Understanding Parkinson's Disease

Parkinson's disease is a chronic and progressive disease of the nervous system. It affects over 6.1 million people worldwide and there are an estimated 90,000 new cases of Parkinson’s disease in the United States every year. 

What causes Parkinson’s disease? 

Parkinson’s disease occurs when a protein, called α-synuclein, is abnormally deposited in neurons. This causes a degeneration of neurons that contain dopamine. Symptoms are then brought on by a lack of dopamine.  

Symptoms 

Parkinson’s disease affects the nervous system. This may cause a combination of movement (motor) symptoms and non-motor symptoms. 

The key motor features of Parkinson's disease are:

• Tremor that typically occurs at rest. The movement of the index finger and thumb may have a "pill rolling" appearance.
• Stiffness or rigidity of the limbs and trunk.
• Generalized slowness of movement (bradykinesia).
• Inability to keep the body in a stable or balanced position.
• Gait difficulty. 

Non-motor symptoms may include: 

• Sleep impairments, such as rapid eye disorder. 
• Affective symptoms, such as depression, anxiety or apathy.  
• Autonomic changes, such as constipation, drops in blood pressure and excessive sweating.    
• Memory changes. 

Diagnosis 

A diagnosis of Parkinson’s disease should be given by a trained neurologist. They will use their knowledge to perform a clinical evaluation and consideration of symptoms, and may also consider responses to certain medications to give a formal diagnosis.  

Treatment Options 

Parkinson’s disease can be treated with a combination of medications, therapies and surgical interventions. 

Your provider may recommend non-pharmacological interventions including:

• Physical therapy. 
• Occupational therapy. 
• Speech therapy. 
• Increased exercise. 

There are several types of medications available depending on the severity of symptoms and comorbidities. Examples of medication classes include dopamine agonists, MAO-B inhibitors, levodopa preparations, amantadine and COMT inhibitors.   

Surgical interventions include deep brain stimulation and focused ultrasound. 

With deep brain stimulation, a procedure is performed to insert electrodes into a targeted area of the brain. Then, during a second procedure, an impulse generator battery (IPG) is implanted to send electrical stimulation to the areas of the brain that control movement. 

Focused ultrasound uses ultrasound beams to cause a lesion in the brain. It may be an option for those who cannot undergo brain surgery for other medical reasons, however the resulting procedure is not adjustable like deep brain stimulation surgery.   

If depression or anxiety is present, appropriate treatment should be sought.