by a neurologist will often sort out other causes of tremor, many of which are quite benign. One example is the essential tremor that Katherine Hepburn had, which affected her voice and head movements. What distinguishes the Parkinson’s tremor from essential tremor is that it typically occurs when the individual is at rest, especially when hands are held at the sides or in the lap. Essential tremor also affects the hands, but is more likely to be evident when the hands are being used. Parkinson’s tremors are slower than other types of tremors and usually start in the hands. Essential tremor is more likely to involve the head.   

Not every patient with Parkinson’s disease has the tremor. The following are some of the other significant Parkinson’s symptoms that should warrant a trip to the doctor.

•    Bradykinesia, or slowness of movements, is one of the more significant symptoms. Bradykinesia is often evident when an individual has difficulties in everyday activities, from brushing teeth to getting dressed. It is sometimes described by patients as feeling as if there is a pause between when the brain tells the body to do something and the body actually does it.

•    Gait disturbance, or difficulty with walking.  An abnormal gait with short steps, a stooped posture and shuffling movements is very typical of Parkinson’s disease and can interfere greatly with an individual’s ability to function. Parkinson’s patients often fall backwards without much provocation.  At times, they feel as though they are walking too quickly, and that they have difficulty stopping after walking.

There are many other factors that can suggest Parkinson’s disease, such as changes in handwriting, specifically when handwriting becomes much smaller than it previously was.  The voice can become lower in volume, or a person may have difficulty with swallowing. There can be a loss of the normal facial expressiveness, which is sometimes described as being “mask-like.”

Additionally, Parkinson’s disease patients may experience conditions that people often do not associate with the disease, including depression, sleep disturbance and memory disturbance.

Is there treatment for Parkinson’s disease? 

In a word, YES!  There are many medications available, including some that may slow down the progression of Parkinson’s disease. The treatment of Parkinson’s is greatly influenced by many variables, including the patient’s age and his/her memory. 

The treatments include medications to:

•    slow down the breakdown of dopamine in the brain

•    stimulate the dopamine receptors,  or nerves in the brain that would normally be stimulated by dopamine (“dopamine agonists”)

•    try to increase the amount of dopamine in the brain (levodopa or “L-dopa”)

Other medications can be used to try to reduce the tremor.  These medications vary greatly from individual to individual, and a Parkinson’s patient typically takes small amounts of multiple medications rather than a large dose of one drug to reduce potential side effects. The management of these medications requires close interaction with a neurologist experienced with Parkinson’s disease.

Parkinson’s disease patients who experience depression can be treated with antidepressants, which can significantly improve their quality of life. It is important for anyone with depression to address concerns about it with his or her doctor, but it is especially important for someone with Parkinson’s disease.  Being treated for depression can really impact overall well-being.

Often, individuals with Parkinson’s disease ask their physicians about whether diet and nutritional supplements can help. These issues are currently under investigation, but a particular diet or supplement has not yet been found to be of benefit.  

There are also surgical treatments available for Parkinson’s disease. Largely, these are done in tertiary care centers and are reserved for patients who are not doing well with currently available medical treatments. While there can be complications from these surgeries, for some patients they can improve the quality of life.

What else can be done to help symptoms? 

As it is for many neurologic conditions, physical therapy is quite important in maintaining and improving an individual’s functional abilities and quality of life. Physical therapy geared towards walking can improve balance and endurance.  Occupational therapy can improve a patient’s ability to perform fine movements with the hands and daily activities. Speech therapy can improve any issues a patient has with speaking and swallowing. There are specialized programs that are available to Parkinson’s patients, including LSVT BIG and LSVT LOUD (see page 7).  

What should I expect with Parkinson’s disease? 

Parkinson’s disease is a “neurodegenerative” disorder, which means that the disease will progress over time. However, it is hoped that some of the medications now available may slow down this progression. In general, the older one is when symptoms begin, the less rapidly the disease tends to progress, but monitoring and treatment by a neurologist helps predict how the disease will behave in a specific patient. It is important for a person with symptoms to seek medical attention as soon as Parkinson’s is suspected.

Neurologist Douglas D. Sankar, MD, is a Phelps Medical Associates physician. He is board certified in neurology and clinical neurophysiology and is a clinical assistant professor at New York Medical College. Dr. Sankar earned his medical degree from Boston University School of Medicine and completed an internship in internal medicine, a residency in neurology and a fellowship in neurophysiology, all at New York University Medical Center. Dr. Sankar sees patients on the Phelps campus in Suite 560 of the 755 Building (914-366-5440).

 

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