Parkinson’s Disease: Living a life without losing hope

As regular readers may be aware, my father was diagnosed with Parkinson’s Disease about 5-6 years back and it was because of this disease that they made the move to Bengaluru. In the last two months, when he was with me in Singapore, I saw closely how it has impacted him and so decided to find out more about this disease.

Parkinson’s disease is an age-related degenerative brain condition that is a chronic and progressive movement disorder that causes parts of the brain to deteriorate, causing more severe symptoms over time. It initially causes tremors in one hand, stiffness, balancing problems or slowing of movement. Symptoms start slowly. The first symptom may be a barely noticeable tremor in just one hand. Tremors are common, but the disorder may also cause stiffness or slowing of movement. While this condition is best known for how it affects muscle control, balance and movement, it can also cause a wide range of other effects on the senses, thinking ability, mental health and more.

The exact cause of Parkinson’s disease is still unknown but it is believed that environment and genetics play a role. Certain medications, toxins and other diseases can produce symptoms similar to Parkinson’s disease, and then it is known as secondary Parkinsonism, which may be reversible. The condition isn’t curable, but there are many different treatment options. In the early stages of Parkinson’s disease, the face may show little or no expression. The arms may not swing when one walks and speech may become soft or slurred. Parkinson’s disease symptoms worsen as the condition progresses over time. As the disease progresses, people may have difficulty walking and talking and patients may also have mental and behavioural changes, sleep problems, depression, memory difficulties, difficulty in swallowing, chewing and speaking, rinary problems or constipation, skin problems and fatigue.

While virtually anyone could be at risk for developing Parkinson’s, some research studies suggest this disease affects more men than women. It’s unclear why, but studies are underway to understand factors that may increase a person’s risk. One clear risk is age: Although most people with Parkinson’s first develop the disease after age 60, about 5% to 10% experience onset before the age of 50. Early-onset forms of Parkinson’s are often, but not always, inherited, and some forms have been linked to specific alterations in genes. Parkinson’s disease symptoms may vary from person to person. Early signs may be mild and may go unnoticed. Symptoms often begin on one side of the body and usually get worse on the same side, even after symptoms begin to affect both sides. Signs and symptoms may include tremors, trembling of hands, arms, legs, jaw and face, stiffness of the arms, legs and trunk, slowness of movement, poor balance and coordination and speech difficulty.

The most prominent signs and symptoms of Parkinson’s disease occur when nerve cells in the basal ganglia, an area of the brain that controls movement, become impaired and/or die. Normally, these nerve cells, or neurons, produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes movement problems associated with the disease. Scientists still do not know what causes the neurons to die. People with Parkinson’s disease also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying position. Many brain cells of people with Parkinson’s disease contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic variants that impact Parkinson’s and Lewy body dementia.

The symptoms of Parkinson’s and the rate of progression differ among individuals. Friends or family members may be the first to notice changes in someone with early Parkinson’s. People with Parkinson’s disease often develop a Parkinsonian gait that includes a tendency to lean forward; take small, quick steps; and reduce swinging their arms. They also may have trouble initiating or continuing movement. Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other. Many people with Parkinson’s disease note that before experiencing stiffness and tremor, they had sleep problems, constipation, loss of smell, and restless legs. While some of these symptoms may also occur with normal ageing, patients must talk with their doctor if these symptoms worsen or begin to interfere with daily living.

Some cases of Parkinson’s disease appear to be hereditary, and a few cases can be traced to specific genetic variants. While genetics is thought to play a role in Parkinson’s, in most cases the disease does not seem to run in families. Many researchers now believe that Parkinson’s results from a combination of genetic and environmental factors, such as exposure to toxins.

There are currently no blood or laboratory tests to diagnose non-genetic cases of Parkinson’s. Doctors, mostly neurologists, usually diagnose the disease by taking a person’s medical history and performing a neurological examination. Imaging tests — such as an MRI, ultrasound of the brain and PET scans — also may be used to help rule out other disorders. Imaging tests aren’t particularly helpful for diagnosing Parkinson’s disease. If symptoms improve after starting to take medication, it’s another indicator that the person has Parkinson’s. Sometimes it takes time to diagnose Parkinson’s disease. Healthcare providers may recommend regular follow-up appointments with neurologists trained in movement disorders to evaluate conditions and symptoms over time and diagnose Parkinson’s disease. Several disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes, such as multiple system atrophy and dementia with Lewy bodies, are sometimes said to have Parkinsonism.

Although there is no cure for Parkinson’s disease, medicines, surgical treatment, and other therapies can often relieve some symptoms. Medicines can help treat the symptoms of Parkinson’s by increasing the level of dopamine in the brain, affecting other brain chemicals, such as neurotransmitters, which transfer information between brain cells, and helping control non-movement symptoms. The main therapy for Parkinson’s is levodopa. Nerve cells use levodopa to make dopamine to replenish the brain’s dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapy — such as nausea, vomiting, low blood pressure, and restlessness — and reduces the amount of levodopa needed to improve symptoms.

For people with Parkinson’s disease who do not respond well to medications, doctors may recommend deep brain stimulation. During a surgical procedure, a doctor implants electrodes into part of the brain and connects them to a small electrical device implanted in the chest. The device and electrodes painlessly stimulate specific areas in the brain that control movement in a way that may help stop many of the movement-related symptoms of Parkinson’s, such as tremors, slowness of movement, and rigidity.

Other therapies that may help manage Parkinson’s symptoms include physical, occupational, and speech therapies, which may help with gait and voice disorders, tremors and rigidity, and decline in mental functions, a healthy diet to support overall wellness, exercises to strengthen muscles and improve balance, flexibility, and coordination, massage therapy to reduce tension and yoga and tai chi to increase stretching and flexibility. Lifestyle interventions such as exercise, healthy eating, sleep, social activity and stress management can also help manage symptoms.

While the progression of Parkinson’s is usually slow, eventually a person’s daily routines may be affected. Activities such as working, taking care of a home, and participating in social activities with friends may become challenging. Living with Parkinson’s disease can be challenging but there are ways to manage it and live a healthy life.

Some ways patients with Parkinson’s disease can manage their lives include eating healthily, exercising which may increase muscle strength, flexibility and balance, avoiding falls, occupational therapy which can help in day-to-day activities such as eating foods, reading, dressing up patients and speech therapy which helps in evaluating and treatment of voice, speech, language or swallowing.

Parkinson’s disease itself isn’t fatal but related complications can reduce life expectancy by 1 to 2 years. However, research involving more than 12,000 people indicates that Parkinson’s can reduce life expectancy if a person receives a diagnosis before the age of 70 years. The researchers report that those with Parkinson’s disease and normal cognitive function appear to have “a largely normal life expectancy”.