Parkinson’s Disease

What is Parkinson’s Disease? 

Parkinson's disease (PD) is a neurodegenerative disorder primarily affecting movement. It is a chronic and progressive condition, meaning it worsens over time. PD is characterised by the death of dopamine-producing neurons in a specific brain region known as the substantia nigra. Dopamine is a neurotransmitter that is crucial in regulating movement and coordination. When these neurons die or become impaired, it leads to a range of motor and non-motor symptoms associated with PD.

In Dr George Samra’s book, The Allergy Connection, natural therapies are considered an adjunct to conventional therapies and may improve disease symptoms. Disease prevention measures in the children of sufferers are also a significant issue for consideration. 

Cause and Risk Factors for Parkinson's Disease

The exact cause of Parkinson's disease is not fully understood, but it is believed to involve a combination of genetic and environmental factors. Here are some key factors and hypotheses related to the causes of PD:

• Age: The risk of PD increases with age, and it is most commonly diagnosed in people over 60.
• Gender: Men are slightly more likely to develop Parkinson's disease than women.
• Family History: Having a close relative with PD may increase your risk, suggesting a genetic component.
• Head Trauma: Some studies suggest that a history of head injuries may be a risk factor for PD.
• Genetics: While genetic factors do not directly cause most cases of PD, several genes have been linked to an increased risk of developing the disease. Mutations in these genes can lead to a familial form of PD.
• Dopamine Deficiency: PD's hallmark feature is a dopamine deficiency in the brain. The loss of dopamine-producing neurons in the substantia nigra is central to the disease.
• Protein Aggregation: The accumulation of abnormal proteins, particularly alpha-synuclein, in the brain is associated with PD. These protein aggregates are thought to contribute to the degeneration of neurons.
• Mitochondrial Dysfunction: Dysfunction in the mitochondria, the energy-producing organelles in cells, has been implicated in PD.
• Environmental Factors: Exposure to certain toxins, such as pesticides, herbicides, and heavy metals, may increase the risk of developing PD. However, the relationship between these environmental factors and the disease is complex and not fully understood.
• Inflammation and Immune System: Some researchers believe that chronic inflammation and abnormalities in the immune system may play a role in the development of PD.

Symptoms of Parkinson's Disease

Parkinson's disease is characterised by various motor (movement-related) and non-motor symptoms. These symptoms can vary in severity among individuals and may develop gradually. Some common symptoms include:

Motor Symptoms

• Tremors: Resting tremors, typically seen as a rhythmic shaking of the hands, fingers, or other body parts, are a hallmark symptom of PD.
• Bradykinesia: Slowness of movement, which can make everyday tasks more difficult and time-consuming.
• Rigidity: Stiffness and inflexibility in the limbs and joints, often leading to muscle pain.
• Postural Instability: Difficulty with balance and coordination, which can result in falls.
• Gait Changes: People with PD may develop a shuffling walk with short, hesitant steps.

Non-Motor Symptoms

• Depression and Anxiety: Mood disorders are common in people with PD.
• Sleep Disturbances: Sleep problems, including insomnia and rapid eye movement (REM) sleep behaviour disorder, are prevalent.
• Cognitive Changes: Some individuals may experience cognitive impairment, including difficulties with memory, attention, and executive function.
• Autonomic Dysfunction: This can lead to constipation, urinary problems, and changes in blood pressure regulation.
• Loss of Smell: A reduced sense of smell (hyposmia or anosmia) is often an early non-motor symptom.

Types of Parkinson's Disease

There are several variations and subtypes of Parkinson's disease, including:

• Idiopathic Parkinson's Disease (IPD): This is the most common form of PD, and its exact cause is unknown. It is also called sporadic PD because it has no clear genetic or familial link.
• Young-Onset Parkinson's Disease: When PD is diagnosed before age 50, it is considered young-onset PD. The symptoms and progression of the disease can be similar to those of older individuals, but it may have distinct challenges due to the patient's younger age.
• Secondary Parkinsonism: This refers to Parkinsonian symptoms caused by other factors, such as certain medications, head trauma, or other medical conditions. It is not the same as idiopathic PD.

