Education

What is Parkinson’s Disease?

Parkinson’s disease is a clinically diagnosed neuro-degenerative disease caused by the deterioration of dopamine neurons in the brain. But what does that mean?

Clinically diagnosed referring to PD, means that it can only be diagnosed on examination of physical symptoms. A doctor will take into account your history, current symptoms and if you have multiple symptoms you will get a diagnosis. There is no blood test or scan for a quick diagnosis due to the complexity and current understanding of PD.s

Neuro-degenerative disease sounds complicated, but is a blanket term for numerous conditions that occur in the neurons of the brain. dopamine neurons are a neurotransmitter. They communicate between nerves and the brain – think of them as electric signals carried from the brain to the nerves. If you think about lifting your arm over your head, the dopamine neurons will carry that message from your brain, through your nerves and into the muscle creating movement. In the case of PD, the dopamine neurons are affected and the overall number of these in the brain has greatly diminished. This is what causes the symptoms of Parkinson’s.

Dopamine neurons are found in the area of the brain known as the Basal Ganglia, specifically the Substantia Nigra. In patients with PD, the Substantia Nigra is significantly diminished. The Basal Ganglia is responsible for providing movement and coordination. This is why PD is associated with motor (movement) symptoms like:

• Tremor – shaking of the arm or fingers down one side of the body.
• Bradykinesia, slow movement often seen in walking or general daily tasks
• Rigidity/Stiffness – loss of muscular flexibility.

Just to mention a few. However, there are also significant non-motor (movement) symptoms that can accompany the disease, for example:

• Sleep disturbances – insomnia or acting out dreams (REM sleep behaviour disorder).
• Mood swings
• Depression and anxiety.

Non-motor symptoms can have an impact on a person just as much as a movement disorder but are often not seen or spoken about, which can cause its own issues.

What next?

If you have been diagnosed with PD you will likely be prescribed medication to treat the symptoms – this is an important point as Parkinson’s medication will have a positive effect on the symptoms without treating the disease itself. It is a manageable neurodegenerative disease but not curable.

Levodopa has primarily prescribed medication. Some common branded names are Sinemet and Rytary. The levodopa combats the motor (movement) symptoms of PD. It does this by supplementing the dopamine as the levodopa is converted to dopamine within the brain.

Once absorbed by the body common symptoms of Parkinson’s can improve significantly. Think of it as a car that starts to stutter as it runs out of fuel – once the tank is filled the car will run smoothly. It can be particularly noticeable when you are in a period of time which the medication has been taken and when it has not. It is important to note that the prescription of medication will usually be given my a specialist neurologist rather than your general practitioner. You will then have regular appointments to track progress and rebalance medication so that it is most effective for you specifically.

Exercise in Parkinson’s Disease

Combined with medication regular exercise is the most effective treatment for PD. And unlike the levodopa, exercise will not only help slow progression of the motor (movement) symptoms but also the non-motor symptoms.

Research has shown that specific types of exercises can be prescribed to patients with specific symptoms. Although all exercise is fantastic, it won’t all improve your quality of life in ways that it might if properly designed. So to explain, generally walking is fantastic exercise, but it won’t help your bradykinesia like doing several large and fast full body exercises on a daily basis.

Symptoms of Parkinson’s Disease

As mentioned breifly above, there are two categories of symptoms in PD. Motor and non-motor.

• Motor Symptoms – effect movement.
• Non-motor Symptoms – other effects in the brain, often unseen.

It is important to understand that it can be extremely unpredictable. No two people generally have the same specific symptoms or or present in the same way.

Motor Symptoms

The three main motor symptoms of PD are:

• Bradykinesia – slow moments and is often seen with hypokinesia which are small movements.
• Rigidity – general muscle stiffness and a lack of flexibility.
• Tremor – often on one side of the body with uncontrollable shaking.

Presence of two of the three above symptoms is often enough for a diagnosis of Parkinson’s.

Other motor symptoms include:

• Freezing – getting stuck while walking or trying to stand up.
• Apraxia – struggling to replicated movements when asked due to coordination difficulty. Also difficulty performing precise finger and hand movements.
• Dyskinesia – uncontrollable limb movements and a lack of body control.
• Dystonia – uncontrolled contraction of muscles, particularly flexors, often seen in toe clawing.

An easier way to remember the motor symptoms is using the acronym TRAP.

T – Tremor.

R – Ridigity.

A– Akinesia/bradykinesia.

P – Postural Instability.

As you can see the motor symptoms vary and can impact different people at different stages of the disease. Levodopa is the best medication to manage these symptoms. Exercise will also help these symptoms, but the more specific to match your symptoms, the better the results will be. So as an example, walking is great exercise and low impact, however, isn’t necessarily going to help with bradykinesia or rigidity which are two primary symptoms.

Doing specific guided exercise with speed and amplitude (size of movement), will help improve these symptoms. This is so important to grasp, and help specify the right exercise for you.

Non-motor Symptoms

Non-motor applies to any of the PD symptoms that don’t physically revolve around the moment. There is a range of psychological and cognitive non-motor symptoms that in my experience people with Parkinson’s were not even aware are apart of the condition. It’s a really important area of the disease to be discussed and researched to improve lifestyle. The more you know the better. Common non-motor symptoms include:

• Depression.
• Apathy – lack of motivation across a range of issues.
• Anxiety.
• Fatigue.
• Cognitive impairment.
• Insomnia – sleep disturbances.
• REM sleep behaviour disorder – acting out your dreams.
• Constipation.
• Anosmia – lose of smell.
• Mood disorders.
• Orthostatic hypotension – loss of blood pressure when changing from sitting to standing resulting in lightheadedness.
• Hallucinations
• Sexual dysfunction.
• Hypomimia – masked or expressionless face.
• Hypophonia – a loss of voice control particularly with volume.
• Visual problems.
• Urinary dysfunction.
• Seborrheic dermatitis – rough and scaly skin on the scalp.

I can imagine this is a long and potentially scary list. However, there are a couple of important things to remember. Firstly, although these are a range of symptoms that have appeared in patients with PD, it is in no means a certainty that you will experience them.

Secondly, if you are aware that some of these issues are apart of your PD, changes in lifestyle and management can help to improve your situation. Great examples are insomnia, mood disorders and anxiety. If you communicate these issues with support base you can improve your communication and interactions with people, finding the best way to get a solution.

Thirdly you are more prepared to speak with your primary physician. Being aware that these symptoms are potentially caused by your PD allows you to explore better medication options as apart of your treatment.