Parkinson’s disease was first recognized in 1817 by Dr. James Parkinson in England, however the symptoms of the condition were written about as early as 175 AD. Previously referred to as the shaking palsy It was often simply assumed that a shaking voice or hand was part of aging. Dr. Parkinson saw similar characteristics in patients with tremor and specific decline in motor skills. Today, as celebrities Michael J. Fox, Alan Alda, and the late Robin Williams and Muhammad Ali, acknowledge having Parkinson’s, it is now a familiar medical condition with one in 300 individuals diagnosed. Fortunately, recognition and research has provided great improvement in understanding the origin, symptoms and treatment. While there is not a cure, there is treatment.
A progressive nervous system disorder, Parkinson’s results when specific neurons in the brain die and cause a decrease in the amount of the chemical messenger dopamine. This results in messages not being sent to move muscles or in other cases to tremor with increased movement. Whereas we typically think of the tremor or shaking, many people have freezing of motion, stiffness of limbs, and slow motions.
Symptoms usually are mild in the beginning and often only one side of the body is affected at onset. By the time physical symptoms are evident, the brain has had reduced dopamine for many years. Many times, subtle changes such as loss of smell, small handwriting, slight stumbling, constipation, depression or voice changes precede the more visible symptoms by many years.
Tremors are often first seen in an arm or hand and are visible at rest. It may include the repetitive rubbing of thumb and forefinger, called pill rolling, or an internal vibration sensation. There is slowed movement/rigid muscles, steps shorten, balance may be affected, and range of motion decreases. The forward stoop and shuffling step associated with Parkinson’s usually appears many years after diagnosis.
One thing to always remember is that the disease presents itself differently for everyone. Some have a diagnosis and very little progression of symptoms. Others have a more rapid progression. Where some people have acute tremor, others have body freezing where they cannot move their feet, legs or hands, or a combination. Sometimes there is associated muscle pain or cramping. The loss of automatic movements such as blinking, smiling or other expressions often result in what is known as the Parkinson’s mask, where the face does not reflect feelings or reactions. When this is combined with a reduction in speech control, such as a soft voice, inability to articulate sounds or very rapid speech, the result is often an inability to communicate well. As the disease progresses, there can be cognitive difficulties, depression, emotional changes, swallowing, chewing and eating issues, sleep problems, bladder and constipation issues, orthostatic hypotension where one is light-headed upon standing or changing position, fatigue, muscle pain, sexual dysfunction and taste/smell dysfunction.
Much research is being done on the causes of Parkinson’s. Environmental toxins, such as herbicides, pesticides and PCBs are potential factors, as is Agent Orange. There is a higher incidence of Parkinson’s in farming areas where exposure to these chemicals occurs. It is not conclusive that Parkinson’s is linked genetically, though there may be a familial condition that contributes when other exposure factors are present. Research is being done on the gene alpha-synuclein, which may play a role. Whereas most cases are in people over 60, early onset Parkinson’s occurs in people in their 20s-40s, where a genetic component may be a factor. More males than females have Parkinson’s and a history of head trauma is also a factor.
Although there is not a way to prevent Parkinson’s, avoidance of pesticides, a healthy diet low in sugar and fat, and some studies have indicated caffeine/coffee, are deterrents. Upon diagnosis, these same preventions can be used in delaying the progression of Parkinson’s with daily exercise being forefront in treatment. Keeping active is critical. Specific Parkinson’s physical and occupation therapy, called LSVT Big, (lsvtglobal.com/LSVTBig) is used to promote long steps and arm swing, increased range of motion, loud voice and continued motion. The Farmington Valley VNA has both physical and occupational therapists trained to bring this therapy into the home with a doctor’s request. Another therapy is Rock Steady Boxing that has shown exceptional benefits for patients. All exercise keeps maximum functioning longer.
The gold standard medication is carbidopa levodopa that increases the level of dopamine, dopamine inhibitors that mimic dopamine or other medications that diminish symptoms. A specialized movement neurologist can provide the medication and therapy recommendations. This geographical area is fortunate that it has these advanced specialists.
Surgical intervention, called Deep Brain Stimulation or DBS, is another method of treatment. By placing electrodes deep into the brain, the electrical stimulation can decrease tremors, reduce rigidity, diminish involuntary movements and improve muscle movement.
Parkinson’s is a progressive debilitating neurological disease, but in many cases, it is very slow in progression and the life span of the individual is not shortened. Although often incapacitating as the disease progresses, with the current drug, exercise and surgical interventions, patients have found an ability to cope with the disease from day to day. Being proactive in therapy, treatment and support is essential.
This article does not replace or suggest medical advice. Please consult with your physician regarding diagnosis and treatment. For further information please go to: parkinsons.org, michaeljfox.org, mayoclinic.org
Farmington Valley Visiting Nurse Assoc.
8 Old Mill Lane, Simsbury, CT 06070