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.

It’s to your advantage to get a grasp on some of the more commonly held myths about PD — what it is and what it isn’t.

PD is not:

• Contagious
• Curable (at this writing, but research is hopefully getting closer!)
• Normal for older people — or impossible for younger people
• A reason to make immediate life-changing decisions (like assuming you won’t be able to work or that you need to move)
• Bound to get you if you live long enough

PD is:

• Chronic (when you have it, you have it — like arthritis or diabetes)
• Slowly progressive (over time — often years) even with treatment
• Manageable (often for years) with proper treatment and key lifestyle changes
• Life-changing for you, your family, and friends (Whether that’s good or bad is up to you and how you decide to face it.)

In many ways these debunkers are the key messages we want you to take away from this book. If you have PD, you have an enormous challenge before you, but tens of thousands of people successfully face it every day. You can get through this — and we’re here to show you how.

Several neurological conditions may appear to be idiopathic (without known cause) PD at first, but they eventually trace back to known causes, progress differently, and respond differently to therapy. These other conditions include the following:

• Essential tremor (ET) is perhaps the most common type of tremor, affecting as many as five million Americans. ET differs from the tremor in idiopathic PD in several ways: ET occurs when the hand is active (as in eating, grasping, writing, and such). It may also occur in the face, voice, and arms. The renowned actress, Katherine Hepburn, had ET, not PD. Differentiating ET from PD is very important because each condition responds to completely different sets of medications.
  

• Parkinson-plus syndromes may initially have the same symptoms as PD. But these syndromes also cause early and severe problems with balance, blood pressure, vision, and cognition and usually have a much faster progression compared to PD.

• Secondary parkinsonism can result from head trauma or from damage to the brain due to multiple small strokes (atherosclerotic or vascular parkinsonism). Both forms can be ruled out through scans (CTs or MRIs) that produce images of the brain.
  

• Pseudoparkinsonism can appear to be PD when in fact the person has another condition (such as depression) that can mimic the inexpressive face of PWP.
  

• Drug- or toxin-induced parkinsonism can occur from taking antipsychotic medications (drug-induced) or from exposure to toxins such ascarbon monoxide and manganese dust (toxin-induced). Drug-induced symptoms are usually (but not always) reversible; toxin-induced symptoms usually aren’t.

Parkinson’s disease is a disease in a group of conditions called movement disorders — disorders that result from a loss of the brain’s control on voluntary movements. In the brain of people with Parkinson’s (PWP), cells that produce this essential substance die earlier than normal.

Parkinson’s is a progressive neurological condition with these main symptoms:

• Tremor – which usually begins in one hand or arm and is more likely to occur when the affected part of the body is at rest and decrease when it is being used. Stress can make the tremor more noticeable. However the presence of tremor does not necessarily mean a that person has Parkinson’s, as there are several other types and causes of tremor. Also, although most people associate Parkinson’s with tremor, up to 30% of people with Parkinson’s do not have this symptom.
• Slowness of movement (bradykinesia) and stiffness of muscles (rigidity) – movements can become difficult to initiate, take longer to perform and lack coordination. People with Parkinson’s often have problems with turning round, getting out of a chair, rolling over in bed, stooped posture, and making fine finger movements, facial expressions and body language.

Although a whole group of conditions are known as parkinsonism, the one that most people know is called idiopathic PD, a Greek word that means arising spontaneously from an unknown cause. As the term suggests, the jury is still out as to the underlying cause (though theories do exist).

Go into a room filled with 50 people with Parkinson’s (PWP) and ask how they first suspected they had PD. You’re likely to hear 50 different stories. Take ten of those people who were diagnosed at approximately the same time and you’re likely to see varying signs of PD progression — from almost no progression to more rapid onset of symptoms. Similarly, you’re likely to experience a variety of attitudes and outlooks from the individuals dealing with their PD.

When you’re diagnosed with PD, you set out on a unique journey — one where your outlook, lifestyle changes, and medical treatment can be key directional maneuvers along the way. In truth, this disease is one that you can live with, surrender to, or fight with everything you’ve got. The road veers and curves differently for each person. Some people may choose one path for managing symptoms, and some people choose another. Sometimes the disease itself sets
the course. The bottom line? No clear roadmaps are available. But one fact is certain: Understanding the chronic and progressive nature of PD can take you a long way toward effectively managing your symptoms and living a full life.