Parkinson's Disease Blog

Medical signs are what your doctor observes during the examination. When you see your doctor, she’ll listen as you describe your symptoms and then conduct an examination to determine what those symptoms indicate. As you talk about your symptoms, your doctor begins a differential diagnosis if your symptoms indicate several possibilities.

Although the actual causes and risk factors for getting PD are still mysterious, the primary signs that signal the presence of PD are very clear. You may have noticed one or more of these signs but then dismissed it as something slight, easily explained, or due to an entirely different condition.

Several resources use the acronym TRAP to illustrate the four primary signs of PD. And, because PD seems to trap your body with your brain’s compromised ability to communicate, the acronym makes the top four symptoms easy to remember.

T = Tremor at rest (uncontrolled shaking)

PD was originally called shaking palsy because the resting tremor (it goes away as soon as the hand is engaged) rarely occurs in other illnesses. Characteristically, the resting tremor begins in one hand and moves to the other hand years later in the disease. The tremor may extend to the leg or foot on the same side and sometimes to the lips and jaw — or you may have no tremor at all. Tremor in the head and neck, however, is less common in primary Parkinson’s disease.

R = Rigidity (stiff muscles)

Rigidity is probably the most ignored and easy-to-explain-as-something-else sign. In plain English, rigidity means stiffness. (Who doesn’t experience stiffness in joints and limbs that makes movement more difficult as they age?) If your doctor observes rigidity (without other signs of PD), he may first suspect arthritis and prescribe an anti-inflammatory medication. But, if medicine doesn’t relieve the stiffness, you need to let your doctor know.

A = Akinesia (absence or slowness of movement)

Especially early on, people with PD (PWP) may experience slight bradykinesia (unusually slow movement). Much later in the progression, that slowed movement may become akinesia (no movement). Get to know these terms because, if indeed you or a loved one has PD, you’ll hear these words again and again. Kinesia means movement in the sense of knowing what you want your body to do. So akinesia and bradykinesia indicate problems initiating or continuing an action. For example, to walk across the room, you stand up and your brain tells your foot to step out — but with bradykinesia, your body doesn’t move right away.

P = Postural instability (impaired balance)

In a healthy person, the natural movement is to alternately swing the arms and step forward with assurance. For PWP, however, the swing slowly decreases; in time the person moves with small, uncertain, shuffling steps. (PWP may adapt by propelling themselves forward with several quick, short steps.) Other PWP experience episodes of freezing (their feet feel glued to the floor). Problems with balance (resulting in falls that can cause major injuries, hospitalization, and escalation of symptoms) are usually not a factor until later stages in PD. In time, PWP may lose the ability to gauge the necessary action to regain balance and prevent a fall. They may grasp at doorways or other stationary objects in an effort to prevent the loss of balance. Unfortunately, these maneuvers can make PWP appear to be under the influence of alcohol or other substances.

Although James Parkinson described the disease nearly two centuries ago and research has been ongoing ever since, the underlying cause — the factor that sets Parkinson’s disease (PD) in motion — is still unknown. A number of theories are under discussion and research, any one of which may lead to the breakthrough in managing symptoms or even curing the disease. The medical community has also made progress in assessing risk factors — some more common than others. In this chapter we cover these potential causes and risk factors so you can better understand them as the hunt for a cure continues.

The underlying event behind the onset of PD is a loss of neurons (nerve cells) in the substantia nigra region of the brain. These neurons normally produce dopamine, a neurotransmitter that helps the brain communicate with other parts of the body, telling them to perform common movements (such as walking, handling objects, and maintaining balance) almost automatically.

PD is a little like diabetes because in both diseases:

• You lose a vital chemical (insulin in diabetes; dopamine in PD).
• The chemicals are essential to the body’s ability to function properly.
• The chemicals can be replaced.

Of course, the diseases are more complex than that, but you get the idea. As we age, all of us lose dopamine-producing neurons, which results in the slower, more measured movements. But the decline of dopamine in people with Parkinson’s (PWP) is not normal.

Why PD targets the substantia nigra at the stem of the brain remains a mystery. But the damage results in abnormal protein deposits that can disrupt the normal function of the cells in that area. These protein clumps are called Lewy bodies, named for Freiderich H. Lewy, the German physician who discovered and documented them in 1908. The presence of Lewy bodies within the substantia nigra is associated with a depletion of the brain’s normal supply of dopamine. For this reason, their presence is one of the pathological hallmarks of PD (although Lewy bodies are present in other disorders).

In reality, Lewy bodies have been found in other parts of the brain affected by PD, which suggests that the problem may be more widespread. This more extensive pathology may explain the occurrence of non-motor and levodopaunresponsive symptoms. Nevertheless, researchers still don’t know whether Lewy bodies cause the damage to the nerve cells or are a by-product of damage caused by another factor.

