Demystifying Parkinson's disease
4/18/2019 by Dr. Paul Takahashi
What most people know about Parkinson's disease (PD) is that it causes tremors and that Michael J. Fox, Neil Diamond and Katherine Hepburn were diagnosed with it. While not uncommon — about 1 million Americans have Parkinson's — it's not well known. These FAQs may help demystify PD:
Q: What is PD?
A: It's a neurological disorder marked by tremors, such as shaking of the hands or head, particularly on one side of the body, and seen at rest, not just when making a movement. It progresses to stiffness and rigidity; patient's mobility is affected; and they may not be able to move spontaneously. PD gets worse over time, and there is no cure.
However, just because a person has tremors doesn't mean they have Parkinson's. Tremors also can be caused by medications that stimulate the body, such as asthma/COPD inhalers, or other conditions.
Q: Are there other symptoms?
A: Patients may not make much spontaneous movement, have limited facial expressions and trouble standing up. When they walk, they may be more stooped, shuffle, take smaller steps and have difficulty turning. Side effects of PD include poor sleep, bowel problems, mood disorders and depression, which may be as challenging as movement issues.
Q: Who tends to get PD?
A: It's more common in men than women, and in whites rather than other ethnicities. Typically, people are diagnosed with PD in their 60s and 70s, although a small percentage may develop it at younger ages.
Q: How is it diagnosed?
A: Your primary care provider usually can do simple tests right in the clinic. No blood test or imaging will reveal PD. As the disease progresses, you may want to see a neurologist.
Q: What is the treatment?
A: Patients usually seek a diagnosis and treatment when the symptoms begin to affect their lives. While there's no cure, there are effective medications to treat the symptoms. The most common and well-tolerated medication is carbidopa/levodopa. This generic drug promotes the production of dopamine, a neurotransmitter in the brain that regulates movement, attention, learning and emotional responses.
As the disease progresses, your provider typically will increase the frequency of your medication and increase the dosage.
Q: What happens as PD progresses?
A: PD is a slow disease, so patients lose more function as time goes on. Disability becomes a challenge, the risk of falls increases and maintaining independence becomes more difficult. Cognitive issues may start appearing, including memory concerns and behavioral changes. PD patients may require support similar to that for those with Alzheimer's or other forms of dementia.
Q: What's being done to cure or improvement treatment?
A: Researchers continue to explore the mechanism of degeneration and what's causing it, down to the molecular level. Drugs that can slow, treat or even reverse PD are in trials. Devices, such as stimulators, are being used to reduce tremors or other symptoms.
Q: After a diagnosis, what should a patient do?
A: If you or a loved one has been diagnosed with PD, you can optimize your situation by maintaining your level of activity, focus on strength training to minimize weakness and eat a healthy, balanced diet. Also, follow your medication regimen and be aware of how it's working: Is it wearing off? Is it causing side effects? Since PD is progressive, now is the time to plan ahead and consider in-home and long-term care options.
If you experience symptoms or have concerns, reach out to your care team for help.
Dr. Paul Takahashi is an internal medicine physician in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM) and practices in the Baldwin Building clinic in Rochester. His interests include geriatric medicine, long-term and nursing-home care, and public health.