Stages of Parkinson's Disease

The progression of Parkinson's disease is typically divided into stages to help understand and manage the disease's course. One commonly used staging system is the Hoehn and Yahr scale, which has five stages:

• Stage 1: This stage is characterised by mild symptoms that typically affect only one side of the body. Tremors and other motor symptoms may be present but are generally not disabling.
• Stage 2: Both sides of the body are affected, and balance problems become more noticeable. Daily activities can still be maintained but with increased difficulty.
• Stage 3: In this moderate stage, balance and coordination issues worsen, and falls become more frequent. Independence in daily activities becomes more challenging.
• Stage 4: Severe symptoms are present, and individuals often require assistance with daily tasks and mobility. They may still be able to stand or walk with assistance.
• Stage 5 is the most advanced stage of Parkinson's disease, marked by severe motor symptoms and the inability to walk or stand. Individuals may be bedridden or require a wheelchair for mobility.

Diagnosis of Parkinson's Disease

Diagnosing Parkinson's disease can be challenging, as no definitive test can confirm the disease. The following steps are often involved in diagnosing Parkinson's disease:

• Medical History and Symptoms: The doctor will gather a detailed medical history and ask about the onset and progression of symptoms, including both motor and non-motor symptoms.
• Physical Examination: A neurologist or movement disorder specialist may conduct a thorough neurological examination to assess motor skills, balance, coordination, and muscle rigidity.
• Response to Medication: One of the key diagnostic criteria is the positive response to dopaminergic medications, such as levodopa. If a person experiences a significant improvement in motor symptoms after taking these medications, it can support the diagnosis of Parkinson's disease.
• Imaging Tests: While not required for diagnosis, brain imaging studies like MRI or CT scans may be done to rule out other conditions that can mimic PD.
• DaTscan: In some cases, a DaTscan, a nuclear medicine imaging test, may be used to assess dopamine transporter levels in the brain. Reduced uptake on a DaTscan can be suggestive of Parkinson's disease.
• Blood Tests: Blood tests may be performed to rule out other conditions or factors that can cause Parkinsonian symptoms.

Early diagnosis can be challenging, and some individuals may receive a preliminary diagnosis that is later confirmed as the disease progresses.

Treatment of Parkinson's Disease

Parkinson's disease is a chronic condition for which there is no cure. However, several treatment options aim to manage the symptoms and improve the quality of life for individuals with PD. Treatment approaches may include:

• Medications: Dopaminergic medications like levodopa are commonly prescribed to help replace dopamine in the brain. Other medications may be used to manage non-motor symptoms, such as antidepressants, antipsychotics, and medications for sleep disturbances.
• Physical and Occupational Therapy: Physical therapy can help improve mobility, flexibility, and balance, while occupational therapy can assist with daily tasks and adaptation to changes in fine motor skills.
• Speech Therapy: Speech therapy can address speech and swallowing difficulties in the advanced stages of the disease.
• Deep Brain Stimulation (DBS): This surgical procedure involves implanting electrodes in specific brain areas and a neurostimulator device in the chest. DBS can help control motor symptoms when medication becomes less effective.
• Lifestyle Modifications: Regular exercise, a balanced diet, and stress management can improve symptom management and overall well-being.

What if Parkinson's Disease is Untreated?

If Parkinson's disease is left untreated or inadequately managed, it can lead to a decline in a person's quality of life and an increased risk of complications. Untreated PD can result in:

• Worsening Motor Symptoms: The characteristic motor symptoms of PD, such as tremors, bradykinesia, and rigidity, will likely progress and become more disabling.
• Increased Risk of Falls and Injuries: Balance and coordination problems can increase the risk of falls and injuries.
• Non-Motor Symptoms: Non-motor symptoms like depression, anxiety, cognitive impairment, and sleep disturbances may worsen and have a significant impact on daily life.
• Reduced Independence: As the disease progresses, individuals may become increasingly dependent on others for daily activities and mobility.
• Complications: Complications such as pneumonia, urinary tract infections, and pressure sores can occur due to reduced mobility and impaired swallowing.

Individuals with Parkinson's disease must work closely with healthcare professionals to develop and maintain an appropriate treatment plan to manage their symptoms and optimise their quality of life. Early intervention and regular follow-up care can help delay the progression of the disease and address emerging challenges.