Theories on causes abound — family history, environment, occupation, and so on. Today’s researchers generally agree, however, that the onset of PD is a multi-factorial process; that is, several conditions are at play in the onset of PD rather than one specific and single cause. But the true causes behind the onset of PD in one person and not another — in one family member and not another — are unknown.

In the medical world, a symptom is

• What you feel or perceive before you see the doctor.
• The reason you ultimately decide to make an appointment.
• The details (vague or specific) you give when the doctor or nurse asks why you’ve come in.

Let’s cut to the chase. You suspect that you or someone you love may have PD or you wouldn’t be flipping through this book and you definitely wouldn’t have turned to this chapter. Ask yourself what’s behind those suspicions.

• A slight shakiness in the hands? Does it occur in only one hand? If the shaking occurs while the hand is at rest, does it stop when that hand picks up a cup of coffee, a pen, or a tennis racket? If the shakiness is in both hands and doesn’t stop when the person grasps something, then PD probably isn’t the cause (but get it checked out anyway).
  

• A general slowing down of movement? Does it take longer to walk from one place to another or to get in and out of the car? Has there been an increase in stumbling, clumsiness, or loss of balance? Do you (or does the person) feel tired, stiff, or just not yourself?
  

• A significant change in energy level or outlook? Everyone experiences days when they’re tired or weaker than usual. And everyone has theblues from time to time. But if you’ve been feeling unusually weak, fatigued, depressed, or anxious for longer than two weeks, those symptoms need attention — even when you have a plausible cause (such as an unusually busy week at work or the death of a loved one).
  

• Gastrointestinal problems (like constipation) or psychological problems (like increased nervousness or anxiety)? In some cases, patients show none of the usual symptoms, so don’t stop with the more traditional PD symptoms.
  

These are the symptoms — the feelings, aches, and pains that have made you think something’s not right. It may be PD or it may not. Either way, you owe it to yourself to get your doctor’s assessment.

My sister is 37 and has been having trouble with her walking for some time. We thought it was a trapped nerve but now the doctor says it is Parkinson’s. I can’t believe it – surely Parkinson’s is an old person’s disease?

At 37 your sister is certainly young to get Parkinson’s, but it is by no means unheard of at that age. Michael J. Fox, the Canadian TV and film actor was only 30 when he was diagnosed and all neurologists will have seen people with Parkinson’s in their thirties and even younger. The illness is certainly much more common in elderly people but can affect those in relative youth. It is estimated that 1 in 20 of those diagnosed are under the age of 40.

Recently we visited an old friend who has been told she has Parkinson’s. She keeps asking herself ‘Why me?’ and wondering if there is anything she could have done to cause it. We reassured her that it was not her fault. Were we right to do so?

You were quite right to reassure her. It is natural to want an explanation for an illness and common for some people, particularly if they are a bit depressed, to be tempted to blame themselves. Bad habits certainly do not cause Parkinson’s! Although we cannot yet answer the ‘Why me?’ question, nobody believes that the cause or causes of Parkinson’s will turn out to be something under the control of those who get it. If your friend continues to blame herself, it would be worth you and her doctor considering whether or not she is depressed.

I am 68 and have always looked after myself. I do not smoke or drink to excess but now I am having all kinds of difficulties and the doctors have diagnosed Parkinson’s. Why me?

As stated elsewhere in this book, the cause of Parkinson’s is unknown and ‘Why me?’ is the crucial question for researchers to answer. Alcohol does not appear to be involved to any extent and the question of smoking is uncertain (see the answer to the next question). You are too young to have been involved in the epidemics of sleeping sickness (encephalitis lethargica) that were around at the time of World War I and which caused a special kind of Parkinson’s. There has recently been some evidence that the body’s inherited ability to turn harmful chemicals into harmless substances may be somewhat reduced in people who get Parkinson’s, but this is an area for future research rather than an established fact at present.

Is Parkinson’s more common in men than in women?

At each age Parkinson’s is somewhat more common in men than in women. Some studies have suggested that men are twice as likely to get it. However, as women on the whole live longer than men, and as the disease gets commoner with age, there are just as many women as men alive with Parkinson’s.

I read somewhere that Parkinson’s is found all over the world. Is this true or is it more common in some countries or climates?

Yes, Parkinson’s is found worldwide. We do not always know what the exact figures are, as good research counting the number of people with Parkinson’s is not available from every country. From what we do know, it does appear that Parkinson’s is possibly less common in countries closer to the equator than it is in the UK.

Is it true that smoking cigarettes can protect people from Parkinson’s?

Most research surveys have suggested that people who get Parkinson’s have on the whole smoked remarkably little. One difficulty of these surveys is that they are biased because some smokers who should really have been included in the survey have already died of other causes, such as cancer. It is also possible that, before symptoms become obvious, there is something that makes individuals who are destined to get Parkinson’s just not enjoy smoking. It remains a possibility that smoking genuinely protects people from getting Parkinson’s. One day we will be able to protect people from getting Parkinson’s but smoking (which causes so much death and disability) will not be a part of the answer!